Recently, in the Journal of the American Medical Association (JAMA), Jack Shonkoff, W. Thomas Boyce and Bruce McEwen discussed a new way of thinking about health promotion and disease prevention.
Adult conditions such as coronary heart disease, stroke, diabetes, and cancer are believed to be causally related to adult behavior and lifestyles only. But recent research indicates that adult chronic disease are linked to processes and experiences occurring decades before, and often as early as intrauterine life.
In the JAMA review the authors outline a new model, which is based on an emerging evidence that the origins of many adult diseases are associated with adversities in the early years of life that establish biological “memories” that weaken physiological systems and produce latent vulnerabilities to problems that occur later, in adult years.
According to the authors, adult conditions and diseases and the causes for poor health “can be embedded biologically during sensitive periods in which the developing brain is more receptive to a variety of environmental signals, whether positive or negative”.
The authors also discuss some new ideas – for example, interventions to reduce significant stress in early childhood may be a more appropriate strategy for preventing adult heart disease than the off-label administration of statins to school-aged children.
The authors argue that exploring the association between early adversity and subsequent health and the identification of biomarkers of toxic stress and its physiological consequences are particularly important.
They conclude that confronting the origins of disparities in physical and mental health early in life may produce greater effects than attempting to modify health-related behaviors or improve access to health care in adulthood. Importantly, effective interventions early in life may have long term effects and can produce “measurable benefits in later educational achievement, economic productivity and responsible citizenship”.