Understanding the potential of state-based public health genomics programs to mitigate disparities in access to clinical genetic services

Abstract

PurposeState Health Agencies (SHAs) have developed public health genomics (PHG) programs that play an instrumental role in advancing precision public health, but there is limited research on their approaches. This study examines how PHG programs attempt to mitigate or forestall health disparities and inequities in the utilization of genomic medicine.MethodsWe compared PHG programs in three states: Connecticut, Michigan, and Utah. We analyzed 85 in-depth interviews with SHA internal and external collaborators and program documents. We employed a qualitative coding process to capture themes relating to health disparities and inequities.ResultsEach SHA implemented population-level approaches to identify individuals who carry genetic variants that increase risk of hereditary cancers. However, each SHA developed a unique strategy—which we label public health action repertoires—to reach specific subgroups who faced barriers in accessing genetic services. These strategies varied across states given demographics of the state population, state-level partnerships, and availability of healthcare services.ConclusionOur findings illustrate the imperative of tailoring PHG programs to local demographic characteristics and existing community resources. Furthermore, our study highlights how integrating genomics into precision public health will require multilevel, multisector collaboration to optimize efficacy and equity.

Diversity in the Era of Precision Medicine - From Bench to Bedside Implementation

“…To identify high-risk individuals who lack access to genomic services, it is imperative to modify PHG programs based on demographic characteristics at a granular level, identify potential local partners with expertise in genetic services, collaborate with local institutions to reach to the medically underserved communities, and access readily available resources such as CDC's Office of Public Health Genomics map. 21…”

Implementation of public health genomics and applications to public health dentistry

“…They also promote evidence‐based guidelines for appropriate hereditary cancer screening and management to payers and health systems. State public health agencies develop and implement public health genomics focused on understanding and reducing health disparities for underserved high‐risk populations . State public health genomic programs have also been successful in integrating genomic objectives into state plans to engage multiple partners to implement genomic efforts related to the core public health functions .…”

“…Examples of core public health functions to consider for dental public health genomics State public health genomics efforts have utilized the core public health functions of assessment, policy development, and assurance to create and implement programmatic goals, objectives, and activities (1,3,17). The core public health function of policy in genomics is to develop standards and guidelines for appropriate use of genetic information including the effectiveness, accessibility, and quality of genetic tests and services (1).…”

“…The field of public health genomics began in 1997 with the recognition that the findings of the Human Genome project would have an impact on public health that would extend beyond newborn screening . Over the past two decades, the Centers for Disease Control and Prevention (CDC) has been instrumental in the evolution of public health genomics efforts at the federal level and in funding implementation at state health departments and other efforts . To date, these federal and state funded public health genomics efforts have not yet included public health dentistry.…”

“…State public health agencies utilize the core public health functions to educate providers and the public about evidence‐based guidelines and the HP2020 objectives for appropriate use of genomic testing and services . State public health genomics programs conduct epidemiologic studies to assess and monitor populations at risk for hereditary cancers and cardiac genetic conditions . They also promote evidence‐based guidelines for appropriate hereditary cancer screening and management to payers and health systems.…”