Health care must move from its current reactive and disease-centric system to one that is proactive and focused on wellness, disease prevention, and the precise treatment of disease. With the boom in predictive and precision technologies, targeted therapies, and the growing evidence of benefits from effective patient engagement strategies, this shift is now possible. Personalized Health Care (PHC) is designed to do this.
PHC is based on the concept that each of us is born with inherited susceptibilities or resistance to various diseases. Genetic susceptibilities for most chronic diseases are greatly impacted by what we do and what we’re exposed to. The Inflection Curve of Disease (see below) illustrates the general trajectory for the development of disease over time and the points at which the individual and the health care system might intervene. As a chronic disease progresses, the chances of reversal of the disease decrease and the cost to the health system increases. Thus, the earlier the intervention, the better.
There are three time periods over the trajectory of chronic disease.
The right portion of the curve is what we hope to avoid; it is when the burden and cost of poor health takes its toll on individuals and society. Early 21st century health care has made great strides in being able to treat disease once it occurs. Our medical technologies are far better than before, but once disease manifests, intervention is often expensive and minimally effective at reversing the underlying problem. For some people, disease development is unavoidable and here personalizing therapy and disease management can substantially improve health outcomes. But for many, the burden of established chronic disease can be greatly mitigated if it is addressed proactively before it develops.
The middle of the curve is the period during which primary prevention is most important. If an individual’s health risks are known, their providers can begin working with them on what is preventable. This can be done through education about lifestyle changes for health enhancement (like healthy diet and exercise), engaging individuals in their health, continuously monitoring risk markers for disease progression, and at times, medications to minimize disease development.
Furthest to the left of the curve is where the greatest opportunities lie. It is the period before a disease begins to develop and provides the greatest opportunity for improving health. Based on an individual’s characteristics, genetics, and environment, one can begin to quantify his or her disease risks and develop a plan to prevent them. At this point, engaging the individual in lifestyle changes to minimize their disease risks can have the greatest impact. By doing so, health care can focus on shifting the interventions to the left of the curve resulting in a far more efficient and effective health care delivery model.
Proactive, personalized intervention, at any point in the curve should minimize ramification of disease progression. The concept of “shifting the arrow to the left” provides great opportunities for the development of more rational approaches to health care.