Addressing Cancer in Africa through Precision Community Health

“Health and biomedical innovations continue to widen cancer disparities in Africa. Precision Community Health offers an immediate practical solution for community-tailored interventions towards health equity.”

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As we watch Africa experience significant increase in cancer burden from 2020 to 2040, with an estimated increase of 89.1%,1 there is an urgent need to find solutions that will address the cancer health disparities experienced by Africans at the population level. Usually, health and biomedical innovations are supposed to close health disparities gaps. Unfortunately, these innovations continue to contribute to health disparities globally as they are not accessible to the populations that are disproportionately affected by cancer in Low- and Middle-Income Countries (LMICs), including African countries.

 There are a number of health and biomedical innovations that provide promises for reducing cancer morbidity and mortality, especially in health disparity populations. For example, the Genome-Wide Association Studies (GWAS) have revolutionized the field of human quantitative genetics, providing the ability to scan markers across population genomes for the purpose of uncovering genetic variations associated with a disease, such as cancer. Another critical innovation is Precision Medicine (PM), a precise and personalized approach to optimize medical benefit and minimize harm for an individual patient by tailoring treatment, prevention and behavioral interventions to individual patients.2,3  One of the critical steps towards PM is Pharmacogenomics, the study of how a person’s genes affect the way he or she responds to drugs. Pharmacogenomics is being used to learn ahead of time what the best drug or the best dose of a drug will be for a person. Unfortunately, Africans have not benefited from these innovations for multiple reasons, including the lack of representation of Africans in existing genomic data. Because PM is not well studied in the African population, there is limited ability to uncover evidences that will help prevent, diagnose, and treat cancer in Africans. Although some African countries are making progress in PM, the progress is not sufficient to slow down or turn around the steep cancer morbidity and mortality increases that Africa continues to experience. There is need for an urgent solution, and Precision Community Health (PCH) may hold a timely solution to address the current limitation of PM. PCH combines two approaches: Community Engaged Research and Precision Public Health.

Community Engaged Research (CEnR) goes beyond the traditional unidirectional academic framework of generating and applying knowledge in communities and focuses on bidirectional academic-community research collaboration. A well-known framework for CEnR is Community Based Participatory Research (CBPR). CBPR is a collaborative approach to research that equitably involves all partners in the research process, including the “researchers” and the “researched community”, and recognizing that each partner brings unique strengths to the research.4,5 It begins with a research topic of importance to the community and has the aim of combining knowledge with action and achieving social change to improve cancer health outcomes and eliminate cancer health disparities.

 Precision Public Health (PPH) is defined as “the application and combination of new and existing technologies, which more precisely describe and analyze individuals and their environment over the life course, to tailor preventive interventions for at-risk groups and improve the overall health of the population.”6 PPH was proposed to address PM’s shift away from strategies needed to address community-based cancer prevention and control efforts, and Social-determinants of health (SDOH). SDOH is defined by the World Health Organization as social conditions in which people live and work,7 including agriculture and food production, education, working environment, unemployment, water and sanitation, healthcare services and housing.

 Precision Community Health (PCH) builds on the principles of CEnR and PPH, focusing on the use of data and evidence to tailor interventions to a specific community. To address the challenges of cancer health disparities in Africa, deliberate and concerted efforts must be made to implement programs that will provide precise community-tailored interventions at the right time. Although there is a strong potential to use population health genomics for PCH, there are unique differences between PCH and PM: (1) the unit of interest for PM is the patient while the unit of interest for PCH is the community; (2) PM improves population health one patient at a time while PCH strives to improve population health one community at a time; and (3) genomic information provides strong foundation for PM while SDOH and (Big) Data provide strong foundation for PCM.

 While PM is the ideal health innovation that we should strive for in Africa, PCH offers an immediate practical solution to implement community-tailored interventions in communities that are currently overburdened by cancer. This will require a concerted effort to apply community-engaged research, cancer surveillance data, data analytics and geographically precise technology to prevent cancer, predict cancer risks and develop tailored and targeted programs that will reduce cancer disparities in African communities.

References

  1. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. 2020. Available from: https://gco.iarc.fr/today, accessed [28 June 2021].
  2. Collins F, Varmus H. A New Intiative on Precision Medicine. N Engl J Med. 2015;379(2):793-795.
  3. Khoury MJ, Bowen MS, Clyne M, Dotson WD, Gwinn ML, Green RF, Kolor K, Rodriguez JL, Wulf A, Yu W. From public health genomics to precision public health: a 20-year journey. Genet Med. 2018;20(6):574–82.
  4. Israel BA, Schulz AJ, Parker EA, Becker AB. Review of Community-Based Research: Assessing Partnership Approaches to Improve Public Health. Annu Rev of Public Health. 1998;19: 173-202.
  5. Israel BA, Schulz AJ, Parker EA, Becker AB, Allen AJ 3rd, Guzman R. Critical Issues in Developing and Following Community Based Participatory Research Principles. In Minkler M, Wallerstein N (eds.) Community-Based Participatory Research for Health. San Francisco. 2003: Jossey-Bass Publishers.
  6. Weeramanthri TS, Dawkins HJS, Baynam G, Bellgard M, Gudes O, Semmens JB. Editorial: Precision Public Health. Front Public Health. 2018 Apr 30;6:121. 
  7. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Available from: https://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf, accessed [6 September 2021].

Prof. Folakemi Odedina, PhD
A/Director, Center for Health Equity & Community Engagement Research (CHCR)
Director, CHCR Global Health Equity Initiatives
Mayo Clinic, USA
Chair, AORTIC Research Committee

Prof. Folakemi Odedina is Principal Investigator and Founding Program Director of the Prostate Cancer Transatlantic Consortium (CaPTC). For almost 30 years, her research, education, training and community outreach activities have exclusively focused on addressing health disparities in minority and underserved communities globally. As a translational behavioral scientist, her research program focuses on the predictors of health disparities and cost-effective, community-based behavioral interventions to improve the health of minority populations, especially Black men globally. Her lab employs community engagement, community data and technology to develop tailored and targeted programs focused on improving health at the individual and community levels.

Prof. Folakemi Odedina

Professor and CHCR Assoc. Center Director, Mayo Clinic