Precision Medicine vs. Public Health: a False Dichotomy?

The recent focus on precision medicine has attracted criticism from the public health community that firmly believes that health is determined by far more than health care, and that more sophisticated medical technologies may not adequately address important determinants of population health. There is no argument that a focus on the wider environmental, structural and social determinants of health is of the greatest importance for improving the health of populations and addressing health disparities. However, we wonder whether a contrast between public health practice and precision medicine is a false dichotomy. Improving the health of populations requires a multifaceted approach that includes access to quality health care and diverse disease prevention efforts. Already public health programs are using the power of genomics and molecular tools in the investigation and control of infectious disease outbreaks. For common chronic diseases, evidence is accumulating for targeting preventive actions that incorporate genomics.

Population health planning and prevention require that efficient use of resources be directed at those most in need.   In addition to other characteristics such as age, gender, and location, genetic susceptibility factors may allow the stratification of populations into risk groups for multiple chronic diseases and thus could provide for much more efficient and effective prevention and treatment strategies.

Finally, in the past few decades, there has also been change in consumer and patient engagement. Patients may now be less inclined to accept top down approaches to health care, whether health promotional advice or screening programs. Placing the individual citizen at the center of health care and disease prevention may require that they be given much more information about themselves. As we discuss elsewhere, ignoring the importance of advances in genomics and digital technology can contribute to a widening schism between medicine and public health. In the era of technology and big data social, environmental, and biological factors are all important in improving health care and preventing disease. Medical and public health practitioners need to work collaboratively to evaluate and use emerging new sciences for the benefit of population health.