Total Exposure Health: an innovation in precision health Published March 23, 2016 By Prerana Korpe Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- Walking in sunlight, being stuck in traffic, painting in a studio, listening to music, washing a car … What do these things have in common? Each illustrates a form of “exposure” through our environment and lifestyle. Health is not independent of environment and lifestyle. Our environment and lifestyle present a variety of factors which directly and indirectly affect our health and wellbeing. Each time we step out into the sunlight, we are exposed to UV rays. When we sit in traffic, we are exposed to vehicle emissions and pollutants. As we tend to our gardens, we are most likely exposed to some form of pesticide or herbicide. Physical exposure and chemical processes cause the body to change the way it performs, much like stress causes a change in the chemical makeup of the body. External exposures can impact the way organs perform and can lead to long-term health consequences. Factors known as “exposures,” are critical to the development of preventive medicine, as we take into account the role of our environment and lifestyle in our total health assessment –through precision health. Precision health is an outcome of the Precision Medicine Initiative, launched by President Obama in his 2015 State of the Union address. While precision medicine focuses on treatment of disease, precision health considers lifestyle and environment as factors in both disease treatment and prevention. “To provide proper interventions requires an understanding of health effects and their root cause –the exposure,” said Col. Kirk Phillips, Associate Chief for Bioenvironmental Engineering, consultant to the Air Force Surgeon General for Bioenvironmental Engineering. “Our medicine is not the only pathway to health. The food we eat, the choices we make, etc., all contribute to our wellbeing,” said Phillips. Precision health involves patient empowerment through research, innovations in technology and policy implementation. Understanding health impacts from exposures will help the total force make more informed choices during daily activities, to help reduce harmful exposures so they do not lead to future adverse health impacts. People will be better positioned to reduce certain exposures or avoid some harmful exposures altogether. This new era of medicine lays the foundation for patients and providers to work together to develop individualized care –putting patients at the helm. Precision health has already begun to make advances. New discoveries and treatments to improve chances of survival and reduction of exposure to adverse effects are underway. Bioenvironmental engineer Colonel Phillips developed the concept of Total Exposure Health to support the Air Force Surgeon General’s commitment to the healthiest and highest performing segment of the population. “In order to be the healthiest population, it will take something extraordinary,” explained Phillips. TEH is an embodiment of precision health. Considering human performance issues and the readiness of warfighters to perform missions, TEH is different because it looks at prevention. While restoring health is important, restoration does not transform a population into the state of “healthiest.” It is important to consider the role of primary prevention –the facet of medicine through which people are kept in the healthy state. Keeping people healthy is the foundation for progression towards the healthiest population. While treating illness is an important part of precision medicine, Total Exposure Health would provide the total force with information that allows people to keep themselves healthy and become active participants in protection of their individual health. Air Force Medical Service provides resources for protection, medical intervention, as well as health and medical testing. Through TEH, this would include advice on protective equipment that acknowledges exposures outside of the workplace. TEH would educate the total force on how to protect themselves from exposures, not just at work, but outside of work as well. "Total Exposure Health will provide our population an opportunity to have their exposures combined from work, the environment and their life style [everyday life choices like hobbies, diet and household chemical use] to receive proactive advice on health and other every day decisions along with information on how to protect them from exposure and thereby protect their health,” Phillips said. “Within the military, human performance issues are of critical concern. The Air Force recognizes the value of its beneficiaries and partnering with their health,” Phillips said. While health care delivery currently offers advice on nutrition and the effects of smoking and alcohol consumption, Total Exposure Health seeks to expand to other exposures and provide more clear advice on protecting health. Take for example, hearing and the different sound exposures which affect the status of our hearing. Based on the decibels, an activity such as listening to music through headphones can have compounding effects on the quality of our hearing over time. According to the National Institute on Deafness and Other Communications Disorders, noise exposure at work or during leisure activities can lead to high frequency hearing loss. Of Americans between the ages of 20 and 69, an estimated 15 percent have experienced high frequency hearing loss as a result of this noise exposure. The NIDCD reports that of Americans age 12 and older, one in eight has experienced hearing loss in both ears. “The infrastructure of health care is changing, just like the world around us,” said Richard Hartman, Ph.D., Chief Health Strategist, Total Exposure Health, Air Force Medical Support Agency. "This is an incredibly exciting time in our history with the advances in science, technology, and information and especially medicine. What makes Total Exposure Health bold is that TEH bridges all those innovations into one common solution.” Across the Air Force, bioenvironmental engineers are developing innovations to monitor, control and document exposures. Sometimes referred to as “exposure scientists,” BEEs have already been in the process of collecting exposure information on worker and community health. Using their expertise in occupational health of individuals along with individual wellbeing, BEEs have the capability to make significant contributions to the fundamental change in health care required for precision health. According to Hartman, the natural development in health care is to move into precision health. "TEH is at the intersection of healthcare and technology … Specifically, it takes advantage of the advances [within] science, medicine, technology and IT to better collect, analyze and understand --workplace, environment and lifestyle-- exposures to better inform the individual but also create a richer clinical experience with all the AFMS providers to create healthier lives,” said Hartman. Total Exposure Health is an AFMS strategic priority, in the early stages of development and will be evaluated through ongoing studies.