A life course approach to public health: Why early life matters

Abstract

This chapter describes the theoretical and mechanistic basis, and public health implications, of the Developmental Origins of Health and Disease (DOHaD) paradigm, which has emerged from overwhelming epidemiological, clinical, and experimental evidence demonstrating the importance of early life development in influencing an individual’s susceptibility to later life disease risk. DOHaD is underpinned by the evolutionarily conserved processes of developmental plasticity. These enable phenotypic adjustment to match the environment and are effected, in part, by epigenetic mechanisms that modulate patterns of gene expression. This chapter uses obesity and its co-morbidities to illustrate how a life course approach can provide an effective strategy for reducing disease risk and have major policy implications. It focuses on early life as a critical intervention point, and recognizes the importance of taking into consideration the full range of influencial biological, behavioural, and contextual factors that operate across the life course.