Analyzing policies through a DOHaD lens

Journal: International Journal of Environmental Research and Public Health
Date: December 2018

Summary
Public health policies are designed to improve community health and safety in ways that benefit every person. These policies have the potential to address structural inequities in society, which are some of the most important determinants of human health.  What if we were to analyze the impact policies have on human health, using a Developmental Origins of Health and Disease (DOHaD) lens? This is what researchers did, in a 2018 commentary in the International Journal of Environmental Research and Public Health.

The authors chose three areas of policy that have the potential to affect early life experiences so significantly that they could improve the lifespan trajectory of future generations: family leave, sugar sweetened beverage taxes and housing policies. They synthesized evidence related to these policies and examined the health implications for multiple generations.

Findings
Paid family leave (PFL): These policies have the most direct implications for intergenerational health. PFL is associated with lower levels of job turnover, long-lasting mental health benefits for mothers and decreased stress levels during pregnancy. Decreased stress can result in augmented growth of babies and newborns and a decrease in preterm births. Birthweight is an indicator of fetal development, and low birthweight leads to intergenerational, chronic health consequences.

The evidence showed that children of adults who had access to PFL were more likely to be breastfed and immunized, had higher quality mother-infant interactions and attachment security, better short-term developmental outcomes and lower infant and child mortality. The authors noted that these effects could be amplified due to the benefits of breastfeeding, which are numerous and long lasting. Breastfeeding reduces the likelihood of many chronic diseases as well as attention-deficit disorder, hearing problems, frequent ear infections and of being overweight.

Sugar sweetened beverage (SSB) taxes: These are implemented to change dietary behavior in order to improve both individual and public health, by making the drinks more expensive to buy. SSBs offer no nutritive benefit and add a large number of empty calories to the diet. The authors note that SSB consumption is highest among adolescents, a critical time in a person’s development, and that drinking SSBs is associated with higher obesity and diabetes risk in children and adults. SSB consumption in pregnancy is associated with adverse birth outcomes that alter lifelong disease risk in offspring.

The authors noted that in order to apply the DOHaD lens to the effects of SSB tax policies in pregnancy, we would need to know more about the intergenerational effects of consuming SSBs before, during and after pregnancy – as well as the consumption by fathers.  This information is not currently available.  However, there are several models around the world that simulate the effects the tax would have at a population level. For example, a simulation built on observed reductions in consumption following Mexico’s SSB tax, predicted a 2.5 percent reduction in obesity after ten years, and prevention of at least 86,000 cases of diabetes by 2030.

Housing policies: These have direct and indirect effects on health, and housing is recognized as a main social determinant of health. Where you live determines your education and your economic opportunities. It determines your stress levels, your transportation options and whether you have access to nutritious food. It determines your access to healthcare, your safety and your early life exposures. Housing policies that offer assistance, like rental vouchers and housing subsidies improve lives, fight poverty and create upward mobility. Other policies that impact housing, such as economic development policies, show mixed results depending on your race and ethnicity.

Even the risk of foreclosure or the threat of eviction can cause mental and physical health problems. Applying the DOHaD lens to housing policies like subsidies or vouchers, the authors found a link between women who had to move out of public housing or who had housing instability, and an increased risk for preterm low birthweight. They note the literature rarely extends to the potential effects on pregnancy and fails to take into account the long-term health implications that birth outcomes set in motion.

Recent work exploring the effects of neighborhood gentrification found that among non-Hispanic Black women, very high levels of gentrification were linked to increased preterm birth, compared to those experiencing low levels of gentrification. However, for non-Hispanic white women, living in a very highly gentrified neighborhood had a protective effect against preterm birth. From a DOHaD perspective, urban renewal that results in the displacement of pregnant women will likely affect the children by increasing the likelihood their babies will be born too soon or too small, both of which sets the trajectory for poor health over the life course.

DOHaD researchers are gaining clear insight to the expected 100-year health effects caused by poor nutrition, unaffordable or unsuitable housing, gender-based violence, racism, poverty, lack of education or work opportunities and other adverse events in peoples’ lives. The authors make a case for using a Health Impact Assessment-type approach to policy-making, using the DOHaD lens to clarify potential effects that policies might have on women of reproductive age. Using this approach, public health would have a more precise tool to evaluate the multi-generational effects of policies, and provide recommendations to decision-makers as they consider which policies to adopt and implement to improve public health.  The OHSU Bob and Charlee Moore Institute of Nutrition & Wellness supports this approach to policy making in the interest of improved health for all Oregonians.

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The OHSU Bob and Charlee Moore Institute for Nutrition & Wellness supports human research that seeks to find the links between maternal stresses, including poor nutrition, and elevated disease risks for babies as they become adolescents and adults. 

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Goodman, J., Boone-Heinonen, J., Richardson, D., Andrea, S., & Messer, L. (2018). Analyzing Policies Through a DOHaD Lens: What Can We Learn? International Journal of Environmental Research and Public Health, 15(12), 2906. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph15122906