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Communicating about family health history: heredity, culture, iatrogenesis and the public good
  1. Roxanne Parrott
  1. Correspondence to Dr Roxanne Parrott, Department of Communication Arts & Sciences, Department of Health Policy & Administration, The Pennsylvania State University, 219 Sparks Building, University Park, PA 16802, USA; rlp18{at}psu.edu

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Family health history is the genetic and ecological contributions and interactions, or what others may refer to as the genomic and bionomic inputs, affecting the life course of family members. The adage to ‘know your family history’ promoted in public health and clinical settings emphasises having awareness of first and second degree relatives’ health status, including causes and outcomes of morbidity and mortality. An overarching aim of promoting awareness of family health history resides in making health a public good accessible to all through informed decisions about resource allocation in personal and societal realms, including effort, time and money. Evidence of the promise associated with family health history awareness emerges in studies such as the ‘Family Healthware Impact Trial’ conducted in the USA. Findings demonstrated that risk-tailored messages associated with self-reports of personal lifestyle behaviours and familial risk for coronary heart disease, stroke, diabetes, and colorectal, breast, and ovarian cancers related to self-reported modest improvements in fruit and vegetable intake, increases in exercise, and greater likelihood of receiving cholesterol screening.1 Messages thus leveraged awareness of lifestyle and family history to increase personal and clinical prevention practices without promoting genetic testing. Emphasising family health history in public health and clinical settings primarily in terms of heredity and genetic testing may have a number of iatrogenic effects, including violence and family dissolution in the wake of parental discrepancy associated with test results.2 Such effects emerge explicitly when considering health and heritage, while others lurk more implicitly in the background of epidemiological data guiding community health endeavours that incentivise some policies associated with genetic testing and newborn screening programmes related to identifying genetic disorders.

One overarching presumption of promoting family health history awareness relates to the assumed view that individuals have access to their biological family. This ignores the reality of …

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