Here’s a sobering statistic – more than 10% of our gross domestic product will need to be spent on health by 2061 if we don’t overhaul our health service model.
According to Treasury, we spent a hefty 7% of GDP on healthcare in 2021, and with an ageing population, one in five of us will be over the age of 65 by 2036. We’ll have to deal with more cancer, diabetes, and heart disease, the types of non-communicable disease that account for 80% of deaths each year.
We need a circuit breaker if we are to keep people healthy longer, and the government is looking to genomics and artificial intelligence to provide it. The Ministry of Health’s long-term insights briefing, which looks at what the health sector needs for the next decade and beyond, has zeroed in on those technologies.
They are valuable tools in what is called “precision health” – using technologies to predict, prevent, diagnose and treat health needs on an individual basis. Your genome, the entire set of DNA instructions found in your cells, can reveal whether you have genetic predispositions to certain diseases, so can inform early health interventions.
But genomics has had “relatively little uptake on a national level and implementation [is] largely occurring in an unplanned manner”, the ministry points out. Even genetic testing, which looks at the composition of single genes rather than the whole genome, is “underfunded and under resourced”. Many tests are sent overseas for processing.
In the US and Europe, we have seen the rise of pharmacogenomics, where you are prescribed a drug based on how your DNA affects your response to drugs. It isn’t a perfect science, but it is showing huge promise in helping doctors choose appropriate drugs and doses for their patients. We are clearly missing the boat on genomics in New Zealand.
Our highly restrictive regulation of genetic modification also hasn’t encouraged pioneering of new treatments in the area of gene editing and synthetic biology, though National is promising to loosen biotech regulations and Labour has asked for a review of the legislation.
A prime example of innovation in this space is Chimeric Antigen Receptor (CAR) T-cell therapy. It modifies a person’s genes and inserts them back into their immune cells to help them fight certain cancers. Wellington’s Malaghan Institute is running the country’s first (CAR) T-cell clinical trial.
Artificial intelligence is easier to introduce into healthcare. It is already being used to analyse medical imagery and manage resources in hospitals. It could automate a lot of the admin doctors currently do, freeing them up to spend more time with patients.
My smartwatch has a sensor that monitors me for atrial fibrillation, an irregular heart rhythm. Wearables can now gather a wide range of biometric indicators from us, which AI can analyse to assess our health status, and detect issues early, so they can be treated.
There’s huge scope to apply masses of anonymised patient data to AI systems to better plan how to allocate precious public health resources. But we’ll need to tread carefully on identifiable information, with the risk that genetic test results or AI-powered health assessments could be used by insurers and employers against us.
“International evidence suggests fear of genetic discrimination has led to individuals declining to undergo genetic testing or be involved in genetic and genomic research,” the ministry notes.
The massive reorganisation of the health sector under way may eventually result in shorter waitlists for surgery, better treatments and more of a focus on preventive medicine. But the consultation the ministry undertook for its long-term insights briefing served as a wake-up call.
Unless we upskill our workforce to use AI, and improve our data infrastructure and genomics capability, we face a long and expensive uphill battle to fix our broken health system.
