It’s been three decades since the Developmental Origins of Health and Disease (DOHaD) emerged as a scientific inquiry field. Since then, an idea has gained traction among many scientists, medical professionals, and community health practitioners: the health problems we experience as individuals and communities take root much earlier than previously thought.
Much of the research in the field of DOHaD suggests that social, environmental, and behavioral factors from the time before conception and throughout the first thousand days of life (up to about age two) significantly influence how vulnerable we are to certain diseases as adults. Epigenetics—the study of interactions between our environments and our genes that result in changes in how our genes express—describes processes that give rise to vulnerabilities that may be passed on from generation to generation. This means that the conditions our grandparents experienced could make us more susceptible to diseases such as obesity, type 2 diabetes, and hypertension.
For many, the ideas emerging from DOHaD ask us to think about health and disease in a very different way than we might be used to. They shift our understanding of what causes certain diseases. They ask us to pay attention to how biology impacts health and consider social and environmental factors affect health, not just within our lifetimes but across the span of generations as well. Because DOHaD requires thinking about the origins of health and disease in a new way, one of the significant challenges facing scientists and community health practitioners working on translating the science into policy and action is how to communicate the results of studies to focus the public’s attention on how addressing issues including poverty, food security, educational opportunity, and safe and secure housing will improve public health for generations to come.
“Because of this work, we have a new understanding of when chronic disease begins and why we’re seeing widespread increases in disease rates across the US and around the globe,” said Liana Winett. “That is why it’s so important that we communicate what we’re finding to the public. We need to start a dialogue to help people understand the implications of DOHaD and to engage the public in a partnership to identify the range of solutions we’ll need to address some of the societal-level challenges that result in a higher risk of disease.”
Winett is an associate professor in the OHSU-PSU School of Public Health. Her research focuses on framing public health issues in media and public opinion. According to Winett, communicating the findings of DOHaD has proved challenging thus far because, outside of the scientific world, we have not yet developed a collective framework to situate our understanding of the broader implications of this relatively new science and what it means for how we organize society. And without that framework, it’s easy to hear or read words like “pregnancy,” “prenatal,” “programming,” “behavior,” “neighborhood,” “race,” or “ethnicity” and misattribute responsibility for the causes of disease—to mothers, communities, or subgroups within the population—because of associations our minds automatically make when we encounter those words.
“We don’t have a widely shared cognitive model with which to process the idea that our risk for disease as adults may be affected by the food systems our grandmothers were exposed to when they were pregnant with our mothers,” Winett said. “And without that framework, it’s difficult to communicate the importance of findings from DOHaD.”
In a recently published paper, “A Framework to Address Challenges in Communicating the Developmental Origins of Health and Disease,” Winett, in collaboration with fellow OHSU-PSU School of Public Health professors Drs. Larry Wallack, Dawn Richardson, Janne Boone-Heinonen, and Lynne Messer presented a framework that scientists and community health practitioners can use as a starting point in their efforts to translate the findings of DOHaD “from the bench to population-level health promotion and disease prevention.”
The communications model proposed by Winett and colleagues is based upon the “Haddon Matrix”: a framework from the field of epidemiology that illustrates the relationships between factors that influence the risk of vulnerabilities to diseases and supports decision-making in the design of interventions. It also incorporates the “First-hit, Second-hit Framework” used by health researchers to explain how “lifelong health can be adversely affected by a series of ‘hits,’ or insults, experienced at critical developmental intervals [before birth] and across the lifespan.”
“We developed the First-hit, Second-hit Planning Matrix to support communities and society in looking at the issues that comprehensively affect DOHaD,” Winett said. “As a communications tool, it works to help us conceptualize the range of sources of risk, from the individual to the societal level. This allows us to address all the variables that we think are relevant to health before, during, and after vulnerabilities occur to minimize the likelihood of disease. And it highlights that to eliminate the ‘hits’ experienced during development truly; we will need to improve the social and environmental contexts in which communities operate.”
According to Winett, DOHaD has changed our understanding of when health and disease begin and drawn attention to how inequity and injustice can get under the skin, predisposing individuals, and communities to higher risks for disease. But we can reduce those risks. The work scientists and pubic health practitioners are doing in the field can lead to societal-level changes if we start considering the ways social and environmental factors influence health outcomes and act to improve well-being and quality of life for everyone. But the data don’t speak for themselves. Real change will require communicating the findings from DOHaD to the public, bringing in communities and policy-makers at all levels, and assembling the broadest range of voices possible to identify solutions to issues facing society.
“Our message needs to be clear,” said Winett. “It will require a broad societal commitment to address the full range of causes and solutions to problems that impact health over the lifespan. These include problems like poverty, access to healthful food, safety, housing, and social opportunity, which are among the most challenging and urgent issues of our time.”