Multimorbidity Is Now the Norm, Not the Exception. BC's Health System Is Still Designed for One Disease at a Time.
- ihsts2023
- May 4
- 3 min read
Written by Clare Koning RN PhD | May 2026
The single-disease model of chronic care made sense when chronic disease was relatively uncommon and relatively contained. That world no longer exists.
Multimorbidity, the co-existence of two or more chronic conditions in the same person, now affects an estimated 37% of adults globally, and the prevalence rises steeply with age.
In BC, as the Ministry of Health's own service plan acknowledges, a higher proportion of people are now living with complex conditions and multimorbidity and require a range of supports that current system architecture struggles to deliver. These are not exceptional cases. They are the majority of people that primary care sees every day.
The problem is that BC's care model, clinical guidelines, specialist referral pathways, quality indicators, funding structures, was built around single diseases. A person with type 2 diabetes, hypertension, depression, and early-stage chronic kidney disease does not fit neatly into any of these pathways. They fall between them, generating fragmented, duplicated, and often contradictory care that is expensive to deliver and poor in outcome.
The Evidence on Integrated Care for Multimorbidity
A 2025 scoping review of 101 studies on multimorbidity interventions, encompassing over 1.2 million individuals, found consistent evidence that multidisciplinary, integrated approaches, combining lifestyle interventions, patient empowerment, care coordination, and pharmacotherapy optimization, are necessary to effectively manage the escalating challenge of multimorbidity. No single-condition program achieves this. It requires coordination across the system.
Research notes that multimorbidity affects up to 37% of people worldwide and is increasing with population aging, driving greater healthcare use, longer hospital stays, higher medication burden, and more fragmented, less coordinated care. Spain's regional governments, facing severe fiscal pressure, introduced integrated care programs for people with chronic disease and multimorbidity. The early results pointed to exactly this kind of system-level return.
The implication for BC is direct. The patients driving the highest healthcare utilization, the most frequent emergency department visitors, the highest consumers of specialist services, the most complex primary care cases, are overwhelmingly people with multimorbidity. Designing care coordination, self-management support, and community-based integration specifically around this population is not a niche clinical interest. It is the single highest-leverage point in the entire health system.
Where Self-Management Fits In
One of the most consistent findings in the multimorbidity evidence base is that patient self-efficacy — the confidence and capacity to manage one's own health – is a critical mediator of outcomes. A 2024 systematic review and meta-analysis of 34 studies involving over 7,600 patients with chronic conditions found that self-management interventions significantly improved quality of life, self-efficacy, and reduced depression and anxiety across diverse chronic disease populations.
Self Management BC, one of IHSTS's partner organizations, has delivered evidence-based self-management programs across the province for years, programs with a demonstrated track record of improving health status while reducing hospitalization rates in randomized controlled trials. The CDC's meta-analysis of the Chronic Disease Self-Management Program found that its public health significance is substantial precisely because of its scalability, low implementation cost, and capacity to reach large numbers of people across diverse settings.
These programs are not niche lifestyle offerings. They are a core component of what integrated multimorbidity care looks like in practice, and they are systematically underpowered relative to the scale of need.
The Design Challenge
The systemic challenge is this: every part of BC's health system, funding, accountability, clinical guidelines, quality metrics, is organized around conditions, not people. A person with five chronic conditions generates five sets of clinical guidelines, five referral pathways, and five accountability frameworks, none of which account for how those conditions interact, how treatments conflict, or how the cumulative burden of managing five separate conditions affects a person's capacity to do any of it well.
Redesigning for multimorbidity means shifting the organizing principle from disease management to person-centred care coordination. It means funding team-based primary care that can hold complexity, not just process volume. It means investing in self-management infrastructure that reduces the clinical burden of follow-up. And it means building evaluation frameworks that measure what matters for people with multimorbidity, quality of life, functional status, treatment burden, and person-reported outcomes, not just disease-specific indicators.
None of this is conceptually difficult. All of it requires deliberate system redesign decisions that no single health authority, program, or clinical team can make alone. That is precisely where sustained provincial coordination becomes indispensable.
IHSTS works with health system partners to build coordinated, community-embedded chronic disease infrastructure across BC. Learn more at ihsts.org.
