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Food is health. Food is hope.

Larry Wallack heads upstream to better understand why place is often a better predictor of health than genetics.

For the last seven years, Ecotrust has been working to expand access to healthy food through institutions. We know that health starts early: Our farm to school team has spearheaded farm to preschool programs across Oregon, trying to reach kids even earlier. But emerging research about epigenetics and the Development Origins of Health and Disease (DOHaD) is showing clearer and clearer links between environmental stress and prenatal and even ancestral genetic wellbeing.

Larry Wallack, a Distinguished Fellow at OHSU’s Moore Institute for Nutrition and Wellness and the director of the Center for Public Health Studies at Portland State University, researches the ways that one’s zip code is often a better predictor of health and wellbeing than one’s genetic code. Communities in areas without access to public goods like public parks and adequate healthcare are at a disadvantage, not just for current members of those communities, but for their children and grandchildren, too. Good food is one of these public goods.

Expanding access to healthy food that is grown responsibly is a big picture project — one that invests in people and place now, and also in people and places far into the future. Wallack’s work upstream keeps ours afloat and firmly in the current, moving toward healthier people and more resilient places. Here is a snapshot of his work:

Excerpted from First 1,000 days may determine a person’s health for a lifetime, Salem Statesmen Journal, Salem, OR, May 20, 2014.

The River of Public Health

At the core of public health is a wonderful upstream-downstream metaphor that reminds us that we are often so busy pulling drowning people out of the river downstream that we don’t have time to go upstream, see what is causing them to fall in, and do something about it. The mission of public health is prevention, and that means making a difference upstream.

Downstream work that public health, medical, and social service agencies do to save people is critically important. But, we know that unless we reduce the number of people falling into the river we will never solve the problem. The workload will only increase. It will only get worse and it will always cost more, because we cannot pull people out of the river faster than they are falling or being pushed in.

Going upstream requires a fundamentally different way of thinking about the world. It is a shift from thinking about individuals to thinking about large populations; from thinking about short-term solutions to thinking about long-term policy change; from thinking about perceived immediate causes and specific programs to address those causes, to thinking about root causes and the broader social change needed to get necessary impact.

From a presentation, “Developmental Origins of Health and Disease,” Oregon State House Committee on Health CarePortland, OR, January 15, 2014.

Developmental Origins of Health and Disease

A recent national commission report produced by the Robert Wood Johnson Foundation states, “When it comes to your health, your zip code may be more important than your genetic code.”

Research on the Developmental Origins of Health and Disease (DOHaD) gives us a basic understanding of how the environment, as characterized by zip code, gets under our skin creates biological changes, and increases our vulnerability for disease and even our kids prospects for social success over their life course and into future generations.   This forces us to rethink where disease comes from and the best way to prevent it and promote health. It identifies what is the most fundamental social equity issue in our society: that initial social and biological disadvantage, established even prior to birth, is made worse by hostile environments throughout the life course. And it tells us that a concerted focus on changing our environment can ultimately change our biology.

“Going upstream requires a fundamentally different way of thinking about the world.”

While [a] mother is obviously the environment of a developing fetus, the community is the environment of the mother. And here is where one’s zip code, sadly, becomes evident as a significant determinant of health.

The two main factors in the community environment that impact healthy development are availability of appropriate nutrition and the level of social stress. “Toxic” stress and poor nutrition are a developmental recipe for vulnerability at birth, poor school performance and social skills early in life, and poor health later in life.

Our genes, we now know, are not a deterministic blueprint for our health but a collection of infinite possibilities that are switched on-or-off depending on the well-being our mothers experienced prior to and during pregnancy, and on the nutrition and social and physical environment we have as infants. This process of gene regulation, or how genes get switched on or off, is known as epigenetics: where nature meets nurture.

The implications of these findings are remarkable. For example, nutrition and stress risk factors are mediated through our community environment, in effect our zip code — and these conditions can be improved through changes in public policy and innovative public health programming.

Our struggle to be successful [in preventing people from falling in the river] is ongoing and is inseparable from the larger social justice agenda of public health. Think of social justice as a product of the collective decisions that we make as a community regarding public policy and the impact of those policies (intended or unintended) on the most vulnerable among us.

From a keynote address, “Developmental origins is the new upstream frontier,” Northwest Regional Primary Care Association Spring Conference, Seattle, WA, May 19, 2014.

Moving Forward

Going upstream requires a fundamentally different way of thinking about the world. It is a shift from thinking about individuals to thinking about large populations; from thinking about short-term solutions to thinking about long-term policy change; from thinking about perceived immediate causes and specific programs to address those causes, to thinking about root causes and the broader social change needed to get necessary impact.

 “If our community were the healthiest place in the world to be pregnant and have a child, what would it look like?”

We need to collectively envision what the upstream territory should be. And we need to come up with big ideas that are commensurate with the complexity of the problems that we face. We need to consider the following kinds of questions that are philosophical and pragmatic, ethical and actionable, and meaningful and measurable.

If our community were the healthiest place in the world to be pregnant and have a child, what would it look like? In other words, how would we design this for the most developmentally sensitive? What kinds of policies would be required to move toward that vision?

Larry Wallack in his Portland office

We need to:

  • Understand that the difficulty of downstream work is linked to upstream causes and work to make these links clearer and more actionable;
  • Explore new relationships with those who might not be the usual suspects; those outside the health field can be valuable new allies and provide important pieces for moving ahead in new ways;
  • Consider how to bridge from our comfort zone where we spend far too much of our time to the much more risky place “where magical things can happen.” This is what innovation is about.

There is no more powerful space in our society than where our best science, our most compassionate values, and our highest instincts as a community come together.

There is no more powerful space in our society than where our best science, our most compassionate values, and our highest instincts as a community come together. The developmental origins of health and disease is such a space. We can make a difference but we need the vision to see that space, the focus to map it out clearly, and…use it as a starting point of a long journey to make the kind of difference that can lead to truly healthier communities. Developmental origins is the next scientific and social frontier.

Learn More:

“Before You Know It,” Caitlin Baggot, Oregon Humanities, Summer 2014

“Epigenetics and Equity” video, Oregon Humanities, October 7, 2014