Offline: In defence of precision public health - The Lancet

Offline: In defence of precision public health - The Lancet



Writing in the NEJM recently, Merlin Chowkwanyun, Ronald Bayer, and Sandro Galea questioned and then attacked the emerging concept of precision public health. They labelled the “precision medicine” movement a “bandwagon”. They drew attention to the way organisations, such as the Bill & Melinda Gates Foundation, had extended the idea of “precision” to public health. They suggested that precision public health could represent “an abandonment of our mission of enhancing population wellbeing”. The core of their criticism was that whereas public health starts with populations, the word “precision” implies a concern only with individuals. The risk is that precision public health would, by its very definition, ignore the broader social, political, economic, and environmental determinants of health. Calling for public health to take a precision approach, they argued, was nothing more than a “rebranding” exercise. It might invite a new era of “magic bullets”. They foresaw precision public health edging towards an individualised, genomics-focused enterprise. They concluded their perspective by stating that, “we believe there's no need to add the word ‘precision’ to ‘public health’”. I think Chowkwanyun et al are mistaken. Precision public health offers a compelling opportunity to reinvigorate a discipline that has never been more important for advancing the health of our most vulnerable and excluded communities.