The
following article was published with modifications in ASTHO Report,
Sept-Oct 1998
Genetics and Public Health - Need
for Information, Integration and Infrastructure
by Timothy Baker,
Assistant Director, CDC Office of Genomics and Disease Prevention
Advances in human genetics will have a profound
impact on the core functions and essential services associated with public health
organizations, and promise significant developments for improving the health of the
public. These initial discoveries have been likened to the first electric service lines
that provided power for light bulbs and simple appliances. Even those initial few who
benefited from its immediate value could hardly conceive of the computers and technologies
which today use electricity to manage our daily lives. As the Human Genome Project
identifies the remaining 80,000 to 100,000 human genes over the next few years, public
health will be faced with tremendous opportunities for translating this information
through public health assessments and research into the development of effective policies
and practices. The integration of human genetics into the health infrastructure creates a
particularly strong emphasis on the importance of sustaining an effective public health
assurance capacity. The potential for inappropriate or premature use of genetic
information without adequate protections for privacy and confidentiality are at the heart
of strengthening the national focus on associated ethical, legal and social issues.
Collaborative efforts are underway among national
and state public health organizations to identify and prepare to respond to these
challenges and opportunities. The Centers for Disease Control and Prevention has developed
a strategic plan entitled "Translating Advances in Human Genetics into Public Health
Action" that outlines a framework and many of the key aspects of this process. This
plan has helped to guide efforts such as the First National
Conference on Genetics and Public Health (May 1998) and initial development of
genetics and public health training programs which are designed to expand and strengthen
capacity. Public health leaders at all levels are becoming increasingly engaged in the
many planning and program development aspects of human genetics, and are identifying key
issues and concerns requiring attention. Several themes resonate as a focus for the next
steps.
First, information. Relevant
information is needed to guide planning and program efforts, and to strengthen public
health knowledge and capacity. Surveillance and epidemiologic research methods will help
to produce the population-based information needed for policy and program development, and
will help to correlate modifiable risk factors with common human genetic variations. This
is the foundation for new information to enhance disease prevention and health promotion
programs affecting large segments of the population.
Second,integration. Developments
in human genetics need to be integrated into public health planning and programs, and into
the core functions and essential services of public health organizations. Public health
leaders are struggling with elevating and expanding the role of genetics from the
traditional maternal and child health specialty into a program-by-program capacity for
common genetic variations associated with chronic diseases affecting millions. A balanced
leadership focus for sustaining existing, effective genetic service strategies while
integrating complementary expertise into meet emerging, cross-cutting programs is needed.
Third, infrastructure. Demands on
public health organizations to effectively integrate advances in genetics into program
activities require a corresponding expansion of core function capacity and capabilities.
Some of the infrastructure needs that have been identified are epidemiologic expertise and
capacity in genetics, clinical expertise in genetics, increased laboratory expertise and
capabilities, legislative and policy developments, genetics and public health training,
and extended information management and analysis capabilities. Achieving sustainable
public health capacity in human genetics requires changes in professional training
programs, and the targeted retraining of public health staff relevant to existing public
health function. Strengthening the over-extended public health infrastructure is pivotal
to integrating information about genetics into public health assessments, policy
development and assurance functions.
