In defence of Precision Public Health

“The right intervention to the right population at the right time”

Whilst the concept of Precision Public Health (PPH) has gained tremendous momentum, with the support of actors such as the Bill & Melinda Gates Foundation and the CDC, a recent perspective in the NEJM titled ‘”Precision” Public Health between Novelty and Hype”, questioned the novelty of PPH [1]. The perspective framed PPH as a concept centralised around the individual, in which vulnerability is conceptualised biologically, particularly genomically, whereas Public Health starts with the population, where vulnerability is framed around structural factors such as social class, gender and sexuality as well as the physical environment [1]. It concludes that PPH is too closely anchored to genomics,  and  that “factors shaping the health of populations have no individual-level analogue but are properties of our shared surroundings”.

“Precision public health offers a compelling opportunity to reinvigorate a discipline that has never been more important for advancing the health of our most vulnerable and excluded communities”.

– R. Horton, 2018

However, more recently the Lancet published a comment in favour of PPH, titled “Offline: In defence of Precision Public Health“.  It argues that PPH indeed emphasises the importance of determinants, reinforced by the power data offers in transforming our understanding.  The comment also debunks the notion that structural factors are neglected by by PPH, exemplified by a case about child mortality. By linking data to child survival to areas within 50km of an armed conflict in 35 African countries, it was discovered that children born within 50km of a conflict zone had 27% higher risk of death when that armed conflict was associated with more than 1000 deaths [2]. This case clearly exemplifies the inclusion of structural factors such politics in PPH.

“Precision public health is about using the power of data to improve health and achieve social justice—equity, social inclusion, and empowerment. It should not be feared. It should be embraced”.

– R. Horton, 2018

We’d love to know your thoughts about Precision Public Health in the comments below! 

 

References

[1] https://www.nejm.org/doi/full/10.1056/NEJMp1806634

[2] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32741-7/fulltext

 

Written by Nefti-Eboni Bempong & Danny Sheath

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