Most middle-income countries will be expanding their health systems and expenditure over the coming decade. However they see that even countries with high GDP per capita and relatively high share of GDP on health are struggling to make their systems sustainable. How best to focus the additional spend to avoid the problems that all developed countries are encountering?
Emergent economies have the opportunity to apply next generation precision medicine technologies to make their systems more proactive and cost-effective than the legacy systems that are so dependent on late stage intervention in chronic disease.
Genomic and other ‘omic’ testing enables those likely to suffer disease to be identified early among those who are clearly at risk. Digital solutions can be personalized to act as guides and prompts for individuals to manage their own health life. Precision testing can distinguish those whose disease is likely to progress rapidly from those for whom ‘watchful waiting’ is the best course. And similar tests can be used to match treatment to the underlying molecular profile of the disease in the individual.
Of course, trained medical professionals will still be vital, but the training they receive needs to be tuned to these new technologies and to the increasingly important ‘health coach’ role to steer and support patients’ own efforts in self-care.
In the work we are doing around the world, we are finding great excitement about the power of these new technologies, but also some tough questions about which are most appropriate and affordable for a specific country. We are also encountering the hope that some of the technologies can be developed or adapted locally, so that life science economies can develop, bringing high value jobs into the country. We have seen this occur in other sectors and situations (such as those in Estonia and Israel) where thoughtful strategies have created indigenous industries able to meet local needs and export markets.
So both national health and wealth can be advanced by applying precision medicine thinking in a manner best suited to the health system and economy of a country or region. In some cases that may mean national genomic sequencing programmes (like those underway in the UK, US and Saudi Arabia); other countries may be able to take the learnings from these ambitious programmes and develop ways to apply them in cost-effectively.
Digital technologies based on smart phones and Web software may be able to rapidly outstrip those designed to run on diverse hospital computer systems, especially where they can guide individual behaviour and adherence to therapy, exercise regimens and nutrition.
We are entering a new era of medicine, one that may hold fewer advantages for systems mainly based on heroic, high tech interventions in late stage disease - and offer more for those countries able to develop democratized, smart healthcare that can avoid, anticipate and manage disease in real time with the power of precision medicine.
Professor Richard Barker
Founding Director, New Medicine Partners