**Background:** Multimorbidity—defined by the WHO as the co-occurrence of two or more chronic conditions in one individual—has been framed as a pressing global health challenge, particularly in sub-Saharan Africa where a 'double burden' of persisting infectious diseases (HIV, TB) and rising non-communicable diseases (NCDs) strains fragile health systems designed for acute, single-disease care. Research priorities, set by the UK Academy of Medical Sciences and the Academy of Science of South Africa, include standardizing case definitions, identifying common disease clusters, improving prevention and treatment, and restructuring health systems around people rather than diseases. However, the authors argue that these efforts risk retracing the same steps by assembling multimorbidity from the same historically-loaded, problematic disease categories it seeks to challenge.
**Methods:** The analysis is based on a non-systematic literature review, complemented by insights from the author group's research on multimorbidity over 20 years. Literature was identified through iterative database searches in Ovid Medline, Embase, and Google Scholar using terms including 'multimorbidity', 'global health', and 'sub-Saharan Africa', with no date restrictions. A purposive and snowballing approach was used to identify further literature from bibliographies and citation trackers. The authors synthesized clinical and public health literature with social science insights from anthropology, sociology, history, philosophy, and science and technology studies to trace how multimorbidity is being constructed as an object of science, policy, and care.
**Key Results:** The article presents several critical findings. First, the single disease model emerged from 19th-century clinical institutions, germ theory, statistical techniques, and the International Classification of Diseases (ICD), enabling biopolitical control. In Africa, colonial and post-colonial dynamics—including neoliberal macroeconomic policies in the 1980s-1990s—systematically defunded public sectors and transferred sovereignty from national governments to northern NGOs, philanthropies, and global health institutions, favoring vertical, disease-specific programming. Second, ethnographic studies from Kenya, Malawi, and South Africa demonstrate that patients like 'Grace' (a 50-year-old woman in Kibera, Nairobi with HIV, diabetes, and hypertension) experience fragmented care: HIV care is free and well-supported, while diabetes and hypertension require out-of-pocket payments and lower-quality services. Third, interventions to integrate care have had limited success. Robust trials in high-income contexts failed to significantly improve patient outcomes, and South Africa's Integrated Chronic Disease Management programme, while perceived as important by health workers, did not address structural conditions like staff shortages, fragmented guidelines, persisting poverty, and language barriers. The authors note that a recent review found the apparent rise of multimorbidity may be as much an artifact of expanding disease and risk categories as a true rise in disease burdens.
**Clinical Implications:** The authors argue that current calls to align priorities around a standardized biomedical definition of multimorbidity risk perpetuating the same classificatory (in)visibilities and neoliberal renderings of health responsibility. Instead, they propose reconceptualizing multimorbidity as an 'experience that manifests through the discrepancy between medical policy and life-as-lived' (drawing on Blarikom et al.). This reframing points to transformations needed across five domains: (1) care delivery systems—moving from disease-defined, fragmented care to integrated, primary-level syndemic care that collapses distinctions between health and social care, with examples from Rwanda's Partners in Health/Clinton Foundation collaboration and Kenya's AMPATH program; (2) medical training—shifting from specialist-dominated, organ-system curricula toward generalism and flat interdisciplinary team structures; (3) knowledge and expertise—dismantling siloed epistemic cultures and elevating social sciences and local knowledge; (4) global governance—shifting priority-setting and funding from northern-driven technological imperatives toward nationally-led, broad-based health system strengthening; and (5) financing—moving from vertical, disease-specific funding to comprehensive primary care investment. The COVID-19 pandemic has underscored the importance of addressing 'underlying conditions' and may provide an unprecedented moment for transformation.