Give future generations a chance: Support mothers to secure future public health

Current approaches to curbing the global rise of chronic diseases, such as diabetes and heart disease, are failing, according to University of Southampton researchers.

Writing in Nature, the group, led by the late Professor David Barker, say more needs to be done to support young girls and women to feel more in control of their lives and so better able to prioritise healthy eating.

They believe this will have significant benefits in improving the health of future generations and reducing mortality rates.

More than 30 years of epidemiological studies at the University of Southampton and around the world have shown that the chances of a person having a chronic disease in later life can be determined when they are in the womb.

The biology underlying the developmental origins of health and disease has begun to be better understood and evidence suggests that women need to start eating healthily well before they become pregnant. Women who are obese, and those whose stores of nutrients mean the supply to their growing fetus is less than optimal, risk having babies with a greater likelihood of suffering diabetes, hypertension, or cancer in later life.

Focus group research has identified that women do know they should be eating healthily – it is not knowledge that they lack. It is more often that they feel out of control of the food choices they make for themselves and their families. The Southampton researchers warn: "The public health approach currently used across industrialized nations (like the UK) of providing women with information about seems unlikely to be effective."

They call instead for initiatives to enhance women's sense of empowerment in relation to their food choices by supporting them to identify the barriers they face and to generate their own solutions. These personal empowerment activities need to be accompanied by environmental changes which make it easier for women to make better choices, the Southampton researchers believe. Similar approaches have been used in small communities in Canada, Australia and America where work to increase people's confidence in choosing and cooking healthy foods has been accompanied by improvements in access to fruits and vegetables and local media campaigns to promote the benefit of eating well.

They say: "So far, public health advocates have called for regulation and legislation as a means to improve diets—an increased tax on fatty and sugary foods, for instance. Yet this is unlikely to happen because raising the tax on soft drinks, say, is not in the interests of industry, or of politicians, who are sensitive to industry pressures and to a public who want cheap soft drinks.

"Instead of wagging fingers, we need to generate consensus. Empowering consumers to call for better access to better food will put pressure on both politicians to respond to voters, and on the food industry to please their customers."

Dr Mary Barker, Senior Lecturer in Psychology in the Medical Research Council Lifecourse Epidemiology Unit at the University of Southampton and one of the authors of the comment piece in Nature, says: "Young women need to be supported to make healthier food choices, but we also need to work with government and industry to make healthy easier. The challenge for public health is to stop telling everyone what they should and shouldn't do and instead empower , policy makers and food companies to generate consensus about what needs to be done."

Professor Cyrus Cooper, Director of the Medical Research Council Lifecourse Epidemiology Unit at the University of Southampton, adds: "Thirty years of scientific discovery at the University of Southampton and around the world have established the importance of early life in determining life-long disease risk. The University is now at the forefront of work to build on this knowledge and develop interventions to address the implications."

More information: The paper is freely accessible at www.nature.com/news/1.14320

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