Genomics and individuals in public health practice: are we luddites or can we meet the challenge?

1. R.L. Zimmern, Chairman, Foundation for Genomics and Population Health⇓

+ Author Affiliations

1. Foundation for Genomics and Population Health, 2 Worts Causeway, CB1 8RN Cambridge, UK

1. Address correspondence to R.L. Zimmern, E-mail: ron.zimmern@phgfoundation.org

Introduction

This paper is directed at my public health colleagues. It is written explicitly to challenge existing ethos and practice. It is deliberately provocative. Its message is that public health will need to amend its practice over the coming decades to take into account two important drivers to which it has so far paid little attention.

The first driver is genomic science. Knowledge derived from it has enabled us to understand with much greater precision molecular mechanisms in health and disease and has led to the development of genome-based technologies that have contributed to diagnosis, risk prediction and the management of patients. The second are the societal changes that place individual autonomy and responsibility at the heart of clinical practice, causing a retreat from professionally-led paternalism to a practice where patient autonomy lies at the heart of all health care.

My argument is that these drivers that have significantly influenced the practice of clinical medicine over the last two decades must also now lead to a change in public health practice. Some of my colleagues, particularly those in academia, are aware of and perhaps even agree with this contention. But the majority of public health professionals have shown little sign that they appreciate such trends, and the day-to-day practice of public health in the UK has not changed significantly by way of response.

Public health genomics was established in 1997 as a field of study and practice which places genome-based science at its core, and is now developing internationally into a specific and recognizable subspecialty.¹ Since the meeting of experts in Bellagio in 2005,^2,3 its official definition has been agreed to be: the responsible and effective translation of genome-based knowledge and technologies for the benefit of population health ‘the responsible and effective translation of genome-based knowledge and …

Genomics and individuals in public health practice: are we luddites or can we meet the challenge?