Whether and when genomics will lead to public health benefit via reductions in chronic disease burden has provided fodder for debate (1,2). A point of agreement among both proponents and skeptics is that directing genomics research to achieve this end will require integration of knowledge across multiple disciplines and levels of analysis (i.e., biological, behavioral, social, and environmental) (3). Getting started on building these collaborations while the territory is new could temper the disciplinary hegemony that so often presents formidable barriers to transdisciplinary research (4). That said, when it comes to genomics, which has been the bastion of bench scientists and most recently epidemiologists, it may be especially challenging to attract the array of chronic disease researchers with expertise in health education, health psychology, health services delivery, and community-based intervention that will be critical to further this research agenda.
Vociferous pessimism expressed by some scientific leaders about the future application of genomic discovery to public health improvements (2) may be scaring off some public health scientists from pursuing genomics research (5). As has been said, "mud sticks whatever its veracity" (6). However, some public health researchers (7) would contend that waiting until genomic discovery is further along to get involved will relegate us to the role of translators, stuck with disseminating the technologies that evolve, even if they are poorly suited to populations or limited in their impact on chronic disease outcomes. Indeed, public health scientists must be among the trailblazers in step with or a step ahead of the science, with a voice in directing genomics research toward public health benefit.
Unfortunately, the emerging public health research agenda for chronic disease is giving relatively little consideration to the future of genomic discovery (8). An informal review of the American Journal of Public Health over the past decade shows that from 1995 to 1999 only eight articles related to genetics were published, a number that increased only to 22 between 2000 and 2004. Publications related to obesity, another area recognized during the same time to be important for chronic disease, increased fivefold from 26 to 138.
So how do we enlist public health scientists in transdisciplinary collaborations that further a public health research agenda? First, it is time for a frame change. The past decade's research agenda was framed to anticipate and protect the public from the potential negative ethical, social, and psychological implications of genomic discovery. Not surprisingly, scientists in the vanguard of this research have been bioethicists, lawyers, and public policy experts. To enlist public health researchers in genomics research, the agenda must be reframed to understand the practical and proximal benefits of genomics for chronic disease. Specifically, we should be figuring out how genomic discovery might help us to address three persistent challenges for chronic disease prevention and management: 1) reducing prevalent behavioral risk factors, 2) reducing disparities in chronic disease outcomes, and 3) improving chronic disease care delivery at reduced cost. Below I suggest examples of research in genomics and chronic disease that could galvanize the transdisciplinary research collaborations needed to address these challenges.