Public health professionals realize 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. Recent research in biological and social sciences provide remarkable findings about the developmental origins of chronic diseases such as obesity, heart disease and diabetes. Further, this research indicates that some of the same factors that increase risk for these diseases also are strongly implicated in a range of problems related to cognitive development, educational performance and mental health.

We now know that the most critical developmental period of vulnerability for health and social problems throughout the life course is from preconception to about age 2, a period referred to as the first 1,000 days. The two main risk factors are biological changes related to the nutritional flow from the mother to the fetus and the level of continuous external stress on the mother — the type of “toxic” stress brought on by conditions such as racism, inadequate housing, unemployment and lack of opportunity.

While the mother is the environment of the developing fetus, the community is the environment of the mother. A recent Robert Wood Johnson Foundation national commission concluded that “our zip code may be more important than our genetic code in determining our health.” It turns out that genes aren’t a rigid blueprint for our health; they are a collection of infinite possibilities, switched on or off depending on the well-being our mothers experienced prior to and during pregnancy, and on the nutrition and care we received as infants. This is known as epigenetics: where nature meets nurture. Environmental stimuli, such as nutrition or toxic stress, affect our genes and, consequently, our health. We can improve these conditions through changes in public policy and innovative public health programming.

Health care reform is placing a large bet on prevention and must incorporate the science of developmental origins of health and disease into planning at all stages. Much work in Oregon has focused on early childhood education and various prevention programs. This is important, but we now know that we need to go back further into the earliest of the first 1,000 days of life, particularly for lower-income populations, to justly, effectively and efficiently address the problems that burden our health care systems and limit educational, economic and social opportunity for individuals and communities.

The most important target population must be females from middle school through the end of childbearing years.

We must link efforts in prevention, early childhood education, housing, maternal and child health, economic development and related areas. We must think bigger, bolder and more comprehensively and apply our scientific knowledge. We must demolish the silo structures by creating a common understanding of the crosscutting factors that put some children at higher vulnerability for a lifetime of social and health problems.

There is no more powerful space in our society than where our best science, our most compassionate values and our noble instincts as a community come together. The urgency of the first 1,000 days 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 the political will to use it as a starting point to make the kind of difference that can lead to a healthier Oregon.

— Lawrence Wallack is a distinguished fellow at OHSU Moore Institute for Nutrition and Wellness.