Precision medicine ‘versus’ or ‘for’ public health? Different configurations of precision medicine in relation to the social determinants of health

The relationship between precision medicine (PM) and public health (PH) is far from straightforward. On the one hand, some scientific experts envision PM as helping to advance PH interventions and the health of populations. This is argued to be realisable through a framework that they term ‘precision public health’ (PPH). On the other hand, a range of PH and other scholars question whether PM is a ‘distraction’ from population-wide health urgencies; in particular, inequalities relating to the social determinants of health (SDH). Consequently, individualized PM is framed as coming at the expense of the population. This paper examines these two poles and other positions in-between, and vis-à-vis major national PM initiatives, to investigate how PM is configured in relation to the SDH. Specifically, we analysed documents relevant to, and conducted qualitative interviews in the context of, the USA Precision Medicine Initiative (PMI) and the UK 100,000 Genomes Project (100KGP). Through these data, we characterise three principal configurations of PM that enact particular relationships with PH that have varying implications for health and societies. We conclude by re-examining the potential contributions of PM to generating knowledge and policy in relation to the SDH, and by calling for PM to more reflexively intervene within the health of populations through - and with - the sociopolitical domain.