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DNA is Here to Stay!

DNA is Here to Stay!. DNA is Here to Stay. Public Health Genomics: The Basics. Minnesota Department of Health Chronic Disease Genomics Project Sheran McNiff, RN, MPH, CHES sheran.mcniff@health.state.mn.us. Today’s Agenda. Background Definitions and Terminology

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DNA is Here to Stay!

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  1. DNA is Here to Stay!

  2. DNA is Here to Stay Public Health Genomics: The Basics Minnesota Department of Health Chronic Disease Genomics Project Sheran McNiff, RN, MPH, CHES sheran.mcniff@health.state.mn.us

  3. Today’s Agenda • Background • Definitions and Terminology • Genomics and Public Health • Challenges • Action Steps • In depth topic discussion: Kris

  4. Background • The Human Genome Project: Completed in April 2003 • Goals: • Sequence DNA of entire genome • Identify all 30,000-50,000 genes • Create databases and tools for analysis and sequencing • Address the ELSI’s

  5. CDC Cooperative Agreement 5 years $1,000,000 CDC States

  6. MDH Genomics Project • Funding for the MDH Genomic Project will support: • Develop leadership and coordination capacity • Planning, implementation and evaluation of genomics tools in public health programs • Integration of genomics tools into new and ongoing public health initiatives • And, the development of products that can serve as a model for others for integrating genomics and building capacity in their PH settings

  7. MDH Genomics Project • Participating MDH Programs • Health Promotion and Chronic Disease • Family Health • Public Health Laboratory • Community Health • Environmental Health • Infectious Disease Epidemiology • Policy and Communications

  8. MDH Genomics Project • The overall goal of the project is to achieve a coordinated and appropriate use of genomics information and tools in public health planning, programs and policy development in Minnesota.

  9. Definitions • Genetics: The study of single genes; single gene disorders and rare disorders • Genome: Refers to all the genetic material (DNA) belonging to an organism. • Genomics: The study of the functions and interactions of the entire genome, including interactions with environmental factors and lifestyle.

  10. Genomics Behavior Health . . . . . Disease Environment DNA

  11. Why Genomics? • Genomics affects all human beings • Promise for improving health outcomes for the population • Discoveries in genomics will be translated into disease detection, prevention, and treatment initiatives that improve public health. • Genomics cuts across virtually all areas of public health

  12. Public Health Model

  13. Role of Genomics as a TOOL in Public Health • Genomics is a tool that can help us create appropriately targeted, cost-effective public health prevention and screening programs with improved outcomes. • Family History is a powerful Genomic Tool for identifying populations at risk. • A public education tool that can be used to enhance the impact of risk reduction campaigns and messages • A tool for conveying the urgency of public health initiatives to policymakers

  14. Core Functions • Assessment: Monitor how genomic factors are contributing to health outcomes. • Policy Development: Establish policies and guidelines based on the science that support the appropriate use of genomics to improve health and prevent disease and protect the public from misuse of genomic information. • Assurance: Evaluate the usefulness of genomics to improve the public’s health, ensure a competent health workforce that is knowledgeable in genomics, and make genetic services available.

  15. Challenges • Lack of Knowledge (genomics ??) • Understand the importance of genomics within public health. • Learn how to integrate genomics into ongoing programs. • And Communicate with and educate different audiences about genomics.

  16. Challenges • Genomics not seen as a Priority (what now?!) • Compete for time and funding • More immediate needs • Integrate genomics

  17. Challenges • New and Changing Field (keeeeping up) • Learn basics • Keep up with new science • Confidentiality and Ethics (scary…) • Discrimination • Misuse of information

  18. Challenges • Data Issues (where’s the stats?) • Better use of existing instruments: BRFSS • Develop new instruments and systems • Establish baselines

  19. Challenges • Public Support • Educate and involve public • Do initiatives with people, not to them!

  20. Genomics Does Not Stand Alone Genetic susceptibility is not health destiny!

  21. Genomics and the Leading Causes of Death • Heart Disease • Malignant Neoplasms • Cerebrovascular Diseases • Chronic Lower Respiratory Diseases (COPD) • Unintentional Injuries (non-genetic origin) • Diabetes Mellitus • Influenza and Pneumonia • Alzheimer’s Disease • Kidney Disease • Septicemia http://www.cdc.gov/nchs/data/nvsr/nvsr49/nvsr49_11.pdf

  22. Genetic Predisposition is NOT Health Destiny! • Almost all of the LCD’s (with the exception of unintentional injuries) have a genetic component. • There are modifiable risk factors for the LCD’s. • Those with a known Family History of disease can engage in preventive behaviors. • Also, with a known Family History of disease, earlier and more frequent screenings can lead to earlier interventions and decreased mortality.

  23. For Example: • Family History of Colon Cancer: How to Intervene • Begin screening under the age of 50 • More frequent screenings • Possible genetic evaluation/testing • Medical intervention

  24. Other Interventions • With a known Family History of chronic disease public health interventions can be targeted to high risk groups • Maintain healthy weight • Increased physical activity • Smoking cessation • Alcohol avoidance • Adequate intake of fruits and vegetables

  25. Action Steps • Educate ourselves, our colleagues and those we serve • Identify populations at high and moderate risk who could benefit the most from medical, behavioral and environmental interventions • Account for both modifiable and non-modifiable risk factors in designing public health interventions

  26. Ethical, Legal, and Social Issues (ELSI’s) • Much misinformation and fear • MN has law protecting individuals from refusal of insurance coverage due to results of genetic testing. • Educate lawmakers about role of Genomics in Public Health • Support non-discrimination laws and policies that insure confidentiality of genetic information.

  27. Summary • Genomics holds promise for public health • Genomics is relevant to most public health professionals—not just a select few • Genetic predisposition is NOT health destiny • Genomics can and should be part of the plan to reduce disease and improve health • There are things you can do – now.

  28. And Remember…….. Genomics is a TOOL, not a weapon

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