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Beyond informal caring for aging and for chronically ill persons in affluent societies, caregiving by kin to procreators critically exposed to societal stress might soon prove a most fruitful human investment. Such a blunt affirmation is based on two domains of knowledge. One is epigenetics[1], a new development in fundamental life sciences which explains the well established relation between fetal well-being (or primal health) and future adult health[2]. The other is a recent, well substantiated social epidemiology observation of paramount importance[3]. Their synthesis opens a radically new approach in public health, namely primal prevention[4].

a) A PROFOUND REAPPRAISAL : According to the new knowledge emerging from already countless epigenetic studies, our genetic hardware is no more considered the unique organizer of an embryonic development programmed independently from its surroundings. On the contrary, at both cellular and organ's scales - together with all the experiences it provides to the growing organism - the environment itself continuously determines in every cell which ‘books of the DNA library’ are closed, and which ones are open (and at what pages[5]). Such an environment-related epigenetic activity within each individual during the primal period of its life[6] is much more important than had been evaluated until recently. It not only tunes cell differentiation and tissue organization during primal life but also determines the individual’s personality, future resilience and adult health[7].

b) THE SUBSTANTIATED OBSERVATION : A well conducted comparison of affluent societies shows that the incidence of the most diverse signs of ill health – from teenage births to imprisonment rates, from children’s poor educational performances to mental illnesses – is larger, in any given society, the larger the income differences within that society.

A KEY SYNTHESIS : In their attempt to explain the above correlation, the authors suggest that inequality creates a societal stress to which all individuals are exposed, with various ill effects at all ages as a direct consequence. In my view, a prominent feature of epigenetic processes, i.e., that they are most active during early development, should be taken into account in a key synthesis. I therefore suggest the following, most plausible hypothesis: Individuals bear the biological impacts of stress when epigenetic activity is most intense, i.e., during their primal life. That various signs of suffering then persist or, for some of them, appear only during childhood or much later in life should then simply be considered a consequence of the persistence of epigenetic modifications left by these initial impacts. True, in a competitive society characterized by income inequality, people who are most directly exposed to stress are the young adults about to procreate, precisely at a period of their life when their professional engagement competes with their engagement as procreators. Thus, in keeping with the above hypothesis, I conclude that it is indirectly, through his procreators’ direct exposure to societal stress, that the child’s primal environment is altered to produce less than favorable epigenetic imprints.

THE PROPOUNDED NEW AVENUE FOR PUBLIC HEALTH : Informal caregiving to procreators during their child’s primal life should be contemplated as a most precious long-term investment. In this respect, any substantial contribution by kin should follow primal prevention strategies, which typically focus on providing future parents with : (i) education (based on authoritative sources) regarding the consequences of epigenetic influences on the child they are about to create, (ii) sufficient leave time for both parents during their child's primal life – the best choice for kin caregiving – , and (iii) financial support if required. Such solidary actions may well become the long awaited alternative, both radical and immediately applicable, to the unbearably expensive attempts at repairing damages of primal origin - life-long ones as well as those appearing late in adult life.

Auguste E. Chinet, MD, MER, retired from the [former] Physiology Department of the University of Geneva, Faculty of Medicine, CMU, rue Michel-Servet. Present address: Grand-Rue 79, CH – 1180 Rolle, Switzerland.

  1. "Epigenetics", Richard C. Francis, 2011. See also: "Origins": How the first nine months shape the rest of your life, Annie Murphy Paul, Time magazine, 176.14, 2010.
  2. "La santé primale", Michel Odent, 1986
  3. "The Spirit Level", Richard Wilkinson and Kate Pickett, 2009.
  4. English version of
  5. "RNA:life's indispensable molecule", James Darnell, 2011 (from this outstanding account of molecular biology developments over the last decades, an extensive view of operational genetics and detailed epigenetic processes can be gathered).
  6. According to the definition given by the Primal Health Research Centre, London, the primal period [of life, or primal life] is from conception to the first anniversary
  7. As an example, see: "Epigenetic Influence of Social Experiences Across the Lifespan", Frances A. Champagne, Developmental Psychology, Wiley Periodicals, 2010. La Santé Primale, Michel Odent, 1986.

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