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Deloitte | A Middle East Point of View - Spring 2021 | Healthcare

34 Deloitte | A Middle East Point of View - Spring 2021 | Healthcare

The future of public : Personalized, participatory, predictive, precise

The Covid-19 pandemic has changed the entire concept of . As we progress through it and the subsequent global pandemic we are likely to face, a future of public health that is personalized, participatory, predictive, and precise will help us navigate changed public health principles and how we deal with ourselves.

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ublic health has developed from analysis of their health all the way down focusing only on health to their genes and granular behavioral P promotion and lifestyle insights (to be combined with data for paradigms—to avoid many preventable Population Health Management), leading —to a more holistic view beyond to decision-making and tailored traditional/clinical personal health and treatments based on data. Finally, the reactive care to include social, political, digitally-enhanced user experience and economic, environmental, and public health and healthcare journeys for geographic determinants, all while individuals, payers and care providers will improving outcomes and ideally reducing be seamless and interoperable, allowing costs. for greater satisfaction, empowered self- management of care, increased With the advent of globalization, efficiency, and reduced costs. increased interconnectedness, social media, and more readily available Public health becomes personalized education, individuals are steadily and predictive becoming the stewards of their own As populations continue their health. We are living in a culture of health demographic and epidemiological and well-being, in which a well-informed, transitions, and people start suffering more health literate person is the from consequent diseases related to ultimate decision-maker and is at the aging, longevity and increased life center of their own health. expectancies, it is possible that future clinical may see increased costs A strong foundation for the future of without significantly improved health public health will be dependent on outcomes. Medicine will therefore seek enabling governments (providing whole- to become more data-driven and less of-government approaches to care individualistic in order to efficiently provision) and collaborative ecosystems, manage and improve the health of based on intersectoral collaboration and populations (versus solely individuals) cross-industry collective research. while keeping costs from becoming too Digitally-enabled healthcare and public high. Conversely, yet in a complementary health sectors will emphasize a 360- fashion, and in order to keep pace, public degree view of the person leading a health will start benefiting from healthier lifestyle or seeking care, taking personalization and individualization of into account their health journey from initiatives and practices for the well-being pre-birth to grave, as well as the detailed of communities and populations.

One of the forerunners of this future era We are living in a culture of health and of precision public health is the science of genomics 1. By taking our knowledge well-being, in which a well-informed, of health beyond the traditional correlates, genomics helps public health more health literate person is the better improve the health of the population and of sub-groups within the ultimate decision-maker and is at the population who are more pre-disposed to certain ailments and conditions that center of their own health. can now be more easily stratified into the more detailed layer of genetic risk and

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predisposition for common or rare will be most useful to improving health Using Big Data to more diseases. Because some countries in the and well-being. GCC are comprised of quite homogenous accurately and more populations, this more precise method of Participatory public health precisely predict trends public health can tailor population-level The Covid-19 pandemic has been a clear interventions to targeted groups whose exemplar of the role each member of and analyze individuals’ conditions may have otherwise been society plays as a part of the public health choices, lifestyle missed in less bespoke and traditional health workforce, and the role all factors and their public health interventions. The individuals must play in supporting increased ubiquity and integration of effective public health outcomes. The environment can help genomic knowledge in clinical practice most successful country responses have authorities, regulators (partially due to the decreased cost been those with robust public health and associated with genome sequencing over healthcare systems under governments and providers apply the last few years) is lending itself to the who have employed a whole-of- tailored interventions delivery of targeted interventions for government approach to their response. patients, better known as precision and promotion and medicine. We should therefore expect In order to obtain effective public health prevention campaigns at the same for precision public health. interventions, there is a continued need the community level, for an intersectoral approach to care that Another aspect of the future of public goes beyond core health stakeholders— especially for at-risk and health that can offer contributions similar one in which academic institutions, vulnerable groups. to those that the field of genomics does, workplaces, religious leaders, social but which focuses more on the sharing of institutions, civil society, law enforcement, interoperable, accurate and secure data, have a place in providing the right culture is Population Health Management. Using and support for sustaining change. By Big Data to more accurately and more continuing to educate, and raise precisely predict trends and analyze awareness in, individuals regarding their individuals’ health choices, lifestyle important participation and key role in factors and their environment can help the improvement of the population’s authorities, regulators and providers health, coupled with digital enablement apply tailored interventions and leading to interconnectivity and promotion and prevention campaigns at empowerment of individuals to own and the community level, especially for at-risk understand their health data, public and vulnerable groups—thus improving health will succeed. the health of the overall population. Predictive public health requires these in- Powerful technology and its ethical depth data analyses to provide a highly use targeted approach that can help prevent The future of public health will render common diseases that are likely to larger amounts of data—personal and spread or become endemic in a system-level—more available than ever community, encourage certain lifestyle before; thus, the challenge and ethical practices applicable to parts of the dilemma of data storage and analysis will community, improve care outcomes, have to be tackled, especially in the field reduce costs, and reach a larger portion of genomics, whose advances have been of the population. By understanding the dependent on, and facilitated by, drivers of health in a population, it will be progress in data science, informatics, easier to predict issues that may rise and, and the development of novel and more accordingly, decide on the strategies that advanced technology. The immense

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The Covid-19 pandemic volume of data that next-generation surveillance during emergencies like sequencing will generate as countries Covid-19 may therefore pose a threat to has shown us that the and public health systems sequence a person’s privacy and consequent bodily lines of privacy larger portions of their populations will integrity, thereby further increasing the require data storage and protection importance of informed consent and protection become possibly beyond available capabilities. privacy protections, along with the blurred in emergency protection of the greater public good. settings. The Beyond the issue of storage and analysis will be the continuous ethical dilemma Not only will there be differences in International Health of data protection and confidentiality. As and the intellectual Regulations require we move toward more integrated and capability to truly have informed consent, consolidated sources of individual and but there will be differing ease of, and states to keep individuals’ population health data and information, barriers to, access of necessary digital data “confidential and some of the questions that will need to technology and broadband services. As be addressed include: What will the governments accelerate the digitalization processed anonymously cybersecurity and identity protection of their public health systems and as required by national implications be? Which disease variants services, they will have to take these law”; nevertheless, in a should be reported? How will issues into account. governments safeguard the safety of crisis it can sometimes their populations’ health information Back to basics – The importance of be necessary to collect and, moreover, how will public health traditional public health and medical healthcare systems protect The Covid-19 global pandemic showed us and disclose certain individuals’ and patients’ health that the traditional aspects of public information without any information? How will employers and health work are as important as ever; undue delay. payers/insurance companies be therefore, despite technological prevented from using this readily advancement, these must not be available and large amount of data as neglected or forgotten. Basic principles bases for discriminatory practices of , disease detection and regarding individuals? prevention measures, screening and immunization, and safe social The Covid-19 pandemic has shown us distancing in cases of outbreaks, and that the lines of privacy protection healthy lifestyle choices to prevent become blurred in emergency settings. chronic conditions have been at the crux The International Health Regulations of successful Covid-19 prevention and require states to keep individuals’ data mitigation—at both the individual and the “confidential and processed anonymously community levels. as required by national law”; nevertheless, in a crisis it can sometimes Due to the constant influx of economic be necessary to collect and disclose migrants, the Gulf Cooperation Council certain information without any undue (GCC) countries have enacted strong delay. If individuals’ health information surveillance and disease diagnostic is to be released outside of the public measures to stop unforeseen outbreaks , it is particularly important of preventable infectious diseases such to avoid the inclusion of any uniquely as Tuberculosis (TB), polio, measles, and identifiable characteristics, such as Hepatitis C. These same surveillance names, government identification measures and technologies have now numbers, fingerprints, or phone been repurposed to respond to the numbers. Screening, testing and Covid-19 pandemic: diagnostic centers

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are used for testing, contact tracers do Based on the trends and focus of Whether we end up living in a digital not have to relearn the process, and rapid countries in recent years, there exists a society, one in which health is part of all decision-making for quarantine/isolation need for a shift in attention back toward policies, one led by technocrats and measures already exist. Furthermore, traditional public health. Key to the scientists, one that has learned nothing passive surveillance systems through success of a nation’s public health is the from the Covid-19 pandemic, one thing is which authorities and providers notify strong foundational infrastructure that certain—and that is that the future of patients and individuals have provided focuses on challenges we see in the public health is here and it will transform the foundation for a more efficient and region relating to both lifestyle factors our health journeys across our entire timely standing-up process for notification and on increasing immunization. lifecycle. and response measures for Covid-19, as was seen in the GCC with the combination Conclusion by Elsy Maria Dumit , Manager, Life of tracking and tracing apps, social media, The one thing we know for sure about Sciences and Health Care, Abdelhamid and regular press conferences by the the future of public health is that it is one Suboh , Partner and Industry Leader, leaders of the response teams and task of uncertainty. Despite the challenges Life Sciences and Health Care, and forces. mentioned in this article, the future of Rohan Sawhney , Partner, Life Sciences public health offers us possibilities and Health Care, Consulting, Deloitte On another note, the most advanced heretofore unimagined by many. Middle East technology for screening and surveillance Globalization, increased will not help much with disease outbreaks interconnectedness, social media, and if necessary and more readily available education are Endnotes isolation/quarantine measures are not opening our eyes to lifestyles of wellness 1. The field of genomics involves the study of the entire genome—how all the genes in cells of an followed once community spread exists, that will allow communities to not only organism interact with each other and with as has been the case with Covid-19. increase their longevity, but their quality environmental factors in order to determine an Moreover, it is now globally accepted that lifespans as well. The future of public individual’s growth, development and ultimate herd immunity for Covid-19 will not be health is paving the way for each of us well-being. Research into genomics and genome achieved before a safe and efficient to become well-informed, more health- sequencing have allowed the practice of healthcare to better understand disease vaccine is widely and ethically distributed literate persons and the ultimate etiology, risk, prevention, diagnosis, and to a significant majority of the world’s decision-makers at the center of our treatment. population. At the end of the day, own health. technology and surveillance might make our health journeys seamless, but it is traditional isolation and immunization measures that will allow us to return to At the end of the day, technology and a normal semblance of life. surveillance might make our health Most GCC countries have well-established childhood immunization programs, journeys seamless, but it is traditional including centralized procurement and distribution infrastructure, that have laid isolation and immunization measures the foundation for a successful roll-out of, and community compliance toward, that will allow us to return to a normal vaccines against Covid-19. As safe and efficient SARS-CoV-2-combatting vaccines semblance of life. are being widely distributed, and which GCC countries have committed to administer free of charge to citizens and residents (and are currently doing so), we do not foresee their administration in the region being an issue.

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