This is the time when many of us set earnest—if unsustainable—resolutions for the year ahead. Come February, the mad rush will have quieted at our local athletic clubs, and our pantries are likely to become home once again to potato chips and double-stuffed Oreos.

As we think about what improvements we could make in 2018, I’d like to focus on how Johns Hopkins Medicine is already making strides to improve health and health care here and abroad. Following Pamela’s lead, I’ll predict how these efforts will impact our field in important ways in the year to come.

Genomic Testing
Pamela forecasts that precision medicine will begin to replace the conventional approach in favor of more personalized medicine that will transform patient care. I agree. I also want to emphasize that precision care will only be as good as the tests that guide diagnosis and treatment.

Three billion pieces of DNA lie within our 20,500 genes. Every one of these genetic elements has an impact on disease, health, even behavior. As medical researchers started to map and study these elements more than 20 years ago, they could begin to locate and identify diseases at a genetic level.

For the first time, researchers had detailed instructions to decipher everything from our susceptibility to disease to genetic tweaks that could make various treatments work better. Now we are using innovations in genetic testing to more precisely predict, diagnose and treat conditions in patients—as unique individuals.

Researchers can use this field of study, called genomics, to target and treat rare disorders, many of which are rooted in our genes. Genetic testing can detect cancers more quickly and effectively, and with less stress for the patient.

Genomics offers potential solutions to conditions that medication could only partially manage before.

Prediction: Given how quickly it's evolving and how much researchers are learning, genomics—combined with clinical and lifestyle data—will bridge the last miles for precision medicine and will begin to form the backbone of how we treat all disease. 

Aging Populations
By 2020, there will be more elderly people than children worldwide, according to the National Institute on Aging.

The graying of populations worldwide raises key questions: Will aging be accompanied by a longer period of good health, sustained mobility and extended periods of social engagement? Or will it be mean more illness, disability and dependency?

For the former, we need to discover cost-effective ways to care for the elderly in countries at different stages of economic development and with varying resources.

People today have fewer children, are less likely to be married and are less likely to live in the same household with older generations—and this is increasingly true in countries all around the world. With declining support from families, we will need better services and tools to ensure the well-being of the elderly.

There is a great opportunity to use education and preventive care to keep older people healthy longer. It is nearly inevitable, however, that many elderly people will lose their ability to live independently because of limited mobility, frailty, or other physical or cognitive declines. Many will require some form of assisted care.

In developed countries, acute care and institutional long-term care services are more widely available, including home care, community care and assisted living—although, for some, the associated costs can be prohibitive.

Less developed countries, however, don’t have the same level of established and affordable care available for the elderly. A common solution is for a family member to withdraw from employment or school to provide care, but with smaller families and a shift to urban centers, this becomes less probable.

Prediction: Given the increases in life expectancy and the unprecedented growth of older populations, we will see more demand to create affordable, in-home care options for the elderly in both developed and developing countries, now and in the decades to come.

Lifestyle Medicine
While New Year’s resolutions are an age-old trend, there is a new branch of research and practice that strives to prevent disease and reduce illness by using “lifestyle interventions,” such as nutrition, exercise and sleep.

Lifestyle medicine is motivated by research that indicates death, disease and health care costs are driven unnecessarily by behaviors we can change—especially physical inactivity and unhealthy eating.

Unprocessed foods, plant-based diets, exercise, sleep, stress management, alcohol moderation and tobacco cessation can replace medications in the prevention, treatment and even the reversal of highly prevalent chronic conditions such as hypertension, diabetes and obesity.

Prediction: While everyone knows it’s bad to eat and drink too much and to exercise and sleep too little, we still aren’t incorporating lifestyle medicine into conventional medicine. With more focus on preventive care, we will better integrate lifestyle and standard medical practices as we work to avert and treat chronic diseases, while also lowering costs and improving patient outcomes.

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