Healthcare systems face a cost crisis as they try to provide an increasingly wide range of transformative but expensive treatments to older, sicker populations. Better prevention that complements new treatments is essential. I will present metabolomics and genetics data from half a million blood samples from three national biobanks, and show that metabolomic risk scores predict future risk of disease better than genetics for most diseases that cause highest morbidity in Europe. I will show targeted analyses of predicting inflammatory bowel disease risk to complement these cross-disease analyses. Finally, I will describe a pathway to real-world implementation of ‘omic-enabled prevention.