Journal Publication

What Does Genetics Mean for Public Health Practice?

On Monday, February 8, 1999, ASTHO held a conference call for all five of its policy committees to discuss the implications of genetics for public health. Over the past year, ASTHO has been building relationships with the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and others to collaborate on the strategic initiative to translate advances in human genetics into public health practice. ASTHO is currently working with these partners to plan the Second National Conference on Genetics and Disease Prevention, to be held December 6 - 8, 1999 in Baltimore, Maryland. This year's theme, "Integrating Genetics into Public Health Policy, Research, and Practice," exemplifies the goal of creating the capacity to incorporate this new knowledge into all areas of public health for the purpose of improving health.

Two years ago, CDC engaged in a strategic planning effort, led by Dr. Satcher, to apply the scientific knowledge coming out of the Human Genome Project to disease prevention and health promotion efforts. CDC's Strategic Plan led to the creation of CDC's Office of Genomics and Disease Prevention (OGDP).

Tim Baker, OGDP's Deputy Director, as well as ASTHO's government project officer for genetics, provided his thoughts on the implications of genetics for public health, as well as CDC's activities and priorities for the upcoming year. He addressed such questions as "How do we use genetic knowledge to improve health?" and "What is the relevance and urgency for public health?" Public health's role, according to Mr. Baker, is "to use genes to identify environmental interactions that allow us to find modifiable risk factors that result in the prevention of disease." In order to do this, we must have the requisite Information, Integration, and Infrastructure (For elaboration on these concepts, see Mr. Baker's article from the September-October 1998 issue of the ASTHO Report).

Dr. Joann Lindenmayer from the Rhode Island Department of Health used the same three themes of Information, Integration, Infrastructure to frame the discussion points from the Genetics State Assessment. This Assessment, conducted by the Council of State and Territorial Epidemiologists (CSTE) in collaboration with ASTHO and CDC, sought (1) to obtain information about state programs and activities related to genetics to assess key issues and concerns for incorporating new genetic information into public health and (2) to heighten awareness in the public health community at the state level of the major issues that will be raised as information from the Human Genome Project becomes available.

The Assessment found that most states do have expertise in the field of genetics (usually within the MCH division), but that there does not appear to be much coordinated planning dealing with genetics at this time. Recommendations include suggestions to build upon MCH expertise and existing resources to develop capacity in other public health programs such as chronic disease, laboratories, infectious disease, environmental health, etc. It was also recommended that strategic planning efforts include representatives from throughout state health departments to develop a comprehensive plan to integrate genetics into all areas of public health, as the science matures.

Unfortunately, there is a lack of information concerning populations and variations of outcomes, but as this information becomes available, state health departments need to be able to use it to develop effective policies and programs. There are some resources and data currently available, such as CDC's Human Genome Epidemiology Network (HuGE Net) and other resources within states.

With regard to genetic testing, the Assessment indicated that most state health departments don't regulate genetic testing and many lab directors think that testing is already covered by existing legislation. There is some good evidence that genetic testing raises some issues and problems that are not covered by existing legislation. The Assessment recommends that state health departments examine existing and proposed legislation and remain aware of the issues that are specific to genetics.

Ms. Brenda Trolin from the National Conference of State Legislatures pointed out that there is a great deal of legislation being proposed in the area of genetics, but currently much of the focus is on human cloning and medical record privacy issues. She indicated that new legislation is being proposed and existing legislation is being revisited, thereby providing state health officials with the opportunity to voice their concerns with regard to the regulation of genetic testing, as well as other issues.

Taking a long-term view of genetics issues, NCSL has formed a Legislative Task Force on the subject and a Blue Ribbon Panel on Genetic Technologies to help develop legislation. Ms. Trolin also announced that NCSL will be holding a conference on genetics in Lake Tahoe in late May. This forum may provide an opportunity for state health officials to speak with state legislators about issues of concern to public health.

Ms. Kaye Bender, Deputy State Health Officer for the Mississippi State Department of Health, presented four components to mobilizing efforts to create a nationwide framework for states to use in developing response plans, as identified by ASTHO's Management Committee:

1. Training. It's optimal that CDC and ASTHO are raising these issues now while there is time to do some planning.
2. Nationwide policy dialogue, much like the public health community has had on other issues. To promote the dialogue in a way that leads to…
3. …Consensus on the content of public health's response. When state and local level agencies can have a national framework in which to place some of these complex issues, it helps us to develop appropriate local policy.
4. Health communications plan. We need to know the quality of the lab testing and the quality of the information, with some standard measures; we also need public health education messages.

Finally, from a practical standpoint, a funding source for planning at the state level to facilitate this process and to support state and local level conferences would expedite the process. Ms. Bender welcomed comments and suggestions regarding these issues on behalf of the Management Committee and Ed Thompson, State Health Officer in Mississippi and ASTHO President.

The role of genetics in public health will continue to grow as new discoveries are made and as gene-environment interactions are better understood. ASTHO will continue to monitor these issues and work with state health departments, federal agencies, and other national partners to develop a sound national public health agenda for using genetic knowledge to improve health.