Towards integrated healthcare

You will find below my opinion published in Le Temps on June 29, 2023

The directors of Switzerland's university hospitals recently took to the media to call on the authorities in the face of rising healthcare costs.

As Rector of UNIL, this is a subject that touches me deeply. The cantonal universities are indeed involved in this issue, as they award academic titles in medicine and finance training and research. Even though I'm not an expert in the healthcare field, two trends caught my attention among the many challenges we face: the development of precision medicine and sustainable health.

Precision medicine aims to provide "tailor-made" healthcare based on lifestyle, genetic heritage, environmental factors and other elements specific to each individual. It should, a priori, become more effective, thanks in particular to advances in artificial intelligence (AI) and medical technologies. Machine learning algorithms enable us to analyze ever-greater quantities of medical data (including patient records and the results of basic and clinical research) to inform decision-making. AI can thus help predict disease progression and recommend personalized treatments. Genetic sequencing, medical imaging and biomarker analysis, combined with this growing computational capacity, will also continue to play a fundamental role in diagnosing pathologies, identifying targeted therapies and predicting disease risk - as we are already doing with the CHUV, for example, to anticipate tumor recurrence or severe forms of COVID.

To achieve this, however, access to data is a sine qua non , so many institutions and healthcare systems are adopting electronic medical records. But the challenge remains immense, as there is a great deal of opposition. So far, this has been a failure in Switzerland. The ethical considerations and privacy issues are indeed gigantic, and it is crucial to address these questions as precision medicine, AI, big data and medical technology innovation continue to evolve. How can we offer secure, sustainable storage for masses of data with a high environmental impact? How can we overcome the racial and gender bias of predictive algorithms? How can we responsibly use the information provided by patients, knowing that we can't guarantee how it will be used in ten years' time? Obtaining informed consent and maintaining full transparency will be essential to building trust between healthcare providers and the public. Furthermore, while precision medicine, AI and access to data have the potential to reduce some of the costs of healthcare, the costs of implementation and the need to address the aforementioned ethical considerations themselves pose financial and societal challenges.

While I remain optimistic about the possibilities offered by advances in precision medicine, I believe that they must integrate multiple dimensions and go beyond the treatment of disease. VITAM, the Centre de recherche en santé durable at Université Laval, with which UNIL has a privileged partnership, offers us a far-sighted vision by introducing the concept of "sustainable health", defined as "a healthy mind in a healthy body, in a healthy living environment, on a healthy planet". As explained by Ophélia Jeanneret, Head of the UNIL-EPFL Sports Department, who collaborates with Jean-Pierre Després, VITAM's Scientific Director and Professor at Laval University, it is no longer a question of assessing health through the presence or absence of disease, but of seeing it as a kind of indicator of quality of life. Our discussions with Prof. Després and the Rectorate of Université Laval convinced me of the need to reinforce in this direction the work already undertaken at UNIL, Unisanté and CHUV in the field of sustainable health. How can we do this? By reflecting on interconnected factors such as physical activity, nutrition, medical-environmental links and sleep, all of which play a key role in maintaining a healthy lifestyle. Here, I'd like to highlight two of these aspects - physical activity and nutrition - via two UNIL initiatives.

Let's start with physical activity. It goes without saying that physical activity improves cardiovascular health, strengthens muscles and bones, and reduces the risk of chronic diseases such as obesity, diabetes and certain cancers. In fact, the World Health Organization recommends that adults engage in at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity per week. However, we can question the imposition of a universal standard. Following the same logic as for precision medicine, it might be more constructive to recommend a tailor-made approach for each individual. This is what Professor Aaron Baggish (UNIL/CHUV) is proposing in an experimental study aimed at generating the first comprehensive map of individual response to a "dose" of exercise. Specifically, he suggests using physical activity in conjunction with in-depth biochemical profiling to examine how "exercise dose" (the product of duration and intensity) has a differential impact on the biochemical profile of human plasma. A fundamental aim of his work will be to examine how age, gender, ethnicity, body composition, epigenetic environment and exercise modality impact the outcome, enabling the tailored prescription of physical activity for each individual.

Let's move on to nutrition. A healthy, balanced diet has a direct influence on the likelihood of developing (or not) non-communicable diseases such as cancer, diabetes or cardiovascular pathologies. The project From Farm to Fork and beyond: A Systemic Approach for Implementing True Cost Accounting for Food in Switzerland, led by Dominique Barjolle (UNIL), Professor Murielle Bochud and Professor Joachim Marti (UNIL/Unisanté) in collaboration with other institutions (EPFL, E4S, HEG-FR), has understood this. Its goal? To make the agri-food chain more sustainable, knowing that food with a lower carbon footprint is also better for your health. From Farm to Fork and beyond will be based on existing international data (notably in terms of years lost due to risk factors), complemented by the very first survey dedicated to adult nutrition in Switzerland (menuCH), and, even more innovatively, blood and urine samples taken from 6-17 year-olds to measure their nutritional status (menuCH-kids) on behalf of the OSAV. These data will enable us to better identify how we can transform our eating habits to avoid the appearance of deficiencies, and then formulate public health recommendations. According to the research team, the ideal solution would be to set up a system of tax or subsidy incentives, and ultimately to increase the price of processed products that are too fatty, sweet or salty, by making healthy foods more attractive.

Faced with the rising costs of Switzerland's ultra-technological healthcare system (which consumes a lot of energy and raw materials), and in view of the ecological and energy crises that lie ahead, it seems clear that we urgently need to change our approach to healthcare. This doesn't mean abandoning our cutting-edge research, innovation in medical technologies and use of AI - quite the contrary. On the contrary, it does mean combining them with integrated, preventive approaches. In this way, UNIL is investing these issues with determination in order to contribute to building together a healthier and more sustainable society, where everyone can live better every day.

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