Genomic Medicine in Community Health: Protecting Human Rights

The promise of genomic medicine lies in its potential for providing a cost-effective strategy for attaining the human right for good health. The initial implementation of the Guilford Genomic Medicine Initiative (www.genomic-medicine.org) fosters the attainment of this goal by providing patient and physician education, allowing for the rapid identification of at-risk individuals based on family history information, referring at-risk patients to genetic counselors, and when appropriate, offering recommendations for genetic testing. These benefits are offset by the possibility of discrimination based upon genetic and family history information, or unavailability of preventive screening because of economic concerns. Successful implementation of genomic medicine in community health care must not only result in a workable package of infrastructure and support for risk assessment, it must also provide safeguards that reduce the likelihood for violations of the recently passed Genetic Information Nondiscrimination Act. Further, insurance reimbursement for screening recommendations based on family history and genetic testing must be available. Finally, because access to healthcare is necessary for ensuring good health, measures to overcome and circumvent access disparities, such as community-based screening programs which accommodate family history as a predictive risk factor, will play an essential role for community health care in the future.