Stanford Medicine leaders on using population health, precision health to enhance health equity
In a virtual chat, the School of Medicine’s dean and the chair of epidemiology and population health discussed how the seemingly distinct fields can intersect to boost health equity.
Combining precision health and population health could be a powerful force in the fight for health equity.
That was the takeaway from a March 22 conversation, via online video, between Lloyd Minor, MD, dean of the School of Medicine, and Melissa Bondy, PhD, professor and chair of epidemiology and population health.
In precision health, physicians harness a patient’s individualized data to maintain health, treat illness or detect early signs of disease. Population health is the study of health risks of particular groups of people. The goal of health equity is to ensure that all members of a community have an equal opportunity to be as healthy as possible.
“Precision health and population health have really evolved and advanced in parallel, sometimes coming together, but more often than not remaining distinct from one another,” Minor said. “I hope in the future that this dichotomy between public health and medicine will become less, and the fields will converge in ways that promote health and well-being. And I think we have a unique opportunity here at Stanford to do that.”
By drawing on population health, Minor and Bondy said, researchers and clinicians can better work with communities to bring precision health to those who could really benefit from it.
Minor gave an example: “We know that among the Latinx community, more than a third of adolescents are obese, and many of these adolescents eventually develop severe health problems later in life, such as diabetes, kidney disease or heart disease,” he said. “We need to be thinking about what interventions might help to combat childhood obesity in this community and others.”
Precision health can support research and patient care in many ways and in a variety of fields, Bondy said. On the research side, Bondy and her colleagues at Stanford’s Center for Population Health Sciences apply precision health to advance health equity.
At Stanford Precision Health for Ethnic and Racial Equity, research projects using technology and data to close the gap in health disparities, including ones that use molecular data to prevent and treat excess weight gain and diabetes risk among Hispanic children, are already in motion, Minor said. He added that telehealth, which has been critical during the COVID-19 pandemic, is a potent approach for boosting health equity, as it creates more opportunities to access care.
COVID-19 as a case in point
Past studies and analyses have demonstrated that social factors, such as a family’s income or education level, and environmental factors, such as living conditions or air pollution, account for roughly 70% of what determines health and well-being. These underlying social and environmental drivers of health have become even more evident during the COVID-19 pandemic, Minor said. Across the United States, Black and Hispanic people have suffered disproportionately higher rates of hospitalization and death from the disease compared with white people. But the pandemic has created an opportunity for precision and population health to advance health equity more broadly, particularly in developing countries, Minor and Bondy said.
“New, innovative and highly effective approaches to designing, manufacturing and distributing vaccines have yielded two RNA-based vaccines now in use around the world,” Minor said. “And there are other advances in vaccine technology that are coming on the heels of the RNA advances.”
Over the past 10-15 years, vaccinology has progressed more slowly than other therapeutics have, but advances spurred by COVID-19 will almost certainly open new doors for vaccines targeting infectious diseases still rampant in the developing world, Minor said. “I think the next decade could see tremendous progress in health equity and care as a consequence of the accelerant effect of COVID-19,” he said.
In the closing moments of the discussion, Bondy and Minor reflected on why Stanford Medicine is uniquely suited to explore new directions in health equity and harness the potential of precision health to enhance population health.
“Our ability to innovate and bring those innovations into a clinical care environment is, I think, unparalleled here at Stanford, and that will continue to grow as we build both our discovery-based enterprise and our health care delivery enterprise,” Minor said. “But it really does come down to our people — people with an entrepreneurial spirit, people who don’t accept the status quo and want to go further to have real impact.”
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