Twinning Public and Individual Healthcare Systems: Until Death Do Them Part

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by Harriet Teare, Terry Vrijenhoek, Bogi Eliasen

Since the inception of modern healthcare in the mid-1800s, public health and (personalized) medicine have drifted apart in many countries. The ties between the two that were still present in the beginning of the 20th century – hygiene advice from general practitioners, vaccine development by medical specialists – have been steadily loosened under the pressure of cost-effectiveness, individualism and commercialisation. Typically, today’s doctors look at physical attributes such as blood tests or imaging scans to assess their patient’s health. Conversely, population health is generally defined by aggregate parameters, such as statistics and GDP percentages.

In their recent position paper, professors Kamel Boulos and Zhang refer to several COVID-19 managing models to illustrate how a precision public health system could take shape. The basis of these models are digital twins, and their integration in various concepts of smart societies. Conceptually, a digital twin is a ‘digital replica or representation of a physical object, process, or service’. They show how the basic concept can be extended to specific applications in personalised medicine and public health. Unsurprisingly, they bring up the use of advanced technologies like DNA sequencing and 3D modelling to provide detailed digital copies of (parts of) the human body, and the use of digital twin models to track and monitor disease outbreaks. Yet Kamel Boulus and Zhang also reason beyond the typical bright-future perspective on personalised medicine, and provide a refreshing perspective on urban dynamics and its impact on health (e.g. GPS-based motility, shadow forecasting). Moreover, they briefly touch upon one of the key challenges that the pandemic surfaced – to not lose sight of humanity in the emerging world of abstractions and statistics.

While the pandemic has provided the most urgent need to tie public health tools (testing and vaccination) to the health and wellbeing of individuals (comorbidity, income status, fears and values), there are also other signs that mark a transformation in our collective view on the relation between public and private. The use of blockchain technology indicates a strong desire to create systems that have a built-in distribution of control and power. The personal benefit and short-term gain that drives the growing popularity of cryptocurrencies is a perfect example of what happens if the link between individual and society is not considered; a rise in energy consumption, and an even more skewed distribution of resources. However – as Kamel Boulus and Zhang indicate – the use of blockchain technology in healthcare has thus far led to e.g. patient-controlled cancer diagnosis and treatment, and a reduction in erroneously rejected insurance claims.

Another area that signals a convergence of public and individual needs, is energy use. In the early days, the primary motivation for individuals to cover their roofs with solar panels, was to make money from the overproduction of energy. Now, the prime motivation is to save energy costs (and environmental impact), which goes hand-in-hand with better insulation of individual houses. The personal benefit (lower costs) is perfectly aligned with that of society (CO2 reduction). Within healthcare, we could follow this transformation, and start looking for links between personalised medicine and public health. The growing use of blockchain technology in healthcare predominantly occurs in the realm of personalising medicine. For public health applications the intuitive response would be to generate even more data. Yet the key may be in looking at existing data differently. Lifestyle data, for instance, are generally used to direct people towards a particular change (healthy living), while they could likewise be used to discern motivations or blockers for particular behaviour. This use of data from different areas of life, to relate to an individual’s health, is necessary for public and personalised health to be better aligned. As with any marriage, connecting the dots between public and individual health requires an open mind, empathy and persistence.