Precision medicine is about providing individuals with treatment and prevention that takes into account individual variability in genes, environment and lifestyle. By contrast, precision public health is about populations. It’s about delivering the “right intervention at the right time, every time to the right population,” states the Centre for Disease Control and Prevention. In essence, precision public health involves the use of new precision technologies to improve public health and practice.
The main driver of precision public health is better technology - or Public Health 2.0, as we like to call it. The objective is to use better and more precise data to target disease prevention and control, and to improve health and health equity worldwide at the population level.
Leveraging targeted public health interventions Here are three key components of Public Health 2.0:
Data-driven decision making: This involves the collection, analysis and interpretation of vast amounts of data. Data can cover environmental factors, healthcare utilisation, social determinants of health, and more. AI plays a pivotal role in finding patterns, trends and disparities that can help with targeted public health interventions. Sadly, although precise data is the norm in many high income countries, large parts of the low and middle income countries don’t reap its advantages. For example, in Guinea it took months, when it shouldn’t have taken days, to gather together sufficient data to identify the start of the largest Ebola outbreak in history, according to an article in Nature. In addition, paper reporting as opposed to digital data gathering - for example, via mobile phones - is also a challenge. This was the case in South Africa, where malaria elimination was retarded by manual data collection and entry.
Personalisation: Unlike traditional public health approaches that use one-size-fits-all approaches, precision public health tailors interventions to specific subgroups within a population. This results in allocation of resources to where they are most needed and will have the greatest impact. So, for example, by focusing on the 14% highest-risk geographic areas, 90% of the mosquito-related infectious disease burden worldwide could be addressed.
Prevention and early intervention: Precision public health places a strong emphasis on preventing diseases and promoting health before problems become acute. By finding high-risk individuals and subgroups and intervening early, health care systems can reduce the burden of disease and improve outcomes.
Thus, Public Health 2.0 offers multiple benefits, including improved health outcomes for both individuals and populations, cost-effectiveness by more efficient allocation of resources, reduced health disparities and greater health equity, early disease detection, and informed policy decision making. Achieving precision public health: four concrete steps
In the developing world, precision public health is more likely to become a reality if these four steps are adopted:
Register births and deaths: If deaths are not registered, it’s hard to know whether public health policies, like vaccination programs, are reducing mortality. Basic demographic data is vital for effective public-health decisions.
Track disease: Careful surveillance requires infrastructure and systems to collect and analyse data, labs to confirm diagnoses, and well-trained personnel. Where countries do not have the resources to support these initiatives, high income countries could help.
Incorporate laboratory analyses: Tissue sampling and laboratory diagnosis should replace ‘verbal autopsies’ i.e., interviews with relatives. It’s vital to know mortality distributions.
More training: Ideally, public-health workers at national and local level should understand the fundamentals of epidemiology, be able to use local information to draw up strategies, and be equipped to translate those decisions into actions.
In conclusion, precision public health, or Public Health 2.0, represents a paradigm shift in the field of public health. By leveraging data, technology and an effectively-trained personnel, it holds the promise of improving health outcomes, reducing disparities, and making public health interventions more efficient and cost effective.