Transforming global approaches to chronic disease prevention and management across the lifespan: integrating genomics, behavior change, and digital health solutions.

Chronic illnesses are a major threat to global population health through the lifespan into older age. Despite world-wide public health goals, there has been a steady increase in chronic and non-communicable diseases (e.g., cancer, cardiovascular and metabolic disorders) and strong growth in mental health disorders. In 2010, 67% of deaths worldwide were due to chronic diseases and this increased to 74% in 2019, with accelerated growth in the COVID-19 era and its aftermath. Aging and wellbeing across the lifespan are positively impacted by the presence of effective prevention and management of chronic illness that can enhance population health. This paper provides a short overview of the journey to this current situation followed by discussion of how we may better address what the World Health Organization has termed the "tsunami of chronic diseases." In this paper we advocate for the development, validation, and subsequent deployment of integrated: 1. Polygenic and multifactorial risk prediction tools to screen for those at future risk of chronic disease and those with undiagnosed chronic disease. 2. Advanced preventive, behavior change and chronic disease management to maximize population health and wellbeing. 3. Digital health systems to support greater efficiencies in population-scale health prevention and intervention programs. It is argued that each of these actions individually has an emerging evidence base. However, there has been limited research to date concerning the combined population-level health effects of their integration. We outline the conceptual framework within which we are planning and currently conducting studies to investigate the effects of their integration.
Competing Interests: SRC’s research is funded by the NHS and was previously funded by Wellcome (an independent charity). SRC receives a stipend for editorial work at Elsevier journals (Comprehensive Psychiatry, and Neuroscience & Biobehavioral Reviews). HB-J is the Director of the UK National Problem Gambling Clinic and the UK National Centre for Gaming Disorders which are now fully funded by the NHS. These clinics have previously received funding from NHS England, Central and North West London NHS Trust, and GambleAware. HB-J is Vice President of the Royal Society of Medicine and sits on several national and international Boards. HB-J has been on research teams funded by the Medical Research Council, the Wellcome Trust, and the Wolfson Family Trust. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2023 Thomas, Browning, Charchar, Klein, Ory, Bowden-Jones and Chamberlain.)