Predictive Health and Society

Health is the essential infrastructure for all that humans are capable of being

doing or becoming individually or together

American health compared to that of other developed countries

Cost• US spends more (15+

% of GDP)• US has steeper rate

of cost increase

“Benefit”• Shorter life

expectancy in US• Slower rate of

increase in life expectancy

“America's health care system is second only to Japan ... Canada, Sweden, Great Britain ... well, all of Europe. But you can thank your lucky stars we don't

live in Paraguay!” - Homer Simpson

We are at serious risk of losing our health while paying dearly for it

The Health/Disease Continuum

NormalLow risk

NormalHigh risk

Predisease

Earlydisease

Latedisease

Predictive Health

Contemporary Medicine

HEALTH

DISEASE

Predictive Health

A personal matter

The Emory Model: A limited number of generic processes can define individual health and predict

premorbidity

GENETICS

ENVIRONMENT

BE

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OX

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IMMUNE HEALTH

Determinantsof

Health

Generic Processes

IMPAIRED

GLUCOSE

TOLERANCE

EARLY

COGNITIVE

DYSFUNCTION

INCREASED CAROTID

IMT

DEPRESSION

ASYMPTOMATICPRE-CANCER

Premorbid Conditions

DIABETES

NEURO-DEGENERATIVE

DISEASE

ATHERO-SCLEROSIS

PSYCHIATRICDISORDERS

CANCER

Figure 4: Hypothetical comparison of a disease focused health care model (Conventional medicine) with a health focused system (the Emory model) for a person born with a predisposition to coronary artery disease

Conventional medicine

0 10 20 30 40 50 60 70 80

direct cost $42,720indirect cost $37,920 (lost productivity)

direct cost $15,000indirect cost $12,000 (lost productivity)

Emory model, risk evaluationand early intervention direct cost $65,000

indirect cost $500,000 (lost economic value x 20 yrs)

Total $672,640

0 10 20 30 40 50 60 70 80

Neonatal risk assessment: direct cost $500indirect cost $0

Annual physical exam direct cost $10,500 ($150/yr X 70 yrs)

indirect cost $4,500 (time off work, .25 day/60yr)

Nanoscreen added direct cost $9,300 ($150/yr x 62 yrs)

indirect cost $0 (combined with annual physical

Add therapeutic direct cost $2,555 (7 yrs of drug at $1/day)

indirect cost $0

Revise therapeutic direct cost $18,250 (50 yrs of drug at $1/day)

indirect cost $0

Total $45,605

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Predictive Health

A societal matter

Interdependence of Individual and Group Health

Healthy People

Healthy Societies

Health matters because it is inextricable from individual happiness, productivity and quality of life, but also because human beings do not thrive in units of one.

Humans don’t thrive in units of one

• Individual health is defined in a social context

• Defining societal health

• Healthy societies healthy people

• Changing the health system means changing society

Predictive Medicine

What others are doing

Johns Hopkins ad in Sunday NYT: April 25, 2005

Predictive Medicine

• Duke University

• Broad Institute

• Washington University

• Institute for Systems Biology

• Johns Hopkins

Predictive Health and Society

It takes a universe

It takes a University

Research Institute for Predictive Health

Generic Pathways

Specific DiseasesCardiovascular

Diseases

Chronic Lung Diseases

Diabetes

Cancer

Other Diseases

Neurological Diseases

Determinants of Health

Environment

Genetics Behavior

Oxidative Stress

Development and

Senescence

Regeneration and Repair

Other Generic Pathways

Immunology and

Inflammation

Education

SomeEnabling

Disciplines

Finance and Economics

Public Policy

Ethics

Systems Biology

Population Biology

SomeEnabling

Technologies

Genomics/ Metabolomics/ Proteomics

Molecular Imaging

Bioinformatics

Nanomedicine

Quantitative Medicine

Novel Therapeutics

Why Emory University?

• A focus on health • Generic processes as definers of health • A special environment • Unique combination of technologies • Integration of science, technology, ethics, humanities,

law, business, health policy, economics • Systems science---cells to societies • Building bridges between population health and

individual health

A Transforming Theme• A destination university---Emory, a recognized destination for the new biomedicine

• Internationally recognized---New knowledge and practical experience with health care innovation will have global implications and will identify Emory as a leader in health care innovation with global implications

• Inquiry-driven---The entire effort will be driven by a passion for new knowledge and how it can be used to impact individual and societal health.

• Ethically engaged---Predictive health is fundamentally an ethical concept.

• A diverse community---Diverse scholars and new definitions of health related diversity that transcend traditionally defined ethnicities.

• Working collaboratively---The nature of the theme dictates dynamic interactions among a diverse group of scholars

• Positive transformation in the world---It is difficult to imagine an effort with as great a potential to impact every aspect of society

• Courageous leadership in teaching, research, scholarship, health care and social action---This is a bold theme with a grandly ambitious goal that integrates research, scholarship and education in an innovative effort aimed directly at revolutionizing care of people to preserve and prolong the health of individuals and of society.