Precision Public Health is Why Health Data Matters
Blog by Scott Frank MD, MS, November 2016
In the 2015 State of the Union Address, President Barack Obama announced the Precision Medicine Initiative (PMI) to advance prevention and treatment in a direction that focuses on the factors that contribute to the health of the individual.
This $215M (2016 budget) initiative is slated to first focus on cancer genetics, and then shift to include will involve a 1 million plus cohort study that will look at participants’ individual genomes, lifestyles, and environmental factors to address chronic disease and overall health. The National Institutes of Health (NIH) describes precision medicine  as "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person." It is in essence a medical model that proposes the customization of healthcare, with medical decisions, practices, and/or products being tailored to the individual patient. Precision medicine is about providing the right treatment to the right patient at the right time.
While PMI generated enthusiasm in biomedical and healthcare settings, public health researchers expressed concern about lack of attention to real and immediate public health issues and whether a PMI approach rooted molecular genetics could realistically improve population health. Concern has been expressed that the initiative continues an American focus on health improvement within the healthcare systems, despite strong evidence that health—and health improvement—happens primarily in the community, not in doctor’s offices and hospitals.
Enter precision public health.
First described in spring 2016 precision public health treats the community as precision medicine treats the body. As such, precision public health involves preventing disease, promoting health, and improving health equity by applying emerging technologies for measuring and geo-locating social, economic, and physical determinants of health, including environmental exposures, risk behaviors, and susceptibility by population and place. This information is then used to develop and implement targeted policies and public health programs to improve health. Just as precision medicine seeks to gain increasing understanding of the complexity of the human body, precision public health examines complexity within communities. Thus, precision public health is about providing the right intervention to the right population at the right time. And just as every human body has patterns of similarities and difference that are constantly shifting, so it is with families, neighborhoods and communities. It is in understanding these complexities with the affected communities that robust solutions are developed.
Four priorities have been described for precision public health. The first is to emphasize the role of multidisciplinary public health sciences, or in our case, the need for diverse stakeholders to be on board for success. The second priority involves the necessary, ongoing shift in from treatment to prevention long advocated by public health. Precision public health can also become a mechanism for improving early detection of pathogens and infectious disease outbreaks. Big data has the potential to accelerate early detection of outbreaks and other community health issues. Finally and most importantly, precision public health is necessary for modernizing public health surveillance, epidemiology, and information systems. It is incumbent upon public health to use new data systems and information technology to support systematic, ongoing collection, management, analysis, and interpretation of data to stimulate and guide action.
It is important to note that precision public health does not change what we seek to accomplish through Health Data Matters. Precision public health simply provides a framework to describe what we are already doing and seeking to do. The movement advocates what we have begun to operationalize: increasingly local, accurate, and real time metrics for exposures, behaviors, and susceptibility that can allow better assessment of the health of neighborhoods and communities, supporting development of policy and programs that promote health and prevent disease. Precision public health gives both language to and validation of our approach in a way that may enhance both effective communication and advocacy; and fund raising efforts to support continued innovation. It is the “hyperlocal” approach that we have taken—that was insisted upon by our stakeholders— that puts Cleveland and Cuyahoga County on the front edge of the precision public health wave. Only if the right people, in the right organizations, have the right resources, and do the right analyses can we provide the right intervention to the right population at the right time. Enter precision public health.
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 Kathy Hudson P. The Precision Medicine Initiative Cohort Program--Building a Research Foundation for 21st Century Medicine. In: Richard Lifton M, PhD, editor. Precision Medicine Initiative (PMI) Working Group Report to the Advisory Committee to the Director, NIH; 2015.
 Khoury MJ, Galea S. Will precision medicine improve population health? JAMA 2016;316(13):1357-1358.
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 Khoury MJ, Iademarco MF, Riley WT. Precision Public Health for the Era of Precision Medicine. Am J Prev Med. 2016; 50(3): 398–401.