1,001 Days
Also by Sue Gerhardt
Why Love Matters
The Selfish Society
1,001 Days
How Our First Years Shape Our Lifelong Health Sue Gerhardt
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First published 2025 001
Copyright © Sue Gerhardt, 2025
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For my grandson, Luca
Everything should be as simple as possible, but not simpler.
(attributed to Albert Einstein)
Introduction:
How to grow heathy humans
Babyhood and old age are seen as polar opposites and are rarely mentioned in the same breath. Yet they are profoundly linked. The earliest experiences we have as fetus and infant have lasting effects on our lives, particularly on our mental and physical health as adults. I first came to understand these links in the 1990s and wrote about them in Why Love Matters: How Affection Shapes a Baby’s Brain. 1 As I embarked on this new book, decades later, I wanted to focus less on the brain and mental health and more on physical health, once again exploring how very early events can shape health – especially our health after middle age.
What I didn’t realise then was what a personal story this would turn out to be. As I started researching and talking to people about it, the first of my circle of friends and family developed a serious illness: my younger sister, Vicky, was diagnosed with a form of lymphoma or blood cancer, which was successfully treated. Then there was Harriet.
Harriet was a lynchpin of our friendly neighbourhood. Attractive, self-deprecating, warm and hospitable, we sometimes gathered at her house for a drink on bonfire night. There she would be, smoking her tiny roll-up cigarettes and making wry comments about the state of the world, or tactfully enquiring about other people’s lives. She looked fit, slim and contented with her own life, so it was a shock to hear that she had developed lung cancer while only in her sixties.
One weekend, some of the residents of our street met up for an impromptu summer picnic on the scrubby common near our
1,001 Days
homes. An unexpected shower had made it so damp that we had to lay coats on the ground. As we passed around the crisps and homemade dips, I explained the theme of this book to her: that many adult illnesses were thought to be linked to early life experiences, often due to the mother’s stress during pregnancy or postnatally affecting the baby’s immune system. Immediately, Harriet responded: ‘That’s me.’ She instantly recognised the possibility that her own difficult childhood may have played a part in her illness, just as much as lifestyle factors had, like smoking.
That was also the summer when it began to dawn on me that my generation of ‘baby boomers’ were starting to come face-to-face with the reality of ageing. There was more to come: first there were the unexpected deaths of iconic figures, such as the musician David Bowie, the actor Alan Rickman and the comedian Victoria Wood, all in their sixties. Then – closer to home – the toll mounted as other neighbours and friends died of things like pancreatic cancer, myeloma and heart disease, among them my close friend Dave, who had suffered from chronic obstructive pulmonary disease (COPD) and kidney failure for several years.
Around this time my own health started to fray at the edges too. Although I was researching and reading hundreds of scientific papers, it took me a while to realise that something had happened to my eyesight: a blood clot in one eye that was affecting my vision. Then I had another shock when, a year or two later, I was diagnosed with Parkinson’s disease. I began to realise that I, too, had entered that stage of life where the body starts to fail.
But this book is not about the gloomy trials of old age. Instead, it has a positive message. It suggests that, with a better understanding of the early roots of health and illness, we could target our efforts differently – both as adults seeking to safeguard our own health and as a society looking to create more effective ways to prevent chronic illness. It also suggests that things could be very different for future generations. As we begin to understand the links between early experience and later disease, the possibility of
prevention becomes more compelling. It opens up new and exciting opportunities to reduce the number of people who develop cardiovascular disease, obesity, type- 2 diabetes, depression and dementia – our number-one health problems, over and above the newly relevant challenge of pandemic viruses.
A clear but complex picture is emerging; there is no simple cause and effect that explains an individual’s health outcomes. Every person’s story is unique. For example, many factors came together to set my friend Dave up for ill health. His parents had little money (his father was a motor mechanic and his mother a cleaner); he described them as harsh parents with sharp tongues who often left him feeling humiliated and unloved, which, he regretfully worried, had an ongoing effect on his adult relationships. Their family food was cheap and filling. It did not feature any vegetables other than the potato. As Dave used to enjoy telling people, in an exaggerated Mancunian accent: ‘My first meal was a chip.’ And although he became a good cook in later life, Dave never gave up his taste for those familiar pies and chips.
People with a less auspicious start in life may not acquire the ‘brain reserve’ generated by positive early life experiences. Those who are held and touched, well fed, warm and emotionally secure are likely to have brains with more neuronal connections, less inflammation and a more robust immune system, which in turn delays the onset of the diseases of ageing. For people like Dave or Harriet, who also experienced stress in early life, or those who lost a parent in childhood, there may be less brain reserve and less resilience in the face of stress or infection.
Does that mean it is too late for those of us who recognise this may have been our own story? On the contrary, it gives us, as adults, more chance of using an awareness of our own particular vulnerability to illness to protect ourselves from the kinds of stress that can trigger it, just as we might use our knowledge of a family history of heart disease to guide us to regularly check our blood pressure. Knowing the history of your own first 1,001 days could motivate you
Days
more strongly to try to reduce the stress in your life – for example, by seeking help with stressful personal relationships, practising selfsoothing techniques, or by collaborating with others to correct social injustices. Equally, it could lead to a greater willingness to take part in screening programmes, to reduce inflammation through your food choices, or just to act more promptly when symptoms appear.
If we could also find a way to pay more attention to these processes at the start of life – by promoting maternal well-being in pregnancy, supporting breastfeeding, and strengthening the early attachment relationships – we would not only help people to enjoy their lives but would also build positive ‘health capital’. The possibility then opens up of reducing the number of people who get cardiovascular disease, obesity, depression, type 2 diabetes and other conditions.
The better we can understand the way these different factors affect us in the present, the more likely it is that we will be able to effectively prevent ill health. But this is a different way of approaching illness from the prevailing medical model, which focuses more narrowly on symptoms, diseases and cures. This book will argue that it is time to expand our thinking. We need to take on board the combined impact of the revolutionary changes that have been happening in a range of sciences, such as neuroscience, developmental psychology, microbiology and epigenetics, which point us to the importance of early experience in being resilient and healthy throughout our life. The knowledge these disciplines have been accumulating in recent decades is, however, mostly found in academic journals and is rarely made accessible to the casual reader. The intention of this book is to make their discoveries as clear as possible, without unnecessary jargon, so that we can see their implications more clearly.
Our current health systems do not, as yet, fully embrace the potential of prevention, especially the power to prevent future illness at the earliest stages of development. Although there are a few significant forms of early prevention, such as early programmes of
Introduction
vaccination in infancy and childhood and the monitoring of pregnant women’s health, the idea of prevention is largely focused on stopping established unhealthy adult behaviours, such as smoking and weight gain.
This book explores some of the deep-rooted political and cultural issues that hinder us from acting on what developmental science is telling us. Some of these wider issues are about the stories by which we live our lives. For example, we take an individualistic framework for granted. Ill health tends to be seen as a result of the wrong ‘lifestyle’ choices, or as an individual struggle against adversity (as can be seen from headlines such as: ‘Olivia Newton-John battling breast cancer again’). We hold fast to the idea that we can determine our lives through our own actions and free will – in fact, many believe this is ‘the essence of humanness’.2
The possibility that our health and well-being depend on other people, particularly on events that occur in the earliest months of our lives, does not fit comfortably with Western thinking. Currently, few people recognise any link between their adult health concerns and what happened to them in the womb or as a baby. This book argues that this is a significant and neglected part of the picture. Each of us is made or grown by and with other people: we can never have unfettered freedom, nor can we single-handedly make ourselves who we are. As René Dubos, the Frenchman who pioneered ecological thinking, put it: ‘each one of us is born with the potentiality to become several different persons but what we become depends on the conditions under which we develop’.3
This is turning out to be true of our health as well as our psychological selves. Each body develops in response to its environment. For example, it is well known that the individual’s acquired immune system is ‘a product of the types, strengths and number of infections, diseases and injuries encountered through life’.4 What is less well known is that several other systems that play a part in regulating the body – such as our stress response, the vagal system, the gut microbiome and various neurotransmitter and hormone
1,001 Days systems that we will cover in this book – can also develop differently in response to different experiences and environments, particularly in response to the nutritional and emotional care we receive early on in life.
This relatively new information suggests the need to update our established ways of thinking about health and illness. Predominant ideas of medicine are focused on eradicating germs, on new technical and surgical fixes, and on finding the genes involved in particular illnesses. These are all worthy goals, for which I am grateful, particularly as someone living with Parkinson’s disease. It also makes sense for adults to adopt a healthy diet and exercise regime, and to stop smoking, to reduce our risk of falling ill. More than that, however, with a greater understanding of our individual health stories, we can be alert to the risks we face and become better able to make informed decisions about our health. But healthy aging also depends on health in infancy and childhood, factors that receive less attention.
Happily, more and more people in the medical profession are raising these issues – people like Richard Horton, ‘activist’ editor of the respected medical journal The Lancet , who has campaigned about the importance of nutrition, the need to reform our food system and to prioritise maternal and child healthcare; or the Cambridge University paediatrician Professor David Rowitch, who recently argued for a ‘healthcare paradigm shift’ towards preventive medicine, identifying the origins of disease early on in order to build health resilience. As he put it, somewhat pessimistically, ‘Beginning disease prevention in middle age is not just closing the stable door after the horse has bolted; those horses have left the field and they’re not coming back’. 5 These voices are getting louder. As this book will make clear, it is way past time to listen to such voices. The growing pressures of climate overheating, unstable democracies, new pandemics and increasing social inequality are making it both more difficult yet more imperative to move away from short-sighted reactive behaviours and move towards long-term
Introduction
planning and thinking, if we are to create a healthy, resilient new generation. There is an urgent need to ‘take control’ of our global economy and of the environment if we are to have a viable future, but, equally, we need to ensure that new people who are born in the years to come are built for healthy lives.
Additionally, armed with new and consolidating information about the physiological systems that underpin and maintain health, we can all benefit by embracing a wider concept of medicine and a growing understanding of how to repair and restore some of our systems that may have developed poorly in early life.
The exciting thing is that we understand more than ever how this can be done.