What’s in a name? Several years ago, we were trying to think of the most appropriate name for our new Society. It was clear that the banner “Fetal Origins of Adult Disease – FOAD” or “Fetal Programming” would not do, as the developmental processes operating to influence risk of later disease functioned both in the embryo and in infancy or later, and they did not set running deterministic programmes of development. My strong preference was for Developmental Origins of Health and Disease. But I remember someone asking me “I can understand developmental origins of disease, but how can health have a developmental origin?”. The question was raised by a very accomplished clinical scientist, and it made me realise just how far apart our points of view could be. As I had trained mainly as a physiologist, my time was spent thinking about how the normal body worked, what made it tick and how it developed to function that way – and even how it might have evolved to develop to function in that way. The processes by which health organisms are adapted to the conditions of life are what fascinated me. But of course to my clinical colleague it was disease that mattered – he wanted to know how development processes could lead to it, surreptiously and irreversibly it would seem.

The boundaries between health and disease can be stark, and of course they seem so to patients and their physicians. But in the DOHaD research area too much emphasis here can be unproductive. We have devoted, it seems to me, too much attention to why low birthweight leads to later disease, when we should have been asking what birthweight stood for, and how a spectrum of disease risk could be related across the spectrum of normal development. It’s a pity, because we still have a long way to go in explaining to health professionals and policy makers why they should not be surprised if interventions to reduce chronic non-communicable disease do not work very well in adults. Or that screening programmes to detect early signs of disease in younger people will not necessarily do more than define the size of tomorrow’s burden of chronic disease. But we are making progress: the description of biomarkers more subtle than birthweight can reveal the ways in which the developmental environment has affected the physiology in all health children, and then help to identify those who, very often for little fault of their own, will go on to have the greatest risks of becoming unhealthy in the environments in which so many of us live, or aspire to live. The processes induced in the developmental origins of health are not turning out to be fundamentally different from those which place us at risk of disease. I’m glad that we did not drop the ‘H’ in DOHaD. Researchers in DOHaD have much to offer to health promotion as well as disease prevention and their findings will have far reaching consequences. The mix of expertise as well as viewpoints which will be integrated in the pages of Journal of Developmental Origins of Health and Disease will document this achievement.