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
Columbia University
School of Nursing

American Public Health Association October 24, 2001

 Why GENOMICS
not 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 Categories
Rare 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 Categories
Common 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”
Genetics Plays a Role in Most
CDC DiseaseWHO
• Heart Disease • Heart Disease
• Cancer • Stroke
• Stroke • Pneumonia
• COPD
• HIV / AIDS
• COPD
• Injury
• Diarrhea
• Pneumonia / Influenza
• Perinatal
• Diabetes • Tuberculosis
• Suicide • Trachea/bronchus/lung
• Kidney Disease cancer
• Chronic Liver Disease • 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
Administration Clinician Health Laboratory Environmental Epidemiology
Educator
Robert Jones Elizabeth Karina Eric Blank Susan Metcalf Robert Teclaw
Tilson Boehm
Kathy Peppe Alan Kathleen Frances Luann White Jennifer
Gutmacher Minor Downes Woodward

Jean Chabut Theresa Kathy Katherine Elaine Krueger Robert Rolfs

Long Vincent Kelly
Joe Kimbrell Andy Scott Harold Richard
Faucett Zimmerman Bengsch Hopkins
Vaughn Upshaw Steve Luanne Tal Holmes
Hinricks Williams
Michele Puryear Jan Bob Fineman
Friedman
Jesse Huang
 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/administrators
 Clinicians

 Epidemiologists

 Health educators

 Laboratorians

 Environmental health workers

 Competency statements have
many uses
• Updating/revising job descriptions
 Do appropriate job descriptions include reference to
genomics
• Employee orientation and training
 As appropriate to program or profession
• Self-assessment by workers
 Am 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 more
 e.g., communicate to policy makers
• Clinicians – 5 more
 e.g., apply genomic concepts to clinical
services
• Epidemiology / Data Management – 9
 e.g., accurately describe
sensitivity/specificity of genetics tests
• Health Educators – 7 more
 e.g. differentiate between genomic education
and genetic counselling
• Laboratory – 7 more
 e.g., perform genetic assays with appropriate
validation studies
• Environmental health workers- 6 more
 apply risk communication principles and
genomic knowledge accurately
 Genomic Competencies
www.cdc.gov/genetics/

Questions / Comments
Andy Faucett
aif3@cdc.gov
Columbia University
School of Nursing