Traditional public health practice has had a central reliance on data, and the core discipline of epidemiology, in order to inform health policy and priority-setting, drive health improvement across whole populations, and target disadvantaged populations. Core activities include risk factor and disease surveillance, screening, development of interventions and evaluation. Since the 1970s, New Public Health has also emphasised community engagement, health promotion, partnerships and advocacy.
In the last twenty years, and particularly with the sequencing of the human genome and advances in information communications technology, new possibilities are opening up for a much more finely delineated view of the ‘time-person-place’ triad, and hence a paradigm shift in public health. We propose wider use of the term ‘Precision Public Health’ to complement the parallel developments in medicine such as Personalised Medicine and Precision Medicine (a term used in a 2011 US National Academy of Sciences Report).
We are excited by the potential contribution of new fields such as genomics, other ‘-omics’ platforms (particularly phenomics and exposomics) and spatial health (geographic information systems or GIS), which together with new monitoring, wearable and mobile sensor devices allow for a more precise view of individuals and their behaviours over their life course, and within their community and local environments.
Furthermore, it is the combination of these new fields and the ability to aggregate, analyse and disseminate much larger amounts of data through advances in data linkage, bio-informatics and communications technologies, that holds even greater promise for advancing public health. In short, we should be aiming to combine the cloud (as in data) and the crowd (as in crowdsourcing and population benefit).
Nevertheless, we have to be aware that public health cannot advance by technology alone, and public health practice must remain grounded in the everyday reality of people’s lives. We need to be mindful of the need for validation of tools and tests, and the steps and pitfalls on the route from cell to bench to person to population. Measurement, classification and language issues may cloud as well as assist accurate interpretation. We also need to be cautious about ethical implications of the new precision technologies for consent and privacy, and indeed their potential to create unnecessary anxiety (through over-testing) and widen existing population-level inequalities.
We propose the following definition of ‘precision public health’: the application and combination of new and existing technologies, which more precisely describe and analyse individuals and their environment over the life course, in order to tailor preventive interventions for at-risk groups and improve the overall health of the population.
In this research topic we are seeking articles to address the following questions.
• What are the new ‘precision’ technologies, and how might they affect existing public health policy and practice, and in which areas (e.g. wellness, illness or disease states; if disease, communicable diseases or chronic diseases)?
• Will these new technologies be able to strengthen preventive strategies, improve access to healthcare or reach currently neglected or disadvantaged populations?
• What new and old technologies need to be combined and/or integrated in order to radically advance public health policy and practice, and lead to improved quality and quantity of life?
• What can we learn from the history and ethics of public health that will allow us to creatively and purposively take advantage of new technologies, many of which are developed in the private sector?
• What are the downsides of the new technologies and how can these be mitigated (e.g. through education or appropriate policy, risk management, systems design, research or regulatory frameworks)?
We specifically invite submissions in three broad areas:
• Genomics, exposomics, and other –omics platforms;
• Spatial health/GIS, population mobility, and sensors and wearables; and
• Data linkage, predictive analytics, and bioinformatics.
We welcome submissions from all countries, with varying levels of public health investment, all of whom have to assess, combine and apply new and existing technologies.
Definitions and clarification of terms The term and concept of ‘Precision Public Health’ was voiced by TW at a meeting convened by MB at Murdoch University in Western Australia in May 2013. By August 2013, it was being used widely by HD in Western Australian Office of Population Health Genomics documents. An earlier version of this research topic and title was first submitted to Frontiers in Public Health in March 2014. Following the announcement of the US Precision Medicine Initiative in early 2015, the term ‘Precision Public Health’ was used in a blog from US Centres for Disease Control and Prevention posted in March 2015, and in an article in American Journal of Preventive Medicine in November 2015.
Genomics is the study of an entire genome of an organism, including the interaction between genes, and with the environment.
Phenomics is the study of an individual’s set of physical and biochemical traits.
Exposomics is the study of the ‘totality of environmental exposures from conception onwards’, which are then linked to biochemical and molecular changes in the body (see
www.exposomicsproject.eu).