The P4 Health Spectrum - A Predictive, Preventive, Personalized and Participatory Continuum for Promoting Healthspan

Prog Cardiovasc Dis. 2017 Mar-Apr;59(5):506-521. doi: 10.1016/j.pcad.2016.08.002. Epub 2016 Aug 18.


Chronic diseases (i.e., noncommunicable diseases), mainly cardiovascular disease, cancer, respiratory diseases and type-2-diabetes, are now the leading cause of death, disability and diminished quality of life on the planet. Moreover, these diseases are also a major financial burden worldwide, significantly impacting the economy of many countries. Healthcare systems and medicine have progressively improved upon the ability to address infectious diseases and react to adverse health events through both surgical interventions and pharmacology; we have become efficient in delivering reactive care (i.e., initiating interventions once an individual is on the verge of or has actually suffered a negative health event). However, with slowly progressing and often 'silent' chronic diseases now being the main cause of illness, healthcare and medicine must evolve into a proactive system, moving away from a merely reactive approach to care. Minimal interactions among the specialists and limited information to the general practitioner and to the individual receiving care lead to a fragmented health approach, non-concerted prescriptions, a scattered follow-up and a suboptimal cost-effectiveness ratio. A new approach in medicine that is predictive, preventive, personalized and participatory, which we label here as "P4" holds great promise to reduce the burden of chronic diseases by harnessing technology and an increasingly better understanding of environment-biology interactions, evidence-based interventions and the underlying mechanisms of chronic diseases. In this concept paper, we propose a 'P4 Health Continuum' model as a framework to promote and facilitate multi-stakeholder collaboration with an orchestrated common language and an integrated care model to increase the healthspan.

Keywords: Allostasis; Allostatic load; Exercise; Healthspan; Nutrition; P4 medicine; Systems biology; Systems medicine; Wellness.

Publication types

  • Review

MeSH terms

  • Chronic Disease* / epidemiology
  • Chronic Disease* / prevention & control
  • Chronic Disease* / psychology
  • Delivery of Health Care* / organization & administration
  • Delivery of Health Care* / standards
  • Health Promotion* / methods
  • Health Promotion* / organization & administration
  • Humans
  • Intersectoral Collaboration
  • Models, Organizational
  • Precision Medicine / methods*
  • Preventive Medicine / methods*
  • Quality Improvement