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Columbia University School of Nursing
American Public Health Association October 24, 2001
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
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Why GENOMICSnot Genetics
• Genomics is a new evolving term• Workgroup chose to encourage
“thinking outside the box”
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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
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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
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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
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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
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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
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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”
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CDC WHO
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
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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
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Team Leaders
• Laboratory Lou Turner• Administration Deborah Klein-Walker• Clinicians Kristine Gebbie / Mary
Ellen Mortensen• Health EducatorsKaren Greendale• Environmentalist Robert Marino
• Epidemiologist Peter D. Rumm
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Team Members
Jesse Huang
Bob FinemanJan Friedman
Michele Puryear
Tal HolmesLuanne Williams
Steve Hinricks
Vaughn Upshaw
Richard Hopkins
Harold Bengsch
Scott Zimmerman
Andy Faucett
Joe Kimbrell
Robert RolfsElaine KruegerKatherine Kelly
Kathy Vincent
Theresa Long
Jean Chabut
Jennifer Woodward
Luann WhiteFrances Downes
Kathleen Minor
Alan Gutmacher
Kathy Peppe
Robert TeclawSusan MetcalfEric BlankKarina Boehm
Elizabeth Tilson
Robert Jones
EpidemiologyEnvironmentalLaboratoryHealth Educator
ClinicianAdministration
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CDC Support
Center for Environmental Health
Office of Genetics
Public Health Practice Program Office
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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
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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).
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Competency categories• All Public Health Workers• All Professional Workers• Specialty/Concentration-Specific
Leaders/administratorsCliniciansEpidemiologistsHealth educatorsLaboratoriansEnvironmental health workers
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Competency statements have many uses
• Updating/revising job descriptionsDo appropriate job descriptions include reference to
genomics
• Employee orientation and trainingAs appropriate to program or profession
• Self-assessment by workersAm I able to …
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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
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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
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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
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Additionally, as appropriate to discipline, agency or program
• Leaders / Administrators – 9 moree.g., communicate to policy makers
• Clinicians – 5 moree.g., apply genomic concepts to clinical
services
• Epidemiology / Data Management – 9e.g., accurately describe
sensitivity/specificity of genetics tests
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• Health Educators – 7 moree.g. differentiate between genomic education
and genetic counselling
• Laboratory – 7 moree.g., perform genetic assays with appropriate
validation studies
• Environmental health workers- 6 moreapply risk communication principles and
genomic knowledge accurately
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Genomic Competencieswww.cdc.gov/genetics/
Questions / Comments
Andy Faucett
[email protected] University
School of Nursing