In Reply We agree with Drs Pachter and Cheng about the value of research into the early origins of chronic diseases. Further progress requires greater investment in large-scale birth cohort studies to better understand the complex interactions of genetic, environmental, and social factors and their trajectories over time.
Birth cohort studies in South Africa have yielded novel and valuable insights for policy makers. Examples include raised blood pressure in Soweto children by 5 years of age and higher levels of respiratory infections in children younger than 2 years resulting from poor air quality from coal burning.1 The goals of such research reflect what we think is a needed shift in the goal of NIH research: to promote and enhance health over the lifespan. The current justification for NIH funding based on breakthrough cures undermines more significant funding opportunities for research leading to sustained health gains and reduced disparities.
Yach D, Calitz C. Prevention of Noncommunicable Diseases. JAMA. 2014;312(23):2573-2574. doi:10.1001/jama.2014.15143