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

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:

• 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 ….

• 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 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 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• 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

• Understand biological basis of diseases• Predict disease susceptibility before

symptoms• Interventions targeted to disease biology• Pharmacotheraphy

• Individualized prevention – “Individually Sized”

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

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

• Laboratory Lou Turner• Administration Deborah Klein-Walker• Clinicians Kristine Gebbie / Mary

Ellen Mortensen• Health EducatorsKaren Greendale• Environmentalist Robert Marino

• Epidemiologist Peter D. Rumm

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

CDC Support

Center for Environmental Health

Office of Genetics

Public Health Practice Program Office

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

• 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• All Public Health Workers• All Professional Workers• Specialty/Concentration-Specific

Leaders/administratorsCliniciansEpidemiologistsHealth educatorsLaboratoriansEnvironmental health workers

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 …

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• 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

• 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

• 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

• 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

Genomic Competencieswww.cdc.gov/genetics/

Questions / Comments

Andy Faucett

aif3@cdc.govColumbia University

School of Nursing