CARLOS T. CARTER
Precision medicine is unique in that it safeguards both individuals and communities. Precision medicine’s mission is to move away from a one-size-fits-all approach and towards personalized healthcare. One of the cornerstones of precision medicine is genetics and genetics are highly individual. We all possess our own unique genetic blueprint that can inform our health decisions. Such information can serve as a user manual when it comes to understanding our own health and what choices to make to optimize it. One such example relates to chronic kidney disease (CKD). When a patient discovers that they have the APOL1 genetic variation that increases the risk of CKD, they can prioritize lowering their blood pressure. This kind of health information empowers and equips individuals in a way that the one-size-fits-all approach has never been able to accomplish.
While genetics is a key factor in precision medicine, it is not the only one. Precision medicine considers social determinants of health, environments, and exposures. Our communities are our contexts. Understanding what happens in our communities and how those things affect health and wellness is squarely within the realm of precision medicine. More than anything, precision medicine offers a glimpse at a future where our neighbors are well-supported and receiving care and treatment that is made for them.
In recent years, social determinants of health have garnered recognition for their incredible ability to predict and affect health outcomes. Social determinants of health include the following categories: education access and quality, health care access and quality, neighborhood and built environment, social and community context, and economic stability. Precision medicine asks the right questions with social determinants of health in mind. Does this person have access to quality health information? What is the air quality or water quality like in this person’s home? Does this person have robust social supports? These questions are examples of how precision medicine and its reliance on the social determinants of health analyzes the whole person and their whole situation.
CKD serves as an excellent example of how precision medicine is going to address community-based needs. CKD disproportionately affects the Black community. Its root causes are not only genetic—they are social. Diabetes and high blood pressure, both risk factors for the development of CKD, are triggered in part by lack of access to nutritious food. Because Black communities are more likely to be situated in food deserts, it is often difficult or impossible to sustain a nutritious diet leading to higher rates of CKD-causing conditions. Precision medicine does not ignore that reality. Instead, it centers and elevates it.
Our hope is that precision medicine will usher in an era of healthcare representation for all. One-size-fits-all approaches based on standards that have historically excluded the Black community will no longer be the default. This great promise of precision medicine is emphasized by its recognition of oppression, injustice, and inequality as factors of health.
Carlos T. Carter is President & CEO, Urban League of Greater Pittsburgh
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