2016: The Year of Precision Public Health!

In our 2015 end-of-year blog post entitled: “Public health genomics 2015: Looking back, looking ahead”, we predicted that 2016 will feature a more in-depth exploration of “key concepts for the development of precision public health beyond genomics to include a variety of personal and environmental data for preventing disease and promoting health.”

One year later, we are well on our way in that exploration. Here are a few highlights. After the publication of our paper on “precision public health for the era of precision medicine”, a flurry of activities and publications refined the idea of precision public health as delivering the right public health intervention to the right population at the right time. Dr Sue Desmond-Hellman, CEO of the Gates Foundation, and her team have shown strong scientific and global health leadership in convening the discussion on precision public health. In June 2016, the University of California at San Francisco in collaboration with the Gates Foundation and the White House Office of Science and Technology held a summit on precision public health attended by more than 130 individuals from fields such as public health, academia, government, technology and philanthropic foundations. The purpose of the meeting was to discuss and scope out how technology and big data can be used to better understand population health and deliver life-saving interventions with more precision. Although the focus of the meeting was on infancy and early childhood, the themes and principles do apply across the life span.

In addition to the summit, 2016 also saw a number of events (example), presentations (example) and publications (example) on precision public health.   Most recently, Dowell et al from the Gates Foundation laid out four steps to precision public health. The commentary expands on the idea that better and more accurate surveillance data can drive interventions for the control and prevention of diseases around the world. Using “data to guide interventions that benefit populations more efficiently is a strategy we call precision public health. It requires robust primary surveillance data, rapid application of sophisticated analytics to track the geographical distribution of disease, and the capacity to act on such information.” While the availability and use of data is the norm in the developed world, much of the developing world is not reaping the advantages of precision population health data. For example, in Guinea, “it took months to assemble enough data to clearly identify the start of the largest Ebola outbreak in history. This should take days. Sub-Saharan Africa has the highest rates of childhood mortality in the world; it is also where we know the least about causes of death.”

To achieve more precision in global public health interventions, Dowell et al outline four concrete steps including:

1- Registering births and deaths, as basic demographic data are necessary for rational public-health decisions.

2- Enhancing surveillance systems to track disease, requiring infrastructure and systems to collect and analyze data.

3- Incorporating laboratory analyses to understand causes of death and disease.

4- Training more public-health personnel to use local information for setting strategies and  translating decisions into action.

As envisioned by the Gates Foundation, “precision public health” is really next-generation public health. For decades, public health has used surveillance data, epidemiology, laboratory sciences, training and community engagement to diagnose, investigate and solve public health problems around the world. What is different in the age of “precision” is that more tools and technologies have become available to accelerate the collection, sharing, and rapid use of information for decision making and targeting interventions.

At the CDC, we continue to explore new tools and technologies that can accelerate the mission and work of public health both in the United States and around the world. The use of emerging laboratory technologies, such as pathogen genomics, has revolutionized the tracking and investigation of infectious disease outbreaks in the nation. Recent examples and projects from the CDC Advanced Molecular Detection Initiative can be found here. In addition, federal and state agencies have enhanced their public health surveillance activities to track selected hereditary cancers in populations, educate providers and measure implementation and disparities in implementation in subpopulations. More broadly, CDC has been modernizing its overall surveillance strategy using new methods, standards, and software.

Precision public health will not happen overnight, however. As the Gates foundation article articulates, investments in core infrastructure, surveillance, laboratory methods, and training of the workforce will be needed to usher a transformation in public health. Emerging approaches will use more data faster and more precisely to reduce the global burden of disease.

We are interested in hearing your feedback and input on success stories in precision public health as well as near-term directions for this nascent field.

Happy New Year from all of us at the CDC Office of Public Health Genomics!