This chapter, written by a founder of the field and a historian with a long-term interest in DOHaD, examines the key (long) decade in the history of DOHaD, bookended by two conferences: one in 1989 and the other in 2003. At the 1989 workshop, David Barker presented his retrospective epidemiological research to an audience of fetal physiologists and clinicians. Discussions about the plausibility and underlying mechanisms of Barker’s findings fostered new research collaborations, methodologies, and projects, which over the next decade produced a new field. By 2003, DOHaD had grown sufficiently in both numbers and ambitions to host a major global conference. This chapter argues that to understand the objectives, methods, research questions, and intellectual networks making the field of DOHaD, the reactions that it provoked, and how it responded to them, we must understand the historical and geographical context in which it was created, first in Europe, especially the United Kingdom, and then globally. Here we identify and explain three key drivers that shaped the field: interdisciplinarity, the history of social class and attempts to address health inequalities in the United Kingdom, and the globalisation of the 1990s informing the intellectual underpinnings of the global health agenda.

Although maternal, newborn, child, and adolescent health is a well-established determinant of health across the lifecourse and across generations, the underpinning concept of DOHaD has not had significant impact on policymaking. This chapter identifies some of the barriers involved and how DOHaD researchers may overcome them. Policymaking is a complex process that is influenced by many factors other than science. Translating evidence to policy requires brokerage that explains the implications of science in a clear, frank way, accompanied by impactful solutions. Yet, the largely preventive approach advocated by DOHaD science does not inherently offer simple, high-impact interventions but rather a broad shift in thinking within the policy community. DOHaD advocacy will need to demonstrate short- and medium-term, as well as long-term, benefits. A complementary approach is to engage with communities to adjust scientific ideas to local knowledge and expertise.

In the last decade, scholars in the Developmental Origins of Health and Disease (DOHaD) have increasingly engaged in translating the field’s insights into policy and society. Several multidisciplinary advocacy groups have been formed to promote women’s reproductive health as well as maternal and child health. They have framed DOHaD in different ways in order to attract policy attention. Framing is the practice of contextualising and interpreting the meaning of research results in various communication activities. Overall, DOHaD has often been shown to exhibit a narrow focus on individual responsibility and translation at the clinician–patient interface instead of focusing on wider socio-economic, cultural, and political factors influencing health in its framing activities. In this chapter, we examine two case studies of multidisciplinary networks (the Venice Forum and UK Preconception Partnership) and explore how they have framed DOHaD findings when communicating with and for policymakers. We analyse the social valences of these framings and make recommendations for framing DOHaD in ways that better align with social justice and health equity goals.

As noted in Chapter 1, it is now over two decades since the field of DOHaD was established, as an extension of the epidemiological findings of Barker and colleagues and their integration with new ideas in developmental physiology, evolutionary biology and medicine. Despite the widespread acceptance of both the underlying science and phenomena of DOHaD, as evidenced in each of the previous 19 Chapters of this book and the range of scientists now engaged in relevant research, the field has had less impact than it warrants on public health, clinical practice or public policy. Here, we review the reasons for this, and suggest some possible solutions.

Two of the pathways by which evolutionary processes can influence disease risk are evolutionary mismatch, where the individual’s evolved coping mechanisms are overwhelmed by a novel or severe cue, and developmental mismatch, where the individual is exposed to an environment that is not matched to its adaptively developed phenotype. Both pathways draw on the evolutionary principle that selection operates to sustain and promote Darwinian fitness, irrespective of the impact on health during the post-reproductive age. In this chapter we will frame DOHaD phenomena within an evolutionary context, showing that human health and disease risk are dependent on our both evolutionary and developmental histories. We also discuss the contributory role of a unique human activity to not only construct a niche but also continually modify it. Using nutrition as the exemplar, we demonstrate how the DOHaD phenomenon is underpinned by both evolutionary and developmental mismatches, and discuss the evidence for how developmental anticipatory responses may confer adaptive advantage in humans.

This chapter provides a high-level overview of the following 19 Chapters, which together create the 2nd Edition of the Developmental Origins of Health and Disease. We encapsulate not only the vastly expanded evidence base and mechanistic understanding underlying DOHaD but also the challenges faced when trying to embed life course ‘thinking’ into environmental, social, educational and health care policies.