Future human capital

Prevention and prevention strategies form the basis of a coordinated path for the future of child healthcare, writes Fiona Stanley.

Child health research is at an important junction where we seem to be heading off on several new paths that are both daunting and exciting in their potential. What has happened is the realisation that many of the pathways to disease and poor health actually commence a lot earlier than previously thought.

It's not just about genes -- although there is a huge genetic influence on almost very disease. It's more about how genes interact, and interact with environmental factors, particularly during exquisitely timed developmental periods.

That realisation has a profound impact for research. For example, to investigate adult cardiovascular disease by looking only in adults at cholesterol, high blood pressure, obesity and ignoring early pathways could mean missing the chance to have a major impact on reducing disease.

If we look early -- and in many instances that includes in utero factors -- then we can draw a much more complete picture of the pathways to disease and identify more opportunities for effective prevention. Thus our research is (and should be) aimed at elucidating early preventative strategies which actually interrupt disease pathways before the disease process is irreversible.

Elucidating pathways to disease

The other exciting development is that we're starting to unpack the socio-economic associations that are arguably the most powerful influences, across the board, in children's and adult diseases. Not so long ago, epidemiologists like me used to 'control' for social class rather than questioning why socio-economic status is such an important predictor of outcomes.

This realisation has opened up a whole new area of research. For example, we are looking at the stress pathways -- including those in utero and early childhood -- and how they influence pathways to disease. It looks likely that stress could affect a range of diseases and disorders such as asthma, obesity, diabetes, autism and behavioural problems, all of which are increasing at alarming rates in our children. We've started to bring together basic scientists who are looking at the mechanism of the HPA axis -- the stress response -- with social researchers, clinicians and epidemiologists. It's by working together in these ways that we hope we can achieve real cutting-edge approaches to finding out the pathways to disease and how best to interrupt them.

A national priority

The diseases and disorders that we now face appear much more complex than those of 50 years ago. Collaboration has become more than an ideal, it's a necessity.

That's why I'm so excited about the progress of the Australian Research Alliance for Children and Youth that was formed to facilitate these types of collaborations so that we can more effectively tackle these big questions in child health.

Finally, here are some observations about our priorities:

We need to continue to lobby for research into prevention and for funds to implement effective preventative strategies. For example, why is it taking so long for Australia and New Zealand to implement mandatory fortification of flour with folic acid, when we have the evidence for its benefits, based on research and implementation in other countries?

We need to ask ourselves why we were so tardy in recognising and acting on the obesity epidemic, when we have known and seen the risk factors for such a long time.

It's really important for us not to ignore the threat of infectious diseases. The enterovirus 71 in South-East Asia and Australia has frightening potential for children, and we continue to be challenged by HIV and other sexually transmitted infections.

Our biggest and most important challenge continues to be to work with our indigenous communities to help them to improve the health and wellbeing of Aboriginal children. The appalling health statistics of Aboriginal children cannot be accepted on any level. While it is complex and challenging, it must never be considered 'too hard'. There are some communities who are doing fantastic things -- we need to look at what works, why it works, and look at a coordinated exchange of knowledge.

There's no doubt in my mind that we're moving into an exciting new period of child health research. The recognition of the importance of early pathways and the emergence of SES as such a pervasive factor reinforces the need for child/family friendly communities, and the fact that child health and development is a national priority. After all, it's our nation's future human capital that we're talking about.

Prof Fiona Stanley is director of the Telethon Institute for Child Health, in Western Australia. In 2003 she was named Australian of the Year.