Department of Epidemiology and Biostatistics, Institute of Rural Health, Lublin, Poland.
Ann Agric Environ Med. 2024 Sep 25;31(3):315-321. doi: 10.26444/aaem/192792. Epub 2024 Sep 18.
The article formulates the following theses and conclusion: (1) the development processes of precision medicine and precision public health (PPH) are correlated; (2) the development of public health genomics depends not only on an increasingly complete exploration of the principles of the human genome, but also on a fundamentally better investigation of how broad environmental factors can alter gene expression or structure; (3) a necessary condition for the development of both precision medicine and precision public health is the collection of increasingly broader and more complete information about pro- and anti-health factors; (4) the above necessary condition is only possible in a situation of strong authoritarianism with regard to taking health-promoting measures. It is likely that in the near future public health will be shaped by health-promoting authoritarianism.
There are two main problems in the development of precise public health (PPH). The first, is maintaining the right proportions between actions based on the genomic data, and actions determined by better understanding of the effect of environmental factors. The second, is the necessity to subject individuals and populations to increasingly closer pro-health surveillance, which must be increasingly more effective, forcing specific health-promoting behaviours on individual and social scales.
PPH in full can only exist in conditions of complete information concerning health determinants of an individual, and each distinguished group of individuals, as well as fully pro-health organization of individual and social life, i.e. in conditions of full individual and social medicalization. However, such a full medicalization cannot be achieved in any way other than authoritarian.
本文提出以下论点和结论：（1）精准医学和精准公共卫生（PPH）的发展过程是相关的；（2）公共卫生基因组学的发展不仅取决于对人类基因组原理的探索越来越完整，还取决于对广泛的环境因素如何改变基因表达或结构的根本更好的研究；（3）精准医学和精准公共卫生发展的必要条件是收集越来越广泛和完整的关于健康促进和抗健康因素的信息；（4）上述必要条件只有在对促进健康的措施采取强有力的威权主义的情况下才有可能。在不久的将来，健康促进的威权主义可能会塑造公共卫生。
精确公共卫生（PPH）的发展存在两个主要问题。第一个问题是在基于基因组数据的行动和更好地理解环境因素影响的行动之间保持正确的比例。第二个问题是必须对个人和人群进行越来越密切的健康监测，这必须越来越有效，在个人和社会层面上强制实施特定的促进健康的行为。
完整的 PPH 只能存在于个人和每个特定的个体群体的健康决定因素的完整信息的条件下，以及个人和社会生活的完全促进健康的组织下，即个人和社会医疗化的充分条件下。然而，除了威权主义，没有任何其他方法可以实现这种完全的医疗化。
