Extending an Antiracism Lens to the Implementation of Precision Public Health Interventions

Abstract

Precision public health holds promise to improve disease prevention and health promotion strategies, allowing the right intervention to be delivered to the right population at the right time. Growing concerns underscore the potential for precision-based approaches to exacerbate health disparities by relying on biased data inputs and recapitulating existing access inequities. To achieve its full potential, precision public health must focus on addressing social and structural drivers of health and prominently incorporate equity-related concerns, particularly with respect to race and ethnicity. In this article, we discuss how an antiracism lens could be applied to reduce health disparities and health inequities through equity-informed research, implementation, and evaluation of precision public health interventions. (Am J Public Health. Published online ahead of print August 31, 2023:e1–e9. https://doi.org/10.2105/AJPH.2023.307386 )

Unconventional data, unprecedented insights: leveraging non-traditional data during a pandemic

“…Commentary on these issues includes calls for more participatory approaches, inclusion of equity and human rights, and representation from groups especially impacted, such as marginalized communities ( 60 , 61 ). Additionally, several conceptual frameworks have been proposed, including ones rooted in data solidarity and data justice ( 62 ), principles of equity, individuals rights ( 59 ), and antiracism ( 63 ).…”

Next-Generation Public Health Genomics: A Call to Assess the Equitable Implementation, Population Health Impact, and Sustainability of Precision Public Health Applications

“…Less is known about barriers, facilitators, and perceptions among organizations that serve underrepresented in genomics research, as well as barriers and facilitators at the interpersonal and community levels. Thus, to fill remaining gaps in our understanding of the planning phase of the implementation of public health genomics applications, using multilevel frameworks with a focus on health equity will be critical [5].…”

“…For example, while we have described how research might fit within the EPIS framework, research that addresses the full EPIS framework will be best positioned to make an impact with public health genomics applications. Multidisciplinary teams with public health researchers at the table are critical for establishing and evaluating public health genomics applications with an eye on ensuring equity [5]. Recognizing the importance of this field to public health missions more broadly will support ongoing and future efforts to harness public health genomics for building population health.…”

“…Yet despite the promise and potential for public health genomics, the population health impact and sustainability of public health genomics applications has yet to be fully measured and achieved. Further access to public health genomics applications has been lower among underrepresented racial and ethnic communities, rural communities, and groups with lower education and income [2], deepening concerns that the field could exacerbate rather than redress health inequities [4,5]. As we enter the next generation of public health genomics, we must shift our focus from not only understanding the collection of genetic risk information and related needs, but also the real-world use of this precision information and its impact on population health outcomes and health equity over time.…”

“…Over the past 5 years, calls for research at the intersection of genomics and implementation science have been raised, with attention to applications in public health [6][7][8][9][10][11]. In particular, implementation science frameworks, which increasingly include an explicit consideration of health equity [5,[12][13][14][15], can guide evaluations of public health genomics applications, our understanding of the factors associated with equitable implementation outcomes, and implementation processes. Process frameworks can help us consider the full life of public health genomics applicationsfrom pre-implementation to implementation to sustainability phases.…”