ESC Geoffrey Rose Lecture in Population Sciences
Making personalised prevention everyone's business
30 Aug 2024
The presenter of this year’s ESC Geoffrey Rose Lecture in Population Sciences is Professor John Deanfield (University College London - London, UK), whose academic career has been dedicated to studying the early onset and progression of arterial disease. More recently, he has become involved in national policymaking, championing the crucial shift from the understanding of science to healthcare delivery.
What are the key themes of your lecture?
While modern medicine has transformed life expectancy, it has not reduced the proportion of people living with chronic diseases. The crux of my lecture is that we need to reframe healthcare, moving away from the traditional practice of just treating established disease towards prevention. I propose that a way to address the Geoffrey Rose paradox is by means of a national, scalable, but personalised, prevention programme.
Such a programme should begin from a young age. We know that intervention early in the development of arterial disease by reducing cumulative exposure to modifiable risk factors such as cholesterol and blood pressure, what I call ‘investing in your arteries’, provides the biggest health returns for CVD. Targeting the common biology that underlies many chronic diseases of ageing further leverages the potential benefit of early management. This national prevention programme should work side by side with the traditional healthcare system and collect longitudinal data on causal risk factors through a digital health platform with broad access. All of this requires deeper understanding of the impact of risk factors throughout a person’s life and the benefits of reducing them in a sustained manner from any age. Key aims are to unburden the stressed ‘disease care system’ and reduce health outcome inequalities in the population, which are largely due to chronic, potentially preventable diseases. New advances in genetic risk assessment as well as novel imaging techniques will refine further our ability to personalise prediction and management.
We’ve come to a moment of realisation that it is no longer possible to just try doing better at what we have always done – we need a broad change in thinking. And the making ‘prevention everyone’s business’ part of my lecture title speaks to the need for input from every member of society, not just the medical profession.
What are the most important challenges?
One of the greatest challenges lies in getting societal buy in. In an era of long waiting lists and underfunding, selling prevention, which will provide benefits in the future, is problematic. Personalised prevention needs to be framed not as another health cost pressure but as an essential way to benefit the economy as well. By making the programme about both health and wealth creation – for example, by considering reduced workforce absenteeism and improved productivity – people more readily understand the consequences for themselves and for society. Other challenges include achieving long-term adherence to preventive management strategies, which will be helped by novel, long-acting agents, for example for the management of people with obesity, as well as the development of new funding models for the new system.
What are the next steps?
Reducing or delaying demand on already stretched healthcare systems by shifting upstream to prevention is something that needs to happen now. It is, therefore, very encouraging to see that politicians around the world are beginning to understand this new type of concept and to give it serious consideration. For the public, it may be beneficial to present such a programme as a ‘new deal’: we will take care of you when you are ill but we need you to take responsibility for understanding and optimising your health. And, in an effort to ‘inform, empower and reward’, it may be feasible to find ways to reward individuals who do look after their health.
Medicine and the technology to enable delivery at scale are moving forward rapidly. The new prevention approach needs to be ‘agile’ and to include a ‘learning system’ whereby innovations can be tested at scale and rapidly deployed. The UK’s Our Future Health programme is aiming to do just that in a diverse community of a projected 5 million volunteers. The findings can be fed rapidly back into the system, resulting in a fast evolution of healthcare, incorporating the newest science and providing benefit for everybody.
Don’t miss!
- ESC Geoffrey Rose Lecture in Population Sciences: Saturday, 09:15–10:00; Helsinki
