In 1985 Professor Geoffrey Rose published a paper that would fundamentally define the way we think about health, wellness, and disease prevention. In it he distinguished two fundamental approaches.
The high-risk strategy, which is centred on identifying those individuals at high risk of disease and intervening intensively with them; and the population strategy, which works to reduce the risk profile of the population as a whole.
Within the Australian healthcare system, we apply both strategies. We screen patients to find those who are at higher risk of specific diseases and then proactively treat and monitor their progress, in keeping with the high-risk strategy. And we also work to reduce risks at the population level by doing things like fortifying wheat flour with folic acid and table salt with iodine. Both approaches have distinctive advantages and disadvantages.
Targeting high-risk individuals brings an immediate return on investment for subsets of people, but to some extent any definition of high risk will have some arbitrariness. For instance, a person with a cholesterol level of 6.45 mmol/L is at a similar risk compared to people who have a level of 6.55 mmol/L, yet only the higher rate is considered high-risk and eligible for statin therapy.
Population approaches, on the other hand, have the capacity to reduce the rate of disease emergence in everyone, but tend to take a longer time for any appreciable benefit and are subject to broader economic and social changes.
Digital health offers new opportunities to more accurately identity people who are at elevated risk by bringing together their health information. Precision medicine, enabled by a deeper understanding of patients and their peers, also allows more nuanced and effective management plans to be developed for those at risk.
Consumer based mobile apps can improve medication adherence to better manage risk. Healthcare providers are also benefiting, with digital tools like the British Medical Journal’s Best Practice app gaining popularity to help guide the management of complex cases.
It is possible that the greatest gains may be made by using digital technology to inform the daily decisions of the entire population. A casual inspection of the products on a supermarket shelf can demonstrate dramatic differences in the nutritional value of otherwise identical looking foods. We already have augmented reality solutions to better inform ethical shopping so could an individual’s online shopping be informed by their dietary requirements and calorie goals? A colleague once said ‘the person who manages a diabetes patient’s glycaemia is whoever puts dinner in front of them’.
And could your mobile phone visually highlight the brand of pasta that’s right for you? Fitness apps are already a booming sector however there is little capacity to personalise these apps with specific health and lifestyle settings. We may see these apps come to their full potential when they can deliver personalised advice and support through a range of screen and augmented reality modes.