A specific health policy concerning public health genomics is currently being developed in Italy by the Ministry of Health . A dedicated National Plan for Public Health Genomics (PHG-NP) has recently been drawn-up that addresses in depth how to translate genomics knowledge into public health . To achieve the strategic objectives of the PHG-NP, systematic health technology assessment of predictive genetic test for complex diseases, promotion of genomic education among physicians and the general public and the development of capacity building among all potential stakeholders for the health care appropriate provision and management of predictive genetic testing will be needed. The public health community is therefore called at playing a proactive role to integrate genome-based knowledge into public health in a responsible and effective way, also anticipating in a certain way the increase in the health service requirements that is likely to occur in the future .
To our knowledge, this survey is the first to be conducted on public health practitioners. The results show that the Italian public health community has the necessary attitudinal background to contribute to the proper use of predictive genetic testing for chronic diseases, but that an additional training to increase methodological knowledge is needed. Despite more positive public health attitudes, public health physicians have more gaps in their knowledge than other public health professionals (who are mainly biologists), reflecting possible deficiencies in the genetics components of current medical curricula in Italy. Compared with Italian physicians, who previously showed significant training needs in the field of efficacy, effectiveness and economic evaluation of health interventions [42, 43], public health attitudes towards predictive genetic testing appear to be more positive among public health practitioners. For example, the percentage of public health professionals who agree that the selection of predictive genetic testing to be delivered to the population should be based on the principles of efficacy and cost-effectiveness are higher than those found among Italian physicians in another survey . Globally, the public health community in Italy appears to be more prepared than physicians for a responsible and appropriate introduction of DNA-technology into health care and public health practice.
Previous surveys carried out in the United States among health educators showed that education and training influence public health genomics knowledge and attitudes [45, 46]. The results of the present survey are consistent with these findings. Exposure to predictive genetic testing during undergraduate and postgraduate training and time dedicated to continuing medical education are significant determinants of both knowledge and positive attitudes. Adequate knowledge is the strongest predictor of positive public health attitudes and there is a high level of interest in further education and training to improve knowledge and skills in this field. Overall, the results of this survey clearly indicate that there is a strong need for specific and targeted training initiatives for the public health workforce.
However, lessons drawn from many areas of medicine indicate that education alone does not necessarily translate into effective and appropriate adoption of innovative practice [47, 48]. Organizational changes are needed within the health care system to provide these services effectively and efficiently. In theory, predictive genetic testing can be used in population screening programs led by public health professionals or for early case detection and intervention in primary care settings. Today, there is a limited evidence base to support either genetic population screening programs or a personalized individual predictive genetic testing, but this scenario is likely to change to a large extent in the future [14, 49–60]. The small number of clinical geneticists in practice will limit their ability to participate in the care associated with an expending menu of genetic tests . Public health professionals could and should play an important role in the “honest broker” evaluation process that can discriminate those genomic applications that can improve health from those that are likely to result in potential harm and unnecessary health care expenditure through premature use. Most importantly, public health professionals can contribute to the modeling of public health genomic programs and primary care services that need to be developed, implemented, and evaluated [61–63].
The main limitation of this survey concerns the generalizability of its results. While the sample surveyed was representative of the study population and the response rate was high, differences between the Italian and other European and non-European public health workforces are likely to exist. Despite the fact that public health is one of the established specialties in the European Union (EU)  and, consequently, a specialist trained in one EU country will be recognized as a specialist in all EU countries, non-uniformity of public health curricula is a recognized problem . Moreover, public health today requires a multidisciplinary workforce , and the non-medical component of the public health workforce – in Italy represented mainly by biologists and people with health profession degrees – could vary among countries. Therefore, the knowledge, public health attitudes and training needs in the field of public health genomics should also be assessed in other countries, hopefully within specific national health policy frameworks.