Lost in the health care debate: Let's focus on beginnings
Author: by Lawrence Wallack
Posted: September 24, 2012

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With so much political attention on Medicare this fall, it is easy for the public to lose sight of the remarkable progress being made in understanding the development of good health that begins in infants and young children. 

The biological and social sciences are producing new findings about what makes us healthy and what makes us sick. An important factor contributing to the causes of chronic diseases such as diabetes and heart disease later in life is the way that the social environment surrounds us and interacts with our experience in the womb and soon after birth. Of course, many factors contribute to these diseases as adults, but we now know that those typically don't compare with what happens during the first thousand days after conception. Through age 2, nutrition and stress are at the top of the list of influences on future health and disease. 

That nutrition is important during this period isn't surprising, but the degree of importance is stunning -- it can trigger up to an eightfold increase in the probability of diabetes and heart disease. 

Research also shows that social conditions play a critical role. To be sure, there must be access to healthy food in every community, and not just available but affordable. But we now know something more: While we all feel stressed at times, chronic stress literally gets under one's skin, triggering chemical changes inside bodies that can harm people's health almost as much as poor nutrition. 

Let's be clear, this is not just being "stressed out." Chronic stress is the kind of persistent high stress associated with poverty, inadequate housing, racial discrimination and similar disadvantages. These experiences aggravate the effects of poor nutrition for pregnant women and take a toll on whole groups of children. 

Chronic diseases such as diabetes and heart disease hurt not only individuals, but also our collective economy. The debate over the future of Medicare is driven not only by increasing numbers of older people, but by spiraling taxpayer costs of increasingly sick people. Our medical and public health systems have the early warning systems in place, and the sirens are sounding. But we aren't doing enough to prevent the damage. 

It's not too late. Based on what we now know, there are cost-effective, science-based policies that can make a difference. The College of Urban and Public Affairs at Portland State University is working with the new Moore Institute on Nutrition and Wellness at Oregon Health & Science University to find new ways to engage the community to move this issue to the top of the policy agenda. Our goal is to translate what research shows about the developmental origins of health and disease, both biological and sociological, into policies and programs that can improve the lives of Oregonians. This will include policies such as expanding urban agriculture, creating more employment opportunities for disadvantaged communities, and developing social and nutritional resources for women of childbearing age. 

This is not just about seniors or children; it is about all of us. We are working on these health initiatives as if our collective future depends on it, because it does. 

Lawrence Wallack is dean of the College of Urban and Public Affairs at Portland State University. Kent Thornburg is interim director of the Bob and Charlee Moore Institute of Nutrition and Wellness at Oregon Health & Science University.