There is a important New England Journal of Medicine perspectives article by The Mailman School’s Ron Bayer and Boston University’s Sandro Galea on the tension between the drive to develop “precision-medicine” clinical interventions and the critical role of public health in improving overall population health. The authors voice their skepticism that the planned large investment in precision medicine will be able to move the needle on improving population health.
The 2013, National Research Council (NRC) and the Institute of Medicine (IOM) report ‘Shorter Lives, Poorer Health” documented that Americans rank at the bottom for almost all health outcomes compared to their counterparts in peer economically developed countries. Health outcomes in the U.S. do not rank so poorly because other countries have adopted high-tech precision medicine clinical approaches, these other countries have not. Bayer and Galea write “…there is now broad consensus that health differences between groups and within groups are not driven by clinical care but by social-structural factors that shape our lives.” Compared to our peer countries, our investment in efforts to alleviate the effects of fundamental causes of poor health, such as poverty and racial and economic residential segregation, is sadly low.
The Journal posted an interview with Ron Bayer talking about the issues described in the article. Ron Bayer co-directs the Center for the History and Ethics of Public Health at the Mailman School of Public Health. Dr. Bayer is interviewed by Stephen Morrissey, the Managing Editor of the Journal. Click play to listen.
– Andrew Rundle