Summary
A high-profile conference was held in London at the Royal College of Physicians on 26 January 2006. It was hosted by the Public Health Genetics Unit, the Faculty of Public Health and the British Society for Human Genetics. During this event leading experts in genetics and public health came together to call for a joint approach to the challenge of using new knowledge and technologies from the Human Genome Project to benefit population health.
Deputy CMO Dr Fiona Adshead endorsed the growing importance of public health genetics, placing it in the context of the public health White Paper, Choosing Health.
Welcoming initiatives to establish public health genetics at both a national and an international level, Dr Adshead said “It is important to make [public health genetics] a mainstream way of thinking in public health”. Public health professionals must seize new opportunities created by developments in genomic science and make them part of a “broad toolkit to face the public health challenges of today”.
Keynote international speakers emphasised the scale of both the promise and the challenges ahead. Dr Muin Khoury, head of the Office of Genomics and Disease Prevention at the US Centers for Disease Control and Prevention in Atlanta, USA, stressed the importance of genomics as part of a coordinated strategy to fight the public health challenges posed by conditions such as obesity, diabetes and coronary heart disease. Public health has a vital role as the “honest broker” ensuring that genetic information is used responsibly for the benefit of population health.
Professor Abdallah Daar from the Canadian Program on Genomics and Global Health asked “How can we make sure that genomics benefits the 90% of people who are not as privileged as we are?” Genomics and biotechnology have much to offer the developing world, he said, in the form of new knowledge and tools to fight infectious disease, malnutrition and environmental degradation.
Closer to home, leading UK geneticists Professor Julian Sampson, Dr Jenny Taylor and Professor Peter Farndon highlighted exciting progress in our ability to diagnose and manage single-gene diseases such as tuberous sclerosis and sudden cardiac death syndromes. Research on these diseases is “pushing the boundaries” of what can be achieved with new technologies. This new knowledge, together with development of a rational approach to the evaluation of genetic tests, provides valuable lessons for the future as we learn more about genetic determinants of common disease.
Insights from epidemiology are essential for applying genomic advances at the population level. Dr Julian Higgins outlined the challenges of building a robust evidence base, and the role of the international HuGENet initiative in establishing a collaborative, coordinated approach.
The ethical, legal and social dimensions of genomics cannot be neglected. Lawyer Hilary Newiss explained the complex issues to be resolved in arriving at a rational policy for regulating the availability of genetic tests. Professor Darren Shickle reminded the audience that although the public is fascinated by genetics and genomics, levels of both knowledge and trust in scientists are low and it will be a challenge to maintain public support.
Closing the meeting, Dr Ron Zimmern emphasised the intellectual and practical challenges for public health genetics in the coming years. It is essential to build awareness and capacity in this new field of public health. New national and international networks offer opportunities for synergy and collaboration. All those with an interest the use of genomics to benefit population health are invited to join.
Programme
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1. Intellectual challenges
Public health practice in the twenty first century can no longer ignore the knowledge derived from genomics and molecular science. An understanding of the cellular mechanisms of disease will be as important to the public health community as an appreciation of the social determinants of health. Opportunities should be created to ensure that all public health professionals become genetically literate with a grounding in basic genetics, cell and molecular biology and an appreciation of their complexity. They should also understand:
2. Practical Challenges
Leadership in public health genetics within the UK should be provided by training between 10 to 12 specialists in public health genetics. This could be best done by seconding existing public health physicians for specialist training and creating specialist jobs when they return to their home region. The remit for these jobs should include input into the specialist commissioning process and contributions to the establishment of national and regional networks.
Service issues in public health genetics that will require attention in the following decade will include :
Public health geneticists should also be involved in informing relevant policy issues. These include but are not necessarily confined to:
At a national and international level, public health professionals should be aware of the impact of genomics, molecular science and biotechnology on the developing world.