From chronic disease to chronic health: the evolving role of doctors in the 21st century

The global phenomenon of an aging population, compounded by the pervasive pandemic of abdominal obesity and metabolic diseases stemming from unhealthy lifestyles, presents formidable challenges for governments and institutions worldwide. These trends not only escalate healthcare costs but also strain the sustainability of existing public healthcare systems. However, simply increasing spending is not a viable solution. Despite healthcare expenditure skyrocketing from $2.8 trillion in 2013 to a staggering $4.1 trillion in 2023, the USA has witnessed a unique and disturbing decline in both lifespan and healthspan.1 In 2019, the life expectancy gap between the USA and other leading industrialized nations was 5.43 years for men and 5.96 years for women. And even within the USA, marked disparities in mortality rates exist, with Asians and Hispanics showing cardiometabolic disease death rates for men 40%–60% lower and for women 30%–40% lower than African Americans.2 Moreover, nearly 90% of healthcare costs in the USA, as in other developed nations, are directed towards treating chronic diseases retroactively, after they have already manifested.1 This underscores the urgent need to transition towards preventative healthcare and educational models, rather than predominantly addressing chronic conditions reactively within hospital settings. It is imperative to lead a cultural revolution reorienting our priorities from managing ‘chronic diseases’ to promoting ‘chronic health’. This entails not only changing individual behaviours but also establishing social and economic health models that prioritize prevention over treatment, with the aim of fostering optimal health throughout life, beginning even before conception. Our choices regarding diet, exercise, mindset, and lifestyle long before procreation can significantly impact future generations for epigenetic reasons. Only by embracing this new approach we can alleviate the societal and financial burden imposed by the growing tsunami of chronic diseases. Indeed, healthy individuals utilize fewer and less expensive healthcare resources than their unhealthy counterparts.3 By reducing the prevalence of unhealthy citizens and promoting healthy longevity until the final months of life (20% of centenarians do not develop any major disease before 100 years of age),4 we can potentially halt or even reverse the trajectory of healthcare expenditure and redirect financial resources towards a greener and sustainable economy. Therefore, embracing a paradigm shift towards prioritizing chronic health is not only beneficial for individuals but also for society as a whole. A wealth of evidence from the field of aging biology indicates that targeting specific metabolic and molecular pathways through selected nutritional, exercise, cognitive, and psychological interventions can inhibit cellular and tissue damage accumulation, extending healthspan and influencing the clinical progression of many common chronic diseases that share a common metabolic substrate.5,6 Time-dependent persistent exposure to unhealthy lifestyles and other toxic external factors, like excessive calorie intake, poor nutrition, sedentary lifestyle, psychological stress, smoking, alcohol, and pollution, accelerates the accumulation of damage and the deterioration of organs, increasing the risk of developing multiple, chronic medical conditions. Empowering individuals to make informed lifestyle choices, supported by digital and sensor-based platforms (Internet of Bodies) that enhance metabolic health and overall well-being, is essential. This paradigm shift requires early education pathways for health literacy across all levels of the school system7 and implementing innovative clinical services of ‘lifestyle medicine’ within advanced and multidisciplinary community healthcare models (Figure 1).8 These community health centres should also serve as social hubs, addressing the increasing challenges of loneliness and social isolation, which significantly impact individual and familial welfare. Lifestyle medicine clinical services integrated within comprehensive policlinics. These integrated units are designed to deliver mechanism-based interventions that are specifically tailored to support individuals at risk (e.g. insulin resistance, high-normal glucose and pre-diabetes, dyslipidaemia, pre-hypertension, abdominal obesity, unhealthy diets, low fitness, poor posture, emotional distress, and more), across all age groups. The overarching objective is to optimize their physical, metabolic and emotional well-being. These services encompass a multifaceted approach, addressing multiple aspects crucial to achieving holistic health. First and foremost, these units offer practical education on healthy nutrition and cooking habits. Patients receive continuous updates on healthy food choices, recipes, and meal preparation methods. In addition, there is a strong emphasis on promoting regular exercise as a cornerstone for enhanced fitness, improved cardiometabolic health, and better posture. Through personalized digital tools such as apps, gamification techniques, wearables, and sensors, patients are provided with individualized guidance and education. These technological aids not only track progress but also serve as motivators, encouraging patients to adopt and maintain healthier habits anchored in a new mindset. Furthermore, workshops are conducted in diverse modules, utilizing both in-person group sessions and telemedicine platforms. These workshops not only serve as educational forums but also foster social connections, providing patients with a support system that reinforces emotional health and positive behaviours Physicians hold a pivotal role in driving this revolution. Beyond traditional medical practice, healthcare professionals should embrace their role as guardians of human and environmental health, well-being, and peace. Their primary duty should be to promote and preserve optimal health by adopting comprehensive approaches that address molecular, metabolic, physical, emotional, psychological, and spiritual dimensions (Figure 2).9 It is key to bear in mind that each individual is not merely a collection of biological functions but a polymorphic being with dreams, fears, and a profound desire for support, connection, and purpose. Clinicians operating in advanced, integrated healthcare facilities, equipped with digitalized lifestyle medicine units, must commit to understanding and addressing the core factors influencing physical, metabolic, and emotional well-being. Furthermore, they should empower men, women, and their children to play an active role in their health journey by providing education, guidance, and support.9 Finally, health professionals are called to embody qualities of compassion and modesty, approaching each person with dignity and respect while acknowledging their emotional, psychological, and spiritual needs. They should not only listen to their symptoms but also delve into their narratives, seeking to comprehend them within the context of their lives, relationships, and aspirations.10 This comprehensive understanding fosters a deeper connection and facilitates more effective healthcare delivery. The new medicine paradigm: integrating science and philosophy with human and planetary health In essence, the evolving landscape of medical practice, informed by a holistic understanding of the biological mechanisms influencing human health, embodies a sacred pact between healthcare providers and patients, grounded in integrity and empathy towards the complexity and beauty of human existence. It demands a deep comprehension of the scientific foundations of healthy aging, coupled with technical proficiency, and a steadfast commitment to the highest principles of healing, humaneness, and global health and welfare. The author declares no disclosure of interest for this contribution. L.F. is supported by grants from the Australian NHMRC Investigator grant (APP1177797), Australian Youth and Health Foundation, and Bakewell Foundation.