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Every year, perfectly healthy people die from a condition that, until that very moment, they likely never knew they had. It’s called hypertrophic cardiomyopathy and it’s a disease that thickens the muscle of the heart. It affects around one in every 500 people and is the most common cause of sudden cardiac death in athletes under the age of 35.
On stage at the annual Bupa Symposium in central London, Dr Michael Murray, Clinical Director at the Institute of Genomic Health in New York City, pointed out that of the five people in recent years who had dropped dead in this manner at the London marathon, three had the condition.
For them, there was little or no way of knowing. But that is about to change.
“All of us are walking around with health risks that we don’t know about,” Murray said to a global audience of people from across the healthcare industry. “But what if we did?”
The next era of medicine, he said, will be shaped by a forthcoming boom in genetic testing. This will allow individuals to understand the conditions from which they are most at risk before they even occur, from heart conditions to cancer to diabetes. As Murray put it on stage: “Once invisible risks are now visible.”
And this is not the only shift that is underway. The Bupa Symposium—which brings together the experts, insights and ideas defining the future of healthcare—showed that the field as a whole is becoming more preventative, personalized, data-driven, and multi-faceted.
“The change is humongous,” says Iñaki Ereño, CEO of Bupa. “Before Covid, many people were still thinking: the health sector is different, we can’t digitize it, it will never change. But it’s changing now. And it’s changing quickly.”
Here are five key insights about what those changes will mean for how we stay healthy, drawn from the Bupa Symposium’s talks…
1. A new era of personalized medicine is dawning
How do you know if a medication you’re taking isn’t actually working? For many, it’s fairly plain: the symptoms you’re suffering from will remain the same, or even worsen. But what if the medication was itself meant to be a preventative? You may only find out when it’s too late.
It’s a situation that Ereño himself found himself in. Approaching his late 50s, he had a routine health check, and his doctor advised him to take Atorvastatin, a drug that lowers cholesterol. So, every night for a year and a half, he did.
When he had his genome sequenced a few months ago, however, it showed a list of the drugs that would have no impact on him whatsoever. “And number one,” he said, “was Atorvastatin.” In many ways, Atorvastatin was doing less than nothing—it meant he wasn’t taking the medication that could have had an impact.
Almost all of us have what are called “pharmacological incompatibilities”. Variants in genes can influence how our bodies process drugs and respond to them. The field of pharmacogenomics aims to uncover these idiosyncrasies. In doing so, it can reveal everything from how fast we metabolize drugs and how likely a drug is to reach its target to the risk of an adverse reaction that can sometimes be fatal.
As the field develops, it’s likely to usher in a shift in how conditions are medicated. Currently, prescriptions are given out on a one-size-fits-all basis. In the era of genome-based medical care, that will change to a precision, patient-specific model where treatments and doses are tailored to each person’s genetics.
“Many doctors are saying that in ten years’ time, when they think about where we are today in terms of prescribing drugs without knowing the incompatibilities that we all have,” said Ereño, “ they will find it very unusual.”
2. Genetic testing will have network effects
Whole-genome sequencing is redefining preventive medicine. By mapping the entire genetic code, it can reveal risks that older testing methods could never see.
Bupa itself is embarking on a genetic testing programme to make genomics-based preventative medicine—long a trope of ‘future of medicine’ discussions—into reality.
Launched in late 2024, the project reports on 36 genetic conditions with defined, actionable interventions such as personalized health plans or risk-reducing surgery.
It has already seen 12,340 people have their genome sequenced and analysed; by the end of 2027, Bupa aims to have delivered a quarter of a million genetic tests.
Bupa’s data shows that in every case, a plan can be created to help that person live healthier. Treatments don’t have to be complicated to be effective: if you have a genetic pre-disposition to skin cancer, for instance, you might just start using a higher factor of suncream and check your moles more regularly.
Perhaps the most intriguing knock-on effect of testing is that, because risk-factors are often inherited, susceptibility may also be prevalent among family members. When one Bupa patient found he was in the 99th centile for the risk of developing prostate cancer, he was relieved after testing showed he was clear. But just as crucially, it enabled him to have conversations with his brother and father. The latter then discovered that he had prostate cancer, and was fortunately able to access treatment earlier.
For all the benefits of whole genome sequencing, however, there is a challenge. Many are simply averse to it, often taking the view that ignorance is bliss. Sequencing could, for instance, show a patient’s risk of Parkinson’s. But as there is currently no cure, most people—understandably—would rather not be tested for it.
This is why it is often seen as advisable only to test for things where treatment or mitigation is possible. In Bupa’s programme, for instance, the report focuses only on conditions where preventive action can be taken.
“Still, if responsible, general-purpose genetic screening becomes more commonplace,” says Murray, “we could reverse the way that the system has traditionally worked.” Typically, someone only seeks out a specific test following a family member’s diagnosis. “We’ve got a system where you have to have a tragedy to get tested.” But with whole genome sequencing, he says, “the testing can be cascaded” to the people you love before tragedy strikes.
3. Mental health is getting proactive
When we think of mental healthcare, we think, naturally, of addressing a problem that’s already arisen. An anxiety that we can’t shift, a depression we can’t shake, a bereavement whose force is only felt some months or even some years later.
But what we rarely think about is proactive mental health. Wouldn’t it be better, after all, to be equipped with coping mechanisms for when our moods do change? Why not seek help, for instance, far before a parent’s health begins to fade, in order to better deal with that life-altering event when inevitably it does come?
The problem is there’s still stigma around mental health. “Mental health facilities used to be built around the corner, out of sight. It’s rumored that’s where the saying ‘going round the bend’ comes from,” says Gosia Bowling, Bupa’s Head of Face-to-Face Mental Health. “We’ve come a long way, but we can still feel the echoes of that Victorian past—the idea that people with mental health issues were mad or bad, rather than just people who are having normal difficult feelings. Research shows around one in five delay treatment for mental health until they are in crises, and some never seek it at all.”
Hence Bupa’s plan to open 200 Mindplace mental health centres around the world over the next three years in high-footfall locations. These will offer individual and group therapy, and a range of support including CBT, mindfulness, and talking therapy. Alongside appointments and therapy programs, the Mindplaces will also accept walk-ins. The hope is that users will drop into one much like they’d drop by the gym—not simply at a time of crisis, but for general wellbeing. Of the seven clinics to have opened in Australia so far, 48 percent of the people who’ve used it have never accessed mental health before.
“I think that’s really impressive,” says Andrea Christie-David, director of Mental Health at Bupa Australia. “It means people are finding it easier to come and get the support they need.”
It ties into a wider trend around making mental healthcare provision more preventative. The UK parliament is considering how policymakers can support psychological resilience, while the Global Wellness Institute considers proactive mental wellness as a defining theme of the year.
Of course, building the facilities is not enough—you also have to change human behavior. Bupa realized that people would only feel inclined to ‘drop in’ to the Mindplaces if they didn’t feel medical—they couldn’t feel like places you only go to in a crisis. Bowling says that particular thought therefore went into both signage and décor. “We are building comforting, warm environments inside our Mindplaces,” elaborates Ereño. “We want to break the stigma around mental health spaces being somewhere you only visit when you’re ill. Mindplace is backed by Bupa’s clinical expertise, but we made sure they don’t feel like a hospital when you’re inside.”
4. The crowd is medicine’s new research lab
It’s estimated that over 1.2bn people around the world now own a smartwatch. That means an eighth of the planet’s population have the ability to track everything from their sleep patterns to their heart rate, their menstrual cycles to their VO2 max levels.
While we find this data personally useful, the true revolution may come when we take it as a whole: a vast health dataset encompassing years and eventually decades. This kind of platform could help us fill in gaps in our understanding, and enable discoveries that previously eluded us because sample sizes were too small.
That effort is already underway, with projects such as Apple’s Heart and Movement Study, and its more recent Health Study, which aims to explore how data can predict, detect, and manage health and wellbeing. As Prof. Calum MacRae, a cardiologist and principal investigator of the Apple Health Study, put it on stage: “We've focused the last probably 1,000 years on measuring illness. But how can you measure wellness?” The problem has been that we don’t have enough data to do so effectively. But wearables, he said, “can become a universal data collection platform” that allows us to fill in the blanks.
Wearables data are already, for instance, challenging current medical advice. Clinicians typically recommended maximum exercise heart rates using a simple formula: 220 minus your age, derived from studies of exercise performed decades ago. The Apple study’s data showed that these numbers fail to take into account how exercise has changed the population, and now these numbers appear very conservative. “It’s actually 220 minus your age minus another 20,” said MacRae.
Good VO2 max levels, meanwhile—the maximum amount of oxygen your body can use during intense exercise—has long been closely linked to avoiding chronic diseases and to good musculoskeletal health. But while VO2 max levels can be improved with regular exercise, much of our VO2 max is defined by other factors. “The missing part of the curve is what’s happening in the first decade or two of your life,” says MacRae. In other words, we don’t know how early development and training can contribute to one’s lifelong ceiling. But the more data we gather, the more we look set to uncover.
5. The built environment has become a healthcare frontier
For those of us who strive to live healthy lives, where we’re living them likely doesn’t factor into our concerns. Yet nearly every study shows it’s one of the most influential factors on our health, mental wellbeing, and lifespan.
As renowned architect Lord Norman Foster put it at the Symposium: “A healthy environment is absolutely vital.” This encompasses everything from air and water quality to access to green spaces and nutritious food.
Foster’s architecture has always emphasized a feeling of space and natural light. But the benefits are not simply about aesthetics. Studies in hospitals, for instance, show that patients with window views not only sleep better, but require fewer painkillers and recover faster.
And while we can’t reengineer our cities overnight, there’s much that’s currently being done to make them healthier environments in which to live. The trend in creating low-traffic neighbourhoods in cities across the UK—pushing traffic to arterial roads—encourages walking and cycling. This goes hand in hand with the rise of an urban planning concept that the Franco-Colombian scientist Carlos Moreno dubbed the “15-minute city”: the idea that vital goods and services should never be more than a 15-minute walk away.
“By 2050, seven out of 10 of us will be in urban environments,” says Nigel Sullivan, Bupa’s Chief Sustainability and People Officer. “So if we can make our cities healthier with cleaner air, green spaces, active travel, inclusive design, we can make entire populations healthier for generations to come.”
But it’s not just about the first order effects of more exercise and less pollution. The second order effects can be just as profound. As we use fewer cars, we engage more with the local community. One of the biggest factors in premature death is perhaps a surprising one: loneliness and social isolation. Studies have shown they increase the risk of premature death by 26 and 29 percent respectively, comparable to smoking 15 cigarettes a day. In 2023, the WHO declared loneliness a “global health concern”.
By focusing on environments that are both local and walkable, we create something that has increasingly been lost: an environment that is also social. So if loneliness is a health risk, then the city itself becomes part of the treatment plan.
Initiatives such as Resilient Cities: Reimagining Health—a coalition led by the Sustainable Markets Initiative Health Systems Task Force with partners including Reckitt and Bupa—are beginning to quantify the benefits of designing healthier cities. New research by the coalition suggests that urban interventions could save up to 725,000 lives and $70bn in healthcare costs each year.
Together, these shifts point to a future where healthcare isn’t just about treating illness, but about designing a world that helps prevent it.
For more information visit the healthcaresymposium.bupa.com.
