Can precision health deliver on its promises?
In the past ten years, precision health has emerged as a multi-billion-dollar global growth industry. The initiative has been underpinned by some exciting innovations in medicine, public health, while wearable devices, smartphones, and other gadgets have flooded consumer markets.
At its heart, precision health seeks to improve the detection, prevention, and management of disease by integrating biological, behavioural, and environmental data; moving from a ‘one-size-fits-all’ approach to one that is proactive and deeply personalised to keep people healthier for longer. However, research by CSIRO’s Precision Health and Responsible Innovation Future Science Platforms has shown that precision health’s vision of integrated, comprehensive, and personalised health for all still requires further development to enhance uptake. Our research identified a looming risk that precision health could exacerbate, rather than fix, current health inequalities.
Healthcare for all, or just a few?
A major challenge in public health is ensuring that new health technologies reach disadvantaged countries, populations, and communities. These populations tend to experience the worst health outcomes while also receiving the least amount of public health research and support. On the other hand, people in high income areas tend to receive the most benefit. Correcting this inequity by developing interventions for and with traditionally disadvantaged groups must be a core tenet of precision health, otherwise it will not achieve its lofty ambitions.
There is no disputing that precision health’s potential is real. Australia’s national science agency CSIRO, among other organisations, is investing in the future of our health system through our Precision Health Future Science Platform research program. This research is furthering decision support tools to support the transition of medical care from treatment to prevention and recognising the significant burden this takes off healthcare systems. Precision health even promises to go a step further from prevention to ‘inception’, taking measures to intervene in the path of the disease before it is detected.
CSIRO’s Responsible Innovation Future Science Platform (RI FSP) takes an objective perspective on research, including studies being undertaken through CSIRO. It aims to analyse the potential risks, benefits, and uncertainties of future science and technology, and ensure that socially responsible science and technology is designed and delivered for all. The program cuts across different areas of the organisation, ranging from tech to energy and advanced manufacturing, and other Future Science Platforms.
With that in mind, this study that was instigated through the Precision Health and RI FSPs focussed on the current state of global precision health research.
Promising trends, glaring gaps
Researchers from CSIRO, Australian National University, and the National University of Singapore conducted a scoping review to map trends and gaps in precision health research. The scoping review searched for primary precision health research in humans throughout five academic databases and in grey literature, over a ten-year period spanning 2010-2020. Initial searches retrieved 8,053 articles, of which, 225 were eligible for inclusion in the review.
Now for the nitty gritty. Our four key findings listed below provide a snapshot of the current state of the art of precision health research. Of the 225 studies we identified and analysed, our results found that:
Research focus: About half of the precision health research focussed on the development of a precision health intervention. Other studies aimed to assess disease or health risks, develop tools to analyse big data, or conduct customised monitoring.
Precision health outputs: Outputs mostly include digital health tools, such as smartphone apps or wearables, and community-based programs that were implemented in places such as churches or schools.
What data do they use? Interventions and analyses typically drew upon a narrow data scope, such as behavioural or psychosocial data. On the other hand, the use or inclusion of genomic and socio-environmental data was uncommon.
Who is involved? Most participants in these studies were located in North America with only 14 studies (about 6%) taking place in South America or Africa. Furthermore, only about 20% of studies involved participants from socio-economically disadvantaged backgrounds.
The results also show that precision health studies infrequently report participants’ race/ethnicity. There was also an observed lack of research that involved minors and the elderly.
Collaborating for an inclusive precision health future
Our findings highlight that the journey towards an equitable and inclusive precision health future will be a long one. By identifying existing gaps in the research, we recommend several steps needed to move the field forward.
First, substantial interdisciplinary collaboration is needed. In order to collect a wider range of data that spans multiple domains and longitudinal timepoints, expertise in the biomedical sciences needs to be complemented by input from experts in public health, psychology, and environmental sciences. Moreover, computer science and/or engineering expertise is needed to develop tools that capture, analyse, and integrate multiple sources and types of information, which will be used in providing actionable and personalised interventions. Social scientists and ethicists are important in ensuring sustainable, ethical, and socially desirable technology development and deployment. They can help understand participation barriers leading to under-representation of particular societal groups and can work with scientists and engineers to facilitate greater inclusion of individuals from traditionally under-represented backgrounds.
Cross-institutional and international collaboration is equally important to bring technologies initially developed in the laboratory or academic departments to users who could benefit from them, along with industry support and linkages to hospitals and other medical/health facilities. That will allow interventions to be produced and tested at a larger scale to determine their safety and efficacy in multiple real-world contexts. Moreover, countries with significant capacity in precision health research should collaborate with under- and unrepresented countries. However, equitable arrangements should be made to ensure fair benefit sharing, respectful data and sample handling, and significant capacity building so that developing countries can eventually lead their own precision health initiatives.
The future of health promises smart phones, smart homes, and smartwatches delivering highly individualised health reports, diagnostic test results, and wellbeing recommendations exactly when and where you need them.
Although our scoping review demonstrates several initial steps being undertaken to make this a reality for the precision health industry, it also highlights the gaps that need to be overcome. Aside from unprecedented multidisciplinary collaboration among experts, health care providers, and consumers, efforts should also be directed towards significantly disadvantaged populations and developing countries, paving the way for global equity in health and wellbeing.