airprom : airway disease , predicting outcomes through patient specific computational modeling ( fp7 ) ; bioshare - eu : biobank standardization and harmonization for research excellence in the european union ( fp7 ) ; ict : information communication technology ; medall : mechanisms of the development of allergy ( fp7 ) ; naepp - epr3 : national asthma education and prevention program , expert report 3 ; ncd : non - communicable disease ; p4 , predictive , preventive , personalized and participatory ; u - biopred : unbiased biomarkers in prediction of respiratory disease outcomes ( fp7 ) ; un : united nations ; who : world health organization . the authors declare that they have no competing interests in relation to the content of this article . may 2008 : 61st world health assembly . who recommended a worldwide priority policy on ncd prevention and control ( 2008 to 2013 ) , including cardiovascular disease , cancer , chronic respiratory diseases   and diabetes , not least because they often have common environmental risk factors . may 2010 : united nations ( un ) general assembly unanimously adopted resolution a / res/64/265 : ' tackling ncds constitutes one of the major challenges for sustainable development in the 21st century ' . december 2010 : the council of the european union adopted conclusions based on innovative and global approaches for ncds in public health and healthcare systems to further develop population - based and patient - centered policies . 2010 : us center for disease control and prevention ( cdc )   says that ' an essential strategy for keeping older adults healthy is preventing ncds and reducing associated complications ' . the classical definition of prevention   includes : primary prevention : to avoid the development of disease . secondary prevention : recognize a disease before it results in morbidity ( or co - morbidity ) . tertiary prevention : to reduce the negative impact of established disease by restoring function and reducing disease - related complications . expanding on the traditional model of prevention , gordon   proposed a three - tiered preventative intervention classification system on the basis of the population for whom the measure is advisable based on a cost - benefit analysis : universal prevention addresses the entire population ( for example , national , local community , school , and district ) and aims to prevent or delay risk factor exposure . all individuals , without screening , are provided with information and skills necessary to prevent the problem . the subgroups may be distinguished by characteristics such as age , gender , family history , or economic status . indicated prevention involves a screening process . according to these definitions , health promotion   should be used for primary universal and selective prevention strategies , whereas p4 medicine ( predictive , preventive , personalized and participatory )   should be used for primary , secondary and tertiary indicated prevention strategies . to prevent the occurrence of ncds by implementing effective action at societal and individual levels : to detect and diagnose disease at an early stage , when it can be controlled effectively . to stratify patients into groups , enabling the selection of optimal therapy . to reduce adverse drug reactions through the predictive or early assessment of individual drug responses and assessing genes leading to ineffective drug metabolism . to improve the selection of new biochemical targets for drug discovery . to reduce the time , cost , and failure rate of clinical trials for new therapies . to shift the emphasis in medicine from reaction to prevention and from disease to wellness . part of the conceptual work presented has received support from the european commission fp7 projects airprom ( grant agreement fp7 270194 ) , bioshare - eu ( grant agreement fp7 261433 ) , medall ( grant agreement fp7 264357 ) , synergy - copd ( grant agreement ) and u - biopred ( grant agreement imi 115010 ) . jb , jma , ac - t , fk , mlk , sp , cp and ca were supported by medall ; pjs , i m a and kfc were supported by u - biopred ; jr and aa were supported by synergy - copd ; cb was supported by airprom ; ac - t was supported by bioshare - eu . the positions , proposals and ideas expressed in this paper have been discussed by several authors ( ca , zc , lh , ab , jb , ac , sa , dc , dn ) during the inaugural event of the european institute for systems biology and medicine of the systemoscope international consortium at the biovision world life sciences forum in lyon on 28 march 2011 .
we propose an innovative , integrated , cost - effective health system to combat major non - communicable diseases ( ncds ) , including cardiovascular , chronic respiratory , metabolic , rheumatologic and neurologic disorders and cancers , which together are the predominant health problem of the 21st century . 
 this proposed holistic strategy involves comprehensive patient - centered integrated care and multi - scale , multi - modal and multi - level systems approaches to tackle ncds as a common group of diseases . rather than studying each disease individually 
 , it will take into account their intertwined gene - environment , socio - economic interactions and co - morbidities that lead to individual - specific complex phenotypes . 
 it will implement a road map for predictive , preventive , personalized and participatory ( p4 ) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information . 
 it will be supported by strategic partnerships involving all stakeholders , including general practitioners associated with patient - centered care . 
 this systems medicine strategy , which will take a holistic approach to disease , is designed to allow the results to be used globally , taking into account the needs and specificities of local economies and health systems .