Precision Public Health for the Era of Precision Medicine.

The Precision Medicine Initiative 1 promises a new healthcare era. A proposed 1 million person cohort could create a deeper understanding of disease causation. Improvements in quality of sequencing, reduction in price, and advances in “omic” fields and biotechnology promise a new era, variably labeled personalized or precision medicine. Although genomics is one driver of precision health care, other factors may be as important (e.g., health information technology). Both excitement and skepticism met the announcement. Public health experts are concerned about the disproportionate emphasis on genes, drugs, and disease, while neglecting strategies to address social determinants of health. A prime concern for public health is promoting health, preventing disease, and reducing health disparities by focusing on modifiable morbidity and mortality. In 2014, CDC estimated the annual number of potentially preventable deaths from the top five causes in the U.S. Data suggest that at least one third of deaths are potentially preventable by reducing prevalence of known risk factors (e.g., smoking, poor diet, and inadequate physical activity). Could the same technologies that propel precision medicine usher in a parallel era of “precision public health” beyond treatment of sick individuals? If precision medicine is about providing the right treatment to the right patient at the right time, precision public health can be simply viewed as providing the right intervention to the right population at the right time. More-accurate methods for measuring disease, pathogens, exposures, behaviors, and susceptibility could allow better assessment of population health and development of policies and targeted programs for preventing disease. The initial drive toward precision public health is occurring, but much more work lies ahead to develop a robust evidentiary foundation for use. The following are examples of priority areas.