Precision public health: Ushering in a new era for disease prevention
Public health is defined as the science and art of preventing disease, prolonging life and promoting health, at both the individual and community level, in order to inform health policy and priority-setting. Although many public health practices (vaccines, universal education) are applied broadly across populations, what if our approach to disease prevention could be tailored more specifically? So precisely, in fact, that we could minimize the risks for breast cancer development or know exactly where to focus prevention efforts for the Zika virus—before the disease becomes rampant? Precision public health may hold these answers.
“Precision public health is an emerging field, but it’s where we hope the field will continue to grow,” said Jay Maddock, Ph.D., dean of the Texas A&M Health Science Center School of Public Health. “It really focuses on two different streams: prevention at the individual level, and using new techniques and technologies to better assess emerging disease patterns to improve the overall health of the population.”
Precision medicine and precision public health
Much like precision medicine hones in on genetics, environment and lifestyle factors to choose the best treatment option for individual patients, the clinical side of precision public health focuses on preventing diseases based on family history and individual risk.
According to Maddock, genome sequencing is becoming quite affordable and will allow the average person and public health experts to better understand their genetic risk and predisposition to certain conditions. “Most people don’t adequately grasp genetic risk,” he said. “Personalized screening for genetic markers will allow public health professionals to do a better job when educating people about their health, instead of only relying on current one size fits all recommendations.”
Maddock explained he believes precision public health has the ability to personalize screening guidelines for the individual—instead of resting on blanket recommendations for the general public. “Take breast cancer prevention, for example. If a woman has a family history of breast cancer along with genetic expressions for the disease, we might recommend she begin screening for the disease as early as 30 years old,” he said. “This would not be the case for a woman who doesn’t have a family history of the disease and very low level of genetic expression.”
Maximizing efforts to minimize risk
Because most public health professionals give out fairly well-known health advice (don’t smoke, exercise 30 minutes per day, eat a healthy diet), precision public health methods will help experts answer the question: Who is most at risk for certain diseases and conditions?
Philanthropic powerhouse The Gates Foundation is pioneering the effort to answer this question—aiming to determine where diseases appear in certain populations—and backing research for a surveillance system to document the time, place and cause of infant mortality in developing countries.
Understanding genetic pre-disposition for diseases may be the key to unlocking the mysteries behind disease risk and prevention—especially concerning diabetes. Most people are exposed to diabetes through family history and genetics. If public health professionals are aware of these risks, they can give better counseling and do earlier screenings for pre-diabetes to stop the development of full-blown diabetes.
“Right now, we miss so many pre-diabetics,” Maddock said. “Better surveillance—possibly in the form of wearable monitoring and mobile sensor devices—could allow for a more precise view of individuals and their behaviors, helping us pick up more people at the pre-diabetic stage. We know certain medications, physical activity and nutrition can all prevent diabetes. We need to do more in the prevention stage, but still target those who are at a higher risk for the disease.”
Prevention in populations
Thanks to advances in big data—and the ability to aggregate, analyze and disseminate much larger amounts of data through advances in bioinformatics—precision public health will bolster baseline prevention methods at both the population and community level—through improved system dynamic modeling (a computer-aided approach to analyze, test and model interacting diseases and risks) .
“These new modeling methods will allow us to look at different behaviors in communities to detect patterns in certain medical conditions like diabetes,” he said. “Where do we expect diabetes to emerge? What are the effects of opening a fast food restaurant in a community over a grocery store? I will be very interested to see what these new data sets tell us about diabetes rates.”
With Zika virus on the rise, more people than ever are concerned about the rapid spread of the virus and where it may surface next. Imagine technology exists that can not only predict the spread of the virus—but also what types of problems it may cause for communities—and where public health professionals should continue to focus their efforts.
“Using big data to better analyze epidemics and how diseases are transmitted will help us develop techniques to slow or stop the spread of emerging infectious diseases,” Maddock said. “With Zika virus, we may be able to pinpoint communities the virus will hit hardest and target our resources there to stop or mitigate transmission—instead of focusing exclusively on universal prevention measures, like mosquito abatement in every community. This may be possible because of the ability to analyze data unavailable to us in the past.”
Balancing cost with common-sense
As with any new technology, it can be easy to get lost in the excitement and forget about the cost. Maddock said the biggest downside to precision public health may be the amount of money spent to fund it.
“Universal prevention will always be important and essential. We can’t afford to lose sight of traditional public health practices like vaccines, prenatal care, universal education, reduction of poverty, clean environments, etc.,” he said. “These factors affect everyone. It’s imperative we don’t divert all our funding to precision public health and neglect the baseline, important public health measures. [pullquote align=”full” cite=”” link=”” color=”” class=”” size=””]Precision public health is the frosting, not the cake.”[/pullquote]