The imaginary of precision public health

Abstract

In recent years, precision medicine has emerged as a charismatic name for a growing movement to revolutionise biomedicine by bringing genomic knowledge and sequencing to clinical care. Increasingly, the precision revolution has also included a new paradigm called precision public health—part genomics, part informatics, part public health and part biomedicine. Advocates of precision public health, such as Sue Desmond-Hellmann, argue that adopting cutting-edge big data approaches will allow public health actors to precisely target populations who experience the highest burden of disease and mortality, creating more equitable health futures. In this article we analyse precision public health as a sociotechnical imaginary, examining how calls for precision shape which public health efforts are seen as necessary and desirable. By comparing the rhetoric of precision public health to precision warfare, we find that precision prescribes technical solutions to complex problems and promises data-driven futures free of uncertainty, unnecessary suffering and inefficient use of resources. We look at how these imagined futures shape the present as they animate public health initiatives in the Global South funded by powerful philanthropic organisations, such as the Bill & Melinda Gates Foundation, as well as local efforts to address cancer disparities in San Francisco. Through our analysis of the imaginary of precision public health, we identify an emerging tension between health equity goals and precision’s technical solutions. Using large datasets to target interventions with greater precision, we argue, fails to address the upstream social determinants of health that give rise to health disparities worldwide. Therefore, we urge caution around investing in precision without a complementary commitment to addressing the social and economic conditions that are the root cause of health inequality.

Toward a Symbiotic Perspective on Public Health: Recognizing the Ambivalence of Microbes in the Anthropocene

“…However, this population-centered model of genomic healthcare delivery has been criticized [37] as being a salvage attempt to rescue something of value from the numerous extremely expensive genome projects that had been the scientific rage of the late 20th and early 21st centuries. Reardon and others [37,53,54] claim PPH is most likely dangerous fantasy, exacerbating global economic differences, taking the "public" out of "public health," and shifting responsibility for health onto the individual citizen [55,56]. PPH has also been criticized for not recognizing the contributions of the symbiotic microbial genomes [38].…”

The Population Health OutcomEs aNd Information Exchange (PHOENIX) Program - A Transformative Approach to Reduce the Burden of Chronic Disease

“…What is new is the modern landscape of health information. Challenges presented by the unprecedented amount and complexity of data include: i) technical difficulties accessing, integrating and sharing health information across multiple domains [60,61] and modalities [62]; ii) ethical [63] and epistemological concerns [64][65][66]; iii) implications of data inaccuracies and selective measurement in routinely collected data [67,68]; and iv) a growing potential for spurious correlations in large datasets [55,65,69]. In turn, a strong foundation in surveillance and descriptive epidemiology is needed to establish an iterative process for interpreting what we know and what we don't know from within and across scientific disciplines (and public health sectors) [55].…”

“…Not everyone is keen on the idea of merging public health with concepts borrowed from precision medicine, especially when genomics is involved [63,[98][99][100]. The utility of Precision Public Health has been questioned because its goals and strategies are not fundamentally different from those of traditional public health [101].…”

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

“…While a consensus appears to be emerging around the concept of PPH, the topic is not without controversy, which has led some junior investigators to argue for the importance of continuing research in this area [12]. 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].…”