1. Wellbeing in Personalised Medicine and Care
Challenges and opportunities for public health
Anne-Marie Bagnall, Reader, Centre for Health Promotion Research

2. Personalised Medicine – A Magic Bullet?
What can we learn one hundred years on from the first medical revolution to help us on the eve of a new one?
Paul Erlich discovered the first effective medicinal treatment for syphilis and initiated chemotherapy. The start of the pharmaceutical industry and one of the founders of the modern medicine revolution. He coined the phrase ‘magic bullet’ for targeted treatments.
Since Erlich we have seen the largest increase in life expectancy in human history and health systems across the world which no one could have foreseen in their scale, complexity and achievements. A huge success story, but we also now have health systems which are organised around profit for big corporations and the specialisms which treatments and clinicians can provide. What can we learn from a public health perspective on the eve of the next major revolution in medicine.

3. 3 key perspectives from Public Health
Inequalities
Health
Wellbeing
Wellbeing
Health
Inequalities
“Inequality affects us all” (The Spirit Level, Wilkinson & Pickett)
“Social injustice is killing people on a grand scale” (Marmot, WHO report on Social Determinants of Health)
‘Feeling good and functioning well in life’ ‘Functioning well in life, for example having a strong sense of meaning and feeling connected to other people’
The whole person - "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“
Individual wellbeing (Connect, Be Active, Take Notice, Keep Learning, Give)
“Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”
Community wellbeing (People, Place and Power)
1) Primary Prevention Promoting health, preventing ill health
Improving our daily living conditions:
Healthy Places, Healthy People
Good education
Fair employment and decent work
The Best Start in Life
2) Secondary Prevention Early identification and healthy choices
Healthy lifestyles, recovery
Testing, diagnosing, screening
3) Tertiary Prevention
Self-management for long-term conditions
Community Capacity and resilience

4. Personalised Medicine – The Challenges
1. Do not forget wellbeing
Integrating around all of a person’s needs - Specialisation means fragmentation
From individual conditions to individualised conditions?
2. Don’t forget health amongst illness
Preventing disease is preferable to curing disease
Look at a range of outcomes
Utilise existing evidence
3. Don’t increase inequalities
Screening, early identification and the inverse care law
Personalisation for the ‘worried well?’

5. Personalised Medicine – The Opportunities
1. Wellbeing
Mental health and depression drugs
Person-centred care and whole-person approach
2. Promoting health and preventing illness
Early identification and risk
Targeted prevention
3. Reducing Inequalities
“The people who are the poorest, improve
their health the fastest.”

6. Personalised Medicine – A ‘magic bullet’ within a whole armoury of approaches for better health and wellbeing?