Reconceptualising precision public health

Abstract

As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalisation, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalisation within research and practice. Social position shapes individuals’ unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualisations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalising these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to the identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualised thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalization, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalization within research and practice. Social position shapes individuals’ unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualizations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalizing these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualized thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.

Scientific challenges for precision public health

“…Finally, in the current context of declining life expectancy and increasing inequalities in the UK,50 it is concerning that PPH approaches are being strongly promoted as solutions 51. We agree with the recent commentary by Olstad and McIntyre that PPH could benefit, conceptually and practically, from a refocus on the upstream social determinants of health 52. In the meantime, while evidence for sound policy and practice is still being sought, we consider Horton’s diagnosis of ‘pilotitis’ premature 1…”

Guidelines for developing geographically sensitive mobile health applications

“…The main thrust of RoadMApp intervention in global health is to improve community level health following precision public health principles. Central to the notion of precision public health is the concept of identifying speci c risk factor pro les that confer vulnerability to poor health [33]. Identifying that long travel times to seek health care is a risk factor motivated the development of the RoadMApp and subsequent guidelines.…”

Precision, Equity, and Public Health and Epidemiology Informatics – A Scoping Review

“…Most notably, some have suggested that PPH could divert attention away from the broader determinants of health towards clinical concepts, which tend to be measured with greater accuracy [13]. For example, the social determinants of health, such as social status, are generally not measured well, so they may play a limited role in characterizing populations and identifying optimal interventions [7,14]. Concerns have also been raised about attempts to use genomic data in PPH, due to the limited availability of such data for many sub-populations and the usually small effect size at a population scale compared to other determinants of health [7].…”

“…While the concept of PPH is gaining traction and initial research results in global health and infectious diseases are promising, there remain many opportunities for informatics research in this area. From a measurement or diagnostic perspective, widely adopted frameworks for measuring non-clinical concepts, such as social position [14] are needed to consistently classify populations for precisely identifying interventions [27]. These advances in measurement, especially through the use of new and large data sources, have some overlap with the concept of digital epidemiology [28].…”