Michael C. Lu was a young obstetrician at UCLA in 1999 when he stumbled onto a mystery that would redefine an entire field. One day, he was asked to fill in for a senior colleague’s lecture on racial and ethnic disparities in birth outcomes at a statewide conference. As the colleague turned to leave, he offered a parting advice: “Just tell them it’s all socioeconomics.”
At the time, socioeconomic inequities—framed as a counterpoint to genetic determinism—were the prevailing explanation for racial disparities in health. But as Lu dug deeper into the data, he began to notice anomalies. Socioeconomic status mattered, he found, but college-educated Black women were still more likely to lose their babies than white women who hadn’t finished high school. Nor did other popular explanations—risk behaviors, maternal stress, perinatal infection, or access to prenatal care—fully account for the persistent gap in birth outcomes.
“Perhaps we’re looking at this all wrong,” Lu thought. “We’ve been taking snapshots of women during pregnancy, when we should have been looking at their entire life stories.”
That realization became the seed of what Lu would later call the life-course perspective—the idea that birth outcomes reflect not only the nine months of pregnancy but the long arc of a woman’s life before it.
That arc begins in early life: prenatal and early childhood experiences shape future health and disease risk, including adverse pregnancy outcomes, by calibrating the body’s adaptive systems—how it responds to stress, restores resilience, and repairs damage through mechanisms like epigenetic programming. It continues through adolescence and adulthood, as repeated adversity takes a cumulative toll on the body’s regulatory systems—a process known as allostatic load.
Together, these forces help explain why snapshots taken during pregnancy cannot fully account for racial disparities in birth outcomes: What unfolds in those nine months is the product of a lifetime of experiences.
In 2003, Lu and his colleague Neal Halfon published a landmark paper that challenged decades of conventional thinking in obstetrics-gynecology and maternal and child health. Their life-course perspective soon became a defining framework for researchers, practitioners, and policymakers, inspiring new research agendas, clinical practices, and policy directions.
“For decades, prenatal care had been the cornerstone of our national strategy for preventing infant mortality,” Lu recalled. “The life-course perspective shifted that policy focus—from simply expanding access to prenatal care to improving women’s health across their life course.”
This month, Lu’s contributions were recognized with one of the highest honors in medicine: election to the National Academy of Medicine. The Academy cited his work for “fundamentally transforming our understanding of the causes and prevention of maternal and child health disparities through his life-course perspective on women’s health, and catalyzing a paradigm shift in research, practice, and policy.”
A life story that shaped a life’s work
Dean Lu with his hero, civil rights legend John Lewis, in 2019.
Lu’s pursuit of health equity and social justice is deeply personal. His mother, the eldest daughter of a poor family in Taiwan, left school after her father died and went to work in a factory at age 11. Later, as a teenager, when she tried to enroll in night school, her mother scolded her: “Don’t be selfish. What good is an education for a girl?”
“My mom’s story probably had a lot to do with what I chose to do with my life,” Lu reflected. “I’ve spent my career fighting for a world where every child—no matter where they come from, the family they’re born into, or the color of their skin—gets a fair shot at reaching their fullest potential.” He paused. “The kind of fair shot my mom never got, and that millions of children in this country and around the world still don’t get.”
Lu’s family immigrated to the United States when he was 11. He studied human biology and political science at Stanford, earned his medical and master’s degrees through the UC Berkeley-UCSF Joint Medical Program, and completed his residency in obstetrics and gynecology at UC Irvine before joining the faculty at UCLA.
At UCLA, he held joint faculty appointments in medicine and public health, published more than 100 papers and book chapters, and mentored a generation of physicians and public-health scholars. He co-directed the residency program in obstetrics and gynecology and a federal training grant in maternal and child health and received several distinguished awards for his teaching. He attended more than a thousand births and was repeatedly named among the Best Doctors in America, based on nationwide peer surveys of physicians.
In 2012, President Barack Obama appointed Lu to lead the Maternal and Child Health Bureau at the U.S. Department of Health and Human Services. There, he oversaw programs serving more than 60 million women, children, and families each year—managing a billion-dollar federal bureau and launching national initiatives to reduce maternal and infant deaths. Those efforts contributed to a 22% reduction in early elective deliveries in the South and a 57% decline in in-hospital maternal mortality nationwide. He also led the creation of a national home visiting program that now provides nearly a million home visits to the nation’s most vulnerable pregnant women and parents with young children, and an expert commission to regularly review and update women’s preventive services, such as breast and cervical cancer screening, to be covered under the Affordable Care Act without out-of-pocket cost.
Becoming a changemaker at Berkeley
Dean Michael C. Lu.
Lu credits UC Berkeley for helping him become a changemaker.
“My time at UC Berkeley taught me to question authority, to challenge the status quo,” he said. “It taught me to ask: Is there a better way to do this? Is there another way to think about health disparities? Is there a better way to improve population health?”
While a graduate student at UC Berkeley School of Public Health, Lu co-founded the Suitcase Clinic, a student-run organization that brought free health and social services to unhoused and underserved residents of the city. “The reason it was called the Suitcase Clinic,” Lu recalled, “was because, at first, we had this naïve idea that we could just carry suitcases full of medicine and treat people at People’s Park or wherever they were. But we soon learned that people were getting sick not only from a lack of medical care, but from a constellation of social problems. If we truly wanted to improve their health, we had to address those issues too.”
Under Lu’s leadership, the Suitcase Clinic grew into a multidisciplinary enterprise that drew students and faculty from optometry, psychology, law, and social welfare—along with hundreds of undergraduate care coordinators and community volunteers—offering everything from chiropractic treatment to pedicures and haircuts. Thirty-five years later, the clinic is still going strong.
“That experience taught me one of the most important changemaker skills,” Lu said. “The ability to bring people together, build trust and collaboration across differences, and work together to solve big problems that affect our communities.”
It was a skill that would serve him well years later in Washington, where he worked to bridge political divides, bringing leaders from both red and blue states to the same table to improve the health of the nation’s women, children, and families.
Now, back at the School of Public Health as dean, Lu aspires to train the next generation of changemakers in health. “We want to prepare future health leaders who bring together scientific rigor with changemaker skills and mindset to help solve the world’s greatest health challenges,” he said.
