title: The P4 Health Spectrum - A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan.
abstract: Chronic diseases (i.e., noncommunicable diseases), mainly cardiovascular disease, cancer, respiratory diseases and type-2-diabetes, are now the leading cause of death, disability and diminished quality of life on the planet. Moreover, these diseases are also a major financial burden worldwide, significantly impacting the economy of many countries. Healthcare systems and medicine have progressively improved upon the ability to address infectious diseases and react to adverse health events through both surgical interventions and pharmacology; we have become efficient in delivering reactive care (i.e., initiating interventions once an individual is on the verge of or has actually suffered a negative health event). However, with slowly progressing and often 'silent' chronic diseases now being the main cause of illness, healthcare and medicine must evolve into a proactive system, moving away from a merely reactive approach to care. Minimal interactions among the specialists and limited information to the general practitioner and to the individual receiving care lead to a fragmented health approach, non-concerted prescriptions, a scattered follow-up and a suboptimal cost-effectiveness ratio. A new approach in medicine that is predictive, preventive, personalized and participatory, which we label here as "P4" holds great promise to reduce the burden of chronic diseases by harnessing technology and an increasingly better understanding of environment-biology interactions, evidence-based interventions and the underlying mechanisms of chronic diseases. In this concept paper, we propose a 'P4 Health Continuum' model as a framework to promote and facilitate multi-stakeholder collaboration with an orchestrated common language and an integrated care model to increase the healthspan.
authors.affiliation: College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; SARENA Clinic, Medical Center and Research Institute. Electronic address: sagner@esprevmed.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Sagner
authors.affiliation: College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: McNeil
authors.affiliation: National Institute for Health and Welfare (THL), Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Puska
authors.affiliation: European Institute for Systems Biology and Medicine, Paris and Lyon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Auffray
authors.affiliation: Institute for Systems Biology, Seattle, WA, USA.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Price
authors.affiliation: Institute for Systems Biology, Seattle, WA, USA.
authors.forename: Leroy
authors.initials: L
authors.lastname: Hood
authors.affiliation: Department of Cardiovascular Diseases, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
authors.affiliation: Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Ze-Guang
authors.initials: ZG
authors.lastname: Han
authors.affiliation: Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Academy of Scientific and Innovative Research, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.
authors.forename: Samir Kumar
authors.initials: SK
authors.lastname: Brahmachari
authors.affiliation: Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY, USA.
authors.forename: Bruce S
authors.initials: BS
authors.lastname: McEwen
authors.affiliation: College of Medicine, University of Illinois, Peoria, IL, USA.
authors.forename: Marcelo B
authors.initials: MB
authors.lastname: Soares
authors.affiliation: Luxembourg Centre for Systems Biomedicine (LCSB), Esch-sur-Alzette, Luxembourg.
authors.forename: Rudi
authors.initials: R
authors.lastname: Balling
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA.
authors.forename: Elissa
authors.initials: E
authors.lastname: Epel
authors.affiliation: College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA; SARENA Clinic, Medical Center and Research Institute.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
mesh_terms: D002908:Chronic Disease / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration; D006801:Humans; D000070516:Intersectoral Collaboration; D017146:Models, Organizational; D057285:Precision Medicine / Q000379:methods*; D011315:Preventive Medicine / Q000379:methods*; D058996:Quality Improvement
keywords: Allostasis; Allostatic load; Exercise; Healthspan; Nutrition; P4 medicine; Systems biology; Systems medicine; Wellness