Understanding the potential of state-based public health genomics programs to mitigate disparities in access to clinical genetic services

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State health agencies (SHAs) have developed public health genomics (PHG) programs that play an instrumental role in advancing precision public health, but there is limited research on their approaches. This study examines how PHG programs attempt to mitigate or forestall health disparities and inequities in the utilization of genomic medicine.


We compared PHG programs in three states: Connecticut, Michigan, and Utah. We analyzed 85 in-depth interviews with SHA internal and external collaborators and program documents. We employed a qualitative coding process to capture themes relating to health disparities and inequities.


Each SHA implemented population-level approaches to identify individuals who carry genetic variants that increase risk of hereditary cancers. However, each SHA developed a unique strategy—which we label public health action repertoires—to reach specific subgroups who faced barriers in accessing genetic services. These strategies varied across states given demographics of the state population, state-level partnerships, and availability of healthcare services.


Our findings illustrate the imperative of tailoring PHG programs to local demographic characteristics and existing community resources. Furthermore, our study highlights how integrating genomics into precision public health will require multilevel, multisector collaboration to optimize efficacy and equity.

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This material is based upon work supported by the National Human Genome Research Institute of the National Institutes of Health, under award number 1K01HG006441-01A1. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the National Institutes of Health. The authors thank two anonymous reviewers for comments on drafts of this paper, and Pilar Ossorio, Daniel Kleinman, and Deb Franko for guidance on the execution of the research.

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Correspondence to Laura Senier MPH, PhD.

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The authors declare no conflicts of interest.

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Senier, L., Tan, C., Smollin, L. et al. Understanding the potential of state-based public health genomics programs to mitigate disparities in access to clinical genetic services. Genet Med 21, 373–381 (2019) doi:10.1038/s41436-018-0056-y

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  • Public health genomics
  • Precision public health
  • Health disparities
  • Determinants of health
  • Implementation

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