Public health is concerned with protecting, preserving and promoting the health of current and future generations. Health emerges from the interplay between physical and social environment; the individual behaviour; genetic inheritance; economic factors. Health in adulthood is the outcome of socially patterned processes acting across the entire life course and starting earlier than ever imagined: in a bundle of cells, a generation or more before a foetus is conceived. The environments we live in irrevocably influence our life stories and that of future generations by changing the way our genetic material is expressed. Our quality of life directly affects how our genes operate, so much so that there is a view that the post code is more important to health than one’s genetic code.

Pregnancy occurs in a limited time period in a woman’s life and it is not independent of the prior life experiences that will also have a bearing on the pregnancy outcome. We have a collective responsibility for the next generations that can be best discharged through access to adequate housing, strong neighbourhoods, green space, schools, employment, and healthy food for all, or, in summary, through social justice. Dr Jonathan Sher has distilled the current evidence on the impact of preconception care and has made a number of recommendations for action.