Skye Nolan

Skye Nolan

My Career   I am currently working at Peter MacCallum Cancer Centre as a Clinical Research Coordinator in the Department of Radiation Oncology. Working closely with doctors, nurses and patients, I coordinate a range of clinical trials aimed at improving outcomes for oncology patients by improving treatments. Prior to commencing at Peter Mac, I was working as […]

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Public Health in the Genomic Era

Public Health in the Genomic Era

By on August 27, 2014 in Genetics with 1 Comment

Public health aims to prevent disease, prolong life and promote health in a whole population, where health is not just the absence of disease but total well-being in all aspects of life.
Public health usually operates within the formal structure of government in conjunction with efforts from organisations and individuals. It combines the study of social, economic, political and biological factors which impact health opportunities and health outcomes.

From the 20th to the 21st Century

Following the discovery of microbes and the development of Germ Theory, the understanding of how to prevent the spread of communicable diseases increased dramatically in the 20th century.

During this time, public health was characterised by initiatives such as the introduction of sanitary reforms, compulsory vaccination and the emergence of the modern hospital.

In the latter half of the 20th century developments in genetics and biotechnology allowed scientists to sequence DNA for the first time. By 2003 scientists had successfully sequenced the entire human genome and we had well and truly entered the Genomic Era. Genomic medicine promises health interventions based on personal risk information derived from the analysis of an individual’s entire genome.

Public Health Genomics

As genomics leads us into an age of individualised medicine, public health must adapt to incorporate the capabilities of genomic medicine into its existing framework to improve health at the population level. Genomics can be integrated into public health research, policy and programs to help us better understand disease, identify those at increased risk and provide more effective prevention.

Some Public Health Challenges of Genomic Medicine

Genomic technologies are at the forefront of science and health, and the idea of a “genetic revolution” is prominent in politics and media. However, the potential of genomic information also raises a number of regulatory and ethical issues.

Protections against genetic discrimination and protections of privacy are needed.

The development of new genomic technologies may also increase the healthcare gap between the affluent and impoverished societies. There is also concern that a ‘Brave New World’ or ‘Gattaca’ society will result from the advancements in genetic analysis, genetic diagnosis and reproductive technologies. The introduction of genomic technologies into public health initiatives requires these issues to be addressed and properly dealt with.

How much can genomic information really improve health outcomes?

While there is much anticipation that genome sequencing will transform health care at every stage of disease, there is also speculation about the potential of genetic risk information to improve health outcomes. Some researchers claim that the age of genomic medicine has not lived up to its promise and are still waiting for a genomic revolution.

Communication of genetic risk

Genomic research continues to identify gene variants associated with increased risk of common complex diseases such as heart disease, diabetes and cancer. Communicating these genetic risk estimates to healthy individuals may motivate them to engage in risk-reducing behaviours, such as making lifestyle changes and using medication.

Public health initiatives can adopt primary prevention strategies to reduce the incidence and impact of these common diseases by identifying those most at risk and target interventions towards those people.

Primary prevention depends not only on estimation of risk, but also on the impact that communication of risk will have on behaviour, and there is limited evidence on the impact of genetic risk information on risk reducing behaviours such as diet and exercise.

1 Reader Comment

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  1. Frances says:

    It seems that genomic medicine is gradually being incorporated into public health rather than transform it.

    I think you’ve got a fair point in recognising that the ‘genetic revolution’ might not ever come – although Gattaca fans may be disappointed!

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