Longevity Governance

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Healthcare Expenditures per capita by Country

The financial resources that a country devotes to health care and how this changes over time and is a result of a wide array of social and economic factors, as well as financing and organisational structure of country’s health system.   Hong Kong, the United States and Switzerland spend more on health care than any other countries in the world. It’s notable that the United States spends a disproportionate amount on health care. Compared with the other G7 countries, the United States spends almost 80% more than Germany and more than twice on healthcare per person in Japan, Canada and France. In the medium term, the US Center for Medicare and Medicaid Services (CMS) expect health spending growth above that of GDP in the United States, driven on by faster growing medical prices. In Hong Kong total health expenditure amounted to $177,447 million in 2018/19, with annual per capita spending at $23,815.

Why the Health Care System is So Expensive in the United States

1. Administrative Costs
About one quarter of health care cost is associated with administration, which is far higher than in any other country.  

2. Drug Costs
Another major difference in health costs between the US and every other developed nation is the cost of drugs. In most countries, the government negotiates drug prices with the drug makers, but when Congress created Medicare Part D, it specifically denied Medicare the right to use its power to negotiate drug prices.  

3. Defensive Medicine
Another big driver of the higher US health insurance bill is the practice of defensive medicine. A 2010 Gallup survey estimated that $650 billion annually could be attributed to defensive medicine. Everyone pays this with higher insurance premiums, and out-of-pocket costs, as well as taxes that go toward paying for governmental health care programs.  

4. Expensive Mix of Treatments
US medical practitioners also tend to use a more expensive mix of treatments. According to data from the World Bank, 17.7% of the United States' GDP was spent on health in 2019. More people in the US are treated by specialists, whose fees are higher than primary-care doctors when the same types of treatments are done at the primary-care level in other countries.  

5. Wages and Work Rules
Wages and staffing also drive up costs in health care. Specialists are commanding high reimbursements, and the over-utilization of specialists through the current process of referral decision-making drives health costs even higher.  

6. Branding
Providers who can demand the highest prices are the ones who create a brand everyone wants. In some markets, the prestigious medical institutions can name their price.

Wasteful Health Care Spendings

Health expenditure is rising in the United States as in most OECD countries. Yet, a considerable part of this health expenditure makes little or no contribution to improving people's health. In some cases, it even results in worse health outcomes.  

The United States could potentially spend significantly less on health care with no impact on health system performance or on health outcomes. Behavioral root causes of wasteful health care spendings include the following:

◆ imperfect knowledge and cognitive biases;
◆ poor management, organization and coordination;
◆ incentives misaligned with system goals.

Healthcare Spending and HALE

Healthcare spendings per capita divided by HALE is efficiency ratio. It shows how much is spent on average in one healthy life year .

The United States spends a disproportionate amount on health care, more than any other country, but HALE is relatively low. It occurs because chronic disease is now the biggest threat to the longevity. The United States now has the lowest HALE levels among high-income developed countries, including Western Europe, Australia, and Japan.

The Luxembourg healthcare system is one of the most comprehensive systems in the world offering virtually unrestricted access to the Luxembourg population. It also ranks in the top five countries for per-capita healthcare expenditure. The total spending on healthcare is almost 8% of the country’s Gross Domestic Product (GDP). High health spendings correlates with high HALE and life expectancy.

India has the lowest value of indicator. India spends the least amount. The main problem is the lack of healthcare facilities which contributes to bad health and low HALE.

Healthcare Spending and Health-adjusted Life Expectancy

As we can see there is no linear relationship between the life expectancy and healthcare expenditures. It means that more public expenditures on healthcare do not guarantee healthier and longer life.   The graph we could divide into two main groups. The first group include developing countries, such as India, Brazil, Russian Federation, Argentina. There increase in public spending contributes to increase in healthy life.  

The second group is developed countries. Wealthy countries spend more per person on health care and related expenses than lower income countries which does not lead to increase in life expectancy.  

The most evident difference in effectiveness of government expenditures on healthcare is between United States and Japan. These countries are approximately of the same level of wealth, GDP per capita equals 65 297,2 and 40 246,2 USD respectively in 2019, but lower healthcare spending per capita in Japan contribute to higher Health Adjusted Life Expectancy (HALE) comparing to United States.

Social Protection and Healthcare vs HALE

To estimate the relationship between social protection and healthcare spendings and HALE we calculated Intraclass correlation coefficient (ICC). It measures the reliability of ratings or measurements for clusters — data that has been sorted into groups. The ICC ranges from 0 to 100%.

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•  A high Intraclass Correlation Coefficient (ICC) close to 100% indicates that variance of dependent variable (HALE) can be explained by the variance of the chosen factor (type of spending).

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• A low ICC close to zero means that relation between values is low, not significant.

The highest ICC is between health spendings per capita and HALE. It indicates that 58.1% variance in HALE can be explained by variance in healthcare spendings. According to our analysis, this type of spending is the most significant factor that influences HALE. Pension spending is the second sufficient indicator, the ICC equals 57.2%. It can be explained by the nature of the indicator such as pension spending provides an income for persons retired from the labour market or guarantees incomes when a person has reached a 'standard' pensionable age or fulfilled the necessary contributory requirements.

Meteorological Analysis. Overview

As can be seen from the temperate climates map on the left, which is based on Köppen climate classification, around 80% of chosen countries are located in a temperate climate zone, which is no coincidence. Though first human civilizations were situated in warmer areas, it has changed recently due to a number of factors, one of which was the Industrial Revolution. The significance of agriculture and warmer climate has drastically reduced, and European countries took over. That’s where economic development and, consequently, healthy people reside.

Though it does not guarantee a sound nation, it surely contributes to the general picture. Ceteris paribus, where does a man have greater productivity: in the country with mild temperatures and relatively comfortable other weather conditions (that is close to a definition of a temperate climate) or in the country where it’s hot and humid or cold and dry? Furthermore, greater productivity is the foundation of economic development, quality of life and healthy longevity. One could argue that with the invention of air conditioning systems and evermore dominant service sector the importance of a mild climate diminishes, and human capital has come to the forefront and could be right, Singapore is a good example of it. Though it still plays and will play its part in the foreseeable future.

Diurnal Temperature Variation

Diurnal temperature variation (DTV) is the variation between a high temperature and a low temperature that occurs during the same day. Although DTV is a key index of climate change, few studies have reported the health burden of it and its temporal changes at a multi-country scale. Therefore, during the investigation was assessed the attributable risk fraction of DTV on mortality and its temporal variations in a multi-country data set.

On any given day, the temperature swing from low and high temperature is roughly 10 to 15°C . A number of conditions can widen or lessen this range, such as:
 

● day length

● cloudiness

● elevation

● humidity

● wind speed

High desert regions typically have the greatest diurnal temperature variations, while low-lying humid areas typically have the least.This explains why an area like United Arab Emirates, can have difference in temperature up to 11.2 °C. At the same time, United States of America, which are on average more humid, has temperature variations of only 7.2 °C, urban Singapore has a diurnal temperature range of little more than 6 °C.

During the past decade, DTV mortality association assessment has received increasing interest in environmental epidemiology, linking large DTV with increased mortality risk in geographical locations with different climate characteristics. Diurnal Temperature Variation

Shown in the diagram life expectancy displays people who live in areas of lower diurnal temperature variation are often live longer and healthier. Thus, low HALE and life expectancy are more often in areas of high DTV, as shown in the examples of the United Arab Emirates, Saudi Arabia, and Turkey. For the whole population, higher DTV significantly increased daily non-accidental mortality, especially cardiovascular mortality.

Sunshine Hours

High levels of sun exposure during the year of birth may increase infant mortality and shorten the average lifespan of a population.For example, peak solar activity brings higher levels of ultraviolet radiation to Earth, and some evidence suggests that UV radiation may increase infant mortality by degrading folic acid, or vitamin B9, which is important for the rapid cell division and growth that happen during pregnancy.

Therefore, we can observe a correspondence between the UV radiation volumes and HALE indicators in different countries. Countries with high life expectancy and HALE are situated mainly in the temperate climate zone where the solar activity is less intensive. For comparison, HALE in Argentina, Brazil, United Arab Emirates does not reach the appropriate mark of Iceland, Singapore, United Kingdom of Great Britain and Northern Ireland.

However, many studies show that people who avoided the sun had a life expectancy 0.6 to 2.1 years shorter than those in the group with higher sun exposure.So, countries with high HALE and life expectancy have low levels of UV radiation, but a relatively larger number of sunny hours per year.

Relative Humidity

Both temperature and humidity are meaningful determinants of mortality. Humidity can affect human health through a variety of mechanisms. On one hand, low-humidity levels can lead to dehydration and promote the spread of airborne diseases, like influenza. On the other hand, high-humidity levels exacerbate the effects of heat stress because humidity impairs the body’s ability to sweat and cool itself. High-humidity levels can also affect respiratory health since they promote the spread of bacteria, fungi, and dust mites. Low humidity levels are especially dangerous, temperature and humidity have a large impact on cardiovascular- and influenza-related mortalities.  

Optimal humidity is between 35 and 50 percent. However, the relative humidity indicator in most countries is not appropriate to this level. The analysis shows that countries with average values (60-67 %) have higher HALE than countries with extreme value of the pointer.

What is Metabesity?

Our metabolism comprises all of the chemical reactions that help keep our bodies alive. Factors such as resting metabolic rate (“RMR”), thermic effect of food (“TEF”), exercise and non-exercise activity thermogenesis (“NEAT”) all work together in a coordinated manner in order to maintain good health. Most of the major diseases of our time (including diabetes, cardiovascular and neurodegenerative diseases, and cancer) have common metabolic roots, and thus may be susceptible to common solutions. This constellation of interconnected diseases can be called “metabesity.”
 
Metabolic syndrome has long been recognized as an important risk factor for cardiovascular disease, and its prevalence has been increasing. More recently, metabolic syndrome and other forms of metabolic dysfunction have been linked to other conditions including dementia, cancer, and the aging process. The term “metabesity” was coined by Dr. Alexander Fleming to reflect the broader impact of metabolic dysfunction on these major diseases.

Influence of Age on the Prevalence and Components of Metabesity and the Association with Mortality Risk Factors

Non-communicable diseases (NCDs), also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behavior factors. Such diseases have common metabolic roots, and their interconnection can be called “metabesity.”
 
The main types of NCDs are cardiovascular diseases (such as heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes. These conditions are often associated with older age groups. Among age-related changes are also dementia and severe memory loss that are considered to be not part of the normal aging process.
 
The prevalence of NCDs are considered to be a “slow motion disaster.” Noncommunicable diseases are driven by forces that include unplanned urbanization, globalization of unhealthy lifestyles and population aging. Unhealthy diets and a lack of physical activity may show up in people as raised blood pressure, increased blood glucose, overweight and obesity. These are called “metabolic risk factors” and can lead to cardiovascular disease, the leading NCD with regard to premature deaths. All risk factors of NCDs lie in non-health sectors, requiring collaboration across all of government and all of society to combat them.

Rising Prevalence of Premature Death from Non-communicable Diseases

Measuring how many people die each year and what are the main causes of death in each country plays an important role for assessing the effectiveness of a country’s health system.   The World Health Organisation reports that non-communicable diseases (NCDs) caused 71% of deaths globally, and 77% of all NCD deaths are in low- and mid-income countries. Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million).

The Prevalence of Communicable Diseases in Developing and Low-Income Countries

Communicable, or infectious diseases, are caused by microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly or indirectly, from one person to another. Worldwide, developed and developing countries are facing the double burden of communicable and noncommunicable diseases. However, developing countries are more exposed and more vulnerable due to a multitude of factors, including geographic, demographic and socio-economic factors. Noncommunicable diseases like cardio-vascular diseases, cancer, diabetes, chronic obstructive pulmonary disease and mental disorders are affecting developing countries with an increasing trend. In parallel, communicable diseases such as HIV/AIDS, malaria, tuberculosis, acute respiratory infections and diarrheal disease are causing high mortality rates especially in low and middle income countries.

Links Between Longevity, Metabesity and Disease

Aging itself is largely a metabolic condition. As we get older, the day-to-day operations of metabolism inflict damage on human cells and organs. Moreover, as this damage accumulates, metabolism itself is thrown into disarray, and these things are no longer coordinated with each other, causing metabolism to malfunction further and inflict more damage.

Among the many signs of metabolic discoordination is a buildup of visceral fat, which may be partly a symptom and partly a cause of aging.

It is well known that carrying excess visceral fat tissue increases risk of age-related diseases, shortens life expectancy, and raises lifetime medical expenditure. For example, excess visceral fat tissue adds to the presence of senescent cells, causing chronic inflammation via several age-associated changes. The more fat tissue, the worse the outcome – even being moderately overweight rather than obese still produces a negative impact on long-term health.

Aging, therefore, along with diabetes, cardiovascular and neurodegenerative diseases, and cancer, is itself an additional component of metabesity. It is also well known that the Western diet and lifestyle similarly contribute to the same metabolic dysfunction and to signs of premature aging. Given how intimately connected aging, metabesity and disease are, seeking to address the metabolic roots of various diseases might also lead us to discover methods for improving the aging process itself, with positive ramifications for everything from obesity to arthritis.

Hypertension and Healthy Longevity

• Hypertension can cause serious damage to the heart. Excessive pressure can harden arteries, decreasing the flow of blood and oxygen to the heart.  

• Hypertension - or elevated blood pressure - is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases.

• An estimated 1.13 billion people worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. ​ In 2019, 1 in 4 men and 1 in 5 women had hypertension. ​

• Fewer than 1 in 5 people with hypertension have the problem under control. ​

• Hypertension is a major cause of premature death worldwide. ​

• One of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by 25% by 2025 (baseline 2010).

Obesity and Healthy Longevity

Overweightness and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer. Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings.

Some recent WHO global estimates follow:

• In 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these over 650 million adults were obese.

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• In 2016, 39% of adults aged 18 years and over (39% of men and 40% of women) were overweight.

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• Overall, about 13% of the world’s adult population (11% of men and 15% of women) were obese in 2016.

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• The worldwide prevalence of obesity nearly tripled between 1975 and 2016.

In 2016, an estimated 41 million children under the age of 5 years were overweight or obese. Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries, particularly in urban settings. In Africa, the number of overweight children under 5 has increased by nearly 50 per cent since 2000. Nearly half of the children under 5 who were overweight or obese in 2016 lived in Asia.

Obesity and Healthy Longevity

Obesity-related diseases will claim more than 90 million lives in OECD countries in the next 30 years, with life expectancy reduced by nearly 3 years. Obesity and its related conditions also reduce GDP by 3.3% in OECD countries and exact a heavy toll on personal budgets, amounting to USD 360 per capita per year, according to a 2019 OECD report.

Some regions of the world, such as Southeast Asia, have seen alarming increases in obesity rates within the past five years. 

Globally, 39% of adults are overweight and 13% are obese, according to the World Health Organization. 

In 2019, 38 million children under the age of 5 were overweight, while for the age group 5-19, an incredible 340 million children were overweight.

Education and socio-economic background affect obesity. Reciprocally, obesity damages labour market outcomes that, in turn, contribute to reinforcing existing social inequalities. Obese people have poorer job prospects compared to normal-weight people, they are less likely to be employed and have more difficulty re-entering the labour market. Obese people are less productive at work due to more sick days and fewer worked hours, and they earn about 10% less than non-obese people. Addressing obesity and the associated negative labour market outcomes would help break the vicious circle of social and health inequalities.

Obesity and Healthy Longevity

Obesity has been linked to a number of chronic diseases, including Type 2 diabetes, cardiovascular disease, and cancer, to name a few. Several experts have postulated that the obesity epidemic may result in a decline in life expectancy and HALE in the United States in the 21st century.

One study has estimated that obesity causes approximately 300,000 deaths per year. Being overweight and obesity in childhood is especially ominous. In men especially, being overweight in childhood has been found to increase the risk of death from any cause. Some researchers have determined that, in those who are extremely obese, life expectancy may be reduced by an estimated 5 to 20 years.

Numerous organizations, including the World Health Organization (WHO), have issued a call to action on the obesity epidemic, citing it as a major global health problem. The WHO estimates that at least 2.8 million people worldwide die each year due to being overweight or obese. The WHO also notes that the prevalence of obesity globally nearly doubled between 1980 and 2008, and where obesity was once associated with high-income countries, it is now associated with low- and middle-income countries as well. Childhood obesity has become a global health problem as well; according to the WHO, over 40 million preschool children were overweight in 2008, and children who are overweight are more likely to become obese as adults.

Such statistics make treatment and prevention of obesity ever more urgent. Individuals can take simple steps to prevent obesity and combat sedentary lifestyles, getting more physical activity on a daily basis and paying close attention to diet. Eliminating sources of added sugar and empty calories can go a long way toward weight management, and a growing awareness on local, national, and global levels is finally beginning to translate into community and policy measures.

Adult and Childhood Obesity

Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally, in 2016 the number of overweight children under the age of five, is estimated to be over 41 million.

Childhood obesity is associated with a higher chance of premature death and disability in adulthood. Overweight and obese children are more likely to stay obese into adulthood and to develop noncommunicable diseases (NCDs) like diabetes and cardiovascular diseases at a younger age. For most NCDs resulting from obesity, the risks depend partly on the age of onset and on the duration of obesity. Obese children and adolescents suffer from both short-term and long-term health consequences.

The most significant health consequences of childhood overweight and obesity, that often do not become apparent until adulthood, include:

• Cardiovascular diseases (mainly heart disease and stroke);

• Diabetes;

• Musculoskeletal disorders, especially osteoarthritis;

• Certain types of cancer (endometrial, breast and colon).

At least 2.6 million people each year die as a result of being overweight or obese.

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Overweightness and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity therefore needs high priority.

The WHO Member States in the 66th World Health Assembly have agreed on a voluntary global NCD target to halt the rise in diabetes and obesity.

A number of countries have developed national strategies and action plans to tackle a troublesome issue.

Tackling Overweight and Obesity in Australia National Obesity Strategy

In 2017-18, the Australian Bureau of Statistics’ National Health Survey showed that two thirds (67.0%) of Australian adults were overweight or obese (12.5 million people), an increase from 63.4% in 2014-15. The National Health Survey also indicated that almost one quarter (24.9%) of children aged 5-17 years were overweight or obese in 2017-18 (17% overweight and 8.1% obese).

At the 12 October 2018 Council of Australian Governments (COAG) Health Council (CHC) meeting, Ministers agreed that a National Obesity Strategy would be developed and that the first phase of the development process would include a Commonwealth funded National Obesity Summit.

The National Obesity Summit was held in Canberra on 15 February 2019 and was attended by approximately 120 participants from government, academia/research, medical and public health organisations, the food industry and consumer groups. The National Obesity Summit brought together experts in obesity to explore factors leading to overweight and obesity and to identify and agree on priority areas for action (for inclusion in the Strategy).

Key conclusions and recommendations:

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• Targeted interventions: Early childhood and the antenatal period are emerging as critical periods for obesity interventions. More interventions for children 0-2 years old to prevent progression towards obesity are required.

• Systems perspective: In the health system, reform is needed to realign and coordinate resources to manage the complex and long term nature of obesity treatment, and increase resourcing for prevention.

• Reframing success: Achieving weight loss has potentially been used as an overly simple definition of success. There is scope to investigate and reframe the conversation towards weight management and achieving healthy wellbeing.

• Working Together: Creation of a statutory body, with bipartisan support and secured funding to allow for long term investments. Development of a stand-alone, resourced Physical Activity Plan with long-term sustainable physical activity programs separate from nutrition, diet or obesity.

Murder Rate per 100 000 population, 2016

Murder Rate

Due to economic inequality, unemployment and unequal development there exists a huge gap in murder rates between ‘core’ countries with high industrialization level and richness, and ‘peripheral’ developing and poor countries. The existing point of view emphasises that long-term improvement of murder rates in Western Europe countries should be considered in complex with general country modernization and following changes in daily life, such as increasing of domesticity, self-control and consolidation of the rule of law.
 
Murder rates are strongly influenced by economic, social and environmental situations and trends, and the rule of law. Conversely, murder rate also has a negative impact on country development. The situation occurred in Mexico is a good example which describes this dependence: from 1995 to 2006 murder rates here declined.
 
Other recent studies confirm, that murders cause substantial reductions in life expectancy. Violence has become a major public health issue in Latin America, as this region experiences the highest murder rate in the world (more than 16.3 per 100  000 people), with some countries in Central America undergoing a recent upsurge in homicides. As a response to existence of murder problem, countries developed mechanisms, systems and institutions aimed to violence reduction and prevention, and degrees of success of such methods varies.

United States
Murder rate in the United states of America is significantly higher than in European countries. It has to be considered that the U.S. spends much more money on healthcare system, but despite this fact has low HALE and Life Expectancy. In the US, an estimated 16,425 people were murdered in 2019. This was a 0.3% increase from the 2018 estimate. A 25 percent increase in murder in 2020 would mean the United States surpassed 20,000 murders in a year for the first time since 1995.

Corruption Impact

The World Health Organization divides corruption into four types: bribery, theft, bureaucratic or political corruption, and misinformation for private gain.
 
Study performed by Lio, Lee, 2015 confirms that dependency between life expectancy and corruption is significant. According to them, “... a country with better control of corruption, or a lower level of corruption, displays better health outcomes—longer life expectancy, lower infant and under-five mortality and lower HIV prevalence. [...] One possible interpretation of our finding is that life expectancy, the infant mortality rate and the under-five mortality rate are indicators of outcomes that involve a substantial amount of people and decisions and involve a complex process of resource allocation.”
 
Corruption and inequality feed off each other, creating a vicious circle between corruption, unequal distribution of power in society, and unequal distribution of wealth. It is known that corruption has bigger impact on health outcomes, such as lower life expectancy and higher infant mortality, in poor and developing countries than in richer and developed nations. Regardless of the level of development of a country, corruption exists to a greater or lesser extent in every country.
 
Examples
Nowadays Denmark holds 1st place in the list of corrupt-free countries followed by New Zealand, Finland and Singapore.

According to the Corruption Perceptions Index in 2020, Germany is perceived to be the least corrupt country in the G20 with a score of 80.

India's rank has slipped six places to 86th among 180 countries in corruption perception index (CPI) in 2020.  

Russia is one of extremely corrupted countries with high levels of corruption in all social spheres, especially education and healthcare. This led the country to great loss in economy, governance efficiency, trust in public institutions and quality of life. All this changes reflect negatively on life expectancy of citizens.

The Shift from Sick Care to Preventive Medicine

With the aging of the population and an increase in the proportion of older persons, the shift in the burden of disease towards chronic conditions has accelerated. And chronic diseases are responsible for 7 out of 10 deaths. These rates are expected to increase significantly over the next two decades, particularly due to the obesity epidemic.

Increases in the prevalence of chronic disease are outstripping reductions in acute infectious diseases. Such epidemiologic evolution demands a focus on public health and prevention.

For years, the United States has approached public health backwards. The health care system has been set up to treat people after they are sick rather than keeping them well in the first place.

Yet economic and technological factors dating from the early 20th century remain strong barriers to effective disease prevention. A key feature of the system is its use of a piecemeal, task-based system that reimburses for “sick visits” aimed at addressing acute conditions or acute exacerbations of chronic conditions.

Economic incentives encourage overuse of services by favoring procedural over cognitive tasks and specialty over primary care. Prevention is the most effective, common-sense way to improve health and reduce health care costs in the United States.

Preventive Medicine and HALE

Healthcare has changed since the decline in mortality caused by infectious diseases as well as chronic and non-contagious diseases, with a direct impact on the cost of public health and individual health care. We must now transition from traditional reactive medicine based on symptoms, diagnosis and treatment to a system that targets the disease before it occurs and, if it cannot be avoided, treats the disease in a personalized manner. Precision Medicine is that new way of thinking about medicine. Precision medicine is poised to have an impact on patients, health care delivery systems and HALE in ways that were only imagined 15 years ago when the human genome was first sequenced.

Progressive Model of P4 Medicine Platform

Precision Health Structure

Advanced Areas P4 Medicine

Constant growth in medicine leads the clinics to the need for choosing some areas to maximize their impact of treatment. It highly impacts the methods they use and the diseases they treat. The most advanced areas can be split into such categories as:

• Personalized Diagnostics. Mostly it uses different "-omic" fields in rational design approaches to provide a cost-effective alternative to expensive and time-consuming laboratory tests in order to assist health care personnel with disease diagnosis decisions.

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• Personalized QALY & HALE Estimation. HALE is a tool to integrate or unite the public health focus on geographic populations and the clinical focus on individual patients, and can be used to explain and assess the effects of interventions on individual patients and on populations. QALY is a generic measure of disease burden, including both the quality and the quantity of life lived.

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• Personalized Biomarker Analysis. Personalized analysis of traceable biomedical substances used for tracking the patient's state. Biomarkers reflect core pathologic mechanisms that enable the identification and characterization of initial injuries and the secondary pathological cascades, as well as determining the risk or progression of a disease and the susceptibility of the disease to a given treatment.

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• Personalized Prognostics. An approach in diagnostic based on precision. It uses multi-omic sequencing, non-invasive continuous monitoring, multi-modal total-body imaging, 3D integration of cross-sectional tissue and organ imaging, and whole-body and organ-specific biological age calculation based on biomarkers.

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• Personalized in vivo & in silico drug testing. Implementation of the personalized approach in drug testing.

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• Preventive Therapies. Therapies that consists of measures taken for disease prevention, as opposed to disease treatment. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

From Precision Diagnostics to Precision Health

Precision Health reimagines medicine to focus on predicting, preventing, and curing disease precisely. Compiling two seemingly different approaches — high-tech and high-touch — science creates new vision of the unique biology and life circumstances of each individual, with an emphasis on catching disease before it strikes. Precision Health represents a fundamental shift to more proactive and personalized care that empowers people to lead healthy lives.

Precision Diagnostics

Precision Diagnostics

Medical knowledge will double every 73 days by 2020 vs. every 3.5 (years) in 2010, and genomic sequencing costs have fallen 99 % since 2003. This has enabled a new frontier in precision medicine to further extend life expectancy, heralding a ‘techmanity’ (technology meets humanity) revolution. Preventive interventions permanently reduced the incidence of cancer, diabetes, heart disease, hypertension, lung disease, and stroke. This, evidently, increase the amount of healthy years which people could live.

Global Government Policy and Precision Medicine

In view of its potential and the high expectations and promises for global health, it is not surprising that worldwide numerous national initiatives have been launched over the past decades to foster the development of personalized health. For example, as early as 1999 the Estonian government decided to create a population-based biobank that has the right “to collect, store and use biological samples and phenotype information for genetic research and is further expected to use the results to improve public health.” Since this innovative and future-oriented decision, Estonia has reached further milestones towards personalized medicine, including the development of a nationwide technical infrastructure that allows for secure electronic exchange of medical information, as well as accessibility of medical data from hospitals, primary care physicians and pharmacies in a strictly regulated manner.  

Meanwhile, other countries with universal health care and comprehensive medical registers have developed similar precision medicine programs on a national scale, including Denmark, France, the Netherlands, Sweden and the United Kingdom. The UK government mandated the Department of Health to initiate the 100,000 Genomes Project, whose goal is to sequence 100,000 genomes from National Health Service (NHS) patients by the end of 2017 and thereby “ create an ethical and transparent program based on consent, to bring benefit to patients and set up a genomic medicine service for the NHS, to enable new scientific discovery and medical insights.”  

On the European level, the International Consortium for Personalized Medicine (ICPerMed) was established following the PerMed project funded by the European Union's 7th Framework Programme (FP7). The consortium is composed of over 30 European and international partners representing ministries, the European Commission, and funding agencies. ICPerMed aims to position Europe as global leader in personalized medicine research by providing a platform where members can exchange and coordinate research and funding activities at the European level and later at the global level.

Outside the Europe, China announced the launch of the “China Precision Medicine Initiative” in March 2017, with an estimated budget of US$9.2 billion over 15 years, indicating that China is about to take the global lead in precision/personalized medicine.

Precision Medicine in Singapore

Singapore is known in the world over for its efficient healthcare system. Research undertaken in this country, proves that patients who received personalised treatment had higher response rates and overall survival compared with those who received non-personalised treatment. One potential area that Singapore may still continue to lead the pack is through its strides in comprehensive genomic profiling and precision medicine which will offer a truly patient-centred approach to cancer treatment in the years ahead.

For example, the latest collaboration between the Australia's Commonwealth Scientific and Industrial Research Organisation (CSIRO) and Singapore's Nanyang Technological University (NTU) aims to help improve seniors' health through extensive research on their gut microbiome.