Epigenetics and primary care

Epigenetics is the study of how changes to chromosome structure record and/ or transmit changes in the expression of genes. Epigenetic mechanisms act during development to control mechanisms such as cell proliferation and differentiation, tissue formation, organogenesis, and the emergence of physiological function. They also act throughout life to regulate gene expression over the long term. Epigenetic mechanisms respond to a wide range of biological signals, including stimuli from the external and social environments. So, why should this matter to general practice? We know that poverty and socioeconomic deprivation are directly linked to premature mortality and morbidity.1 We also know that, despite universal access to free health care, inequitable healthcare outcomes persist in socioeconomically deprived populations.2 Although some of the disease-causing effects of poverty and deprivation are biologically direct, such as inadequate diet or exposure to alcohol, tobacco, and other toxins, there may also be later-emerging effects, in which epigenetic mechanisms play a part