摘要：States include genetics services among their public health programs, but budget shortfalls raise the question, is genetics an essential part of public health? We used the Essential Services of Public Health consensus statement and data from state genetics plans to analyze states’ public health genetics programs. Public health genetics programs fulfill public health obligations: birth defects surveillance and prevention programs protect against environmental hazards, newborn screening programs prevent injuries, and clinical genetics programs ensure the quality and accessibility of health services. These programs fulfill obligations by providing 4 essential public health services, and they could direct future efforts toward privacy policies, research on communications, and rigorous evaluations. IN 2000, THE WHITE HOUSE declared that the sequencing of the human genome, a 13-year effort, was an achievement leading to “new ways to prevent, diagnose, treat and cure disease.” 1 Since that time, the media have continued to fuel public interest in genomics research with headlines about creating designer babies and cracking the code of life. 2 , 3 Whereas the goals of the US National Human Genome Research Institute are more limited than those of the White House, the institute has also communicated an ambitious vision, “to improve human health and well-being.” 4 (p836) Certain genetics services, most particularly newborn screening and other maternal and child health services, have been part of state public health programs for several decades. 5 – 7 As these activities have expanded, researchers and policymakers have weighed in with their views on how genetics might be incorporated more broadly into the public health infrastructure. 8 , 9 Over the same period that states were expanding genetics services, however, states experienced combined budget deficits of almost $80 billion. 10 Although conditions are improving, spending pressures for public programming continue. Shortages may compel states to respond to the “persistent critique of public health. . .that the field has strayed beyond its natural boundaries” 11 (p1055) by only engaging in core activities such as infectious disease surveillance or immunizations. The competition for scarce resources raises the question, is genetics an essential part of public health? Finally, we offer perspectives on how public health genetics programs can incorporate the essential services missing from current state activities.
