Health Choices: Personal vs. Public

April 2007
Written by Laena Maunula

Tags: health, nutrigenetics, science and society

Public Health and Genomics: Medicine for the individual or the masses?
Kevin pulls into the Jumbo Burger with a car full of friends. They’re on their way to a soccer game and need to “fuel up” first. “I can’t eat anything from this place!” Lindsay moans, “It’s all too fattening!!!” “Well, I can eat whatever I want and it doesn’t affect me,” says Amy, “I’ll have an order of deep fried mozzarella sticks!” “Ugh, fast food makes me sick…” grumbles Brad.

Kevin isn’t concerned. He’ll just silently look down at his cell phone and pulls up his personalized nutrition plan, designed especially for him, based on his genes. This exclusive diet will make sure he gets the nutrients his body needs, help prevent diabetes and heart disease, and control his weight all at once. He knows exactly what to order.

Your Genes/ Your Food/Your Medicine
Sound too good to be true? It’s called “nutrigenomics” (nutrition + genomics): the study of how diet, genes, and environment interact and affect health. Recently, diet plans developed for individual genetic makeup—personalized nutrition—have become available, although for the most part these claims are based on limited and somewhat controversial evidence.

Still, some scientists predict personalized nutrition could become big business in the future. And since obesity, diabetes, heart disease and some cancers are strongly associated with diet in combination with certain genetic backgrounds, this could have a huge impact on the health of the entire population. And best of all, its just one of the many possibilities of genomics technology.

Imagine this revolution in medicine: Battling inherited disorders through gene therapy… DNA technology for better and faster diagnoses… pharmaceuticals developed with your genes in mind, made to order. It boils down to studying and working with the tiny biological pieces that make you, you.

Social Determinants
Perhaps even more interesting is that having this kind of technology could affect the way we think about why we get sick and how to get better.

Let’s put it this way: Say Kevin, and everyone at your school, embarks on their own personalized nutrition plan. Will this alone eliminate diet related disease? Probably not. Sure, obesity is linked to what we eat and how much, but what we eat is not always a matter of choice. Maybe Kevin can’t afford the whole grains, fruits and vegetables his optimal diet mandates. Perhaps his home life is very stressful and he turns to junk food for comfort. What about exercise? Physical activity is a great way to reduce your risk for obesity and diabetes. Then why are so many people inactive? Often it has to do with lifestyle choices and circumstances, for example not having the opportunities to exercise, access to places such as parks or gyms in the area, climate and environmental conditions, and even how safe the neighbourhood is.

These “social” circumstances play a large role in determining health. So although Kevin might receive a personal diet plan, it might not be possible for him to use it. This is where public health comes in. These things are called the “social determinants of health” and have very little to do with genetic makeup. And to public health, they are a vital part of understanding not only who gets sick, but why.

Changing How We Think About Health
Public health is concerned with the health of entire populations: your school, city or province. It is geared toward improving and promoting health through large-scale, community-wide efforts, for example, combating cancer through smoking bans, or seasonal influenza through flu shot programs. In public health, the focus is on the community as a whole, like making sure Kevin and his friends know about the benefits of exercise, and providing fitness programs they will be comfortable using.

Personalized testing however, might encourage us focus our attention on the individual.
So how might personalized medicine affect public health? Do you think an emphasis on individual traits will shift our focus away from community-scale issues such as poverty or sanitation? Could it lead to a change in mind set— toward a personal responsibility for health based on genetic make up? For example, imagine we all have our own complete “plans” to achieve our best possible health. If one of us somehow gets sick, does that mean he or she did something wrong? Or if someone chooses not to follow their health plan, is it their fault if they get sick? Should they be blamed or punished for the strain their illness causes on others?

The Challenge
The possibilities of genomics technology are truly tantalizing, so here is the challenge: When adopting more and more of these breakthroughs into public health practice, we have to be sure we won’t compromise the commitment to protect the population as a whole. While fighting disease through genomics technology, we can’t forget about the bigger picture—and the social determinants that affect our health. How would you find a balance between medicine for the individual and medicine for the community?

For further reading see:
Knoppers, B.M. (2005). Of genomics and public health. CMAJ, 173 (10)
Retrieved February 15, 2007, from
http://www.cmaj.ca/cgi/content/full/173/10/1185

Trivedi, B. (2007). Feeding hungry genes. New Scientist, 2587. Retrieved February 15, 2007, from
http://www.newscientist.com/article/mg19325871.600-feeding-hungry-genes.html