The Public's Health: The Microbiome and the Public's Health | Public Health Post

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Each of us is a living ecosystem with trillions of microorganisms living on and in us, our microbiome. Each of us has her own collection of such microbes, inhabiting skin, mouth, gut, lungs. Yes, it’s surprising that identical twins are barely more similar to one another in microbial composition than are non-identical twins; that our personal menagerie changes over time; that a sufficiently extreme short-term dietary change can cause the gastrointestinal flora of different people to resemble one another within days. Yes, the microbiome may well turn out to play a critical role in an individual’s health, a very intriguing prospect. But when nearly two dozen federal agencies—NIH, FDA, EPA, NSF—join together to release a five-year strategic plan to bolster the study of microbiomes, we wonder why these same agencies can’t get together on another day to make a second strategic plan. This one a plan for public health, not private health, one that could save lives and reduce morbidities next year by focusing on what we know matters to our health: the policies that drive behavior.
We are at that moment in a relatively new scientific field when everything seems to influence it; the microbiome’s composition is altered by sleepstressexercise. We, who work far from the basic science lab, believe it would indeed be meaningful if someday that by controlling our behaviors, we might know how to control our personal microbial community and thus our health. Yet a “personalized” microbiome remains a distant and unlikely dream.
We agree with our microbiomist colleagues that our environment, from the personal to the atmospheric, matters. And that our social networks, with whom and how we interact, matter too. But we would prioritize attention to the known drivers of longevity and quality of life for today’s population—poverty, insurance gaps, homelessness, the broad distribution of preventive services—hard problems that we can change and that would benefit from strategic health planning. We are envious that the microbiome brought 23 federal agencies together in common cause, even if their report included the usual recommendations: share data, make access to data easier, collaborate, and expand the number of studies.
Let’s appreciate microbiome research for what it is—pure, joyous, creative science that may produce fascinating new findings in a decade or two and in the meantime a workforce development venture for young scientists. But let’s collaborate on equally hard macro-level puzzles that may better and sooner benefit the public’s health. 

Michael Stein & Sandro Galea