Precision in Public Health
How do you prevent diseases in high-risk population groups? How do you identify people who need to be tested for a disease? How do you get people to obtain treatment and ensure they continue it? These were some of the questions that were addressed by Wafaa El Sadr, University Professor of Epidemiology and Medicine, Columbia University, as she presented the Second Distinguished Yusuf Hamied Lecture by a Mailman School of Public Health faculty member organized by Columbia Global Centers | Mumbai on January 30, 2020.
As the need for evidence-based policies grows, population-based data and intervention strategies seem to hold the key to disease prevention. Precision public health is the science of using ‘big data’ to guide interventions that benefit populations. It is an emerging focus of public health that complements precision medicine and can be implemented through leveraging population-level data, science of ‘omics’ and other technological advancements. Emphasizing the need for precision public health, while citing examples from her work on HIV/ AIDS, Professor El Sadr remarked, “40% of people living with HIV currently are not accessing treatment and there were 1.7 million new cases of HIV across the world in 2018. To combat the spread of diseases, it is essential to gain access to the population, identify people at risk and provide treatment to such individuals.” Elaborating further on developing population-based strategies for disease prevention, she discussed the role of a well-functioning health system and provided a comprehensive overview of the essential building blocks that include human resources, service delivery, commodities, laboratory, information systems, governance, financing, and at the centre of it all, the community.
Professor El Sadr, who is also Director of International Centre for Aids Care and Treatment Program (ICAP) at Columbia University, also gave a historical perspective on HIV/AIDS, the impact of HIV/ AIDS on life expectancy, and the Population Based HIV Impact Assessment Project (PHIA) undertaken by ICAP. Work at ICAP is mainly undertaken to reduce inequity in health that exists across the globe with a focus on four areas – evidence-based health programs, high quality education and training, research surveys, and measurement and impact assessment. While deliberating on the topic of identification of high-risk population groups for testing of diseases, Professor El Sadr posited that research findings from national surveys can help in bringing precision to the global response to diseases. She also credited the work of Dr Yusuf Hamied, who had made opening remarks at the event, for his commitment to providing HIV drugs at affordable prices to low income countries and populations as a game changer in saving lives and making treatment accessible at a large scale.
Achieving precision in public health by providing the right intervention to the right population at the right time while also focusing on reduction in health disparities was extremely important, stressed Professor El Sadr. Her presentation was followed by an interactive session with the audience where she pointed out the need of community engagement, broad data capture and data sharing, and tailoring health programs using individual and community level information for disease prevention. There was active participation from the audience, some of who agreed that with changing disease patterns and escalating costs of care across the world, precision public health seems to be a plausible solution to disease prevention and control in the near future.