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Addressing the Polypharmacy Challenge in Older People

The Polypharmacy Challenge Blog


New PhD research addressing the multimorbidity challenge in working-age adults

Esca van Blarikom recently joined the APOLLO-MM team in her role as NIHR ARC North Thames funded PhD candidate. In this blog post, Esca sets out why her project exploring working-age adults' experience of living with co-existing physical and mental health conditions is so necessary.

I was drawn to this PhD because I loved the idea of working in a multidisciplinary team. Also, as a medical anthropologist, I am interested in studying the dynamics of health inequities, and the intersections of social, psychological, and physical vulnerabilities. ‘Multimorbidity’ is considered a major health challenge around the globe today, but it is a fuzzy concept; not so much indicating a pathological problem ‘out there’, but rather pointing out challenges in the organisation of care. Ethnography as a method lends itself particularly well for studying ‘messiness’ and complexity and unpacking taking-for-granted concepts carrying not-so-taken-for-granted meanings, which is why I am excited to work on the theme of ‘multimorbidity’.

It is commonly thought that multimorbidity is first and foremost a health problem associated with aging. But I was struck to discover that in terms of absolute numbers multimorbidity is most prevalent among adults of working age who live in socially disadvantaged communities and experience a combination of mental and physical comorbidities. Only a few studies have focused on how this population group navigates a maze of mental and physical health care systems while at the same time securing a livelihood through employment or engagement with social services.

With my PhD research, I intend to address the ‘multimorbidity challenge’, focusing on a group of people whose health needs to date have been neglected by researchers.

Through in-depth interviews, observations, and visual methods, I will explore lived experiences and treatment burdens of working-age adults who are juggling self-care responsibilities with work, social, and/or family life. The focus on mental and physical co-existing health conditions will inform what ‘good practice’ for integrating mental and physical health care could look like and how care could be better organised to meet the complex care needs of working-age adults.

Before joining this PhD programme, I completed a Master’s in Medical Anthropology and Sociology at the University of Amsterdam. During my Master's studies, I undertook research on care for pregnant women with psychosocial vulnerabilities, focusing on how care providers from a variety of disciplinary backgrounds identified and managed vulnerable patients during pregnancy. I also investigated community building and social exclusion of the urban nomads of Amsterdam. After a law made squatting illegal in the Netherlands in 2011, the urban nomads took to squatting plots of abandoned land near Amsterdam, where they built communities out of trailers and beautiful wooden constructs, quickly attracting a variety of ‘outsiders’: people with psychiatric, drug, alcohol and financial problems. I spent time with the community in its last year of existence before they were finally evicted from their self-built community and the group dispersed.

For the past 6 years, I worked at the Kriterion in Amsterdam, a film theatre run non-hierarchically by students. I worked as a programmer and organised many film-related events. This has made me hyperaware of the potential of film as a catalyst for discussion, collective initiatives, and change, and has shaped my interest in visual, participatory research methods such as photovoice which I will pursue during the PhD.


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