Forum: Pay more attention to social determinants that affect health

Dr Kanwaljit Soin's piece on preventive care paints a rosy picture of precision health, pointing out its use to encourage healthy behaviour in the population (Lots of medical care but not enough health - a new reset button, March 26).

It is easy to see the allure of this approach. Precision health promises cutting-edge, customised solutions that will bring forth exponential increases in efficiency, little uncertainty and minimal suffering.

But precision health is not magic. While the precision health approach may be particularly useful in some cases (for example, for selected inherited diseases or sequencing pathogens), we should be careful of overestimating its potential. I offer two cautionary points.

First, we should make sure that resources allocated to precision approaches are not disproportionate to the benefits they can bring.

The pursuit of precision health often attracts vast amounts of funding for genome sequencing and other expensive tools that could be better diverted to more conventional interventions.

Dr Soin rightly points out that social determinants of health account for a greater proportion of overall health outcomes compared with medical care and genetics, but typically receive less attention.

Tackling upstream factors such as poverty, homelessness, job insecurity and other causes of stressful environments should be given resources that are commensurate with their impact on population health. Addressing these issues may sound less sexy and more challenging, but are well known to improve health outcomes.

Second, we should bear in mind that approaches over-emphasising individual responsibility for behaviour change can widen health disparities.

For instance, those with more resources are more likely to access, afford and adopt technologies like personal genomics. They are also more likely to keep track of, comply with, and make full use of personalised recommendations.

Behavioural interventions like the National Steps Challenge (as highlighted by Dr Soin) may therefore end up attracting self-selected population groups who are already more active and perhaps more well-to-do.

By contrast, for disadvantaged groups such as the poor, worrying about finances places a burden on their mental resources. Stressors like this make it difficult to commit to and benefit from interventions which depend heavily on individual effort.

In such cases, "personalised" health will not necessarily improve their personal health.

Shannon Ang (Dr)

Join ST's Telegram channel and get the latest breaking news delivered to you.