Transcript Layla Jader - Health in Wales

The Second Annual Course on The Impact of Genomics
on Public Health
Epigenetics should be shaping our
public health policy
Dr. Layla Jader
Consultant in Public Health Genomics
6 & 7 November 2014 Cardiff
The main determinants of health (Dahlgren and Whitehead, 1991)
General
socioeconomic
conditions
We &
our
genes
are
more
flexible
than we
ever
thought
before
The wider
environment
Individual life
style factors
Genomics
Examples- Exercise, obesity & Diabetes
• A study evaluated methylation in healthy
men exercising 1.8 hours /week for 6
months
• Waist-hip ratio ↓ with ↑methylation of a
gene previously associated with waist-hip
ratio,
• Significant methylation changes were also
observed in 18 candidate genes previously
associated with obesity &
• 21 genes associated with Type II Diabetes
• Meta analysis of data on 240,000 people
from 54 studies in adults & children on
FTO gene
• Carriers of 2 FTO ‘fattening’ gene variants
had a 23% higher risk of obesity
• But if they were physically active their risk
is lowered by 30%.
• Our genes are not our destiny!
Smoking & obesity
• A study has assessed paternal smoking &
obesity on markers of DNA damage or
instability in cord blood of their offspring.
• They tested blood cells, spermatozoa & cord
blood from 39 family trios & identified
transgenerational DNA changes in offspring of
smoking fathers.
• Hypomethylation at IGF2 (Insulin like growth
factor 2) gene in umbilical cord blood has been
found to be associated with paternal obesity.
Pregnancy
At embryological development, epigenetics
controls how & when certain genes are
turned on & off to help the body grow &
develop into various tissues forming
different organs
Epigenetics in normal human development
3 generations at
once are exposed to
the same
environmental
conditions (diet,
toxins, hormones,
etc.).
University of Utah Genetics Science Learning Centre Website
Diethylstilbestrol (DES) exposure in the
uterus
•Given to pregnant women to reduce risk of
miscarriage 1930s-1970s
•Women exposed prenatally developed
structural anomalies of reproductive tract,
menstrual irregularity, infertility, miscarriages
& increased risk of Gynae cancers especially
vaginal cancer.
•These abnormalities have been replicated in
mouse model.
•The granddaughters also showed
menstrual irregularities & infertility
•Similar studies in mice have shown the
same outcomes in female descendants.
•DES is a teratogen & carcinogen in humans
•Possible transgenerational effects were
proposed by the researchers
Transgenerational inheritance to 4th & 5th
generations has been directly observed
in rats.
•Cambridge researchers have also found
that some rare methylation can ‘escape’ the
reprogramming process & can thus be
passed on to offspring revealing how
epigenetic inheritance could occur.
So, what are the epigenetics
implications to Public Health Policy?
1. We now have evidence at the molecular
level confirming that positive life style &
environmental changes lead to
epigenetic modifications that can lead to
improved health outcomes.
2. Research findings in this area are
increasing in an exponential manner &
public health professionals need to catch
up with their important significance to their
practice.
3. These advances are shedding light as to
where our public health priorities should
lie.
5. Health of mothers during pregnancy is
hugely important, not only for her own
future health & the health of her foetus &
his future health as a child & as an adult
but also for the future health of her
grandchildren (reproductive cells) (3
generations)
6. The health of growing children especially
in mid childhood & pre-puberty is of
paramount importance for the child & as
he/she become an adult & for their future
pregnancies & children.
7. Early embryonic development & mid
childhood are the epigenetics plasticity
period when the body is very susceptible
to outside environmental factors
8. There is a total scientific agreement that
support the above statements.
Although we cannot change our
genome, we can change our
epigenome through life style
changes & through ameliorating
environmental factors
The Health economic argument is strong
First
Intervention
Continuous Favourable
Environment
Health outcome
Effect of same 1st intervention
Child development is the most important & cost
effective time to intervene & prevent diseases
Risk of chronic diseases
Birth
Life course
Fixed genetics contribution to risk +
Environmental influence in utero
Inequality in early cognitive development of
children in the 1970 British Cohort Study, at ages
22 months to 10 years
IQ heritability 50-80%
•Transgenerational research findings in mammals
suggest that the impact is more than just 3 generations
•There are disagreements on this among scientists
As to how often it does happen & for some, if at all
Whether epigenetics is the basis or another
genetic mechanism.
•Environmental, social & economic factors not only
influence the health of the present generation but if
adverse they can blight future generations
•A downward spiral may continue through
genome alterations, perpetuating the ill health
cycle
•This gives inequalities in health a new
challenge, a new dimension & an added
urgency to change our policy
• It emphasises the need for a public health
policy that prioritises early life from before
pregnancy up to puberty. This should cover
ALL children & ALL aspects of their lives
(physical, emotional, material, social &
cultural)
• Maternal & child health programmes have to
be annually accepted as number 1 priority.
Improve foetal health
& Childhood
health
Healthier
children &
grandchildren
Improve
health of the
whole nation
Reduce
inequalities
in health
Improve education of
parents
& education
of children
Improve
employment &
chances of
social mobility
Improve the
economy &
prosperity
• Public services like health & education have
direct access to the ‘theatres of actions’
(antenatal services, social services, nurseries
& schools),
• Also direct access to a captive audience
(mothers, babies, toddlers & school children).
• Adhering to the principle of ‘Sustained
Synergy of Intertwined Actions on Both
Children’s Health & Education’.
• The total outcome will be more than the sum
of health plus education as one strengthens
& magnifies the other.
Antenatal
clinics
Pre-school
School
Safe Havens
A captive
audience
Midwives
Health
Visitors
School
Nurses
Public Health & Wellbeing
Agents
Develop an integrated & comprehensive
strategy
Sustainable synergistic actions on both health &
education
We should raise the bar in all quality
aspects of health & educational systems
• This means raising the bar
 When assessing the quality
threshold of standards of health &
education systems
 In selection of students entering
professional career training
programmes
• Such a government policy prioritising
health & education have to be the centre
stage of government priorities for many
years, irrespective of which political party
is in power
• Only a sustained & consistent approach
will ensure better outcomes
• It has implications to other policies &
employment laws concerning maternity,
child care & child protection as it reinforce
their values.
• Future policies in these areas must reflect
the new knowledge that considers
pregnancy as an incubator of future
generations &
children as the guardian of our future
genome.
Improve
health
Reduce
inequalities in
health
The new
Strategy
will
Improve the
economy
Improve
social mobility
Will take a
decade or two
to be achieved
Advocate for the establishment of a new
‘Children’s Prioritisation Act for Wales’
• To complement existing laws & measures
concerning children & the rights of the child, but
going further
• To create new duties for public bodies (& where
possible voluntary & private bodies) to prioritise
meeting maternal & childhood needs.
Only such a Bill will fully achieve our aims in
improving the nation’s health & prosperity
• It shows that strong convincing evidence have
been sought & found.
• It shows unity of purpose for the whole country
• It obliges ministers, organisations, groups &
individuals to give it its rightful place.
• It will raise the society’s awareness, changing the
culture & attitudes which are pre-requisite of any
big societal change that is required to give
children their rightful place in society.
•
•
•
•
Will ensure wide coverage of this important area
Gives it the gravitas it deserves
It will strengthen other child laws
A bill that follows the example of Scandinavian
countries in being broad in nature that create
conditions for children’s health & education to be
at the forefront of policies in every governmental
department & every public, private & voluntary
organisation will reduce inequalities in health in
Wales.
Sustainable Future Generations Bill now
renamed ‘Well Being Future Generations Bill’
Royal Ascent in April-May 2015
What is the use of ensuring a sustainable planet
around us if we are unable to live healthily &
long enough to enjoy it?
A new policy based on cutting edge science will
be the best sustainability initiative we can device
for our ‘Future Generations’
Our children are our future