Precision medicine and public health – making health more preventative and proactive across populations
Mathias Egermark, MDHead of Core Lab and Disease Area Network Head for Cardiometabolic for Roche
Hsien-Hsien Lei, BA(Hons), PhD, MDChief Executive Officer (CEO) of The American Chamber of Commerce (AmCham) in Singapore
Michelle Griffin, MDClinician, Strategist, and Advisor
Prof. Patrick Tan, BA, MD PhDExecutive Director, PRECISE (Precision Health Research, Singapore), Executive Director, Genome Institute of Singapore, A*STAR and Professor, Duke-NUS Medical School, Singapore
Precision medicine and public health – making health more preventative and proactive across populations18 October 2022 | 6min
Precision public health, an emerging topic where the concepts of precision medicine and public health meet, aims to find the right intervention at the right time for the right population
Successfully implementing precision public health requires massive amounts of data and significant computing power to allow appropriate interventions at the population level
Experience in Singapore and the UK demonstrate that in order to generate the rich data sets needed, trust, significant human resources, and high-quality standardized processes are required
Precision public health is a new and emerging topic where the concepts of precision medicine and public health meet. Public health focuses on protecting and improving the health of people and their communities. It promotes health via education, programs, and science that drives the prevention, detection, and eventual treatment of infectious and chronic diseases to improve the health of entire populations.
Public health has always been important, but even more so now during the COVID-19 pandemic than ever before. Policymakers around the world have seen the critical importance of having diagnostic testing infrastructure combined with data-driven decision-making in place to better detect, contain, and direct health resources to where they are needed most.
Over the last decades, we have also witnessed the rise of precision medicine. Precision medicine aims to find the best treatment option for an individual patient. Rather than casting a wide net, precision medicine strives to identify the right treatment for the right patient at the right time through the personalization of therapeutic approaches. This is done using precision treatments combined with highly specific diagnostics and personal information to tailor treatments to meet the needs of the individual patient.
Healthcare Transformers, in collaboration with Lab Insights, recently held a panel discussion about precision public health, an emerging topic where the concepts of precision medicine and public health align. Hosted by Dr Mathias Egermark, Disease Area Network Lead from Roche Diagnostics, a distinguished panel of global experts including Dr Hsien-Hsien Lei, CEO, American Chamber of Commerce (AmCham) Singapore; Prof Patrick Tan, Executive Director of the Precision Health Research Singapore; and Dr Michelle Griffin, Clinician, Strategist and Advisor, UK shared their thoughts on what precision public health is, and, more importantly, why it matters.
Precision public health is built on data on a grand scale
According to Dr Lei, public health is really about the use of data and in that sense, it is very like precision medicine, just on a population level. The difference is one of scale. Precision public health, therefore, tries to find the right intervention at the right time – every time – for the right population. At the population level, massive amounts of data are available from an abundance of sources. The goal of precision public health is to integrate these various sources of data to allow for better prediction, and therefore more precise interventions, for these populations at the right time.
You can learn more from the recently formed Precision Public Health Asia Society in their white paper on responsible data sharing in health and healthcare.
Dr Lei also spoke about the difference between design data and organic data. Design data comes from sources like clinical trials. This data has many uses but is limited by the confines of the study design. Organic data, on the other hand, is generated from sources like electronic health records or wearables. Organic data, when combined with advanced computing power, will allow us to design the best interventions at the population level, or to build detailed maps of increased disease prevalence at scale, or incidences as they happen.
A recent paper published in Frontiers of Public Health in April 2022 outlined three horizons to achieving precision public health. First, build the necessary digital infrastructure workflows and partnerships. Second, develop analytics and data-driven decision-making. Third, create digital-first models which can predict and then prevent disease. You can read the paper here.
Precision public health comes to life in Singapore
Prof Tan shared a concrete example of a public precision health initiative. Like many countries, Singapore is facing an aging population which results in a greater chronic disease burden. As a result, the Ministry of Health is exploring several different approaches to combat this. One is Healthier SG, a public health initiative aimed at improving population health.
Because Singapore is a multi-ethnic Asian country with three major ethnic groups, relevant data is needed to inform these crucial public health decisions. As these are not available elsewhere, the government has kicked off the PRECISE-SG100K population cohort study to understand population health better. This study aims to collect detailed baseline health information and biological specimens from 100,000 participants, and then monitor long-term health outcomes via a combination of approaches, all linked to the national electronic health care record system. Precision Health Research, Singapore (PRECISE) is the central entity set up to coordinate this whole government effort to implement Singapore’s 10-year National Precision Medicine strategy.
The local, multiethnic dataset will be Asia’s most deeply characterized and will open avenues for the development of analytical precision genomics tools to predict disease before it happens, and even intercept disease at an earlier stage.
The crucial bridging role of hospitals and labs
Dr Griffin emphasized the role hospitals and clinical laboratories play in enabling precision public health. For population health, super-rich datasets are invaluable – and to generate those, you need people and high-quality standardized processes.
Trust is key. To assure patients that their data is safe and being collected and analyzed for the greater benefit of the population, the hospital can play a powerful bridging role. In the UK, for example, hospitals acted as key recruitment centers for Genomics England. Genomics England was set up by the Department of Health and Social Care to run the 100,000 Genomes Project, and are looking at cancer, rare disease, and infectious diseases on a population level. Hospitals already running oncology, rare disease, or infectious disease clinics were able to offer an additional layer and recommend relevant patients to the Genomic England program.
Beyond hospitals, the UK government also looked for clinical laboratories to participate in Genomics England. In doing so, they set the standard in outcomes, processes, data security, and governance. As a result, a strengthened bond was created between participating hospitals and labs, as well as between laboratories themselves. Genomics England proves that precision public health can be adopted at a national level, with hospitals and clinical labs playing a key role in convincing the public to participate thanks to their culture and governance already in place.
What questions are top of mind for healthcare leaders around precision public health?
The discussion continued during a live Q&A round guided by Mathias Egermark from Roche. Some of the questions that Drs Lei, Tan, and Griffin answered included:
- What efforts have been made to convince external healthcare stakeholders to share real-world data with researchers and healthcare companies in order to succeed in executing the goals of precision public health?
- Is there a need to also monitor the human factor for employees in health organizations, in addition to data and analytics, to be able to deliver the best possible services?
- How much effort is put into the standardization of data and how would you recommend healthcare organizations wishing to collaborate to begin to tackle standardization?
- With some of the ‘lifestyle’ information required to make useful recommendations, the completeness and accuracy of information e.g., on exercise engagement/ dietary intakes is always lower than things like biochemical testing/genomic analysis. How can this be managed?
- What do you think is the importance of quality and cost when we are talking of Precision Medicine and Public Health?
- In the future, are we going to see a major move toward more and earlier screening, pre-disease, for general populations?
Mathias Egermark, MD is a licensed clinical practitioner, who studied Business and Economics at the Stockholm School of Economics and holds a Doctor of Medicine degree from Uppsala University in Sweden. Since joining Roche in 2010, Mathias held roles with increasing responsibility, including Strategic Marketing Director at Roche Diagnostics in Sweden and Lifecycle leader for Cardiac & Critical Care, Women’s Health and Personalized Healthcare in the global Roche Diagnostics organization. Before joining Roche, Mathias held various leadership roles in clinical development at Novartis and Pfizer, after having worked as a clinical practitioner in general practice and surgery. In his current role, Mathias is leading the global Cardiometabolic Disease Area Network at Roche Diagnostics.
Hsien-Hsien Lei, BA(Hons), PhD, MD is Chief Executive Officer (CEO) of The American Chamber of Commerce (AmCham) in Singapore — the largest and the most active international business association in Singapore and Southeast Asia representing nearly 600 companies. Hsien is also an Adjunct Associate Professor at the National University of Singapore Saw Swee Hock School of Public Health, a member of the Johns Hopkins Bloomberg School of Public Health’s Advisory Board, Vice President of the Precision Public Health Asia Society and serves on the board of TalenTtrust. Prior to AmCham, Hsien was Vice President, Medical and Scientific Affairs, at Medtronic Asia Pacific, where she was responsible for the Medtronic Innovation Centers in Japan and Korea, training and education, as well as the company’s health systems transformation strategy in the region. Hsien has extensive experience in scientific affairs, corporate and healthcare communications, advertising, public relations, and government affairs.
Michelle Griffin, MD has nearly 20 years of experience in healthcare across the NHS and Public Health England in the UK and the World Health Organisation. She is a clinical doctor specializing in obstetrics and gynecology and now specializes in women's health, especially in health tech. She has been the Gynecology Lead for the National Cancer Registration Service and Lead for the National Rare Disease Registration Service, both of which are linked to Genomics England and personalized healthcare. She now works as an independent health expert and strategy advisor in women's health tech, specializing in women's health.
Prof. Patrick Tan, BA, MD PhD is the Executive Director (ED) of PRECISE and will oversee the implementation of Phase II of Singapore’s National Precision Medicine Strategy, which aims to transform healthcare in Singapore, and improve patient outcomes through new insights into the Asian genome and data-driven healthcare solutions. During the 2020 COVID-19 pandemic, Prof Tan was Programme Director of Operation Stronghold, establishing one of Singapore’s largest COVID-19 testing facilities through a joint effort involving A*STAR (Agency for Science, Technology, and Research), National University Health System, and Temasek Holdings. Prof Tan is also the Executive Director of the Genome Institute of Singapore and a Professor at the Duke-NUS Medical School. He is an elected member of the American Society for Clinical Investigation (ASCI), the Bioethics Advisory Committee (BAC), a Board Member of the International Gastric Cancer Association, and on the Board of Reviewing Editors for Science.