From Sick Care to Health Creation: Berkeley’s Michael C. Lu on Redesigning Systems for Lifelong Well-Being

By any measure, health systems worldwide are under pressure. Populations are aging, chronic disease is surging, and costs are spiraling. The instinctive response has been to pour more resources into treatment. Yet Michael C. Lu, Dean of the UC Berkeley School of Public Health, argues that this approach is misguided. Instead of doubling down on “sick care,” societies should pivot toward “health creation”—designing conditions that enable people not just to live longer, but to live better.

In an exclusive interview with GeneOnline, Lu unpacked a vision that blends biology, policy, and education. Drawing on decades across academia, government, and clinical medicine, he lays out a framework to rethink care from life’s earliest stages through old age.

Aging Starts Before Birth

For Lu, the first principle is deceptively simple: health does not begin at adulthood, or even at birth. “Aging actually starts before you were born,” he said, referencing the developmental origins of health and disease theory. Low birth weight, for instance, has been strongly associated with higher risks of hypertension, diabetes, and heart disease later in life.

Lu’s research career began in obstetrics and gynecology, where he saw firsthand how prenatal care was treated as a stand-alone intervention. “Trying to cram all the good things into nine months of pregnancy is expecting too much,” he reflected. Instead, he advanced the idea of a life course approach: if you want healthy pregnancies, you must begin much earlier—supporting women when they are children, adolescents, and young adults, long before they become mothers.

This view reshapes how we think about aging. Rather than a sudden biological decline that begins in one’s 60s, aging becomes a continuum shaped by social and biological forces throughout life. For policymakers, this means tackling child poverty, nutritional access, and environmental exposures is as much a longevity strategy as funding geriatric clinics.

Rethinking Prenatal Care: From the Clinic to the Home

One of Lu’s sharpest critiques targets the way prenatal care is still delivered. The system, designed more than a century ago, asks women to attend up to 15 clinic visits during pregnancy—often involving hours of waiting for just a few minutes of rushed consultation.

“For low-income women, that means lost wages, childcare costs, and multiple bus rides for what? A blood pressure check, a urine dip, a fundal height measurement, maybe 10 minutes with a doctor who’s already behind schedule,” Lu explained. “Is that really the best we can do in the 21st century?”

His proposed alternative is radical yet increasingly feasible: home-based, technology-enabled prenatal care. Wearable devices could track vitals continuously, rather than relying on a single reading in the clinic. AI algorithms could triage risk, flagging who needs a home visit, who requires counseling, and who must come to the hospital immediately. Environmental and social supports—from cleaning up mold to ensuring stable housing—would round out the care model.

“Instead of one-size-fits-all care, we could tailor support to each woman’s needs,” Lu said. “That’s what prenatal care really should look like.”

Payment Reform as the Linchpin

Technology may unlock possibilities, but Lu insists that systems change hinges on payment reform. “There’s not going to be systems innovation without payment innovations,” he said. Health systems that reward visits and procedures, rather than prevention and well-being, leave little room for redesign.

He argues that payers—whether governments like Taiwan’s National Health Insurance or private insurers elsewhere—must align financial incentives with long-term health creation. Life insurers, too, stand to benefit if people live longer in good health. “There are win-wins here,” Lu emphasized. “But somebody has to design them.”

The implication is clear: without tackling the economics, promising models of home-based care or AI-assisted monitoring will remain pilots, never mainstream.

The Biology of Stress and Aging

While policy redesign is one half of the story, biology is the other. Lu draws on a striking metaphor to explain aging at the cellular level: the gas pedal and the brake pedal.

“When you’re young, growth pathways like mTOR and IGF-1 are essential. They help you grow, reproduce, fight infections,” he said. “But if the gas pedal gets stuck, it accelerates inflammation and disease. Meanwhile, the brakes—your repair mechanisms—wear down or get switched off. Sooner or later, the car crashes.”

This imbalance explains why modern environments—characterized by chronic stress, poor sleep, unhealthy diets, and constant exposure to pollutants—can accelerate biological aging. Yet science also suggests ways to restore balance. Epigenetic reprogramming, caloric restriction, intermittent fasting, and exercise all appear to reactivate repair pathways. Even cold plunges, Lu noted, may serve as “good stress” that wakes up the body’s defenses.

The research is no longer hypothetical. Studies in mice have shown that reprogramming factors can extend lifespan by 30% and even reverse blindness. “It challenges the idea that damage is irreversible,” Lu said. “Maybe it’s just a glitch in the program. And if you reboot, the system can work again.”

Educating and Connecting Changemakers

Transforming public health begins with transforming the people behind it. Academia’s role is no longer limited to training researchers—it must prepare leaders who can navigate complexity, build coalitions, and translate knowledge into action.

“Most people who come into public health want to make the world better,” stated Lu. “But wanting isn’t enough. You need the tools to lead change, to collaborate across divides, to think in systems.”

That philosophy has reshaped how universities approach education. At Berkeley, the Changemaker Curriculum extends beyond epidemiology and biostatistics to include leadership, design thinking, and communication—skills essential for turning ideas into impact. “We encourage students to question authority,” Lu added. “There’s got to be a better way—whether in climate, health, or peace.”

Academia also serves as a neutral bridge between government, industry, and communities. Lu noted that breakthroughs often emerge when unlikely partners share data and resources—such as collaborative screening or disease research initiatives led across institutions. “Universities can play the trusted role,” he said. “The question is, can we harness that goodwill to solve big problems?”

By reimagining both education and collaboration, academic institutions can help build a generation of changemakers ready to move health systems from isolated care toward collective health creation.

Toward a Way Forward for Health Creation

Lu frames the future in terms of a pathway—a set of priorities that, taken together, could transform health systems from reactive to proactive:

• Recognize that health starts before birth and is shaped by lifelong environments.
• Reimagine prenatal care as home-based, personalized, and supported by technology.
• Reform payment systems to reward prevention and health creation, not just sick care.
• Address social determinants of health: poverty, housing, nutrition, and pollution.
• Leverage the science of stress and repair to extend healthspan, not just lifespan.
• Educate public health leaders with the tools to lead change and bridge divides.
• Foster cross-sector alliances, bringing government, academia, and industry together.

“The goal is not only to help people live longer, but healthier,” Lu said. “We are on the cusp of a healthcare revolution. The science is there. The technology is there. What we need now is the will to bring everyone to the table.”

The Bigger Picture—Act Now, Not Later

Lu’s argument reframes public health as a grand challenge of system design. It is not enough to chase breakthroughs in biotechnology or AI in isolation. Those must be embedded in payment reforms, social policies, and educational pipelines that align incentives with human well-being.

His message resonates far beyond Berkeley or the U.S. For countries facing demographic cliffs, from Taiwan to Italy to Japan, the choice is stark: invest in health creation now or drown later in the costs of sick care.

And while his roadmap may sound ambitious, Lu insists it is achievable. “We’ve seen global cooperation on climate, on COVID, on big scientific projects,” he said. “Why should health creation be any different?”

Universities can broker data-sharing and payment pilots among pharma, payers, and public agencies, turning goodwill into governance that rewards health creation—not service volume. Lu frames academia as the trusted catalyst for those deals. Image: GeneOnline

Author

Bernice Lottering