MLTC: An Unnoticed Health Issue

From the ancient plague outbreak to the current COVID-19 pandemic, various diseases and public health issues have affected people's lives all over the world throughout history. Presently, a public health issue has been increasing for a while that is multiple long-term conditions (MLTCs).

People who have two or more chronic diseases are said to have multiple long-term conditions. We must first know about chronic diseases in order to understand multiple long-term conditions. A chronic disease is one that develops gradually or lasts for a lengthy period of time, typically more than three months. Both communicable and non-communicable diseases can be considered chronic conditions such as high blood pressure, diabetes, heart disease, drug addiction, tuberculosis, HIV, mental illness, bone disease, or injuries. A person is referred to as having multiple long-term conditions if they have two or more of the above diseases. 

Research indicates that 95 per cent of those over 65 worldwide suffer from multiple long-term conditions. It has been found that individuals with multiple long-term conditions have a considerably higher risk of premature death and a lower quality of life than the general population.

According to the national survey, 2018, conducted across the nation, as people get older, they are more likely to have several health problems at once. This means that older adults often deal with more than one long-term illness at the same time. Similarly, the noncommunicable disease risk factors STEPS survey (2019) showed that factors raising the likelihood of developing multiple long-term conditions are also increasing. These factors include obesity and overweight, unhealthy diet, tobacco and alcohol use, and physical inactivity.

Health care programmes and systems around the world are disease-focused, meaning they only treat one disease at a time. Consequently, physicians and health providers view people with a singular disease approach. These days, with the rise of multiple long-term conditions, there is an increase in the frequency and duration of hospital stays, frequent admissions, doctor appointments, and the use of various drugs and their adverse effects, thus increasing the usage of health services. Besides these, when an individual gets ill, they miss work, which further adds to their medical expenses. Multiple long-term conditions cause financial strain on both the individuals and society. In addition to medical expenses, it increases the burden on the health care system and care providers, family members, and the community. As a result, it is increasingly essential to provide services that focus on multiple long-term conditions rather than just one. 

The government has tried various approaches to resolve the rapid rise of multiple long-term conditions, but the approaches are not sufficient to tackle the issue. Thus, cost-effective, innovative, and integrated approaches with strong research evidence are essential to meet the increasing demand for management of MLTCs.

The Global Health Research Centre (GHRC) for the MLTC project plans to enhance the care of people with multiple long-term conditions through community engagement and digital intervention such as telemedicine and electronic decision support systems (EDSS). It is being conducted in districts (Kathmandu, Bhaktapur, Lalitpur, and Kavre) of Nepal. 

The programme is also being carried out in India. This five-year project is being conducted in Nepal under the leadership of Kathmandu Medical College. It is being funded by the National Institute of Health and Care Research (NIHR) and led by the Public Health Foundation of India and the University of Leicester (UK). Improving the care of individuals with multiple long-term conditions is the main goal of this research. Additionally, it will provide attention and raise awareness in the community about the multiple long-term conditions.

To promote the long-term health and well-being of the population, there must be cooperation and collaboration between the community, policymakers, and healthcare professionals. By collectively focusing on prevention through reducing various risk factors of MLTC and efficiently managing these conditions within the healthcare system, we can effectively tackle the challenges posed by MLTC. This approach will help to create a healthier environment by encouraging the adoption of healthy practices to ultimately improve the quality of life.

(Ghimire and Yadav are working as Research Assistant at NIHR GHRC for MLTC, KMC.)