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1,000 Days: The Crucial Window for Life-long Health

By: Nalini Saligram; originally posted on 1,000 Days

We know that the right nutrition from pregnancy to a child’s 2nd birthday (the 1,000 day window made popular by the 1000 Days partnership) can have “a profound impact on a child’s ability to grow, learn, and rise out of poverty.” Many scholars now agree that we can influence the life-long health of the child, and even prevent chronic diseases, by intervening during this period.

We are all aware of the incredible benefits of healthy pregnancies in the short-term – how they save lives, enable women to survive childbirth, and help children survive past age 5.  The global health world is consumed with finding innovative ways to educate women about healthy pregnancies, to persuade women to give birth in a health center, and to demonstrate to parents the powers of vaccination. And it’s working. We salute the successes in global health that have brought under-5 childhood mortality down from 12.5 million in 1990 to 8.8 million in 2008. Millennium Development Goal #4, reducing child mortality by two thirds between 1990 and 2015, is not out of reach.

It’s the long-term health benefits from healthy pregnancies I find intriguing.  There is growing evidence that poor maternal nutrition during pregnancy, and low birth weight, can predispose the baby to develop chronic diseases later in life. By chronic diseases, I refer to the four most prevalent chronic non-communicable diseases (NCDs) – cardiovascular disease, diabetes, cancer and chronic respiratory disease.

In 1989, David Barker discovered the relationship between birth weight and the lifetime risk for coronary heart disease. He showed that the lower the weight of a baby at birth and during infancy, the higher the risk for coronary heart disease in later life. Later studies showed that low birth weight is associated with an increased risk of hypertension, stroke and type 2 diabetes. Peter Gluckman, Mark Hanson, Terrence Forrester and their colleagues who argue eloquently for the developmental origins of health and disease, posit that early epigenetic influences can dictate whether a child gets NCDs later in life.

Many of us in the global health community believe that aggressively strengthening ongoing maternal and child health programs would be a powerful way to save lives while simultaneously reducing one of the biggest health and development challenges of the century – NCDs. We appeal to global health practitioners to emphasize one clear message as they rally health workers around the world to engage with pregnant women – Eating right and having a normal birth weight baby could give your child the best start in life, by preventing NCDs 30 years later. Pretty appealing, don’t you think?

We appeal to all global health advocates to help the next generation come into the world without an elevated risk for developing NCDs like heart disease and diabetes later in life. Concerted global action around this effort is urgently needed, and we must not think of NCD prevention as a separate silo – it is an integral part of maternal and child health.

We must all work together to deliver a healthy, sustainable world. A world where women don’t die in childbirth, and where children grow up healthy is a world that is truly a better world for the next generation. In the spirit of Rio+20, and the global dialogue on sustainability, this is our generation’s responsibility, and our children’s right. We can and we must reach across different global health disciplines, work together to integrate NCD prevention into maternal and child health, and deliver a healthy future for our children.

 

Nalini Saligram, Ph.D., is the founder and CEO of
Arogya World, a U.S. based non-profit organization committed to changing the course of chronic disease, one community at a time. Under her leadership, the organization has built a network of thought leaders, advisors and partners, is advocating for NCD prevention globally, and implementing programs on diabetes prevention through lifestyle changes in India. The organization also made a major mHealth commitment at the Clinton Global Initiative Annual Meeting in 2011.

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