Genes (DNA) are the cause; the inherited traits are the effect.
Variation within a population (different alleles) is the raw material on which natural selection works. Without variation there is nothing to select.
Artificial selection uses the same variation, but the human breeder decides which individuals reproduce.
Genetic diseases show what can happen when a harmful recessive allele becomes homozygous; communities reduce this through awareness, screening and counselling, which also respects human differences and protects the health of future generations.