Optimizing Precision Medicine for Public Health

Abstract

Advances in precision medicine have presented challenges to traditional public health decision-making paradigms. Historical methods of allocating healthcare funds based on safety, efficacy, and efficiency, are challenged in a healthcare delivery model that focuses on individualized variations in pathology that form the core of precision medicine. Public health policy and decision-making must adapt to this new frontier of healthcare delivery to ensure that the broad public health goals of reducing healthcare disparities and improving the health of populations are achieved, through effective and equitable allocation of healthcare funds. This paper discusses contemporary applications of precision medicine, and the potential impacts of these on public health policy and decision-making, with particular focus on patients living with rare diseases and rare cancers. The authors then reconcile these, presenting precision public health as the bridge between these seemingly competing fields.

Keywords: genetic disease; genetic therapies; genomic testing; genomics; molecular diagnostics; policy; precision medicine; public health.

Figure 1

The precision public health cycle. The cycle illustrates the benefits of precision approaches to improving patient care and population health.

Figure 2

Pathways, intersections and precision medicine. The intersections of (a), (b), and (c) represent opportunities for better risk stratification, surveillance, and therapeutics. For example, understanding the biological pathways resulting in the intersecting pathologies at (a,c), (a,b,c), and (b,c), can facilitate improved cancer surveillance (e.g., cancer screening).