Evolutionary public health: introducing the concept

Abstract

The emerging discipline of evolutionary medicine is breaking new ground in understanding why people become ill. However, the value of evolutionary analyses of human physiology and behaviour is only beginning to be recognised in the field of public health. Core principles come from life history theory, which analyses the allocation of finite amounts of energy between four competing functions-maintenance, growth, reproduction, and defence. A central tenet of evolutionary theory is that organisms are selected to allocate energy and time to maximise reproductive success, rather than health or longevity. Ecological interactions that influence mortality risk, nutrient availability, and pathogen burden shape energy allocation strategies throughout the life course, thereby affecting diverse health outcomes. Public health interventions could improve their own effectiveness by incorporating an evolutionary perspective. In particular, evolutionary approaches offer new opportunities to address the complex challenges of global health, in which populations are differentially exposed to the metabolic consequences of poverty, high fertility, infectious diseases, and rapid changes in nutrition and lifestyle. The effect of specific interventions is predicted to depend on broader factors shaping life expectancy. Among the important tools in this approach are mathematical models, which can explore probable benefits and limitations of interventions in silico, before their implementation in human populations.

Reproduction and longevity A Mendelian randomization study of gonadotropin-releasing hormone and ischemic heart disease

“…2 To address this gap, CVD is being re-conceptualized within the well-established evolutionary biology theory that growth and reproduction trade-off against longevity. 3 4 Dietary restriction mimetics are being investigated in CVD. 5 Genetic selection in favour of both fertility and ischemic heart disease (IHD) has been demonstrated.…”

Patients Are Our Teachers

“…Public health finds the concept of many individuals living in varying environments and thus comprising different populations to be a powerful source of insights into why certain persons and not others are affected by a disease. 12 The wider community, all of whom will be patients at one time or another, collectively benefits when doctors are skilled and proficient; when they have the time and resources to attend to their patients on an individual basis; and when medicine can prevent some diseases, effectively treat those that cannot be prevented, and address the impairments, disabilities, and losses of well-being that often ensue after an illness has run its course. The whole community gains when doctors learn from their patients.…”

Towards a capability approach to child growth: A theoretical framework

“…The parentoffspring conflict theory helps to explain other phenomena as well, such as why interventions that provide additional protein and energy to the mother during pregnancy tend to have a relatively modest impact on foetal growth (Ceesay et al, 1997), and may have greater effects on maternal fertility (Gibson & Mace, 2006). Rather than being invested in the growth of the offspring, the additional energy may be retained by the mother, enabling her to produce the next offspring faster (J. C. Wells, 2003;J. C. K. Wells, Nesse, Sear, Johnstone, & Stearns, 2017).…”