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INTRODUCTION

The goal of this chapter is to discuss the role and promise of precision medicine in public health and preventive medicine. This chapter is organized as follows: First, we define precision medicine and review its history and evolution. Second, we present an overview of comprehensive theoretical frameworks that can inform the conception and implementation of precision medicine to optimize its impact on individual and population health. Third, a brief discussion follows that highlights state-of-the-art technologies, data pipelines, and computational tools across multiple levels and contexts in accordance to theory and, importantly, how these can be leveraged to advance precision medicine in public health research and practice. Fourth, specific examples of precision medicine in action in both national and global contexts are presented. Finally, we discuss the future of precision medicine from the perspective of public health and preventive medicine in terms of achieving a vision for precision health.

EVOLUTION OF PRECISION MEDICINE

Definitions

Precision medicine is defined as “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person.”1 Historically, the term “personalized medicine” has been used interchangeably with precision medicine, as both terms are interrelated and draw heavily from genomics; however, the two concepts have notable differences (see Table 3-1). The importance of a distinction in terminology arose from the concern that personalized medicine can be interpreted as treatment and prevention strategies that are “developed uniquely for an individual,” whereas precision medicine’s aims to explore “how treatment or prevention approaches can be developed based on the combination of genetic, environmental, and social factors which could be targeted to individuals or populations.”1,2 In other words, precision medicine is not limited to an individual, but holds great potential for developing population-wide interventions with targeted precision. Another reason for distinction is related to the commonly shared notion among physicians that medicine is already personalized since treatments are individualized based on a patient’s clinical context and care trajectory.3 However, such a definition of personalized medicine misses additional elements that precision medicine carries, specifically the focus on new and precise approaches to diagnostics and therapeutics.

TABLE 3-1a

KEY DEFINITIONSa

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