What strategies could fill the gaps?

Given the potentially devastating effects that multiple chronic diseases could have on the economy and on society at large, bold policies would need to be developed and implemented to facilitate the transformation of existing health and social services. Such policies should at the least make it easier to fill most of the gaps identified in all of the preceding chapters, with an emphasis on:

- Efficient monitoring of the incidence, prevalence and impact of multiple chronic diseases (Chapters 1 and 2).

- Bold health promotion and disease prevention efforts at all levels (Chapter 3).

- The implementation of innovative models for complex chronic disease management, fostering leadership at the front line and bottom-up innovation (Chapter 4).

- The adaptation of existing health and social services to promote optimal integration and coordination of roles, workflows and processes at all levels (Chapter 6).

- The minimization of unnecessary suffering and the optimization of supportive care services throughout the entire natural history of multiple chronic diseases, and particularly at the end of life, for patients and their caregivers (Chapter 7).

- Strategies to engage people living with multiple chronic diseases and their caregivers in effective self-management programs (Chapter 5), demedicalizing their care as much as possible (Chapter 8).

Achieving this will not be easy. In fact, it could be argued that the slow nature of the policy-making process and the resistance to change that pervades all levels of the health system will hinder our ability to introduce the radical changes that are required to ensure that people living with multiple chronic diseases can achieve optimal quality of life without bankrupting the economy.

The jury is out. Let us hope that we have the foresight and courage necessary to bring about the creative partnerships among the government, academic institutions, the public and industry; the rigorous trans-disciplinary research and development work; the effective knowledge mobilization and management; and the level of political will needed to meet the unprecedented challenges created when we live long enough to accumulate multiple chronic diseases.