Role of Predictive Genomics in Sustainable Healthcare

Many healthcare systems across the world are perilously approaching the no-return in terms of sustainability.

FREMONT, CA: In terms of sustainability, many healthcare systems around the world are alarmingly close to the point of no return. The increased prevalence of non-communicable diseases (NCDs) such as cancer, cardiovascular disease, and diabetes is being driven by ageing, which is leading to an increase in patient numbers with various ailments, sedentary lifestyles, and changing nutritional profiles. At the same time, the higher healthcare costs are expected to be borne by the young, healthy, and productive population (which must shoulder the socio-economic burden of older generations). As a result, there is a potentially catastrophic sustainability pressure on healthcare systems' functioning, which can exacerbate inequities, particularly in Low- and Middle-Income (LMIC) settings, where resource availability and prioritisation are very competitive. As a result, healthcare systems and policymakers must thoroughly evaluate new ways to predict and prevent NCDs, providing citizens with the tools to change their lifestyles while also assisting public health professionals with the most cutting-edge tools available to effectively allocate dwindling resources.

The genetic material, organised into genes, serves as the operating template for all of our biological activities, and sequence differences in the genetic material have been related to giving genetic disadvantages, such as an increased risk of developing certain types of cancer in some circumstances. Predictive genomics is the ability to harness the power of genetic data and interpret it in a clinically meaningful way to aid in illness prevention and/or healthy lifestyle management. Polygenic inheritance, which involves numerous common genetic variants with minor effects, plays a larger impact in most common diseases, such as coronary artery disease and type 2 diabetes, than much rarer abnormalities in single genes. As a result, the ability to interpret the chances of developing the disease(s) may become a crucial component of future healthcare delivery. Predictive genomics has the potential to shift healthcare systems away from an emergency-based response, which focuses on treating individuals who get ill, and toward a proactive approach that focuses on helping everyone stay as healthy as possible for as 

long as feasible. This could be accomplished on an individual level by encouraging healthy lifestyle choices and/or giving more effective medication based on each individual's DNA, as well as on a societal level by improving the accuracy of targeted public health screening programmes and treatments. Thus, a more preventative view of healthcare systems is expected to emerge as a result of tools like genomics, extending the time window in which lifestyle changes or therapies can be proposed to forestall the onset of preventable disease.

Governments have shown an interest in the potential of genomics to improve the sustainability of healthcare systems. For example, many major European economies (UK, France, Germany, Italy, Spain, and others) have undertaken genomic projects in the last five years, but these are mostly focused on diagnostics (with a shorter market implementation horizon) rather than long-term prevention. Furthermore, pan-European projects such as 1+ Million Genomes (2), Beyond 1+ Million Genomes, and the Million Veteran Program in the United States – to name a few – illustrate governments' collective thirst for genomics. Only a few countries (Finland, the United Kingdom, and Estonia) have made significant investments in predictive genomics. Predictive genomics can create practical, ethical, and legal concerns, which is one of the reasons for doing so. Predictive genomics, for example, is a data-intensive strategy for improving diagnosis and developing new treatments for severe diseases; yet, the increased sharing of personal data raises questions about data privacy, commercialization, and public confidence.

As a result, the time is right for the following three discussions to take place about the role(s) predictive genomics can play in establishing long-term healthcare systems. First, a discussion of how clinical attention and resources are allocated across patients with varying levels of genetic risk, as well as how predictive genomics will be integrated into ordinary healthcare practice. Second, a health economics discussion to assess the cost implications of predictive genomics as part of routine healthcare planning and delivery. Third, the broader public and political discussion to find a new balance between the benefits of predictive genomics, the potential ethical and legal hazards, and how to manage them.