of a better way of treating diseases and other medical conditions. Chapter 3 features some of the innovations and disruptions—past, present, and hopefully future—found across health and medicine. I also describe the environments that are most likely to give rise to innovation.
In chapter 4, I focus on the importance of basic science and its role in discovery. As much as we know about the human body and how it functions, we get daily reminders that there is still much more to learn. Only by advancing our understanding will it be possible to develop the therapies that can improve health and well‐being. In this chapter I profile several trailblazers whose breakthroughs rest on a foundation of basic science.
The chapters that follow are dedicated to the three main pillars of Precision Health. In chapter 5, I discuss the many different ways in which it’s possible to preemptively identify deviations in health that may become debilitating, which makes it possible for individuals—acting alone and/or with health care professionals—to focus on interventions that will increase the likelihood of staying healthy. In chapter 6, I show how a range of tools—from smartphone technology to genome sequencing—are helping to avert illness and promote health and wellness. In chapter 7, I document a range of breakthroughs—particularly in the cancer field—that are being applied to help people recover from illness or disease. In the conclusion, I look at how health and medicine have evolved over the past century and how they may continue to evolve in the future.
For anyone with an interest in issues related to health and medicine, this is an exciting moment. We are learning more and more about what contributes to human health, and the different ways in which individuals can empower themselves to lead healthier lives. We are on the brink of an amazing transformation in the practice of medicine.
I hope this book will help you understand the dynamic future that lies ahead. I also hope it will inspire you to work with others—whether family, friends, or your broader community—to help ensure that the Precision Health vision can become a reality for people in the United States and throughout the world.
CHAPTER 1 THE STATE OF U.S. HEALTH AND HEALTH CARE DELIVERY
One of the motivations for launching Precision Health was to confront an uncomfortable reality: in the United States, there’s a lot about health conditions, and our health care system, that’s unsatisfactory. To be sure, the United States can be the very best place in the world to obtain the latest, most scientifically advanced treatments for severe diseases for those who have access to these services. But there are dramatic disparities in health and in access to high‐quality health care, based on factors such as income and geography. There are also shortcomings embedded in the U.S. health care system, which is one reason why we spend more on health care, on a per‐capita basis, than any other country, but our health indicators (such as life expectancy) put us on par with countries that spend less—much less. In this chapter, I examine both U.S. health conditions and U.S. health care, and show how millions of Americans are not seeing the health benefits that are typically associated with living in a high‐income country such as the United States.
THE HEALTH PARADOX
Health conditions in the United States are heavily bifurcated, with certain segments of the population seeing great progress while others see their health eroding.
The backdrop to the progress is the revolution in health that’s unfolding, with much of it happening in and around Silicon Valley. It’s clear that we’re living in a time of unprecedented possibilities, with new knowledge and technologies accelerating the pace of biomedical discovery. In the area of biomedicine, there’s a convergence of different fields and ideas and approaches underway.
One small but revealing symbol of the potential for progress is the research being conducted by Stanford faculty. Approximately two‐thirds of the professors in the chemistry department are doing biologically focused research. So are about 30 percent of those in Stanford’s engineering school. Several factors account for this shift in focus to research questions and opportunities in biomedicine by experts in other disciplines. The fields of biology and medicine have become quantitative endeavors. Gone are the days when the scientific inquiry in biomedicine was driven principally by qualitative description. The same analytical methods and approaches that have fueled advances in the physical sciences and technology for many decades are now being applied with enormous success in biomedicine. The questions being addressed and the discoveries being made, thanks to these quantitative approaches, are having a tremendous impact.
There are many examples of the transformation in biomedicine that is occurring because of the adoption of quantitative approaches. Mapping of the human genome and the subsequent advances in sequencing technology have changed the landscape of genetics. These advances—exciting as they are—increasingly seem modest compared with the impact of more sophisticated algorithms focused on identification of the relationships between the genome and diseases as well as the interactions between the genome and other nongenetic risk factors for disease. These same transformations are having an impact on fundamental, discovery‐focused science.
The cell atlas initiative of the Chan Zuckerberg Biohub focuses on building a repository of all the different cell types in the human body—something that is currently unknown. Understanding all the different cell types is crucial, points out Steve Quake, a Stanford professor and co‐president of the Chan Zuckerberg Biohub: “Having this knowledge will lead to greater understanding of the basic biology of human beings as well as what goes wrong and causes disease” [1]. It will be enabled by exciting new technologies such as CRISPR (“Clustered Regularly Interspaced Short Palindromic Repeats”), a gene‐editing tool that will be used for experiments exploring whether certain combinations of genes can halt the progression of a disease—or even reverse it. The findings can be the basis for new medicines and new tests that are focused on combating specific diseases.
As breakthroughs like these are pursued, we are seeing the adoption of various technology‐based products that are enabling people to become more engaged with their health and, ultimately, to live longer, healthier lives.
But set against this hopeful environment is an altogether different reality: certain segments of the U.S. population are experiencing a decline in basic indicators of good health. There are many ways to illustrate this decline, but life expectancy is perhaps the easiest to understand.
At the beginning of the 20th century, U.S. life expectancy was just 47.3 years. That figure rose steadily in the decades that followed, thanks in large part to medical advances, and by the start of the 21st century U.S. life expectancy was 76.8 years [2]. For the next 14 years, the incremental gains continued. But then something happened.
In 2015, life expectancy declined. Then it happened again in 2016, and again in 2017. This was the first decline in U.S. life expectancy over three consecutive years since the period coinciding with the end of World War I and the Spanish influenza. While the declines were quite modest, they did help illuminate the U.S. health challenges. The declines were also a reminder that the United States fares poorly in international comparisons. U.S. life expectancy is now only the 43rd highest in the world [3]—in 1960, the U.S. ranked 13th [4].
The U.S. average masks wide disparities. For example, there is a six‐year difference in life expectancy between the residents of Hawaii and Mississippi, according to a study published in the Journal of the American Medical Association in 2017. There is a 20‐year difference between one county in Colorado and one in South Dakota [5].
There is also a large life expectancy gap based on income. Men with earnings in the top 1 percent of the population live 14.6 years longer than men in the bottom 1 percent (among women, the