November 2009 - Hot Topic

Public Health and Genetics: the Porcupine Health Unit Experience

“Public health genetics is a new discipline. It brings together the insights of genetic and molecular science as a means of preventing disease and of protecting and improving the health of the population. Its scope is wide, and requires an understanding of genetics, epidemiology, public health, the principles of ethics, law, and the social sciences and much else besides.” [1]

In 1973, a group of forward-thinking women called the Imperial Order of the Daughters of Isabella (IODE) established a “Concern for Children fund” and some of their monies were designated for the development of genetic services in Northern Ontario. Through the cooperative effort of the IODE and the Association of Genetic Counsellors of Ontario, an outreach clinic was established in 1975 at the health unit in Sudbury as a two-year project.

The Sudbury and District Genetic Services project was a resounding success.

The group saw the infrastructure of health units as being appropriate to support genetic programs. After the success of the Sudbury program, the IODE began providing funding for genetic counseling services in other Northern Districts and in 1983 to the District of Cochrane. Within a year, in1984, the Ministry of Health and Long Term Care (MOHLTC) took over this funding. This year marks the twenty-sixth year of genetic service in the Cochrane District. The union of northern health units and the MOHLTC has helped northern families receive genetic assessments without having to travel to Southern Ontario Genetic Centres.

In the Cochrane District four two-day clinics attended by two geneticists are held every year. Approximately 100 families are seen in clinic per year. Services can also be provided via videoconferencing. We are grateful to Dr. Wendy Meschino, our genetic advisor, for providing service to the Cochrane District for well over 20 years.

There are now five outreach clinics in the North including our own serviced by visiting Southern Ontario geneticists. The other sites are: Algoma Public Health Unit, the Hospital Regional de Sudbury Regional Hospital, Thunder Bay and District Health Unit, and the North Bay and Perry Sound District Health Unit.

Over the years, public health nurses in genetics at the Porcupine Health Unit have become increasingly involved in service provision by counseling for families with a history of breast cancer as well as for some single gene disorders under the direction of Dr. Meschino. The goal is to give access to timelier counseling, which helps to alleviate the wait lists for clinics. The nurse counselor explains genetic services in Ontario, takes a family history, prepares the family pedigree, gathers medical documentation, and organizes the specialized testing done by laboratories around the world. They also provide information on conditions, patient follow up, and organize referrals to other services.

What we know about genetics is increasing at a rapid rate and it has significant implications for individuals, their families, and public health. As identifiers of health indices, public health epidemiologists in partnership with genetic service providers can take a leadership role in the integration of genomics into mainstream health care. The Ontario Prenatal Screening Program and the newly expanded Newborn Screening Program are just two examples of growing and evolving public health programs based on genetics.

“The identification of genetic conditions and genetic susceptibilities which is already on the horizon will guide the design of future health care services. It will dictate health promotion and prevention messages suited to specific and varying population bases.”
“Health Units already providing health promotion and prevention programs will be able to use the emerging genomic knowledge to define and direct those same programs and messages.” [2]
“At the core of public health genetics is the notion that genes, like the classic environmental factors that have been shown over many decades to be causally implicated in disease, are themselves important determinants of health; and that they play as important a role as exposures to physical and biological agents or to social and structural factors such as poverty and unemployment. But, as with environmental determinants, genes act not on their own but in combination with other factors. Every gene interacts with others in a genome and with a host of external exposures to produce the full range of human characteristics.” [3]

For more information about genetic services in the district of Cochrane, contact Lynda Collins R.N. B.Sc.N. at (705) 267-1181 ext. 15 or Nathalie Roy R.N. B.Sc.N. at (705) 267-1181 ext. 17.

 

 

References

[1] Genetics, Health Care and Public Policy. An introduction to Public health Genetics by Alison Stewart, Philippa Brice, Hilary Burton, Paul Pharoah, Simon Sanderson and Ron Zimmern Cambridge University Press, 2007

[2] Ibid.

[3] Ibid.