Trajectories: The social science of developmental pathways to health from preconception to childhood in South Africa

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In the 21st century, scientific advances have fundamentally challenged the view that an individual's health and well-being is written into their genes. Human development and health are now understood as profoundly shaped by early life environmental conditions. There have been significant public health investments in developing interventions during pregnancy and early childhood, particularly for decreasing obesity and non-communicable disease in the next generation. Recent evidence shows that interventions in pregnancy for decreasing obesity risk is of limited efficacy, and scientists are turning to the period before conception as a window of opportunity to shape intergenerational health. Testing this theory requires clinical trials that start before pregnancy and measure outcomes in the next generation. These new scientific approaches raise important questions that require urgent consideration given their possible societal impacts. The 'preconception' focus could productively emphasise the wide range of social determinants of health, but also has the potential for a loss of gains in reproductive rights and gender equality, and diminished attention to the social drivers of health inequities. As evidence from preconception trials begins to shape global health policy on women's and children's health, it is crucial that we advance our knowledge of how our social environments get 'under the skin' to shape health outcomes.This timely programme of research meets the urgent need for (1) Social science attention to the social and ethical implications of research and intervention in the 'preconception period', including how preconception trials are conducted, the assumptions underpinning this research, and what this means for global public health policy;(2) Innovative qualitative methodologies for studying the social factors that shape life trajectories. To do this, the PI and team hosted at King's College London will partner with the Developmental Pathways for Health Research Unit at the University of the Witwatersrand in South Africa, who have recently launched a preconception trial as part of the Healthy Life Trajectories Initiative (HeLTI) study. This trial is hosted by the World Health Organisation and will be conducted in Canada, India, China and South Africa. The trial will recruit 6000-9000 women in each site and it will primarily assess the effects of a complex set of nutrition and behaviour change interventions on early childhood development outcomes and child obesity risk at age 5. Drawing on the Fellow's expertise as a clinician and anthropologist, and an excellent interdisciplinary team of anthropologists, bioethicists and public health researchers, this project will conduct the first ethnography of a preconception trial and will initiate the first qualitative longitudinal study of a cohort of this kind, tracking sixty women enrolled in the HeLTI trial for a 5-year period to trace the interaction of the social and biological factors that shape health outcomes - from preconception to early childhood, and across the life course. This project will advance our theory and understanding of the social contexts of early life development and obesity risk; improve scientific practice; and create a space for public dialogue on the implications of new scientific knowledge for how we understand patterns of intergenerational health and disease. It will offer ground-breaking insights into how life course interventions can work most effectively to decrease health inequities, and will build the interdisciplinary research capacity needed to achieve this aim.