With advances in technology come new possibilities for balancing the genetic, biological, environmental and social determinants of disease. This may lead to new preventive and treatment options and the next paradigm shift in public health, namely “Precision Public Health” (PPH).

What is precision public health?

PPH is a term established by the Health Department of Western Australia and it complements terms such as “personalised medicine” and “precision medicine” coined in the US. The first time it was officially used was for the Precision Public Health Summit held in San Francisco in 2016, a meeting focused on data integration and sharing, new partnerships, community engagement and social justice for better primary health outcomes.

PPH is an emerging field that utilises data to guide the right intervention to the right people at the right time. In short, PPH describes:

The application and combination of new and existing technologies, which more precisely describe and analyse individuals and their environment over the life course.

A slightly more comprehensive explanation would be:

The combination of data-related skills and technologies (e.g., in epidemiology, data linkage, informatics, and communications) and the ability to aggregate, analyse, visualise, and make available high quality data, larger or linked, in closer to real time, that is at the heart of PPH, much like epidemiology is at the heart of traditional public health.

The goal of PPH is to tailor preventative interventions for at-risk groups and improve the overall health of the population.

Precision Public Health in 2018

Precision Public Health has gained significant traction and forward momentum these past few years. In the midst of this evolution, one can only wonder what the scope of precision public health is and when the term should be used.

A main driver of precision health is ‘better technology’ but the distinguishing feature of precision public health is ‘collaboration’. Collaboration is strongly promoted across a broad range of stakeholders and achieved by uniting public health practitioners, academics, researchers, policy makers, industry leaders and consumer advocacy groups to build strong foundations for future partnerships.

Precision public health in 2018 describes ‘populations’ as the unit of intervention that use enabling technologies. It guides the right intervention to the right ‘population’ at the right time.

Enabling technologies

Big data is one element that has consistently helped to achieve PPH. It delivers to practitioners a volume and variety of structured and unstructured data not previously possible. Examples of success using big data are surveyed in surveillance and signal detection, predicting future risk, targeted interventions, and understanding disease.

Other enabling technologies include:

• Genomics and other omics
• Personalised technologies
• Real-time analytics
• Spatial technologies and climate change
• Data linkage
• Artificial intelligence

Community input

The engagement needed to advance precision public health goes further than diverse recruitment in research studies. Rather, local community members who are the primary beneficiaries of health programs should be true partners. Community members can add meaning and priority to the vast amount of precision data, guiding which types of data should be analysed and combined.

The vision for community engagement in precision population health includes engaging participants in setting research priorities and ensuring that they receive research findings in ways that are accessible, meaningful, and foster education and implementation. A good example is the Connected Health Cities program in the UK, where community members actively vote on the acceptability of linking personal health data with other public datasets. More locally we have the Local Health Needs Assessment. The full 2018 Local Health Needs Assessment report, plus a range of local health fact sheets, are being developed and will be distributed in early 2019.

Questions to take forward into 2019

The core mission of public health is to preserve, promote and improve the health and well-being of individuals at the population level. Marginalised and disadvantaged groups have the greatest needs and therefore have the most to gain from public health programs and initiatives. The way in which technology is utilised to enable Precision Public Health must be considered carefully as a delicate balance exists between promoting equity and exacerbating inequity.

As we move forward with PPH we must ask:

• What can we learn from the history and ethics of public health that will allow us to creatively and purposively take advantage of new technologies, many of which are developed in the private sector?
• What are the downsides of the new technologies and how can these be mitigated (e.g., through education or appropriate policy, risk management, systems design, research, or regulatory frameworks)?
• What are the possible social, ethical, legal, governance, perception and acceptance challenges and obstacles?

Precision Public Health Asia 2018 will be held October 18-19 in Fremantle, Western Australia.