I congratulate the editors of Health Economics for 20 successful years. Continued success requires publishing research at the frontiers of knowledge. One frontier is the developmental origins of health.
Among early deaths in the USA, some claim that 40% are due to patterns of behavior, 30% are due to genetic predispositions, 15% are due to social circumstances, and 10-15% are due to shortfalls in medical care (McGinnis et al., 2002). It is a matter of record that the USA spends trillions of dollars on health, 95% of which is on treatment, not prevention. Much contemporary research in health economics studies the costs and benefits of alternative treatment and delivery systems. In contrast, research has only started to consider how early-life prevention and later-life remediation can extend the quality and length of life and avoid costly treatment. 1 Two distinct bodies of research suggest that the early years of childhood shape many adult behaviors and outcomes. The 'fetal programming' literature surveyed in Gluckman and Hanson (2006) demonstrates that in utero environments affect adult health. The essays in Gluckman and Hanson discuss the importance of a variety of early environments on adult health. Fogel (1997Fogel ( , 2004) ) shows that early nutrition affects adult health. Barker (1998) demonstrates that environmental insults in utero and in infancy predict the onset of adult coronary disease, stroke, diabetes, and hypertension. Fetal and maternal nutrition are important predictors of adult health. Currie (2009, 2011) and Almond and Currie (2011) survey empirical relationships between early-life conditions and adult health reported in the recent literature in economics.
Although epidemiologists typically adopt a life cycle, developmental, perspective (see, e.g., Davey-Smith, 2007), most health economists do not. For example, the influential analysis of Grossman (1972Grossman ( , 2000) ) focuses exclusively on adult health investment decisions, taking childhood health endowments and adult preferences as given. Galama and van Kippersluis (2010) and Galama (2011) substantially extend the Grossman framework. However, they do not model how preferences or childhood endowments are determined.
Parallel to the epidemiological literature, an emerging developmental literature in economics demonstrates the importance of early environmental conditions on the evolution of adolescent and adult cognitive and noncognitive capabilities (see, e.g., Knudsen et al., 2006;Cunha and Heckman, 2007). These capabilities strongly influence educational attainment, criminal behavior, earnings, and participation in risky behaviors (see Almlund et al., 2011). Similar to the fetal programming literature, this literature documents critical and sensitive periods in the development of capabilities. Unlike the fetal programming literature, it also considers environmental influences on development over the entire life cycle from childhood through adulthood.
Remediation of early disadvantage and resilience in response to adversity receive much more attention in this literature than in the current literature in health economics. For policy purposes, it is not enough to know that early-life conditions matter. It is important to know the costs and benefits of remediating early-life deficits.
Each literature has much to learn from the other. Evidence on the importance of early environments on a spectrum of health, labor market, and behavioral outcomes, suggests that common developmental processes are at work.