Working towards a sustainable health system

If there is one thing on which almost everyone agrees, it is that we can enjoy a solid healthcare system in Belgium. A system that not only excels in terms of quality, but that is also easily accessible thanks to far-reaching reimbursements from consultations, treatments and medicines. A large majority of Belgians would like to keep it that way. However, this is a major challenge, because our healthcare system will no longer be affordable in the long term because of its current design.

Costs are rising faster than gross national product and healthcare revenues. Increasing life expectancy, the ageing population, the increase in the number of chronic diseases and the high cost of innovative therapies are all factors that put our model – and actually most healthcare systems in the Western world – under pressure. If we do not intervene, we risk evolving into a model that either offers less quality or is much less accessible.

Changing medical practice

In many other economic and societal sectors, technological solutions are often intensively sought when facing problems. The irony is that technological innovation is at the heart of the greatest challenge facing healthcare, along with other factors of course, and that is driving up costs, giving us a more expensive system that is no longer sustainable.

At VITO Health, around one hundred employees reflect and work on the healthcare of the future. This needs to become a system that is inherently sustainable and therefore resistant to constantly changing medical practice. An example of such a change that is currently posing major challenges to the system is personalised medicine. Take immunocell therapy, for example; a new and promising cancer treatment. This therapy focuses on the patient's individual characteristics. The price is therefore high, and in the current context, this cannot remain affordable for society. The fact that personalised treatments such as immunocell therapy are so expensive is also a consequence of the market logic in which healthcare is trapped. In any case, the sustainable health system of the future will have a different logic.

Complex ecosystem

It is not only the people of VITO that are convinced that things need to change. All stakeholders in the sector agree that the healthcare system must be (thoroughly) redesigned. Or perhaps we should think about a complex ecosystem: a dense network in which many stakeholders each have their own specific role to play. In recent years, similar initiatives have emerged from different levels and niches of this network, as demonstrated by the 'vision paper' published earlier this year by some of these stakeholders. In this paper, a number of concrete reform measures were already proposed with the aim of making the transition towards high-quality and affordable healthcare. All in all, this strengthens our conviction that we all share the same common goal: a sustainable health system.

4P medicine

But how can we achieve this? The role of VITO Health is not only to identify problem areas and develop solutions, but also to identify and create opportunities and then convert them into something that works in society. It should come as no surprise that it is precisely this new technological innovation that opens the door to these new possibilities. The spectacularly improved availability of analysis and diagnostic equipment is a good example of this. After all, it enables a much better insight into how diseases occur. This ranges from sequencing of the entire DNA (the genome) to the genetic analysis of the intestinal bacteria (the microbiome) and mapping of the proteins in the cell (the proteome).

This so-called omics revolution is also linked to a working framework that is becoming increasingly accepted in the development of a sustainable health system, namely that of the four Ps: predictive, preventive, personalized and participatory. In '4P medicine', the emphasis is shifted from healing to prevention. At VITO Health, we cherish the combination of technological developments with a data-driven approach. As a result, we are shifting the focus from disease to health.

Predicting and anticipating

In essence, we can say that at VITO Health, we try to predict how the healthcare system will change as well as possible, in order to anticipate this as accurately as possible. On the one hand, we do this by using groundbreaking research to chase up new insights. A good example is the I AM Frontier study that we have launched (see inset). On the other hand, we launch concrete initiatives and projects based on existing insights. In both cases, we focus on studies and initiatives that are complementary and closely aligned.

One of these initiatives is the digitisation of an existing health guide of Domus Medica, a medical association with more than three thousand general practitioners. With this prevention guide, citizens can, together with their general practitioner, draw up an individual risk profile based on validated questionnaires. By transforming the paper guide into a digital, well-secured platform, we are hoping to make it more usable and, above all, more accessible to the public. This platform can also be used to integrate medical data from the GP's office. What is more, the digitised guide is linked to a personal prevention plan: a range of preventive actions and tailor-made services. The latter can also be offered by the local authorities. This is important because, of all the authorities, the local level of government is closest to the citizen. The aim is for citizens to feel involved and, with the support of these authorities, to play an active role in the preventive improvement of their health.

Keeping the flywheel turning

The concrete initiative of the digital health guide illustrates how we at VITO Health map out the way to a sustainable healthcare system. That system is up and running: it is active and constantly changing due to developments that simply cannot be avoided. It is therefore not a question of developing a new system from scratch, but of pushing the existing system in the right direction, and of ensuring that the transition doesn't falter or stall. In other words, we must keep the flywheel of the transition turning.

VITO Health does this by working closely with as many ecosystem stakeholders as possible (such as Domus Medica), by making small but significant and medically validated adjustments (such as the digitisation of the health guide), and by ensuring that the system as a whole moves forward. It is therefore a realistic approach that also puts an end to the utopian nature of a brand new sustainable health system.

There's more

A unique study

VITO Health has recently launched a groundbreaking study in which thirty employees are turned inside out, figuratively speaking: a cohort study called I AM Frontier. The health of the participants is screened for a year and a half, together with an extensive range of (micro)biological parameters. This is carried out by taking regular blood, urine, stool and even hair samples. We then use these samples to identify cells, DNA, proteins and other molecules. In short, the complete biological complexity is mapped out and, more importantly, monitored over time. The research has received an investment of 1.3 million euros.

The I AM Frontier study is a first step in the I AM my health research programme by VITO Health. In that programme, we are hoping to focus on preventive health care, based on a personalised approach. With this cohort study, VITO Health is hoping to gain new insights into the relationship between physical health, underlying biological processes, lifestyle and environment. The research design differs a great deal from conventional health studies, where a snapshot is generally created of a very large population and where correlations are sought by using statistics. In our cohort study, however, we work longitudinally. This means that we search for correlations and deviations in time within individuals. In this sense, it is a pilot study that starts with 'only' thirty participants, which of course means that it is not representative of the general population. However we do this in order to study the methodology behind it in detail now, with a view to scaling it up later.

When seeking participants, we look for 'disturbances' at different biological levels. If, for example, we find something in the gene expression, we will look to see whether it persists at other levels, such as in proteins. If that is the case, then this means that we have found a disturbance that is not coincidental. But in order to identify disturbances, we do, of course, need natural reference points. In contrast to extensive studies, we work with an individual version of 'normal'. For example, we can compare this with our body temperature which is 37 degrees Celsius on average, but can differ significantly in different individuals. In some people, the 'normal' temperature is higher or lower. The same can be said for normal glucose levels in the blood, which also vary from person to person. The participants in our study undergo a thorough examination every month for a period of one and a half years. Whether this results in sufficient measurements to find disturbances to the 'norm' at the various screened levels remains to be seen in our evaluation research.

Our cohort study is unique, even in Europe. For the first time, we look longitudinally at the changes at protein level (the proteome) within individuals. This distribution in fluctuations has only been studied at population level to date and usually concerned a snapshot. What is more, the study may signify a breakthrough in the way in which data-driven health studies are organised. After all, it will generate a rich dataset and thus show the way to upscaling and a long-term vision on the collection of health data.

There are many challenges associated with this upscaling, not least in terms of logistics and ethics. The thirty participants provide researchers with an insight into their personal health data. That is why we have deliberately chosen VITO employees (outside the VITO Health unit), because they understand the importance of such groundbreaking research. What is more, they also receive feedback from a collaborating doctor who interprets the data together with us. The ethical aspects of the study are also scientifically researched and the study design has been approved by the Ethics Committee of Antwerp University Hospital.

Although the cohort study is unique to VITO, the design and execution of this type of research is in our DNA. VITO Health can build on more than twenty years of experience in molecular measurements, as well as in environmental and health studies among the general population that examine the effect of chemicals on health.