Why should early career public health researchers pay attention to precision medicine?

In a recent commentary published in the American Journal of Public Health, I had the privilege of working with a group of early career investigators to begin a conversation about the impact that the debate between the utility of precision medicine and public health approaches is having as we begin our research careers.

To begin, let’s clarify the meaning of the often used but rarely defined terms of precision medicine and public health and why is there a debate about these two approaches.

Precision medicine: an emerging approach for disease treatment and prevention that takes into account individual variability in environment, lifestyle, and genes for each person.

Public health: the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.

Based on these definitions, it is clear that there is overlap in the goals of these fields and approaches. Ultimately, precision medicine and public health both have the common thread of seeking to prevent and treat disease, with key differences being where the emphasis is placed to achieve this goal. Advancing population health by combining precision and public health approaches is a field known as precision public health (defined as: “a field focused on providing the right intervention to the right population at the right time”). Skeptics of precision public health suggest that there is potentially minimal benefit of integrating the two fields of precision medicine and public health, and at worst, precision public health approaches could diminish or overshadow the efforts of a more traditional approach to public health.

In our commentary, we describe two reasons we believe early career investigators should pay attention to and be engaged in precision medicine via a precision public health approach.

• Reaping the population health benefits of precision medicine and ensuring equity in access and health impact

The first concern about the lack of collaboration between precision medicine and public health is that that separating the two fields will further entrench disparities in the implementation of precision-based approaches. Examples of this include the limited representation of diverse populations in the current use of molecular biomarkers. While newer initiatives such as the All of Us Research Program have sought to encourage participation among historically marginalized communities, there is continual work that needs to be done to foster equitable implementation and uptake of precision medicine advances across the population.

One great opportunity for the proactive collaboration between precision medicine and public health is through implementation science. This field and related methods fills a much needed void and may enable the adoption and integration of evidence-based precision medicine into routine health care and public health settings to improve impact on population health.

• Addressing the complexity of public health problems

The second concern raised among skeptics of precision public health is about the debate between individual and population approaches to solving health problems. Macro-level factors (e.g., environment, systems, and policies) that are often the focus of public health approaches are essential to individually-focused precision medicine approaches, and vice versa. Embracing this complexity and multi-level nature of the two fields will be critical to advancing efforts on both sides.

We believe it is necessary to reframe the debate about precision medicine’s value into testable research questions with hypotheses would allow us to objectively investigate important, complex questions about precision public health as it applies to multiple levels. For example, a recent article by Sabatello et al., began addressing how to better include individuals with disabilities in precision medicine research. Engaging this population is not only valuable in increasing diversity of cohorts, but also requires that researchers confront and address challenging historical and ethical questions related to including people with disabilities in research. In this first nationwide study, researchers found significant support among people with disabilities to engage in precision medicine research; however, authors offer numerous additional questions and barriers that could be studied, including opportunities to design tailored educational interventions and addressing barriers that span across the socio-ecological model (e.g., accessibility, communication, economics, institutional, and personal).

Moving Forward

Ultimately, emerging public health professionals and researchers have a unique role in addressing these challenges in disparities and multi-level influences of health. There is a need for creativity and collaboration, which should be encouraged, particularly among early career investigators. Working at the intersection of precision medicine and public health will be necessary as the field of precision public health continues to evolve. Early career investigators can be leaders in these efforts.

We welcome hearing from other early career investigators working to advance the integration of precision medicine and public health through precision public health approaches.