California is a microcosm of the challenges and opportunities posed by the crisis in health care in the United States. As the elderly population of the state doubles in the next fifteen years the prevalence of disabilities and chronic diseases, such as heart disease, Alzheimer’s, and cancer are projected to rise. With California’s medical system under increasing fiscal pressures, what is needed now, more than ever, are innovative approaches promoting both individual and population health, bringing health care costs down, and improving the quality of life of our citizens.
Many researchers believe society is in the early days of a digital transformation of health and health care that will radically change how disease is diagnosed, treated, or prevented. This transformation will be ushered in by an explosion of biomedical data coming from sources as varied as personal “real time” health sensors for behavioral and physiological monitoring to population-wide individual genetic sequencing. The increasing digitization of individual medical and behavioral data across human populations, combined with digital data on environmental factors important to health, will support new discoveries about the causes of premature morbidity and mortality. Individuals’ access to their own data will provide direct feedback on the effects of diet and exercise. This data revolution will synergize with continuing fundamental research in biomedicine and neuroscience.
Modern automobiles have real-time sensors that record all vital internal factors, leading to a “personalized service” in which preventive maintenance is carried out by comparison of deviations of the automobile from the population of autos of the same model. This leads to long lifetimes of vehicles compared with several decades ago. Similarly, wireless wearable or implantable sensors, combined with blood tests on a wide variety of molecules, will be able to detect “signature” perturbations in an individual’s biological, behavioral or environmental status compared to the population as a whole. These perturbations, if left undiscovered, may lead eventually to disease symptoms that often manifest themselves only after irreversible damage has occurred. Aided by advances in pharmacogenetics and bioengineering devices, very early detection can lead to therapies that correct problems and provide feedback about behavioral changes which promote wellness.
As a result, early recognition of these system biology perturbations will gradually lead to a shift toward a “wellness” rather than “sickness” paradigm, with the primary emphasis becoming the maintenance of health, while also allowing for more efficient treatment of existing conditions. Under this emerging paradigm fewer people will develop extended episodes of chronic illness. This will gradually free up resources and allow their redirection to the promotion of children’s health as a foundation for lifetime health for all. The rapid increase in social networking technologies will enable more effective wellness interventions and illuminate important social differences in community-based ethical standards and privacy issues.
The continuing explosion of data in each of these areas requires an increasingly sophisticated biomedical cyberinfrastructure to store, integrate, compute, visualize and model patterns of data important to health. Calit2 will organize collaborations among engineering, medicine, public health, and the biological, behavioral, and social sciences to create early examples of the realization of this vision.
