The Role of Genomics in Public Health

[摘要]

The American Public Health Association,

Recognizing that genomics in public health can be defined as the study of all elements of the human genome and their functions in relation to health and disease¹; and

Understanding that the Human Genome Project announced the successful mapping of the reference sequence of the human genome in 2001²; and

Realizing that the population impact of many genetic tests is relatively unknown, that the reliability, sensitivity, and specificity of these tests, and the predictive value in populations may not be well characterized and details of emergent genetic tests may not be disseminated to public health practitioners, to whom the public may turn for guidance regarding the use of such tests³; and

Taking into account that fears of release of genetic information may influence access and utilization of genetic tests⁴; and

Realizing that increased information about gene-environment interaction and gene expression over the lifespan holds great promise for the control of major common diseases of adulthood⁵; and

Realizing that genomics will impact multiple public health programs and systems: epidemiology, statistics, laboratory sciences, environmental health, infectious disease, chronic disease programs, nutrition, birth defects and disability, mental health, health education, communications, and law^6,7; and

That genomics will increasingly apply to multifactorial acute and chronic diseases; in addition to social, behavioral, and environmental determinants of health; and

Understanding that population-based research when identifying whether the common genetic risk factors are sufficient contributors for disease development, poses unique challenges to informed consent in human subject research⁸; and

Realizing that communicating the population-based proportion of disease risk that is genetic compared to social, behavioral, or environmental may pose unique challenges to health communicators, educators, and others in the public health community; and

Understanding that public health organizations have produced policy statements, white papers, and initial assessments of states’ genomics capacity and have determined genomics competencies for the public health workforce that can guide much-needed genomics education^9-11;

Therefore, APHA

1. Supports that genomics will have broad-based impact on public health, influencing the ten essential public health services of state and local public health, but that much research is still needed; and
2. Encourages the Centers for Disease Control and Prevention Office of Public Health Practice Program Office, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, the National Association of Local Boards of Health, and the Association of Schools of Public Health, and the National Coalition of Healthcare Professions Educators in Genetics (NCHPEG) to determine the genomics-related educational needs of the current public health workforce following the already established core competencies in genomics, and to work together to deliver education targeted to those needs; and
3. Calls upon Congress to support funding for collaborative genomics efforts, including public health research, communications, and programs at the national, state, local, and tribal community levels.

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References

1. Public Health Genomics Centers grant applications, 2001 (personal communication: CDC Office of Genomics and Disease Prevention).
2. Venter JC, Adams MD, Meyers EW, et al. The sequence of the human genome. Science 2001. Feb. 16; 291:1304-1351.
3. Association of State and Territorial Health Officials: Translating genetics advances into improved health, April 7, 1999. Available from URL: http://www.astho.org/ppt/Survey/index.htm.
4. American College of Medical Genetics. Points to consider in preventing unfair discrimination based on genetic disease risk, July 1, 2001. Available from URL: http://www.acmg.net/Pages/ACMG_Activities/Policy_Statements.htm.
5. Centers for Disease Control and Prevention. Translating advances in human genetics into public health action: a strategic plan (1997). Available from URL: http://www.cdc.gov/genetics/about/strategic.htm.
6. Beskow LM, Khoury MJ, Baker TG, Thrasher JF: The integration of genomics into public health research, policy, and practice in the United States. Community Genetics, July 25, 2001. URL: http://www.cdc.gov/genetics/info/reports/research/wheel. htm.
7. Olden K, Guthrie J, Newton S: A bold new direction for environmental health research. Am J Public Health. 2001;91:1964-1967.
8. Beskow LM, Burke W, Merz JF, Barr PA, Terry S, Gostin LO, Gwinn M, Khoury MJ. Informed consent for population-based research involving genetics. JAMA. Nov. 2001.
9. Association of State and Territorial Health Officials. A framework for public health genetics policies and practices in state and local public health agencies. Available at: http://www.astho.org/phiip/pdf/geneticsfw.pdf.
10. Lengerich G. Council of State and Territorial Epidemiologists: Support of state-based efforts and capacity for translating advances in human genetics into public health action. URL: http://www.cste.org/ps/1997/1997-cd-01.htm.
11. Association of State and Territorial Chronic Disease Program Directors. Genomics and Chronic Disease Summit, January 30-February 1, 2002. http://www.chronicdisease.org/ Genomics_Summit_Report.pdf.

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[发布日期] 2002-11-13

[学科分类] 医学（综合）