To effectively manage healthcare systems, public health practitioners have to constantly weigh trade-offs between the needs of society at large and those of specific sub-populations. In the absence of detailed population health data and tools for public health management, these trade-offs can raise difficult operational and ethical questions.

The COVID-19 pandemic showed how challenging these trade-offs can be. Over the past few years, public health leaders repeatedly wrestled with choices about when to enact lockdowns, how to allocate vaccines, whether to restrict access to care, and other decisions that might save lives at a national level but impose hardships on some segments of the population.

Enter the 21st century concept of ‘Precision Public Health’ (PPH), an emerging field that aims to make public health more data-driven and targeted at the sub-population level. The term, first coined in Australia in the 2010s [1], was more recently adopted by the US CDC, which expanded the concept to encompass areas such as precision medicine, pathogen genomics and enhanced surveillance informatics [2].

While the PPH movement includes active participation from a wide variety of stakeholders, the clinical lab community has a unique opportunity to play an important and possibly even central role in its success. Clinical lab data, after all, can provide a valuable window on the health of populations and the impact of public health interventions.

What exactly is PPH?

Participating in the PPH movement first requires a clear understanding of what exactly it is. At Roche Experience Days 2021, a recent thought leadership conference hosted by Roche Diagnostics Asia Pacific, Singaporean healthcare policy expert Dr Jeremy Lim helped introduce the concept of PPH to a clinical lab audience.

“PPH can be simply thought of as precision medicine in aggregate,” noted Dr Lim, who serves as President of the Precision Public Health Asia Society. He also leads a microbiome startup and serves as Director of the Leadership Institute of Global Health Transformation (LIGHT) at the Saw Swee Hock School of Public Health in National University of Singapore.

The ultimate goal of PPH, according to Dr Lim, is to deliver the right intervention to the right place at the right time. One example is the use of advanced mosquito tracking technology that allows countries to collaborate on infection migration. Indeed, PPH research has shown that 90% of the mosquito-related infectious disease burden can be addressed by focusing on just 14% of high-risk geographies [2].

What can clinical labs do to facilitate PPH?

As PPH gains momentum, one area where clinical labs can contribute is in helping to provide data and insights on population health management. This is one of the goals of the Clinical Lab 2.0 Initiative, which aims to leverage clinical lab expertise to improve clinical outcomes of populations, manage population risk and reduce the overall cost of delivering healthcare.

“Clinical labs have significant opportunities to help solve healthcare challenges through…post-diagnostic computation and analysis—turning data into clinical action,” said Mr Khosrow Shortorbani, one of the leaders of this initiative, in a 2019 interview with Lab Insights. “It’s about connecting the dots over time to produce meaningful insight to improve outcomes while minimising financial risk and thus achieve alignment with the strategic goals of healthcare systems.”

PPH may also result in a greater attention to earlier detection of diseases and preventative care, an area where clinical lab data and expertise is often crucial. Labs can help drive more targeted screening, such as the efforts currently underway to promote new HCV screening programmes in Pakistan, or initiatives to improve the rate of prenatal and newborn screening, which can be considered an archetypal PPH opportunity.

Seeing the bigger picture

To be successful, clinical labs must collaborate with many stakeholders in order to effectively integrate diagnostic data with the various systems, technologies and policy frameworks that can help make the vision of PPH succeed. These include electronic patient recordkeeping systems, cloud and mobile networks, international data sharing agreements, and even the idea of ‘digital twins’ (virtual models of our physical biology that support diagnostic and medical planning processes).

The PPH journey is not without hurdles ahead. Some public health practitioners have reservations about the appropriateness of precision medicine to accommodate social determinants. Others view PPH as going back to the basics, lacking evidence to support the transition from traditional risk factors to the era of ‘omics [3]. Patient privacy remains a big topic for discussion, as does ensuring that PPH does not further marginalise the vulnerable populations who already lack critical access to basic healthcare needs. Even workforce upskilling must be considered in order to maximise the potential of PPH [4].

Clinical labs can and must be at the table to help address these concerns and shape the conversation. But the lab community is still only scratching the surface of what it can contribute to public health. More education in the clinical lab community will be necessary to ensure that we can collectively realise the dream of PPH while minimising the challenges and risks.

References:
[1] Weeramanthri, Tarun et al. “Editorial: Precision Public Health”. Frontiers in Public Health: Apr 2018.
[2] Khoury, Muin et al. “Precision Public Health: What Is It?” US Centers for Disease Control and Prevention (Genomics and Precision Health): May 2018.
[3] Khoury, Muin et al. “Precision Public Health for the Era of Precision Medicine”. Am J Prev Med: Mar 2016.
[4] Kee, Frank; and Taylor-Robinson, David. “Scientific Challenges for Precision Public Health”. BMJ Journal of Epidemiology and Community Health: Jan 2020.