Video: Epigenetics and equity: The health and social impacts of racism and inequality
Friday, May 15, 2015BMSG co-founder Larry Wallack, who directs public health studies at Portland State University, joins Rachael Banks, manager of Multnomah County's Healthy Birth initiative, to discuss a new area of science that shows how certain lifetime stresses create inheritable changes in our bodies. The science challenges prior understanding of genetic inheritance and has major implications for public policy that seeks to create equal health outcomes for communities of color. Below is a transcript of Dr. Wallack's talk.Transcript
I recently heard someone say, "If you are working on an idea that you can get done in your lifetime, then you're not thinking big enough." Aspiration is a powerful force that motivates us. It is a combination of a big idea, a big heart, and a dogged determination to succeed. Obviously, we may have organizations to run, jobs to do, daily tasks to accomplish, and lives to live. But what if we could accomplish something collectively, something that could make a far greater difference than anything we can do individually? The developmental origins of health and disease is an organizing framework for a very big idea, even a social movement. And it is one that can change the world. Let's get some definitions out of the way: First, developmental origins of health and disease is a body of research that has shown that the risk of chronic diseases such as type 2 diabetes, stroke, heart disease and even some cancers is set pre-pregnancy through the first 1000 days, up to about age two. Risk for problems of cognitive function and significant mental health issues is also established. Second, epigenetics is the process by which our genes respond to environmental cues. These responses can influence how our genes are programmed to regulate biological functions. 'Epi' refers to being above or on the genes. The genetic code does not change, but the biological switches that turn those genes on and off do. And here's the rub: These altered regulatory commands can be passed from parent to child so that altered gene expression patterns that affect one's health all the way into adulthood can be passed on to the next generation, and the next. Third, health equity seeks to reduce group differences in health outcomes that are unjust, predictable and preventable. Developmental origins is the ultimate social and health equity lens because it helps us understand how history, sociology and biology combine to create lifelong prospects for health and social success at the earliest stages. I've worked in public health for 40+ years. This profession is grounded in an ethical framework of social justice ÛÓ the idea that inequality follows from the adverse impact of privilege, power and exclusion, and this social inequality is linked to health inequity. We know that the collective policy decisions we make as a community determine the distribution of risks and benefits, obstacles and opportunities, disease and health. The public policies we debate and implement today will predict the public health problems we face tomorrow. A recent report produced by the Robert Wood Johnson Foundation concluded, "When it comes to your health, your zip code may be more important than your genetic code" "... your zip code may be more important than your genetic code." Epigenetics explains how the environment, our zip code, literally gets under our skin, creates biological changes that increase our vulnerability for disease, and even our kids' prospects for social success over their life course and into future generations. This science forces us to rethink where disease comes from and the best way to promote health. It identifies the most fundamental social equity issue in our society: that initial social and biological disadvantage, established even prior to birth, in fact even linked to the social experience of prior generations, is made worse by adverse environments throughout the life course. But, at the same time, it provides hope because it tells us that a concerted focus on improving our environments can ultimately change our biology and the trajectory of disease into future generations. Where does the idea of developmental origins come from? In the 1980s, David Barker, an English physician and epidemiologist, published the hypothesis that the risk for chronic diseases originated in the earliest developmental stages and not later in life. Dr. Barker, who died in 2013, had strong Portland ties in the latter part of his life and was a principal at OHSU's Moore Institute for Nutrition and Wellness. In a nutshell, David's data, and data from around the world, found that chronic diseases such as diabetes, hypertension, stroke and heart disease were programmed into our systems as a result of nutritional deficiency during the critical developmental period of pre-pregnancy up to about age two. Poor nutrition, associated with disadvantaged living conditions, slowed fetal growth and forced tradeoffs that harmed longer-term health. Low birth weight alone predicted a three-to-seven-fold increased risk of chronic diseases like type two diabetes and heart disease later in life. This is a huge impact. So here is where the research inspired by the Barker Hypothesis has led. We now know that:- The first thousand days from conception to about age two is the most critical and sensitive time for development. Risk for chronic and other diseases is programmed into the function of key organs, settings in metabolism and hormonal feedback are altered, and an increased vulnerability to adverse environments later in life is established;
- Our genes, we now know, are not a deterministic blueprint for our health but a collection of infinite possibilities that are switched on-or-off depending on the conditions our mothers experienced prior to and during pregnancy, and on the nutrition and social environment we have as infants. This research suggests that people mostly get chronic diseases not because of the genes they inherit but because of how those genes act in response to environmental stresses. This epigenetic process of gene regulation is where nature and nurture come together.
- While the pregnant woman is the environment of the developing fetus, the community is the environment of the mother. The two main factors in the community environment that impact healthy development are availability of appropriate nutrition and the level of social stress. "Toxic" stress and poor nutrition are a developmental recipe for vulnerability at birth, poor school performance and social skills early in life, and poor health over the life course.
- If the Portland Metropolitan region were the healthiest place in the world to be pregnant and have a child, what would it look like?
- How would it be different than it is now? What would need to change?
- What kinds of policies would be required to move toward that vision?
- How can we create a social movement built on this collective vision to force the necessary political will to demand change? How can existing partnerships be expanded? How can we develop new partnerships with new allies to move ahead?