The Synergy between Precision Health and Population Health
Recently, the phrase “precision health” has become a major buzzword in medicine. At the same time, the conversation about population health has also increased. At first glance, these two different approaches to healthcare may seem to represent two opposite ends of the spectrum. One approach focuses on the unique genetic makeup of the individual patient, while the other is concerned with risk and treatment across entire communities.
However, these two seemingly disparate philosophies actually have many similarities. Both approaches rely heavily on data analysis and have the potential to change medicine radically in the years to come. Moreover, the two approaches are not necessarily opposed to each other.
Approaches to Care
According to the American Journal of Population Health, population health deals with the health outcomes of a defined group of individuals and the distribution of outcomes within these defined groups. Examining these outcomes involves analyzing data from electronic health records and other sources of information, including data about the social determinants of health. Increasingly, technology is helping drive population health by providing new data points, whether from patient portals in healthcare systems or wearable devices connected to the Internet of Things. New technologies are used to monitor adherence to treatment regimens and medical advice, as well as collect additional socioeconomic data that can be used to gain better perspective on the health outcomes of large groups of people.
Precision health, however, focuses on the differences not among groups, but among individuals. Small changes in genes, lifestyles, and environments can have a strong bearing on the effectiveness of a given medical treatment. Precision health has led to the development of targeted treatments, such as immunotherapy, which can use technology to boost the natural defenses of the body to achieve a better outcome in disease treatment. These kinds of treatments require the collection and analysis of massive amounts of genomic data. Such analyses give clinicians more data about how individual differences between people affect health outcomes.
Bridging the Philosophical Divide
On the surface, population health and precision health seem fundamentally opposed, but they operate on a similar principle and one approach may soon inform the other. For example, think about using genomic testing to track genetic mutations in a group of individuals who work in the chemical production industry. This population may be exposed to hazardous working conditions, and continual monitoring of genetic changes could help identify and resolve issues in individuals before they become major health problems.
At the same time, understanding these genetic changes may help future generations of this population avoid similar issues, which aligns with the primary concern of population health. As researchers learn more about the risk factors involved with certain genetic patterns and mutations, it will take a population-based approach to implement life-saving interventions.
Many healthcare providers already use precision medicine, even if that only means connecting patients to clinical trials that may benefit them. This practice has become common in oncology, but it may become standard practice in the management of other chronic diseases, especially as population health knowledge expands.
The National Institutes of Health launched the All of Us Research Program to collect data about how lifestyle, environment and biology work together to influence health and disease. This research will make population health risk algorithms more accurate, allowing clinicians to connect patients to needed interventions, even if experimental, most likely to benefit them. Such a healthcare method represents a bridge between these two approaches.
Building a Multi-focused Approach
Recently, David B. Nash, MD, MBA, founding dean of the Jefferson College of Population Health in Philadelphia, spoke at the annual J.P. Morgan Healthcare Conference in San Francisco about the synergy between precision health and population health. Speaking from the perspective of a population health expert, Nash explained how precision medicine is necessary to identify the smallest segments of the population at risk of rare disease, so they can get the education and screening needed to reduce morbidity and mortality. In other words, precision medicine can play an important role in improving population health, provided that professionals from these different healthcare approaches work together to identify key research questions.
The conference provided an opportunity for experts in both approaches to explore how they can work collaboratively in the future. However, the widespread use of genomics in primary care may not be too far off in the future. Recently, NorthShore University Health System in Illinois announced a partnership with Color, a San Francisco-based innovative health service to identify serious hereditary conditions, to sequence the entire genome of 10,000 patients. This genomic data will be integrated into patients’ health records as a means of improving care — both for each individual patient and all patients the healthcare system serves. In this way, the initiative represents a crossover between precision health and population health.
