The Health Secretary has recently laid out plans to transform the NHS, with a primary focus on solutions, which will help us move from ‘sick care’ to ‘health care’.
Today, a golden opportunity exists, via genomic prevention, to deliver Wes Streeting’s health system of the future. Genomic prevention is a ground-breaking innovation that will shift the NHS from reactive treatment to proactive, personalised prevention.
This approach will enhance NHS efficiency and optimise NHS spending. It will also provide wider economic benefits and enhance the growth agenda by boosting workforce productivity – successfully preventing disease, or catching it early when outcomes are better, will dramatically reduce working hours lost to ill health across the economy.
Genomic prevention as a breakthrough innovation
Until a few years ago, if you had the entire DNA sequence of a healthy person in early middle age, you would learn something medically actionable in only 1–2 per cent of cases.
Recently, that position has changed dramatically. Now, if you have genomic information on that same person, you learn something medically actionable in 70 per cent of cases.
Genetics has traditionally played into healthcare via what is called Genomic medicine, in which, a single genetic change has major health consequences. Examples of these conditions include cystic fibrosis, Huntington’s Disease, and muscular dystrophy.
The UK is a world leader in this area, through the 100,000 Genomes project and now Genomics England and the Genomic Medicine service within the NHS. These conditions are often very serious, but thankfully, they are individually rare and also collectively rare. Many of them manifest early in life, so for a healthy middle-aged person, there are unlikely to be any single genetic changes of major impact to be discovered.
In addition to these rare conditions, genetics turns out to be fundamentally important for all the common diseases as well – diseases like heart disease, diabetes, breast cancer, and prostate cancer – the conditions that cause most of the sickness and premature mortality in our populations, and which use 70-80 per cent of healthcare budgets. The economic and systemic benefits of being able to prevent such common diseases would be extraordinary.
It is only in the last few years that we have learnt how to measure, and quantify, the genetic component of risk for each of the common diseases. We now know that for each disease, there are a million or more places in our DNA that affect our chance of developing the disease.
This can be summarised for each disease by what is called a polygenic risk score (PRS), with a single genetic test – taken once in a person’s life and revealing their risk scores for all the common diseases.
The impact of genetics is large. For example, some people are 30 times more likely than others to develop diabetes, or 20 times more likely to develop heart disease, because of their genetics. For breast and prostate cancer, there are 15- and 40-fold differences, respectively.
Obesity also has a major genetic component. For people with healthy BMI at age 25–35, those with unhelpful genetics are 10 times more likely to transition to obesity in middle age than those with helpful genetics.
This presents a totally different, and new, opportunity, which has been called genomic prevention. Each of us will be at high risk for a few diseases, because of our genetics, but neither we – nor our doctors – will know which.
But with genomic prevention, we can now measure and understand those risks when a person is still healthy, years before any symptoms develop.
This allows us to give advice to individuals about the particular steps they can take to help them live a longer, healthier life. But critically, the information will allow the health system to target all its current screening and prevention programmes more effectively – we can get the right people into the right programmes at the right time to help avoid disease entirely, or to catch it early when outcomes are best.
Getting prevention right, through the use of powerful personalised risk estimates, could be a game-changer – the UK is leading the world in this ground-breaking new technology.
Genomic prevention requires different skills, different technology, and different deployment via clinical pathways. It provides a route to a health system that is smarter, more efficient, and more personalised, with substantial improvements to people’s health and longevity and related financial benefits in terms of NHS spend and workplace productivity.
Delivering Wes Streeting’s vision for a health system ready for the future
Genomic prevention is the route to bring into reality the vision of the Health Secretary. As he stated at the Labour Party Conference, September 2024, “Advances in genomics and data mean the healthcare of the future will be more predictive, more preventative, and more personalised than ever before.”
And this approach works. We have already seen a successful trial within the NHS in cardiovascular disease prevention, where more than 90 per cent of GP responses agreed that genomic risk tools could be easily incorporated into routine primary care. It was also really popular with patients, with 98.5 per cent of them finding the information useful for their health.
The approach both changed the management of a significant number of patients (13 per cent) and changed the nature of the GP-patient conversation about prevention. Bupa will be deploying genomic risk MHRA-registered technology early in 2025. It is already being deployed in the USA.
Integrating genomic risk and genomic prevention into public health programmes – including initiatives to address our biggest challenges, such as obesity, heart disease, and cancer – would also be significantly more effective in helping people stay healthier and productive for longer.
Genomic prevention: Shaping the future of the nation’s health
Integrating genomic risk into the NHS will support early disease prevention and provide a more equitable healthcare service – prioritising those who need the most help, regardless of background.
Genomic prevention can facilitate all the future directions identified by Lord Darzi, including community care expansion, technological innovation, and contributions to national prosperity.
Giving individuals information early in life about some of their long-term health risks offers them the opportunity to become co-pilots on their health journey rather than just passengers.
In particular, it equips them with the information about which behavioural changes will be most effective for them and how they can complement the efforts of the NHS to actively improve their health outcomes.
We should aim to move to a culture in which younger and middle-aged adults invest as much in their physical and mental health in retirement as they currently do in their financial health.
And for this to happen, investing in genomic prevention is the way forward. Genomic prevention is a strategic investment that will fuel both better health outcomes and long-term economic growth.
Featured image via angellodeco / Shutterstock.
Professor Sir Peter Donnelly
DesignationCEO and Founder of Genomics
