key: cord-0961623-6nwn7j7q authors: Hanson, Mark; Aagaard‐Hansen, Jens title: Developmental Origins of Health and Disease: Towards a combined bio‐social life‐course perspective date: 2021-06-07 journal: Acta Paediatr DOI: 10.1111/apa.15905 sha: d8796baf186e7ebf7c5badfe2e1261d2dca87c30 doc_id: 961623 cord_uid: 6nwn7j7q The life-course concept has been widely used during the 20th century to give insights into biomedical as well as wider social issues. However, the biomedical and social science fields have developed concepts in parallel without much cross-fertilisation. For the developmental origins of health and disease (DOHaD) biomedical scientific discourse, the focus has largely been on pro- and retrospective epidemiological cohort studies of risk of non-communicable diseases (NCDs) and of underlying mechanisms such as epigenetic processes. In parallel, numerous long-term studies within the social sciences have provided strong evidence on how generations interact and the changing social relations and family structures over the past century. This article explores how the life-course concepts from these fields can be combined, arguing for a re-invention of a social medicine approach to family health in communities based on a long-term, diachronic perspective. The life-course concept has been widely used during the 20th century to give insights into biomedical as well as wider social issues. However, the biomedical and social science fields have developed concepts in parallel without much cross-fertilisation. For the developmental origins of health and disease (DOHaD) biomedical scientific discourse, the focus has largely been on pro-and retrospective epidemiological cohort studies of risk of non-communicable diseases (NCDs) and of underlying mechanisms such as epigenetic processes. In parallel, numerous long-term studies within the social sciences have provided strong evidence on how generations interact and the changing social relations and family structures over the past century. This article explores how the life-course concepts from these fields can be combined, arguing for a re-invention of a social medicine approach to family health in communities based on a longterm, diachronic perspective. The life-course perspective within DOHaD emerged from the confluence of several lines of biomedical research. Retrospective epidemiological studies of cohorts of individuals characterised from birth led to the perception that prenatal development, measured using the proxy of birthweight, was associated with risk of NCDs such as cardiovascular disease and diabetes many decades later. 1 This led to a plethora of studies in experimental animals of many species, and insights drawn from the fields of developmental and evolutionary biology, which revealed that the prenatal processes leading to NCD risk in humans later in the life course were at one end of a spectrum of adaptive processes normally occurring in early life which are not necessarily pathological. 2 This contrasted with predominant views that NCD risk was a combination of genetic predisposition and unhealthy adult lifestyle, a controversial proposition which begged a mechanistic explanation for a phenomenon with such a long latency between initiating stimulus and overt response. Possible mecha- Such models have led to considerations of the most appropriate interventions and timepoints in order to reduce the risk of NCDs in the DOHaD context. Increasingly, the focus of attention has been on early pregnancy and even the preconception period, as epigenetic processes operate in the early embryo to influence development. In addition, as a substantial proportion of pregnancies are unplanned, interventions to promote healthy early development may be necessary before conception. 7 Moreover, the paternal transmission of risk makes it important to involve both parents in risk reduction for their child. 8 In parallel to the biomedical life-course discourse described above, there has been a similar growing focus within the social sciences. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. However, in addition intergenerational social interaction bridges generations and thereby shortcuts the chronology (running counter to the chronological direction). None declared. Both authors have contributed to all phases of the paper from conceptualisation to writing and approve the final version. Fetal origins of coronary heart disease Early developmental conditioning of later health and disease: physiology or pathophysiology? Epigenetic mechanisms and the mismatch concept of the developmental origins of health and disease The Lifestyle Diseases Timebomb Developmental origins of epigenetic transgenerational inheritance What are the public health implications of the life-course perspective? 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