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Public health genomics has evolved to responsibly integrate advancements in genomics into the fields of personalized medicine and public health. Appropriate, effective and sustainable integration of genomics into healthcare requires an organized approach. This paper outlines the history that led to the emergence of public health genomics as a distinguishable field. In addition, a range of activities are described that illustrate how genomics can be incorporated into public health practice. Finally, it presents the evolution of public health genomics into the new era of precision public health.

Keywords: public health genomics, precision public health, genomics, population genetics, population health

The field of public health emerged as a means to protect the health of the individual and the community, and thereby minimize morbidity and mortality associated with disease (1, 2). Differentiating itself from the medical field, public health places an emphasis on improving the health of society as a whole through the use of organized, population-wide approaches. Instances of public health efforts have been documented throughout history. For example, by the eighteenth century, it was common practice to isolate and quarantine sick individuals, in order to contain the spread of contagious diseases such as leprosy and the plague (1, 3). Developing and delivering appropriate public health services requires an understanding about health and wellbeing, the presence and absence of disease, how health outcomes are distributed within populations and the factors that determine these outcomes.

Over the last two centuries, the essential activities of public health have evolved significantly. In the nineteenth century, the primary focus of public health was on managing the physical environment, such as the provision of safe drinking water and the development of effective sewerage systems. In the twentieth century, the scope of public health was increased to include social factors (such as housing, employment, income, educational level, and access to transportation and health care) and lifestyle behaviors (such as physical activity, diet, smoking, and alcohol consumption) that are now known to influence health outcomes. This led to the emergence of the health promotion era of public health, which stemmed from a movement aimed at providing evidence-based education that would enable people to increase control over and improve their health (4). The health promotion movement drove action in a range of areas of public health including: developing public policy, creating environments that support healthy behaviors, and empowering people to develop personal skills to make choices that lead to healthier lives.

At the heart of public health today is the recognition that health outcomes are influenced by a range of social, cultural, political, economic, environmental, behavioral, and biological (e.g., genetic) factors (5). Otherwise known as the determinants of health, these factors may favor health or be harmful to it. Further, while some factors cannot be changed (such as age or ethnic background), others may be modifiable (for example, weight or smoking status). Understanding how these factors influence health outcomes is key to informing public health approaches for promoting health and wellbeing, through the implementation of practices that aim to prevent poor health. These prevention strategies can be categorized into three levels, being:

• Primary: where the aim is to prevent disease and injury from occurring, which will reduce their incidence in the population. This is done largely through interventions to eliminate risk factors. For example, seatbelts, sunscreen, tobacco-use cessation.

• Secondary: where the aim is to reduce the more immediate impact of disease and injury if it does occur. The focus of interventions is on early detection and treatment to alter or slow progress of the disease or injury, and thereby prevent the onset of long-term or permanent adverse consequences such as complications and disabilities. For example, population screening programs.

• Tertiary: where the aim is to help people manage the longer term impact of ongoing disease or injury. The focus of interventions is to improve, as much as possible, factors such as physical and mental functioning, quality of life, and life expectancy. For example, chemotherapy, rehabilitation.

A fourth category of prevention, known as quaternary prevention, has also been proposed (6, 7). This is defined as: action taken to identify a patient or a population at risk of over-medicalization, to protect them from invasive medical interventions and provide for them care procedures which are ethically acceptable [(6), p. 3]. In other words, the aim of quaternary prevention is to identify and protect those individuals for whom medical interventions are likely to cause more harm than good (7, 8).

Core functions of public health

Following from the health promotion movement was a growing recognition that public health had changed significantly over the years, and that the governmental role in providing public health services needed to be clearly defined, adequately supported, and fully understood. This led the Institute of Medicine (IOM; now known as the Health and Medicine Division) of the United States of America's National Academies of Sciences, Engineering and Medicine in 1988 to identify and define the three core functions to be provided by all public health agencies (3), being:

• Assessment: to assess and monitor the health of communities and populations at risk, and to identify health problems and priorities. This requires the regular and systematic collection, assembly, analysis, and dissemination of information on the health of populations.

• Policy development: to formulate public policies, plans, standards, guidelines, and resources in collaboration and partnership with stakeholders, and to solve identified local and national health problems and priorities.

• Assurance: to assure that all populations have access to appropriate and cost effective care (including health promotion and disease prevention services), and to evaluate the effectiveness of healthcare and public health interventions.

Building on this work, in 1994 the three core functions of public health were further elaborated into 10 essential public health services, to support the application of the core functions in practice (9, 10). These 10 essential public health services are presented.

Boards of chiefs and pioneers fundamentally associated with dynamic or making approaches. Additionally, associated with selling and purchasing the offers. Likewise, they keep a decent relationship among the investors and partners. Aside from the higher administration, there are individuals who work underneath them in various leveled request. Doctors straightforwardly engaged with treating the patients and deal with patients and give drugs on schedule. Likewise, there will be representatives who work beneath the doctors like medical caretakers or ward young men, and so forth they have obligations to help the specialists/doctors additionally helps the patients when they are almost required. Yes medical care associations should screen business exercises consistently. Any wellbeing meds or approaches should refresh as quickly as time permits. Since late refreshing in strategies or prescription in medical care association may influence individuals/patients wellbeing.There are situations where local area wellbeing appraisal is more required dependent on the dieses/drug for key arranging. We should take the case of individuals locally who experiences H1N1 fever. If so the essential arranging depends on the number of individuals are influenced because of H1N1 fever and how conditions survey. Vital arranging additionally deals with individuals admitted to medical care. Wards of beds need to treat and so on. Variety/globalization in medical services staff will help in authoritative execution. They can learn new things to treat the patients. Enhancement or learning new things will assist with saving time and patients' life. In the long run, it will have in hierarchical execution.

QUESTION #1...

Consider you are the Director of Operations in a large multi-specialty group practice in a suburban area. This practice has a strong partnership with a large hospital two miles away. A new competitor has recently arrived in your area and you have seen a drop in patient volume. You have also noticed your employee turnover rate has increased in the last few months. The company leaders are concerned with this new competitor and want to outline a strategy to remain competitive.

1. Outline the strategic plan for the organization including a business plan, communication plan, and an employee retention plan. Explain in depth.

A.) Describe how you would ensure employee empowerment, address leadership and change, and build teamwork through a total quality approach. Describe your plan for overcoming politics, negativity, and conflict within the workplace. Explain in depth.

B.) Outline the organizations plan to leverage Health Information Technology. How would you integrate Total Quality Management? Explain in depth.

C.) Identify and describe your organizations plan for future growth into the areas of ACO, Precision Medicine, and Population Health. Explain in depth.

References:

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Zeis, M. 2013. How the Dynamics of Physician Alignment Are Changing. HealthLeaders Media. Published September 13.

Collins, F. S., and A. Prabhakar. 2013. BRAIN Initiative Challenges Researchers to Unlock Mysteries of Human Mind. The White House (blog). Published April 2

Lee, S. S.-J. (2013). American DNA. Current Anthropology, 54(Number S7), S77S86.

Plsson, G. (2012). Decode Me! Current Anthropology, 53(Number S5), S185S195.