When It Comes to Your Health, Your Zip Code Matters More Than Your Genetic Code

Today is the one year anniversary of the passage of the Affordable Care Act and guess what? According to a recent survey, over one half of Americans don't think health reform is actually a law.

It is folks.

I'm marking the one year anniversary by attending the National Association of Black Journalists Media Institute on Health, Health Policy and Health Disparities in Washington, DC.

I heard two very profound statements today that tell the story about rampant health disparities impacting communities of color. Those two statements were not long prognostications about the social determinants of health or the root causes of these racial and ethnic inequities.

The comments indeed were about those things, but they were short enough for Twitter but utterly profound in answering those questions.

Comment #1: "Your zip code may be more important than your genetic code when it comes to health disparities."

Comment # 2: "We have a sick system not a healthcare system."

Comment 1 struck me because it alarms me that where you live is one of the key drivers of your health. According to the World Health Organization, Report on the Social Determinants of Health, avoidable health inequities arise because of the circumstances in which people grow, live, work and age and the systems put in place to deal with illness. In turn, the conditions in which people live and die are, in turn, shaped by political, social and economic forces.

That's why I was really impressed with a new initiative by The Joint Center for Political and Economic Studies, called Place Matters, which seeks to address conditions in the natural environment, built environment and social environment that lead to poor health. The goal is to eliminate health disparities by identifying the complex underlying causes and defining strategies to address them.

I am convinced these issues play a significant role in maternal and child health.

Comment # 2 was just too simplistically truthful to ignore. Healthcare is a misnomer for our system. It takes care of your sickness but does little to protect your health. In fact, today I learned that for every $1 spent on healthcare only 5 cents goes to prevention.

This is pathetic because so many mothers wouldn't needlessly die if there were more prevention programs and community-level interventions.

What's in Your Womb? Pre-programming for the rest of your life, that's what.

Do you have heart disease, high blood pressure, diabetes or high cholesterol? Like many people, you're probably thinking that your diet, exercise (or lack of it), or weight play a significant contributing factor. And they likely do. But there's something else to consider. Are you ready? Here's the 64 million dollar question: Were you a low-birth weight baby?

Did you know that being a low birth weight baby could make you more susceptible to having heart disease or high blood pressure 40 or 50 years later?

This amazing nugget relates to a new discovery in epigenetics, called fetal programming. Fetal programming refers to the process whereby a stimulus or insult at a critical point in fetal development creates permanent changes in the structure and function of the baby's vital organs, leaving lasting or even lifelong consequences for health.

The idea of fetal programming was first introduced by Dr. David Barker and his colleagues at the University of Southampton in England. Barker and his team made a connection to poor fetal growth inside the womb (which resulted in low-birth weight) and coronary heart disease, diabetes, high blood pressure, diabetes, high cholesterol and a many more chronic adult illnesses later in life.

Barker hypothesized that similar to programming a computer, a baby's heart and other vital organs are actually "programmed" inside the womb. If something negative happens during pregnancy then those organs may not get the proper programming and never fully function at their best over a lifetime.

It's an amazing way of thinking about the long term effects of pregnancy beyond just what happens at delivery. It was one of the many Aha! moments I had last week, as Dr. Michael Lu, from UCLA, presented on the Life Course Perspective as part of the Women's eNews Black Maternal Health Conference (click here to watch the webcast)

Lu discussed the "Barker hypothesis" and showed that although it was initially met with some skepticism in the scientific community, over the past decade more and more scientific evidence is building to support this idea.

Two key areas that Dr. Lu highlights:

• Maternal stress linked to ADHD in children. When a woman is stressed out during pregnancy, her baby is immersed in a stress hormone called cortisol. Studies indicate that over exposure to cortisol in the womb results in permanent changes in the structure and function of the fetal brain. There are more and more studies linking maternal anxiety and stress during pregnancy to neurological disorders in children, including ADHD.
  
   


• Maternal nutrition linked to childhood obesity.  Poor fetal nutrition cause permanent alterations in key organs such as the pancreas, kidneys and blood vessels which can lead to diabetes, hypertension and heart disease later in life. In addition, poor fetal nutrition affects the genes the help the body use and store energy more efficiently. They are called the "thrifty genes." In our food-crazy society, those turned on "thrifty genes" mean that body will hang onto to every calorie possible, predisposing a child to a lifelong struggle with obesity.

The point is, so much is happening in the womb that affects your baby not just at their birth but for the rest of  life. And if we really want to prevent obesity and heart disease in children and adults, then we have to go back to the womb and make sure those organs are properly optimized from the start.

Learn more about what you can do to prepare your womb for optimal fetal programming by reading Dr. Lu's book.