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Genetic/Genomic Competencies for Public Health. Stephen Margolis, PhD; Kristine M. Gebbie, DrPH, RN; Andrew Faucett, MS, CGC; Genetics Competencies for Public Health Workforce Team. Columbia University School of Nursing. American Public Health Association October 24, 2001.

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genetic genomic competencies for public health

Genetic/Genomic Competencies for Public Health

Stephen Margolis, PhD; Kristine M. Gebbie, DrPH, RN; Andrew Faucett, MS, CGC; Genetics Competencies for Public Health Workforce Team

Columbia University School of Nursing

American Public Health Association October 24, 2001

why genomics not genetics
Why GENOMICSnot Genetics
  • Genomics is a new evolving term
  • Workgroup chose to encourage “thinking outside the box”
genetics is currently thought of in relation to conditions
Genetics is currently thought of in relation to conditions:
  • That most people working in public health are rarely involved with
  • Learning genetics had limited value for a public health career
  • Examples include chromosome abnormalities such as Down syndrome and single gene mutations such as Cystic Fibrosis or PKU
genomics refers to those conditions plus
GENOMICS refers to those conditions plus ….
  • Discoveries from the Human Genome Project (HGP) which show that most adult onset and chronic diseases can be partially caused or prevented by genetic factors
  • Environmental factors also play a significant role
  • Nature and Nurture, not versus
two categories rare gene high risk
Two CategoriesRare gene / High risk
  • Gene frequency usually less than 10% but risk for disease can be greater than 50%
  • HNPCC Colon Cancer
  • BRCA 1 and 2 Breast Cancer
  • MODY 1,2,3 Diabetes
  • Alpha-synuclein Parkinson Disease
two categories common gene moderate risk
Two CategoriesCommon gene / Moderate risk
  • Genes that are very common in the general population (30-50%) but only increase the risk moderately and almost always require environmental factors and other genes
  • ApoE Alzheimer
  • Factor V Leiden Stroke / Clotting
  • CCR5 HIV/AIDS resistance
genomics and public health
Genomics and Public Health
  • Human diseases result from gene-environment interaction
  • Public health leadership needed to translate gene discoveries
  • Genetics affects all public health functions: assessment, policy development and assurance
  • Public health must plan to train the workforce in order to build genetics capacity across programs
human genome project future impact
Human Genome Project future impact
  • Understand biological basis of diseases
  • Predict disease susceptibility before symptoms
  • Interventions targeted to disease biology
  • Pharmacotheraphy
  • Individualized prevention – “Individually Sized”
genetics plays a role in most disease
Heart Disease

Cancer

Stroke

COPD

Injury

Pneumonia / Influenza

Diabetes

Suicide

Kidney Disease

Chronic Liver Disease

Heart Disease

Stroke

Pneumonia

HIV / AIDS

COPD

Diarrhea

Perinatal

Tuberculosis

Trachea/bronchus/lung cancer

Traffic Accidents

Genetics Plays a Role in Most Disease

CDC

WHO

why now
Why Now ?
  • Technology will produce inexpensive and efficacious genomic risk tests
  • We will have to evaluate relative risk to the community
  • We will have to develop focused messages to those at high risk
  • Consistent with overall public health workforce initative
team leaders
Team Leaders
  • Laboratory Lou Turner
  • Administration Deborah Klein-Walker
  • Clinicians Kristine Gebbie / Mary Ellen Mortensen
  • Health Educators Karen Greendale
  • Environmentalist Robert Marino
  • Epidemiologist Peter D. Rumm
team members

Administration

Clinician

Health Educator

Laboratory

Environmental

Epidemiology

Robert Jones

Elizabeth Tilson

Karina Boehm

Eric Blank

Susan Metcalf

Robert Teclaw

Kathy Peppe

Alan Gutmacher

Kathleen Minor

Frances Downes

Luann White

Jennifer Woodward

Jean Chabut

Theresa Long

Kathy Vincent

Katherine Kelly

Elaine Krueger

Robert Rolfs

Joe Kimbrell

Andy Faucett

Scott Zimmerman

Harold Bengsch

Richard Hopkins

Vaughn Upshaw

Steve Hinricks

Luanne Williams

Tal Holmes

Michele Puryear

Jan Friedman

Bob Fineman

Jesse Huang

Team Members
cdc support
CDC Support

Center for Environmental Health

Office of Genetics

Public Health Practice Program Office

the process
The Process
  • Consistent with other competency definition projects in emerging area of practice
    • A combination of expert opinion and consultation with practice field
  • Key dates
    • March 2000 – Team Leaders Meet
    • August 2000 – Teams Meet and Draft 6 Sets
    • Drafts Revised & Combined – Email & Conference Call
    • March 2001 – Team Leaders Meet – Edit & Cut – Format
    • April 2001 – Outside Review by 60+ Associates of Team Members
    • May 2001 – Comments Combined – Team Leaders Review by Email
    • June 2001 –Document Released on OGDP Web Site
individual competencies
Individual competencies
  • Complex combination of knowledge, skills and abilities demonstrated by organization members that are critical to the effective and efficient function of the organization (Center for Public Health Practice, Emory University).
competency categories
Competency categories
  • All Public Health Workers
  • All Professional Workers
  • Specialty/Concentration-Specific
    • Leaders/administrators
    • Clinicians
    • Epidemiologists
    • Health educators
    • Laboratorians
    • Environmental health workers
competency statements have many uses
Competency statements have many uses
  • Updating/revising job descriptions
    • Do appropriate job descriptions include reference to genomics
  • Employee orientation and training
    • As appropriate to program or profession
  • Self-assessment by workers
    • Am I able to …
all public health workers should
All Public Health workers should
  • Demonstrate basic knowledge of the role that genomics has in the development of disease
  • Identify the limits of his/her genomic expertise
  • Make appropriate referrals to those with more genomic expertise
all public health professionals should
All Public Health professionals should
  • Apply the basic public health sciences … utilizing the genomic vocabulary …
  • Identify ethical and medical limitations …
  • Maintain knowledge on the development of genetic advances
  • Identify the role of cultural, social, behavioral, environmental and genetic factors in … disease
and should
and should
  • Participate in strategic policy planning …
  • Collaborate … to solve genomic related problems
  • Participate in the evaluation of … genomic services in public health
  • Develop protocols to insure informed consent and .. protection
additionally as appropriate to discipline agency or program
Additionally, as appropriate to discipline, agency or program
  • Leaders / Administrators – 9 more
    • e.g., communicate to policy makers
  • Clinicians – 5 more
    • e.g., apply genomic concepts to clinical services
  • Epidemiology / Data Management – 9
    • e.g., accurately describe sensitivity/specificity of genetics tests
slide22
Health Educators – 7 more
    • e.g. differentiate between genomic education and genetic counselling
  • Laboratory – 7 more
    • e.g., perform genetic assays with appropriate validation studies
  • Environmental health workers- 6 more
    • apply risk communication principles and genomic knowledge accurately
genomic competencies www cdc gov genetics

Genomic Competencieswww.cdc.gov/genetics/

Questions / Comments

Andy Faucett

aif3@cdc.gov

Columbia University School of Nursing