Wellbeing in Personalised Medicine and Care Challenges and opportunities for public health Anne-Marie Bagnall, Reader, Centre for Health Promotion Research

Personalised Medicine – A Magic Bullet? What can we learn one hundred years on from the first medical revolution to help us on the eve of a new one? Paul Erlich discovered the first effective medicinal treatment for syphilis and initiated chemotherapy. The start of the pharmaceutical industry and one of the founders of the modern medicine revolution. He coined the phrase ‘magic bullet’ for targeted treatments. Since Erlich we have seen the largest increase in life expectancy in human history and health systems across the world which no one could have foreseen in their scale, complexity and achievements. A huge success story, but we also now have health systems which are organised around profit for big corporations and the specialisms which treatments and clinicians can provide. What can we learn from a public health perspective on the eve of the next major revolution in medicine.

3 key perspectives from Public Health Inequalities Health Wellbeing Wellbeing Health Inequalities “Inequality affects us all” (The Spirit Level, Wilkinson & Pickett) “Social injustice is killing people on a grand scale” (Marmot, WHO report on Social Determinants of Health) ‘Feeling good and functioning well in life’ ‘Functioning well in life, for example having a strong sense of meaning and feeling connected to other people’ The whole person - "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ Individual wellbeing (Connect, Be Active, Take Notice, Keep Learning, Give) “Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” Community wellbeing (People, Place and Power) 1) Primary Prevention Promoting health, preventing ill health Improving our daily living conditions: Healthy Places, Healthy People Good education Fair employment and decent work The Best Start in Life 2) Secondary Prevention Early identification and healthy choices Healthy lifestyles, recovery Testing, diagnosing, screening 3) Tertiary Prevention Self-management for long-term conditions Community Capacity and resilience

Personalised Medicine – The Challenges 1. Do not forget wellbeing Integrating around all of a person’s needs - Specialisation means fragmentation From individual conditions to individualised conditions? 2. Don’t forget health amongst illness Preventing disease is preferable to curing disease Look at a range of outcomes Utilise existing evidence 3. Don’t increase inequalities Screening, early identification and the inverse care law Personalisation for the ‘worried well?’

Personalised Medicine – The Opportunities 1. Wellbeing Mental health and depression drugs Person-centred care and whole-person approach 2. Promoting health and preventing illness Early identification and risk Targeted prevention 3. Reducing Inequalities “The people who are the poorest, improve their health the fastest.”

Personalised Medicine – A ‘magic bullet’ within a whole armoury of approaches for better health and wellbeing?