Overview of the 1997 Genomics Strategic Plan
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The development of this plan was guided by the following vision, mission, and value statements drafted by the task force:
Scope and assumptions
The plan focuses on human genetics only. Other research in genetics that affects public health, such as genetic variation in microorganisms, insect vectors, and other nonhuman species, that affects public health, was considered beyond the scope of this plan.
The plan is based on the assumption that the use of genetic information in public health is appropriate in promoting health and in diagnosing, treating, and preventing disease, disability, and death among people who inherit specific genotypes. Such prevention concerns the use of medical, behavioral, and environmental interventions to reduce the risk for disease among people susceptible because of their genetic makeup. It does not include efforts to prevent the birth of infants with specific genotypes.
The plan is also based on the assumption that most diseases of significant public health impact result from the interaction between genotype and environmental factors. This interaction occurs for rare conditions usually associated with a few genes, as well as for more common diseases associated with multiple genes and environmental factors. Because this interaction occurs, genetic risk factors should be incorporated into the traditional epidemiologic paradigm (Khoury et al., 1993). The paradigm could also account for how gene-environment interaction can increase the risk for various diseases, such as cancer.
The plan assumes that much of the delivery of genetic tests and services for disease prevention and health promotion, including adequate family history assessment and genetic counseling, will be done within the context of the evolving health care system. Managed care organizations will play an important role in integrating genetic services into disease prevention and health promotion activities. Large-scale mandated public health programs are not viewed as the foundation for the implementation of this plan.
As outlined by the Institute of Medicine Report on the Future of Public Health (IOM, 1988), public health agencies will have an increasing role in assessing the health needs of populations, working with the private sector in ensuring the quality of genetic tests and services, and evaluating the impact of interventions on medical, behavioral, and psychosocial outcomes.
Human genetics is a global rather than domestic issue. However, most of the activities proposed in this plan pertain to the U.S. population and involve partnerships at the federal, state, and local levels. CDC’s responsibility as a partner in global health should be continually addressed as the strategic plan is implemented.