I spent years building a precision health platform. The thing that struck me hardest wasn't the technology or the data. It was how fundamentally broken our model of healthcare is. We wait for people to get sick, then we try to fix them. That's not a health system. That's a sick-care system.
The Short Version
- New Zealand's health system is built around treating illness, not preventing it. We spend roughly 80% of health budgets on conditions that are largely preventable
- Precision health, using genetics, biomarkers, and lifestyle data, can identify risk years before symptoms appear
- The barrier isn't the science. Genomic sequencing costs have dropped 99.9% since 2001. The barrier is how we structure care delivery
- Moving from reactive to proactive healthcare requires changes in policy, funding models, and clinical workflows, not just better technology
The Model We Inherited
Our healthcare system was designed for acute care. Someone breaks a leg, we fix it. Someone gets an infection, we treat it. That model made sense when infectious disease was the primary killer and life expectancy was 55.
It doesn't make sense anymore.
80%
of New Zealand's health spending goes toward chronic diseases, many of which are preventable with early intervention
Source: New Zealand Ministry of Health, Annual Report 2021
Today's biggest health challenges, cardiovascular disease, type 2 diabetes, many cancers, are chronic conditions that develop over years or decades. By the time symptoms appear, you're managing damage rather than preventing it. And management is expensive, painful, and often too late.
I saw this up close when I was leading Edison, our precision health platform. We were working with clinicians who could look at a patient's genomic profile and see clear risk markers for conditions that wouldn't manifest for another 10 to 15 years. The science was there. The ability to act on it? That was the gap.
What Precision Health Actually Means
Precision health isn't a wellness app that tracks your steps. It's the integration of multiple data streams, genomics, blood biomarkers, family history, lifestyle factors, into a picture of your individual health trajectory.
Think of it as the difference between a weather forecast and a climate model. Standard healthcare gives you today's reading: your blood pressure is X, your cholesterol is Y. Precision health gives you the trajectory: based on your genetic profile, biomarkers, and lifestyle patterns, here's where you're heading, and here's what we can do about it now.
The technology to do this exists. Genomic sequencing that cost $100 million in 2001 now costs under $1,000. Blood biomarker panels can identify early signals of metabolic dysfunction years before a diabetes diagnosis. Pharmacogenomic testing can tell a clinician which medications will actually work for a specific patient, rather than the trial-and-error approach we still rely on.
$600
approximate cost of whole genome sequencing in 2022, down from $100 million in 2001
Source: National Human Genome Research Institute, 2022
Why New Zealand Should Be Leading This
New Zealand has structural advantages most countries would envy. We have a public health system with centralised data infrastructure. We have a relatively small, geographically contained population. We have strong research institutions and a culture of pragmatic innovation.
And we have a problem that's getting worse. Our chronic disease burden is growing. Health inequities, particularly for Māori and Pasifika communities, are persistent and well-documented. The reactive model isn't just expensive. It's failing the people who need it most.
A precision health approach could change the equation for these communities specifically. Genetic risk profiling, combined with culturally appropriate preventive care, could address conditions like gout, cardiovascular disease, and diabetes before they become debilitating. But only if we build the system to do it.
The Barriers Are Structural, Not Technical
When I talk to people about precision health, they assume the challenge is scientific or technological. It isn't. The barriers are structural.
Funding models reward treatment, not prevention. Our health system pays clinicians to treat sick people. There's no equivalent funding model for preventing illness. A GP who identifies a patient's genetic risk for cardiovascular disease and puts them on a preventive programme generates less revenue than treating that same patient's heart attack in 15 years.
Clinical workflows aren't built for longitudinal data. A clinician sees a patient for 15 minutes. They have access to that visit's data, maybe some recent lab results. They don't have a longitudinal view of that patient's health trajectory informed by genetics, biomarkers, and lifestyle data. The information exists, but the workflow doesn't surface it.
Patients don't know what's possible. Most New Zealanders don't know that pharmacogenomic testing could tell their GP which antidepressant will actually work for them, instead of trying three or four over 18 months. They don't know that genetic risk scores for cardiovascular disease are clinically validated and available. The awareness gap is real.
What Needs to Change
This isn't a problem technology alone can solve. But technology is part of the solution.
We need platforms that integrate genomic data, biomarker data, and clinical data into a single view that clinicians can actually use in a 15-minute consultation. We need funding models that reward prevention. We need clinical education that includes precision health approaches. And we need to make this accessible, not just available to people who can afford private testing.
The science is ready. The economics make sense, prevention is cheaper than treatment. The question is whether we have the will to restructure a system built around sickness into one built around health.
I believe we do. But we need to stop pretending that incremental improvements to the reactive model will get us there. The model itself needs to change.