Precision Public Health

Precision medicine is needed to improve the quality of individual health. Rather than using the same approach for everyone, interventions can be adapted to the specific conditions of each individual.

KOMPAS/RIZA FATHONI

Health service activities at the Precision Medicine polyclinic at Yarsi Hospital, Cempaka Putih, Jakarta, Friday (13/1/2023). Precision medicine is believed to be the future of public health services.

Scientific progress in understanding the molecular basis of disease has led to the development of precision medicine, which is promising for the improvement of individual health. However, personalized treatments can lead to inequality if it is not oriented toward public health.

On 14 May, 2013, actress Angelina Jolie made headlines around the world when she announced that she is a carrier of the BRCA1 genetic mutation and is at risk of developing breast and ovarian cancer. In an opinion piece in The New York Times, she explained her decision to get tested and have a double mastectomy (a procedure to remove breast tissue) to prevent cancer.

Jolie lost her mother to ovarian and breast cancer, while her grandmother and aunt died of breast cancer. Data from the United States National Cancer Institute show that women who inherit the BRCA1 gene have a 55-66 percent risk of developing breast and ovarian cancer. The risk for women carrying the BRCA2 mutation is 45 percent, while the risk is at 12 percent for women in the general population.

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After this publication, the popularity of precision medicine was on the rise. Findings in The BMJ in 2016 revealed a major spike in screening for genes that increase the risk of breast cancer following Jolie’s confession. Even so, there was no significant increase in mastectomy.

At the time, testing for BRCA1/2 cost over US$3,000 in the US, excluding the operating costs. Its clinical benefits, however, are still being debated in a number of countries.

Amid this controversy, the precision medicine business in its various forms continues to grow. A recent Bridge Market analysis showed that the precision medicine market is continuously growing, reaching $59.29 billion in 2021 and is expected to reach $145.36 billion in 2029.

Treatment based on a patient’s genetic variation is a key aspect of “personalized treatment,” which focuses on how an individual’s DNA influences the way the body processes and responds to drugs.

In Indonesia, several health facilities promote testing for genes that are associated with the risk of various diseases, including cancer, diabetes and kidney diseases. Some offer gene examination in relation to drug selection and dosage, commonly known as pharmacogenomics.

Treatment based on a patient’s genetic variation is a key aspect of “personalized treatment,” which focuses on how an individual’s DNA influences the way the body processes and responds to drugs. This field combines pharmacology and the study of genes and their functions to develop treatments that are effective and safe according to an individual’s genetic variation.

There are also those that offer genetic examination packages to determine the metabolic ability of a nutrient, known as nutrigenomics. The cost of these examinations can reach tens of millions of rupiah. At these costs, there would be limited public access and increased health disparities in the population.

KOMPAS/AHMAD ARIF

Officers from the Community Health Center took blood samples from residents of Hupu Mada Village, Wanokaka District, West Sumba, Sunday (24/7/2016). This genetic sampling was carried out in the context of research on the origins and diaspora of Indonesian humans by the Eijkman Institute for Molecular Biology, Ministry of Research, Technology and Higher Education.

Overcoming inequality

Scientifically, precision medicine is needed to improve the quality of individual health. There is increasing evidence showing that genes, behavior, exercise and eating habits, as well as the environment, are all factors that influence an individual’s health. Rather than using the same approach for everyone, interventions can be adapted to the specific conditions of each individual.

Precision health has emerged more recently and seeks to complement precision medicine development by leveraging advances in genetic technology, including new information from big data analysis and biobanks that target population-scale healthcare.

Precise public health is deeply rooted in addressing health inequalities and using the best data for more effective and efficient interventions for those most in need.

Precision health has broader dimensions than precision medicine or treatment as it includes approaches from outside a doctor’s setting or hospital, such as disease prevention and health promotion activities for populations.

If precision treatment can be understood as providing the right intervention to the right individual at the right time, precision health can be understood as providing the right intervention to the right population at the right time.

“Precise public health is deeply rooted in addressing health inequalities and using the best data for more effective and efficient interventions for those most in need,” says Richard Horton (The Lancet, 2018). Because of this, research on mapping health risk factors in the population is very important to form the basis for policy.

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There is still much work to be done for precision health. The Institute for Health Metrics and Evaluation report by Nick Golding and his team (2018), for one, reviewed the causes of child mortality in 46 African countries. The death map of children under 5 years reported in this new “precision” data “provided key information for decision makers to intervene in populations most in need in Africa.”

Mapping like this is needed in Indonesia, for example, to explore the high rates of stunting and child mortality in Papua. It can also be used to understand the connection between genetics and environmental changes, how lifestyle affects this and what is the best intervention.

Without prioritizing a public health approach, precision medicine may only widen the inequality gap. The practice of precision treatment, which is currently being offered by several facilities at exorbitant prices, is only accessible to the wealthy. Thus, precision health initiatives with an emphasis on preventive and health promotion efforts at the population level should be prioritized.

This article was translated by Kesya Adhalia.