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Public health genetics—potential for public health?
H. Brand*Correspondence: Dr Helmut Brand MSc MFPH, Director, Institute of Public Health North Rhine-Westphalia (lögd), Westerfeldstr. 35–37, D-33611 Bielefeld, Germany, helmut.brand@loegd.nrw.de
Although it is well understood that the disciplines of medicine and public health are different in their goals and practices, in the context of genomics this difference is even more pronounced. While medical genetics concerns the clinical decision made by a doctor to use genomic knowledge for the benefit of the patient, public health genetics may be defined as the systematic integration of genomics into public health research, policy and practice.1 What does it mean?
When on 27 June 2000 the BBC announced the revealing of the human genome, the so-called ‘book of life’, it was predicted that this step in scientific research would make it possible to ‘banish inherited disorders, screen people for their vulnerability to diseases, tailor treatment to an individual's genetic make-up, create thousands of new drugs and extend human lifespan...’. The results have dealt everyone some surprises, for example that humans have far fewer genes than had once been thought (somewhere between 26 000 and 38 000) or that we share 
99% of our genome with the chimp. Scientists also discovered small variations between individual humans' genes that can explain our obvious differences in susceptibility to certain common diseases like asthma, cardiovascular diseases, dementia or infectious diseases. These small variations, known as single nucleotide polymorphisms (SNPs), consist of variations of just a single basepair of the DNA building blocks. Between any two individuals, it is estimated that there may be some 2–3 million SNP differences. Fascinatingly, however, >99% of these differences turn out to have little or no biological significance, i.e. only <1% of the variations occur in functional genes. Today, in 2005, a range of genetic tests has been developed. The four-letter code seems to determine everything from eye colour, through obesity to adverse drug effects, perhaps even intelligence.
On the other hand, in the scientific community, these recent and remarkable developments in molecular genomics and accompanying technologies have launched a discussion about a changing comprehension of health and disease, as well as new approaches to prevention and therapy.2 It has been stressed that strategies will have to focus in detail on the specific protein products of certain genes, and use those proteins, rather than genes, as targets for precise and stratified disease interventions.3 Are there any consequences for public health that can be drawn from this knowledge? And if so, can it be responsibly and timely translated into policies and practice? Should we start already now to think strategically about these issues that are likely to determine the future of our health? On the other hand, does the combination of public health and genetics imply a dangerous potential? What are the ethical implications?4 Right now, there seem to be more questions than answers.
Of course, at the beginning of the new millennium, no one can predict exactly (and this, by the way, is true for all scientific discoveries!) what the impact of genomics on medical practice and health care is likely to be or when it will happen. Nevertheless, on the available evidence, its importance and potential cannot be underestimated. We need to plan strategically in advance for the kinds of changes that undoubtedly lie ahead. In Europe there is a discrepancy between the overriding importance of the public health sciences for consumer protection, provision of health-care services and health improvement on the one hand, and the limited interest of the public health profession in policy-making on integrating genomics on the other hand. How then can the public health community approach the task of translating the growing amount of genomic discoveries into specific public health action and policies?5
Certainly, the public health sciences are essential to further our understanding of the relative importance of environmental, lifestyle and genetic causes of disease to identify strategies to improve the wellbeing of the population and to evaluate health. Even my genius teacher, the late Geoffrey Rose, would certainly agree on this: where a population has many people with a genetic susceptibility to a certain disease, the promotion of certain preventive measures that directly affect the regulation of disease genes could be highly effective. And another thing is also certain: the genetics of the 21st century will be quite different from the genetics of the 20th century, and public health in the future will be quite different from public health in the past!
References
1 Beskow LM, Khoury MJ, Baker TG, Thrasher JF. The integration of genomics into public health research, policy and practice in the United States. Community Genet 2001;4:2–11.[CrossRef][Medline]
2 Khoury MJ. From genes to public health: the applications of genetic technology in disease prevention. Am J Public Health 1996;86:1717–22.
3 Burke W. Genomics as a probe for disease biology. N Engl J Med 2003;349:969–74.
4 Moldrup C. Medical technology assessment of the ethical, social, and legal implications of pharmacogenomics. A research proposal for an Internet citizen jury. Int J Technol Assess Health Care 2002;18:728–32.[Medline]
5 Brand A. Public health and genetics—a dangerous combination? Viewpoint section. Eur J Publ Health 2005;15:112.
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  H. Brand Public health genetics--potential for public health? Eur J Public Health, April 1, 2005; 15(2): 112 - 112. [Full Text] [PDF]
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