Magazine article The Nation's Health

Genomics Heralded as New Tool for Improving Public Health: Emerging Science

Magazine article The Nation's Health

Genomics Heralded as New Tool for Improving Public Health: Emerging Science

Article excerpt

WITH the completion of the Human Genome Project in 2003, public health professionals were handed a tool that holds promise for improving lives and preventing common chronic diseases. Today, advances are taking place rapidly in the field of genomic medicine, but a host of hurdles must be overcome before it can be fully integrated into public health practice.

The study of genomics has broad applications to public health, especially as the science grows from its traditional focus on rare diseases to include more common chronic diseases, such as heart disease, cancer, stroke and diabetes. According to the Centers for Disease Control and Prevention, genomics plays a part in nine of the 10 leading causes of U.S. deaths, and can likely help health care professionals understand why certain infections, behaviors and environmental factors will make some people sick but not others. Such information could lead to new and better ways to improve health and prevent disease.

"All branches of public health will be touched by genomics, if not today, in the next five to 10 years," said Muin J. Khoury, MD, MPH, director of CDC's National Office of Public Health Genomics.

CDC defines genetics as the study of inheritance, or the way traits are passed down from one generation to another. Genomics is a newer term that describes the study of all the genes in a person, as well as interactions of those genes with each other and with that person's environment.

Genomic advances are occurring rapidly. On March 30, for example, scientists from the National Human Genome Research Institute announced that they had identified six additional genetic variants that are involved in type 2 diabetes, raising to 16 the total number of genetic risk factors associated with increased risk of the disease. And new research published in Nature in April found that people who carry a certain gene may be particularly likely to get addicted to cigarettes and may consequently be at greater danger of lung cancer and other diseases.

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Despite its promise to public health, genomics technology is so new that most U.S. health care professionals, including public health professionals and physicians, are largely unprepared to integrate it into clinical and public health practice.

Education, training and competency-based learning are needed to prepare the public health work force to embrace genomics, "not to become genomicists, but to be able to use the new tool to improve the health of the population," said Khoury, an APHA member.

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The development of public health genomics training is a major initiative within the CDC genomics office, which has also funded public health genomics training and capacity-building programs in several states.

"At the end of the day, public health professionals are very pragmatic and down to earth," Khoury said. "They want to improve the population's health and they want to use whatever tools are at their disposal. Our job is to close the gap between those new scientific genomics discoveries and our ability to actually use them to improve population health."

Translating genomic discoveries into real-life applications for preventing disease has been slow, in part because of a lack of funding.

"When the Human Genome Project was completed, we were all revved up," said Deborah Klein Walker, EdD, a past president of APHA. "We thought there was going to be a lot you could implement fast, but it's been a lot slower. There has not been enough research money for the translation of the findings of what we know about genomics into clinical and public health practice."

Translational research must be done in the public sector, Walker said. However, much of the work in genomics right now is taking place in the private sector, which might have different incentives than the public sector, and "might not be looking out for the full benefit of everyone in the population," she said. …

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