SOCIAL DISCRIMINATION AND HEALTH DISPARITY ACROSS GENERATIONS: ARE WE SUFFICIENTLY INFORMED?

Irina Pollard, Biological Sciences, Macquarie University, Sydney, Australia

ipollard@rna.bio.mq.edu.au

Good health is not a natural state or universal right, rather it’s a matterof achievement – a consequence of privilege, or just good luck

Presentation’s Aims:

PART I : To provide a biological appreciation of transgenerational equity issues by integrating lifestyle variables, fetal programming with glucocorticoid involvement and postnatal health

PART II : With heightened biological consciousness advance ethical responsibility aimed at reducing the prevalence of preventable intergenerational inequity

HEALTH DISPARITY ACROSS GENERATIONS

The physical and social environments encountered from preconception to birth exert powerful influences on physiological function and risk of disease in postnatal life

PART I : ON MAINTAINING HEALTH AND WELLBEING

GENERAL WELLBEING IS SHAPED BY:

1. Genes

2. Upbringing

3. Personal circumstances and choices

4. Social conditions under which we live

Epigenetic Effects

LIFESTYLE DISEASES DEVELOP WITHIN THE SOCIO-BIOLOGICAL CONTEXT

COMMON LIFESTYLE DISEASES

1. Cardiovascular 2. Compromised immune system 3. Cancer 4. Gastrointestinal disturbances 5. Hypertension 6. Diabetes and other metabolic anomalies 7. Depression 8. Psychosis

1. Family2. Community3. Socioeconomic hierarchies 4. Incidents in childhood 5. Preconceptional-prenatal development

SOCIAL CONTEXT

LOWER SOCIAL STANDING

FEWER OPPORTUNITIES

LESS TRAINING

DECREASED FLEXIBILITY IN DECISION-MAKING

INSUFFICIENT CONTROL OVER OUR LIVES – POWERLESSNESS

STRESS-RELATED PHYSICAL AND PSYCHOLOGICAL DISEASE

DETERMINE THE HEALTH AND WELLBEING CONTINUUM

ENVIRONMENTAL DEGRADATION AND SOCIAL INJUSTICE OPERATE IN CONCERT

CHALLENGING SOCIAL DISCRIMINATION AND HEALTH DISPARITY IN CONTEMPORARY AUSTRALIA

Large sections of the Indigenous community is experiencing reprehensible poverty consequent to past inequities and present marginalization and neglect

LOSS OF:

1. Land2. Culture3. Beliefs and practices4. Identity5. Children 6. Self esteem7. Institutionalization8. Exclusion9. Genocide Women recording history (from ‘Yarrtji: Six Women’s Stories from the

Great Sandy Desert.’ Aboriginal Studies Press, Canberra, 1997, Plate 80)

EMPOWERMENT

‘TERRA NULLIUS’ FOR ~60,000 YEARS

MAP OF COLLECTED LANGUAGE, TRIBALAND NATION GROUPS OF THE INDIGENOUSPEOPLE OF AUSTRALIA

‘Citizenship’ by Sally Morgan

INTRODUCTION OF INFECTIOUS DISEASES HAD DRAMATIC IMPACTSON INDIGENOUS HEALTH AND WELLBEING

1. Smallpox

2. Measles

3. Whooping cough

4. Scarlet fever

5. Tuberculosis

6. Influenza

HIGHLIGHTING THE SCANDALOUS REALITY THAT IN ONE OF THE MOSTECONOMICALLY SUCCESSFUL NATIONS ON EARTH THE BENEFITS ARENOT SHARED FAIRLY AMONG ALL AUSTRALIANS

AUSTRALIA HAS SECTORS OF ITS CITIZENRY EXPERIENCING LEVELSOF DISADVANTAGE AKIN TO THE POOREST NATIONS ON EARTH

1. 15% of Indigenous households are overcrowded compared with 4% of other households

2. Infant mortality is three times the national average

3. 13% of Indigenous births are low birthweight compared with 6% of non-Indigenous births

4. In early to middle age (25-64 years) lifestyle diseases

such as hypertension, cardiovascular, respiratory, renal and metabolic diseases, are 6-10 times higher than for

the population at large

FROM THE AUSTRALIAN BUREAU OF STATISTICS WE CAN SEE THE STATISTICS OF POVERTY

6. School retention rate is 25-50% less than for other youths and university attendance is 5% compared with 23% of the general population

5. Life expectancy for Aboriginals is 15-20 years below that of the general population

7. Indigenous people are three times more likely then non-indigenous people to be unemployed or employed in a casual, low-income capacity

8. Drug and alcohol abuse is a severe social problem among Aboriginal Australians

9. Deaths from external causes such as accidents, suicide, homicide and assault account for one in every six registered Indigenous deaths

10. Suicide is 2-3 times more common among Aboriginals and 5-6 times more prevalent among Indigenous youth compared to non-Indigenous youths

13. Indigenous people constitute 2% of the Australian population but account for 20% of the prison population

Harmful Epigenetic Variables May Disrupt Normal Development by:

● Disrupting DNA forming deleterious mutations

● Changing gene imprinting processes and their consequent expressions

● Activate fetal programming strategies that change endocrine / immune feedback indices that modulate normal growth, development and postnatal fitness

All of the above challenge the health of future generations and future societies

WE INHERIT MORE THAN JUST OUR GENES FROM OUR ANCESTORS

DEVELOPMENTAL PROGRAMMING OR THE ‘FETAL ORIGINS’ HYPOTHESIS

(From ‘Bioethics and the New Embryology’ by Gilbert, Tyler & Zackin. Sinauer Associates, 2005)

‘Programming’ is ascribed to any situation where a stimulus or insult duringdevelopment establishes a permanent physiological response

“LIFE IN THE WOMB WILL BE WRITTEN ON YOUR TOMB”

Human Reproductive Health Through the Ages http://www.ranzcog.edu.au/connexion/pdfs/womb-to-tomb.pdf

Developmental Programming identifies how adverse environmental factors operating in utero may program susceptibility to adulthood diseases by hindering the establishment of robust neuroendocrine and immune systems

Hand-face contact in a 12 weeks old fetus (Photo courtesy S. Tye)

FETAL PROGRAMMING – A RESPONSE TO STRESS

Fetal programming is an adaptive evolutionarystrategy in mammals that confers some survivaladvantage in utero albeit at an increased risk ofadult-onset degenerative diseases

‘Fetal Programming’ occurs when the normalpattern of placental signaling is disrupted bystressful challenges that signal the fetus to adapt to the unfavorable intrauterine conditions

Glucocorticoids program the fetal hypothalamic-pituitary-adrenal (HPA) axis which, in turn, influence physiological function throughout the course of life

Epigenetic markers, including DNA and histonemethylation, are considered likely mechanismsto induce long-term programming effects

(www.msm.edu/ncpc/pcp5powerpoint/Newport-HELA-PregnancyMDD-WebOnly.ppt)

THE ‘BRAIN-SPARING’ EFFECT – A FETAL SURVIVAL STRATEGY

Spare vital organs necessary to survive intrauterine life atthe expense of the organs necessary for extrauterine life. Increased peripheral vascular resistance shunts circulatingvolume away from most organs to maintain or increaseblood flow to brain, myocardium and adrenal glands – effect asymmetrical growth (intrauterine growth restriction)

STRESS FROM THE TRANSGENERATIONAL PERSPECTIVE

(from Pollard, I. Reproduction. 129:2005;391-402)

SUMMARY OVERVIEW – PHYSIOLOGICAL MECHANISMS

(from Pollard, I. Reproduction. 129:2005;391-402) BIOETHICAL CHALLENGES

ECOGENETICS REINFORCES THEURGENT NEED TO UPGRADE SOCIAL, ECONOMIC AND POLITICAL RESPONSIBILITIES

Photos Irina Pollard

THANK YOU FOR LISTENING

(from Pollard, I. A Guide to Reproduction, Social Issues & Human Concerns. Page 147)