The P4 Health Spectrum – A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan
Section snippets
The P4H continuum model
There is broad agreement that the current framework used to guide healthcare and chronic disease management is largely ineffective. As such, there is a need to re-conceptualize the paradigm to focus on wellness and the prevention of chronic disease and associated risk factors first and foremost. The concept of wellness, an optimal state of health, is a paradigm-changing concept for transforming healthcare. In the future, healthcare must shift its focus to promoting a state of wellness, from the
P4 principles throughout
Clearly the reactive health care model that currently exists is suboptimal, requiring a paradigm shift to improve global to individual health and address the current challenges we face with chronic disease and associated risk factors. We need a new approach, focusing on care that is preventive, predictive, personalized and participatory (P4) as core principles of the P4H continuum model. Table 1 lists key factors to consider in delivering P4 medicine and subsequent sections describe key
Leveraging technology
The use of technology to continually engage individuals in preventive medicine and healthy lifestyle messaging, information and interventions is vital moving forward.37., 38., 130. Health-focused platforms continue to emerge and evidence demonstrating the meaningful impact of technology-based healthy lifestyle interventions is continually growing.131., 132., 133., 134. There is particular value potential in utilizing the smartphone platform for continual engagement centered on preventive
Systems medicine and the complexity of chronic diseases
An old Indian story talks about a group of blind men coming across an elephant. Each of the blind men touched a different part of the elephant and gave a description of what he believed an elephant was. The first person touched the elephant's trunk and claimed the elephant to be a snake. The second person touched the elephant's leg and declared the elephant to be a tree trunk. Then the last person came forward, touched the elephant's ear and positively identified the elephant to be a sail.
Convergence of principles from Eastern and Western medicine
Eastern medicine, like P4 medicine and systems medicine, considers human biological systems as a cohesive whole. Eastern medicine also considers the human body as a holistic entity of harmonious organs and approaches health from this framework. Eastern medicine principles are mainly derived from Chinese and Indian cultures, with long-term practical experience in the prevention, diagnosis and treatment of chronic diseases.
Principles of Chinese medicine and its role in the P4H continuum
Traditional Chinese medicine has evolved over thousands of years and represents one of the oldest paradigms of translational medicine in the world.137 Chinese traditional medicine considers the human body as an open organism operating in a continuous biological and mental exchange process with the outside environment; human health is maintained by the balance between Yin and Yang that respectively represents two opposing factors in nature.138 The diagnosis and stages of health (i.e., Stage A),
Principles of Indian medicine (Ayurveda) and its role in the P4H continuum
Ayurveda basically means “knowledge (Veda)” of “life (Ayur).” Ayurveda is an ancient system of personalized medicine documented and practiced in India since 1500 B. C.140 Today, Ayurveda not only plays a key role in Asian health care systems but is also increasingly recognized in the European and North American model.141
A unique aspect of Ayurveda is the comprehensive understanding of the biological basis of human individuality through Prakriti (literally meaning basic nature or the healthy
The P4H continuum: Impacts from population to cellular health
The key benefits of the P4H continuum model, from the population to cellular level, include the following examples: 1) prevent the occurrence of chronic diseases and associated risk factors by implementing effective interventions at all levels; 2) detect and predict disease at an early stage, when it can be controlled and reversed effectively; 3) stratify individuals into refined specific disease phenotypes, enabling the selection of optimal therapies; 4) reduce adverse drug reactions through
Conclusion
To address chronic diseases globally and in their totality, and in order to reduce their burden and societal impact, medicine has to evolve from a reactive to a proactive system, the latter of which is committed to a healthy aging process (i.e., lengthening the healthspan). It is proposed that chronic diseases should be viewed as a single expression (i.e., chronic diseaseome) with common risk factors and themes. Efforts to make healthcare more predictive, preventive, personalized and
Statement of conflict of interest
None of the authors have any conflicts of interests with regard to this publication.
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Statement of Conflict of Interest: see page 517.
Disclosure: None.
Officially Endorsed by:
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The European Society of Preventive Medicine, United Kingdom.
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European Institute for Systems Biology and Medicine, France.
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Luxembourg Center for Systems Biomedicine, Luxembourg.
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Institute for Systems Biology, USA.
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Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, China.
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