 response illustrates the mounting pressures for a rapid transition from gene discovery to integration in clinical practice, which could result in the premature development and offering of genetic tests.
This book begins to explore the growing impact of the genetics revolution on public health practice in the new millennium. Section I addresses an overview of the integration of genetics in public health, starting with an overall framework (chapter 1), followed by historical perspectives (chapter 2), opportunities provided by the human genome project (chapter 3), models of public health genetics policy development (chapter 4), and the multidisciplinary nature of genetics in public health research and education (chapter 5).
Over the last 5 years, public health agencies have begun examining how advances in human genetics can be used to prevent disease and improve the health of the population (10). For example, as CDC developed a strategic plan (11) to address both the opportunities and challenges posed by advances in human genetics on public health practice, it became clear that much of public health training, infrastructure, policy and program development has not taken genetics into consideration. Notable exceptions are newborn screening programs for metabolic diseases, birth defects surveillance systems, and programs for children with special healthcare needs. Yet, as the science of gene discovery matures, there will be an increasing role for public health in closing the gap between gene discovery and applications to prevent most, if not all, human diseases, especially adult-onset chronic diseases.
The Institute of Medicine (IOM) report on the future of public health (12) can be used as a starting point for developing a long-term strategic plan for integrating genetics into public health practice. The IOM report defined three core functions for public health agencies: assessment, policy development, and assurance. Although genetics was not mentioned specifically in this report, the substantial recommendations of this report apply to all emerging areas in public health, including genetics.
The Interface of Genetics and Public Health
In recent years, a new hybrid subspecialty of genetics and public health has emerged. Public health genetics (a term mostly used in the United States [13-14]) has been defined as the application of advances in genetics and molecular biotechnology to improving public health and preventing disease (14). Community genetics (a term mostly used in Europe ) has been defined as "a branch of genetics that has service and science components." The service component seeks to integrate genetic services into community interventions. The science component encompasses the research needed to develop and evaluate services (15). Public health genetics and community genetics could be viewed as one and the same. Nevertheless, as we think about the broader mission of public health, namely "to fulfill society's interest in assuring conditions in which people can be healthy" (12), there will be unavoidable integration of new genetic information into all public health programs and across all diseases, whether or not the diseases are labeled "genetic diseases.", or the services called "genetic services". All public health professionals, therefore, will need an increasing appreciation for integrating genetic research, policy and program development into their daily work. This is not different from the expected integration of genetics into health care in general and across the various medical subspecialties (16-17). While recognizing the need for a cadre of public health researchers and practitioners fully trained in genetics, we also believe that all public health professionals will be using advances in human genetics in research and practice. We do not particularly endorse the creation of a new public health subspecialty in genetics; rather, we encourage and emphasize the smooth integration of genetics into public health practice. Some of the distinctions between these views are shown in Table 2. Nevertheless, the read