The Role of Government in Precision Medicine, Precision Public Health and the Intersection With Healthy Living

doi:10.1016/j.pcad.2018.12.002

Progress in Cardiovascular Diseases

Volume 62, Issue 1, January–February 2019, Pages 50-54

https://doi.org/10.1016/j.pcad.2018.12.002 Get rights and content

Abstract

This paper focuses on the significant role of government in promoting precision medicine and public health and the potential intersection with healthy living (HL) and population health. Recent research has highlighted the interplay between genes, environments and different exposures individuals and populations experience over a lifetime. These interactions between longitudinal behaviors, epigenetics, and expression of the human genome have the potential to transform health and well-being, even within a single generation. Precision medicine can elucidate these longitudinal interactions with a granularity that has not been previously possible across the exposome. Understanding the interactions between genes, epigenetics, proteins, metabolites, and the exposome may inform more evidence-based, effective policy, system, and environmental change to optimize individual and population health. Government has an important role in helping to fund primary research in precision medicine and precision public health, as well as creating and enforcing standards related to food systems, air quality, and access to health care, defining and optimizing measures of health care quality and safety, and ensuring data privacy standards and protections, interoperability, and integration with surveillance systems. Government partnership and collaboration with the non-profit and private sectors can optimize precision medicine and precision public health for the benefit of the United States and global population.

Section snippets

The All of Us Research Program

The All of Us Research Program (AoURP) is a longitudinal cohort study that aims to recruit at least 1,000,000 people living in the United States (US) and will evaluate behavioral, environmental, and biological exposures over at least 10 years. The study launched in May 2018, and as of October 2018 has recruited more than 100,000 participants, with more than 60,000 of those having completed biospecimen gathering, physical examinations, and electronic health record donation. The AoURP prioritizes

Non-profit sector commitment to precision medicine and public health

Non-profit organizations like the American Heart Association (AHA) catalyze a commitment to health and well-being through precision medicine at the local, state, national, and international levels. Specifically, the AHA has established an Institute for Precision Cardiovascular Medicine (Institute). Fig 1 depicts the five impact strategies of the Institute: to be a convener, provide transformational grants, enable date discoverability and access, act as the critical translational agent, and

Appropriations

Appropriations at all levels of government are needed to fund primary research for precision medicine and precision public health and their translation to clinical practice, quality initiatives, policy, systems and environmental change, and public health infrastructure. Governments can also amplify private sector investment in precision medicine and precision public health research and workforce development.²⁴ Federal investment in research includes the NIH, the Centers for Disease Control and

A vision for the future

Moving at the speed of trust through local communities and meeting people where they are will be as important to precision medicine and precision public health as any large change that affects people's and population's health and well-being. Continual digital innovation will be needed for sharing data equitably and securely, and innovative research combined with data science to drive new policies, prevention strategies, diagnostics and treatments for the right person at the right time for

Conclusions

Governments have a central role to play in precision medicine and precision public health, helping to transform what is learned into evidence-based, equitable policy, system and environmental changes. Richer, more granular longitudinal data will be used for better decision making in medicine and public health to transform healthy living. A visionary future creates transparent, secure, and fair systems to equitably promote health, well-being, and better health care.

Statement of conflict of interest

Mark Huffman: MDH receives grant support from the World Heart Federation to serve as its senior program advisor for the Emerging Leaders program, which is supported by unrestricted educational grants from Boehringer Ingelheim and Novartis with previous support from AstraZeneca and Bupa. MDH also receives support from the American Heart Association, Verily, and AstraZeneca for work unrelated to this project. MDH also serves as associate editor for JAMA Cardiology for which he receives

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^☆: Statement of Conflict of Interest: see page 54.

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The Role of Government in Precision Medicine, Precision Public Health and the Intersection With Healthy Living☆

Abstract

Section snippets

The All of Us Research Program

Non-profit sector commitment to precision medicine and public health

Appropriations

A vision for the future

Conclusions

Statement of conflict of interest

Lancet Public Health

Prog Cardiovasc Dis

J Clin Epidemiol

Health Policy Technol

Genetic architecture: the shape of the genetic contribution to human traits and disease

Nat Rev Genet

Epigenetics: definition, mechanisms and clinical perspective

Semin Reprod Med

Environmentally induced gene expression

Health hazards in the home: an assessment of a southern Nevada community

J Community Health

Environmental effects on gene expression phenotype have regional biases in the human genome

Genetics

Public health and precision medicine share a goal

J Evid Based Med

A new initiative on precision medicine

N Engl J Med

Four steps to precision public health

Nature

Precision medicine initiative: privacy and trust principles