The future of healthcare: prevention and precision global health

Compared to few decades ago, nowadays we pay much more attention to our health. This is because, every now and then, some new findings highlight lifestyle tips that have positive impact on our existence. So why not to follow them? Everyone knows that smoking is bad (read here), or that regular physical activity is beneficial for our health. At the same time, we learn that a particular diet is better than others to prevent some pathologies (I explained that here). This is to say that the available information is massive and continues growing. Our health is gathering benefits from it, and this is demonstrated, for example, by extension of average lifespan. How does this affect healthcare systems? Are healthcare issues less prominent thanks to these knowledge? Should national healthcare systems adapt to these changes?

Extension of lifespan is not painless, because it creates new problems. For example, the rate of tumor diagnosis increased significantly in the last decades. This is partially due to the improvement of diagnosis techniques (read here for an interesting example), but also to the extension of people’s life (generally cancer affects older people). This answers the question about healthcare systems’. Obviously, they have to adapt to this tendency, for example by increasing funding to cancer research and by making sure that healthcare centers are suitable to face the increasing request of cancer treatments.

How is the healthcare status?

Someone might think that healthcare is not anymore a major issue, at least in developed and rich countries. Well, that is totally wrong. Countries needs to keep track of each case of every disease to prevent potential pandemic consequences. You can see it like this: “today there is no war, but you never know what happens tomorrow”. So you don’t complain too much when your government spends billions in weapons instead of funding instruction or research. With health it works in a similar way. Several diseases are won and no more cases are recorded, but if a case happens tomorrow you need to be able to solve it right away. Do you remember Zika? 2016 saw the rise and fall of the epidemic first in the Americas and then worldwide, until the World Health Organization (WHO) declared on the 18th of November that the virus no longer constituted a Public Health Emergency of International Concern (PHEIC), but represented a “significant enduring public health challenge requiring intense action”.

What should be done about prevention?

Ideally, prevention should begin at birth and continue throughout the course of each person’s life, because prevention is cheaper than curing a disease. Moreover, spending in prevention (e.g., vaccines) investments during a child’s early years helps mitigating deleterious effects of poverty and social inequality. From an economical point of view, preventing diseases during childhood pays back into lifelong benefits in terms of labor-market participation, earnings, and economic growth, with a financial return of up to 25%. Governments should therefore invest more in children’s and women’s health. At the same time, it is important to make a bigger effort in preventing cardiovascular diseases and cancer, which are the two main causes of premature death ion industrialized countries.

A look into the future: precision global health

In the last years, it became popular the expression “precision global health”. What is it? It is the translation of precision medicine (individually-personalized treatment for a disease) from single individuals to communities. Wernli and colleagues, in 2016, described precision global health as the response of health to globalization, by crossing borders and solving multilevel health issues. It is based on multiple disciplines that combine and analyze data from different sources. The idea is to exploit biological, social and geographical information to plan interventions to target communities in low-income countries. This approach is data-driven and requires advanced computational and statistical tools to provide practical and low-cost interventions. For example, satellite images, climatic conditions and epidemiologic data are combined and analyzed to map the location of parasite vectors for malaria and freshwater snails that host parasites responsible for schistosomiasis. Moreover, large databases of genomic sequences of pathogens help to identify origins of outbreaks. This improved the prediction of how many people are at risk of these diseases and where, allowing a more efficient distribution of antimalarial drugs and preventive chemotherapies.

The next step towards precision global health is to move beyond cartography and to consider individuals, because health status varies by demographic, behavioral and social factors within a community. Two more features of precision global health are the principle of equity and the respect of human rights (because health is considered a human right, it is important to guarantee access to affordable health care to everyone) and to work in a sustainable way (devices and services have to be offered in accordance to the planet’s needs).

Precision global health establishes targets to reach. One ambitious and mandatory objective is the abolishment of child mortality. The efforts to achieve this goal are ongoing, but so far results are insufficient and unequal. In some areas progress was achieved by targeting precisely causes of death, but there are also hotspots in sub-Saharan Africa that are not yet included in the Sustainable Development Goals (SDG) by 2030, as demonstrated by Burke and colleagues in 2016. This negative result indicates that working at sub-national level, rather than at country-level, could provide a more accurate and useful overview of where and why children are still dying.

Is the world ready to face epidemics?

Do you remember of Ebola epidemic? The Ebola outbreak in 2014-2016 in West Africa was devastating because countries were not ready to fight it. The outbreak was the largest recorded in history, accounting for 11,323 deaths and 28,646 confirmed cases, mainly across Guinea, Liberia and Sierra Leone, but also in Nigeria, Mali and Senegal. One of the main reasons why it was so devastating was the late call for PHEIC by the WHO, which is the main reference for African healthcare. Together with the late call, disaster was assisted by lack of core capacities, poor technical assistance and often-absent operational systems, which are common features of African healthcare systems. The outbreak was controlled only when digital technologies were introduced. The main advantage of using digital technologies in diagnosis and therapy is the speed and precision at which tasks can be executed and completed. In this meaning, the Ebola case became the turning point when it was realized how artificial intelligence can be paramount in healthcare. You don’t believe it? Check it here!

References

Wernli D, Tanner M, Kickbusch I, Escher G, Paccaud F, Flahault A. Moving global health forward in academic institutions. J Glob Health. 2016; 6(1):010409.

Black MM, Walker SP, Fernald LCH, et al. Early childhood development coming of age: science through the life course. Lancet 2017;389:77-90.

Burke M, Heft-Neal S, Bendavin E. Sources of variation in under-5 mortality across sub-Saharan Africa: a spatial analysis. Lancet Glob Health 2016; 4: e936–45.

Bempong NE, Ruiz De Castañeda R, Schütte S, et al. Precision Global Health – The case of Ebola: a scoping review. J Glob Health. 2019;9(1):010404.

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