A smarter, more precise way to think about public health | Sue Desmond-Hellmann

Summary

The speaker discusses the power of precision public health, using personal experiences in oncology and global health to highlight disparities between rich and poor countries. By leveraging tools like big data and gene sequencing, precision public health can identify specific health issues in vulnerable populations, targeting interventions to save lives. The speaker emphasizes that this approach could prevent millions of infant deaths annually, allowing parents everywhere to name their babies with confidence, knowing they have a chance at a healthy future.

Takeaways

• 😀 The speaker introduces her family and reflects on the joy of naming babies, something she cherished growing up.
• 😔 In Ethiopia, some parents delay naming their babies due to fear of early infant mortality, making the loss less emotionally painful.
• 😟 2.6 million babies die worldwide before reaching one month of age, often without clear reasons for the cause of death.
• 🔍 The speaker, a scientist and doctor, emphasizes that understanding the cause of these deaths is essential for developing solutions.
• 🧬 Precision Public Health is a new approach, inspired by precision medicine, that aims to target public health problems more effectively.
• 🎯 The speaker’s work with Herceptin, a breast cancer drug, revolutionized cancer treatment by precisely targeting cancer cells and sparing healthy ones.
• 🌍 The speaker argues that precision techniques used in wealthy nations should also be applied to public health in poorer regions.
• 👶 Targeting pregnant women in high HIV-risk areas has already halved mother-to-child HIV transmission, showcasing the power of precision public health.
• 🧑‍⚕️ Precision Public Health can help identify specific causes of infant mortality, such as bacterial infections, allowing targeted interventions like penicillin.
• 🌟 The speaker believes that applying precision public health could save one million babies annually and address broader global health issues like malnutrition and malaria.

Q & A

What is the main contrast the speaker draws between two parts of the world?

The speaker contrasts the joy and excitement of naming a baby in one part of the world with the fear and reluctance in Ethiopia, where parents delay naming their baby due to high infant mortality rates.

Why do some parents in Ethiopia delay naming their babies?

Parents in Ethiopia delay naming their babies because they fear the baby might die shortly after birth, and not giving the baby a name might make the loss a little more bearable by creating less emotional attachment.

What statistic does the speaker provide about neonatal deaths globally?

The speaker mentions that 2.6 million babies die globally before they are one month old, which is equivalent to the population of Vancouver.

Why is the term 'neonatal' problematic according to the speaker?

The term 'neonatal' is problematic because it is not a cause of death but rather an adjective that indicates a baby is less than a month old. The speaker argues that it reflects the fact that we often don't know why these babies are dying.

What is the speaker's professional background and how does it relate to her current work?

The speaker is a scientist and oncologist who originally worked in cancer treatment, including developing precision medicine like Herceptin for breast cancer. Her experience in targeting treatments precisely for individuals informs her current work on precision public health.

What is 'Precision Public Health' according to the speaker?

Precision Public Health is an approach that applies the tools of precision medicine, like data and targeted interventions, to public health issues. The aim is to bring the right remedies to the right populations at the right time.

How has Precision Public Health already made a difference in HIV/AIDS prevention?

In HIV/AIDS prevention, Precision Public Health has helped reduce mother-to-child transmission of HIV by half in the last five years by targeting antiretroviral treatment to pregnant women in areas with the highest HIV rates.

What does the speaker suggest about current methods of determining causes of infant death in high-mortality regions?

The speaker criticizes current methods, which often involve health workers interviewing mothers about symptoms months after their baby has died. This method is not only emotionally painful for the mothers but also ineffective at identifying precise causes of death.

How can precision public health prevent infant deaths from Group B streptococcus?

By identifying that Group B streptococcus infections are causing infant deaths in certain areas, healthcare providers can administer penicillin to mothers to prevent transmission and reduce infant mortality.

What is the speaker’s ultimate goal for Precision Public Health?

The speaker’s goal is to save a million babies’ lives each year by applying precision public health to identify and address the causes of neonatal mortality. She also envisions using this approach to tackle other global health challenges like malnutrition, cervical cancer, and malaria.

Outlines

00:00

🌏 Cultural Differences in Naming Newborns

The speaker begins by sharing a personal story about their large family and the joy of choosing names for new babies. This is contrasted with a practice in Ethiopia where parents delay naming their children to lessen the emotional impact should the child die young. The speaker highlights the tragic reality of infant mortality, with 2.6 million babies dying before reaching one month old, and emphasizes the need to understand the causes to prevent such deaths. The concept of 'Precision Public Health' is introduced as a new approach to tackle these issues.

05:02

💊 Precision Medicine and Its Impact

The speaker discusses their background as a cancer doctor and the evolution of precision medicine, exemplified by the development of Herceptin for breast cancer. This approach allows for targeted treatment with fewer side effects. The speaker then extends this concept to public health, advocating for a similar precision in addressing global health issues. They provide the example of HIV/AIDS prevention in pregnant women, where targeted interventions in high-risk areas have significantly reduced mother-to-child transmission.

10:02

👶 The Need for Precision in Infant Mortality

The speaker addresses the current method of determining infant mortality causes in high-mortality countries, which often relies on retrospective interviews with grieving mothers. This method is emotionally taxing and provides limited information for prevention. The speaker proposes applying precision public health to identify specific causes of infant mortality, such as Group B streptococcus, allowing for targeted and cost-effective interventions like penicillin. The potential of this approach to save a million lives a year is emphasized, along with its broader implications for tackling other public health issues like malnutrition, cervical cancer, and malaria.

Keywords

💡Precision Public Health

Precision public health refers to a new approach aimed at targeting health interventions more accurately to populations most in need. This concept extends the idea of precision medicine, which focuses on individual care, to public health by using data to determine who, what, where, and how to address larger health challenges. In the video, the speaker highlights how this approach could drastically reduce neonatal mortality by applying tailored solutions.

💡Neonatal Mortality

Neonatal mortality refers to the death of infants within the first month of life. In the video, it is emphasized that 2.6 million babies die globally before reaching one month old, and the speaker underscores the tragedy that many of these deaths occur without clear causes. The video discusses the urgent need to understand and address the root causes of neonatal deaths, particularly in developing regions.

💡Herceptin

Herceptin is a targeted drug used to treat HER2-positive breast cancer. The speaker references this drug as an example of precision medicine, which revolutionized cancer therapy by attacking cancer cells without harming healthy cells. The video uses Herceptin to illustrate how precision can improve treatment outcomes and suggests applying a similar targeted approach to global public health.

💡HIV Transmission

HIV transmission refers to the spread of the Human Immunodeficiency Virus, particularly from mother to child during pregnancy. The speaker discusses how precision public health has helped reduce mother-to-child transmission of HIV in sub-Saharan Africa through targeted testing and antiretroviral treatments. This approach has nearly halved HIV transmission rates, demonstrating the success of precision interventions.

💡Global Health Disparities

Global health disparities are the differences in health outcomes and access to care between wealthy and poorer regions. The video contrasts the joy of naming a newborn in wealthier areas with the fear in parts of Ethiopia where parents delay naming their babies due to high mortality rates. The speaker calls for bridging the gap between the rich and poor worlds through precision public health.

💡Group B Streptococcus

Group B Streptococcus is a bacterial infection that can be passed from mother to baby during childbirth, significantly increasing the risk of infant death. The speaker mentions this as an example of a preventable cause of neonatal mortality in certain parts of Africa. By identifying this risk, simple interventions like penicillin can be administered to save lives, highlighting the power of knowing the cause.

💡Cancer Therapy

Cancer therapy refers to the treatments used to fight cancer, often involving surgery, chemotherapy, radiation, or targeted drugs. The video discusses the limitations of early cancer therapies, which harmed both cancerous and healthy cells, causing severe side effects. The breakthrough of precision medicine, exemplified by Herceptin, transformed cancer therapy, allowing more effective and less damaging treatments.

💡Big Data

Big data refers to the vast amounts of information collected from various sources, which can be analyzed to uncover patterns, trends, and insights. In the context of precision public health, big data is used to target health interventions effectively by identifying high-risk populations and causes of diseases. The speaker emphasizes that harnessing big data can revolutionize public health as it did in medicine.

💡Antiretroviral Therapy

Antiretroviral therapy (ART) is the treatment used to manage HIV infection and prevent the transmission of the virus, especially from mother to child during pregnancy. The video highlights ART's effectiveness in preventing HIV transmission to newborns, particularly in high-risk areas of sub-Saharan Africa. This example illustrates how targeted health interventions can have a significant impact on public health.

💡Infant Mortality

Infant mortality refers to the death of children under the age of one. The video focuses on the tragedy of high infant mortality rates in the developing world, particularly in the neonatal period. The speaker argues that many of these deaths could be prevented if health systems were better equipped with data and resources to understand and address the underlying causes.

Highlights

The speaker introduces their large family, sharing a nostalgic memory about picking names for their siblings.

In some parts of Ethiopia, parents delay naming their babies out of fear that the child might not survive, reflecting stark differences in global realities.

2.6 million babies die before they turn one month old globally, a number equivalent to the population of Vancouver.

The term 'neonatal' in global health often indicates uncertainty about the true cause of infant deaths.

The speaker, a scientist and doctor, emphasizes that without knowing the cause of death, it is impossible to find a solution.

The introduction of 'Precision Public Health' is a promising approach to identify and solve public health issues by targeting specific populations and diseases.

Herceptin, a drug used for targeting HER2-positive breast cancer, is highlighted as a breakthrough in precision medicine.

The speaker advocates for applying the same precision medicine techniques, used in cancer treatment, to public health challenges in the developing world.

A precision public health approach is already showing success in reducing HIV transmission from mothers to babies in sub-Saharan Africa.

The 'who, what, where, and how' are essential elements of precision public health that help target and address specific health issues effectively.

In many high-infant-mortality countries, causes of death are often unknown because they are based on conversations with grieving mothers.

Identifying bacterial infections like Group B streptococcus in certain areas can prevent future infant deaths with simple interventions like penicillin.

The speaker believes precision public health could save one million babies' lives every year through targeted interventions.

Precision public health could also tackle other global challenges like malnutrition, cervical cancer, and malaria.

The speaker emphasizes the importance of bridging the gap between the rich world and the poor world to apply scientific advancements to global health issues.

The ultimate goal of precision public health is to ensure every parent can name their child with confidence that their life will be long and healthy.

Transcripts

OK, first, some introductions.

My mom, Jennie, took this picture.

That's my dad, Frank, in the middle.

And on his left, my sisters:

Mary Catherine, Judith Ann, Theresa Marie.

John Patrick's sitting on his lap and Kevin Michael's on his right.

And in the pale-blue windbreaker,

Susan Diane. Me.

I loved growing up in a big family.

And one of my favorite things was picking names.

But by the time child number seven came along,

we had nearly run out of middle names.

It was a long deliberation

before we finally settled on Jennifer Bridget.

Every parent in this audience

knows the joy and excitement

of picking a new baby's name.

And I was excited and thrilled

to help my mom in that special ceremonial moment.

But it's not like that everywhere.

I travel a lot and I see a lot.

But it took me by surprise to learn

in an area of Ethiopia,

parents delay picking the names for their new babies

by a month or more.

Why delay?

Why not take advantage of this special ceremonial time?

Well, they delay because they're afraid.

They're afraid their baby will die.

And this loss might be a little more bearable without a name.

A face without a name might help them feel

just a little less attached.

So here we are in one part of the world --

a time of joy, excitement, dreaming of the future of that child --

while in another world,

parents are filled with dread,

not daring to dream of a future for their child

beyond a few precious weeks.

How can that be?

How can it be that 2.6 million babies

die around the world

before they're even one month old?

2.6 million.

That's the population of Vancouver.

And the shocking thing is:

Why?

In too many cases, we simply don't know.

Now, I remember recently seeing an updated pie chart.

And the pie chart was labeled,

"Causes of death in children under five worldwide."

And there was a pretty big section of that pie chart, about 40 percent --

40 percent was labeled "neonatal."

Now, "neonatal" is not a cause of death.

Neonatal is simply an adjective,

an adjective that means that the child is less than one month old.

For me, "neonatal" said: "We have no idea."

Now, I'm a scientist. I'm a doctor.

I want to fix things.

But you can't fix what you can't define.

So our first step in restoring the dreams of those parents

is to answer the question:

Why are babies dying?

So today, I want to talk about a new approach,

an approach that I feel

will not only help us know why babies are dying,

but is beginning to completely transform

the whole field of global health.

It's called "Precision Public Health."

For me, precision medicine comes from a very special place.

I trained as a cancer doctor, an oncologist.

I got into it because I wanted to help people feel better.

But too often my treatments made them feel worse.

I still remember young women being driven to my clinic

by their moms --

adults, who had to be helped into my exam room by their mothers.

They were so weak

from the treatment I had given them.

But at the time, in those front lines in the war on cancer,

we had few tools.

And the tools we did have couldn't differentiate

between the cancer cells that we wanted to hit hard

and those healthy cells that we wanted to preserve.

And so the side effects that you're all very familiar with --

hair loss, being sick to your stomach,

having a suppressed immune system, so infection was a constant threat --

were always surrounding us.

And then I moved to the biotechnology industry.

And I got to work on a new approach for breast cancer patients

that could do a better job of telling the healthy cells

from the unhealthy or cancer cells.

It's a drug called Herceptin.

And what Herceptin allowed us to do

is to precisely target HER2-positive breast cancer,

at the time, the scariest form of breast cancer.

And that precision let us hit hard the cancer cells,

while sparing and being more gentle on the normal cells.

A huge breakthrough.

It felt like a miracle,

so much so that today,

we're harnessing all those tools --

big data, consumer monitoring, gene sequencing and more --

to tackle a broad variety of diseases.

That's allowing us to target individuals

with the right remedies at the right time.

Precision medicine revolutionized cancer therapy.

Everything changed.

And I want everything to change again.

So I've been asking myself:

Why should we limit

this smarter, more precise, better way to tackle diseases

to the rich world?

Now, don't misunderstand me --

I'm not talking about bringing expensive medicines like Herceptin

to the developing world,

although I'd actually kind of like that.

What I am talking about

is moving from this precise targeting for individuals

to tackle public health problems

in populations.

Now, OK, I know probably you're thinking, "She's crazy.

You can't do that. That's too ambitious."

But here's the thing:

we're already doing this in a limited way,

and it's already starting to make a big difference.

So here's what's happening.

Now, I told you I trained as a cancer doctor.

But like many, many doctors who trained in San Francisco in the '80s,

I also trained as an AIDS doctor.

It was a terrible time.

AIDS was a death sentence.

All my patients died.

Now, things are better,

but HIV/AIDS remains a terrible global challenge.

Worldwide, about 17 million women are living with HIV.

We know that when these women become pregnant,

they can transfer the virus to their baby.

We also know in the absence of therapy,

half those babies will not survive until the age of two.

But we know that antiretroviral therapy can virtually guarantee

that she will not transmit the virus to the baby.

So what do we do?

Well, a one-size-fits-all approach, kind of like that blast of chemo,

would mean we test and treat every pregnant woman in the world.

That would do the job.

But it's just not practical.

So instead, we target those areas where HIV rates are the highest.

We know in certain countries in sub-Saharan Africa

we can test and treat pregnant women where rates are highest.

This precision approach to a public health problem

has cut by nearly half

HIV transmission from mothers to baby

in the last five years.

(Applause)

Screening pregnant women in certain areas in the developing world

is a powerful example

of how precision public health can change things on a big scale.

So ...

How do we do that?

We can do that because we know.

We know who to target,

what to target,

where to target and how to target.

And that, for me, are the important elements of precision public health:

who, what, where and how.

But let's go back to the 2.6 million babies

who die before they're one month old.

Here's the problem: we just don't know.

It may seem unbelievable,

but the way we figure out the causes of infant mortality

in those countries with the highest infant mortality

is a conversation with mom.

A health worker asks a mom who has just lost her child,

"Was the baby vomiting? Did they have a fever?"

And that conversation may take place

as long as three months after the baby has died.

Now, put yourself in the shoes of that mom.

It's a heartbreaking, excruciating conversation.

And even worse -- it's not that helpful,

because we might know there was a fever or vomiting,

but we don't know why.

So in the absence of knowing that knowledge,

we cannot prevent that mom, that family,

or other families in that community

from suffering the same tragedy.

But what if we applied a precision public health approach?

Let's say, for example,

we find out in certain areas of Africa

that babies are dying because of a bacterial infection

transferred from the mother to the baby,

known as Group B streptococcus.

In the absence of treatment, mom has a seven times higher chance

that her next baby will die.

Once we define the problem, we can prevent that death

with something as cheap and safe as penicillin.

We can do that because then we'll know.

And that's the point:

once we know, we can bring the right interventions

to the right population in the right places

to save lives.

With this approach, and with these interventions

and others like them,

I have no doubt

that a precision public health approach

can help our world achieve our 15-year goal.

And that would translate into a million babies' lives saved

every single year.

One million babies every single year.

And why would we stop there?

A much more powerful approach to public health --

imagine what might be possible.

Why couldn't we more effectively tackle malnutrition?

Why wouldn't we prevent cervical cancer in women?

And why not eradicate malaria?

(Applause)

Yes, clap for that!

(Applause)

So, you know, I live in two different worlds,

one world populated by scientists,

and another world populated by public health professionals.

The promise of precision public health

is to bring these two worlds together.

But you know, we all live in two worlds:

the rich world and the poor world.

And what I'm most excited about about precision public health

is bridging these two worlds.

Every day in the rich world,

we're bringing incredible talent and tools --

everything at our disposal --

to precisely target diseases in ways I never imagined

would be possible.

Surely, we can tap into that kind of talent and tools

to stop babies dying in the poor world.

If we did,

then every parent would have the confidence

to name their child the moment that child is born,

daring to dream that that child's life will be measured in decades,

not days.

Thank you.

(Applause)