Genomic screening, data from activity trackers and predictive data models are likely to be drawn on to a larger degree in the restructured public health system as the government seeks to get serious about precision health.
According to Manatū Hauora, the Ministry of Health, precision health “aims to use emerging technology and all available information (such as an individual’s genome, current biophysical measures, and environment) to predict, prevent, diagnose, and treat disease, more precisely, for people and whānau”.
But the ministry points out that precision health technology and practices are “underdeveloped in Aotearoa”.
“We have also have no national strategy or system-wide effort to coordinate initiatives exploring aspects of this topic,” it noted in a paper seeking feedback on precision health, which it intends to make the focus of its first Long-term Insights Briefing (LTIB).
“As a result, our health system has generally not been able to adapt as well or take advantage of current precision health options to the same extent as some other countries, such as Australia and the United Kingdom. This also means we are less prepared than we could be to consider future precision health opportunities,” the paper points out.
The ministry outlines a few scenarios where precision health could play a role in improving health outcomes and equity in the health system:
- Routine genomic screening tests available early in your mother’s pregnancy can identify genetic variants indicating any diseases you are at a higher risk of developing later in life. These tests show you are at risk of a certain type of cancer. Over your life, you have regular, non-invasive screening checks for any signs of cancer developing and, if a tumour develops, you receive targeted intervention so that it does not become a life-threatening disease.
- You have type 1 diabetes. You receive biologic and genomic testing to identify how your diet will impact your blood glucose, and any specific changes to your care plan that you need. The results will tell you, for example, whether you are getting the right insulin analogue, considering the impact of your expected diet.
- Regular wastewater surveillance identifies an outbreak of a novel virus in your local community. Local authorities and community health providers are notified and they put public health measures in place to prevent a large-scale outbreak.
- Your activity tracker identifies you have high blood pressure and an irregular heart rhythm so you contact your primary care provider for a check-up. Using data from your activity tracker, your provider identifies early signs of heart disease and works with you to lower your risk of a heart attack.
Precision health nirvana
Auckland-based health software maker Orion Health has explored the pontentail in this area through its Precision Driven Health initiative in conjunction with Te Whatu Ora Waitematā (previously Waitematā District Health Board) and Waipapa Taumata Rau – the University of Auckland.
“There’s a nirvana that precision health is aiming for; a patient comes to you; you’ve got access to all of the data about them, and you use that to both specifically give them the advice that they need, and not waste time and resources on things that will clearly not work for them. The ‘precision’ piece is about being quite specific,” Kevin Ross, the chief executive officer of Precision Driven Health wrote in an update on the initiative’s work last month.
As the ministry points out in its consultation paper, data access and privacy will be major issues to tackle with a move towards precision health.
“For example, misuse of information associated with precision health, especially individuals’ genomic information, could occur through privacy violations, discrimination in employment and insurance, inappropriate financial gain, and reinforcing ethnic disrespect and health disparities,” it notes.
“We acknowledge that without careful planning and consideration, some people are likely to experience these challenges more than others.”
Privacy is number one
Dr Chris Hobson, Orion Health’s global chief medical officer, told Tech Blog that other countries’ health systems had overcome privacy issues to draw on more unified sets of data to serve patients better.
For instance, in the UK, mental health data is treated the same as heart health. They say, if you’ve got your protections around that data in the first place, why is mental health any different. But we often wall off things like mental health and sexual health and only certain people can access the data,” he says.
“So the aggregated model definitely works. But you obviously need to be careful and you have to get past objections. Privacy is number one.”
Submissions on the ministry’s proposed Long-term Insights Briefing close at 5pm Friday 27 January, 2023.