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Understanding Life Course

Origins of Life Course

  • Life course perspective: proposed by Michael Lu and Neal Halfon in 2003 as a new approach to examining racial and ethnic disparities in birth outcomes.
  • Synthesis of two longitudinal biomedical models: an early programming model and cumulative pathway model.
  • Offers a broader way of looking at health, over a life span rather than disconnected stages (infancy, adolescence, child bearing years, old age) integrating biological, behavioral, psychological, social and environmental factors which contribute to health outcomes across the course of a person’s life.

Key Life Course Concepts

  • Timeline: today’s experiences and exposures determine tomorrow’s health
  • Timing: health trajectories are particularly affected during critical or sensitive periods
  • Environment: our social, physical and biological environments strongly affect our capacity to be healthy
  • Equity: inequities are health determinants

Specific risk and protective factors can be mediated during critical periods.

Evidence and Theories

  • Critical periods: perinatal and peripubertal periods are sensitive times in human development. Disruptive events that occur during these times can have lasting effects on health.
  • Early Programming:
    • Early programming: early experiences can program an individual’s future health and development, either directly in diseases/conditions or through vulnerabilities to disease in the future.
    • Developmental/Fetal origins of disease (Barker): susceptibility to cardiovascular disease, diabetes, cancer, obesity, and high blood pressure are programmed in utero as a response to fetal undernutrition.
  • Cumulative Pathways:
    • Weathering (A. Geronimus)/Cumulative effect: stressors can accumulate over time and have a profound direct impact on health and development through allostatic loads.
    • Adverse childhood experiences (ACE study): children exposed to adverse experiences have a graded increased risk for multiple chronic health conditions.
  • Epigenetics: our physical environment (including food, toxins, etc) can activate heritable changes in gene expression.

Linking It All Together

  • Life course, social determinants, and health equity are all complementary, synergistic, and integral to health
  • Life course helps explain and illustrate how social determinants influence health
  • Life course helps explain and illustrate how health inequities develop
  • Life course incorporates human development into our understanding of health

Translation to Practice

  • There are multiple critical windows of time for intervening for health
  • We can act on health through interventions, policy and systems in expanded settings
  • Policies can have differential effects on families, which is why life course supports comprehensive approaches to health that include the family as the focus of intervention