What is Public Health Genomics? A Day in the Invisible Life of Public Health Genomics

June 2, 2011 by Muin J Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention

Public health usually works behind the scenes and many people aren’t even aware of public health programs. When you get sick you visit your doctor and get advice and treatment to make you feel better. Doctors and other medical professionals work to improve health one person at a time, but public health professionals focus on improving health at the population level through disease control and prevention. The new field of “public health genomics” is no exception. It focuses on public health policy and programs to make sure that genomic science is used effectively and responsibly to improve the health of all people. Public health genomics seeks to provide policy-makers and the public with unbiased information and services based on scientifically credible genetic information. To illustrate how public health genomics works behind the scenes, we will tell you a made-up story inspired by “A day in the life of public health” published by the El Paso County (Colorado) Department of Health and Environment. We want to make our readers aware of this new field and invite your feedback and comments.

A Day in the Invisible Life of Public Health Genomics

The sun wakes you up and it’s “A Blue Day” says the radio news announcer. It’s nice that the air quality is good and that public health is around to monitor the levels of many pollutants in the blood of Americans through national and state surveys. Public health researchers are also studying how such levels are affected by genetic factors and are developing programs to cut down on pollutants based on such knowledge. You’ve read on the CDC Public Health Genomics website that your strong family health history of asthma may put you at increased risk of developing respiratory illness. You make a mental note to check into that ride-sharing idea that is being offered at your workplace, one personally motivated way that you can champion environmental quality in your city.

You hear your son laughing in the other room as your husband gets him ready for daycare. Public health gave you confidence that he is healthy, thanks to the newborn screening program in your state that screens all newborn babies for several genetic and metabolic conditions. You give him a glass of milk, confident in the knowledge that it is safe and that public health checks the dairies, tests lab samples, and refrigeration levels of dairy products. Although several members of your family including yourself have lactose intolerance , you have been reassured through a recently done stool test that your son doesn’t have this condition and thus is able to benefit from milk.

You remember the call from your mother last night to say that she is relieved to have been able to get a doctor appointment today in her own town. Public health recognized the need for doctors in her rural area and helped to place one there. You are pleased that she won’t have to spend the day traveling to and from her appointment in the city miles away. Several days ago, she filled out the online US Surgeon General’s family health history questionnaire , which she will be discussing with her doctor because of her family history of heart disease. She promised to tell you what she finds out.

It’s time to leave for work and you buckle seatbelts around yourself and your son. It is a habit now, thanks to public health educational messages that have greatly reduced automobile- related deaths in this country. The childcare center director welcomes you and your son. She and her staff have been trained in the public health measures necessary to run a safe, healthy program. Ultimately, her center is trying to avoid the unnecessary epidemics that can occur with improper hand washing and childcare techniques. You’ve heard about an outbreak of E. coli infection at another nearby daycare center. The public health laboratory conducted genetic analysis of E. coli samples collected from affected children, identified the source of the outbreak and stopped it from spreading. Also, your child care center displays a poster distributed through a public health education campaign for recognizing the 10 early warning signs of genetic primary immune deficiency disorders. You read the poster and you are reassured that your son does not have any of these warning signs.

Heading on to work, you stop and pick up an egg sandwich at your favorite fast food restaurant. You know that the quality of the food is good because the local health department inspectors have awarded 97 out of 100 possible points, ensuring that the standards have been met. Now a different public health message is stuck in your mind. You remember that you have a strong family history of heart disease and your cholesterol level is already a bit high. Enjoying the last bites of your sandwich, you make a decision to get up earlier the next day and eat the cereal you bought last week.

Work is good and relatively stress-free. You feel good because you have started a lunchtime walking program with five of your colleagues. The exercise increases aerobic fitness and helps your stress level for the rest of the afternoon. Public health studies have shown the positive effects of avoiding or lessening the risks of chronic disease by exercising routinely.

You are also happy because your business has opted to become a smoke free working environment. It has become clear through the years that smoking has definite links to cancer and other chronic diseases. With your family history of asthma and heart disease, you don’t need any extra risk from breathing other people’s smoke. Public health has been encouraging people and organizations to give up smoking to improve the overall quality of life.

It is the end of the day and you and your son head home after a brief play stop at a local park. Your husband has made dinner so you spend the rest of the evening relaxing with your family. You get a phone call from your mother informing you that her doctor’s appointment went well and that she has received personalized prevention recommendations during her visit. She was asked to share her family health history information with you and to encourage you to fill out the US Surgeon General’s questionnaire for your husband’s family, too. A CDC survey has shown that while more than 90% of Americans think that family health history is important for their own health, only about 30% of people have ever actually collected such information in a systematic way.

While watching TV, you hear a story about a Senate hearing that occurred earlier today on whether at home personal DNA tests offered directly to consumers are a marketing scam or medical breakthrough. Your husband, an avid runner, tells you that he has been considering taking one of these tests to help him modify his diet and become more athletically fit. Taking a minute to check the CDC website for the latest public health perspective, you learn that these tests have scientific limitations. You decide to save your money for a new pair of running shoes instead.

As you lie in bed musing on the day, you don’t even realize that public health is at work to help make sure that genomic technologies are used to benefit all people.

How many ways can public health genomics touch your life every day? Tell us what you think.

To find out more about public health genomics, go to the CDC Office of Public Health Genomics website and read what different state health departments are doing.

June 2, 2011 by Muin J Khoury, Director, Office of Public Health Genomics, Centers for Disease Control and Prevention