The aim of this glossary is to encourage a dialogue that will advance the life course perspective.

https://jech.bmj.com/content/jech/57/10/778.full.pdf

Life course epidemiology

The life course paradigm has replaced child-based, growth-oriented (“ontogenetic”) accounts of the person with models that emphasize the timing, social context, and organization of lives from birth to death. The chapter begins with a story of this intellectual change from the thematic precursors of life course studies to the present. The next section identifies heuristic concepts that capture the dynamic properties of settings and contextualize the individual, including social pathways, the cumulation of experiences, trajectories and transitions, and turning points. The life course paradigm also offers core principles that link social change and developmental trajectories, including those of life-span development, human agency, timing, linked lives, and historical time and place. In combination, these principles represent key contributions to the study of human development. They establish development as a life-long phenomenon that includes aging into late adulthood; to highlight the agentic nature of people as they create and shape their settings within limits; view development as the confluence of age, the generations, and history; and situate each person's trajectory in terms of family, neighborhood, community, and society. Life course insights have been especially revealing in research on health, and offer great promise in the study of biology, experience, and adjustment.


Keywords:

social pathways;
birth cohorts;
contexts of human development;
developmental and social trajectories;
historical change;
transitions

The Life Course and Human Development.

A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular way that time and timing in relation to physical growth, reproduction, infection, social mobility, and behavioral transitions, etc., influence various adult chronic diseases in different ways, and more ambitiously, by how these temporal processes are interconnected and manifested in population-level disease trends. In this review, we discuss some historical background to life course epidemiology and theoretical models of life course processes, and we review some of the empirical evidence linking life course processes to coronary heart disease, hemorrhagic stroke, type II diabetes, breast cancer, and chronic obstructive pulmonary disease. We also underscore that a life course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes.

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A life course approach to chronic disease epidemiology

Background: In the United States, Black infants have significantly worse birth outcomes than do White infants. The cause of these persisting racial disparities remains unexplained. Most extant studies focus on differential exposures to protective and risk factors during pregnancy, such as current socioeconomic status, maternal risky behaviors, prenatal care, psychosocial stress, or perinatal infections. These risk factors during pregnancy, however, do not adequately account for the disparities. Methods: We conducted a literature review for longitudinal models of health disparities, and presented a synthesis of two leading models, using a life-course perspective. Traditional risk factors during pregnancy are then reexamined within their life-course context. We conclude with a discussion of the limitations and implications of the life-course perspective for future research, practice, and policy development. Results: Two leading longitudinal models of health disparities were identified and discussed. The early programming model posits that exposures in early life could influence future reproductive potential. The cumulative pathways model conceptualizes decline in reproductive health resulting from cumulative wear and tear to the body's allostatic systems. We propose a synthesis of these two models, using the life-course perspective. Disparities in birth outcomes are the consequences of differential developmental trajectories set forth by early life experiences and cumulative allostatic load over the life course. Conclusions: Future research on racial disparities in birth outcomes needs to examine differential exposures to risk and protective factors not only during pregnancy, but over the life course of women. Eliminating disparities requires interventions and policy development that are more longitudinally and contextually integrated than currently prevail.

Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective

The life course health development (LCHD) framework organizes research from several fields into a conceptual approach explaining how individual and population health develops and how developmental trajectories are determined by interactions between biological and environmental factors during the lifetime. This approach thus provides a construct for interpreting how people's experiences in the early years of life influence later health conditions and functional status. By focusing on the relationship between experiences and the biology of development, the LCHD framework offers a better understanding of how diseases occur. By suggesting new strategies for health measurement, service delivery, and research, as well as for improving health outcomes, this framework also supports health care-purchasing strategies to develop health throughout life and to build human health capital.

/pdf/life-course-health-development-an-integrated-framework-for-5qdpjq7zfw.pdf

Life Course Health Development: An Integrated Framework for Developing Health, Policy, and Research

The health development organization (HDO) is a new approach to the organization and delivery of children’s health and social services. The HDO would combine the best features of vertically integrated HMOs with horizontally integrated, child-focused social services and longitudinally integrated health promotion strategies. Its mandate would be to develop the health of children in a community. The impetus for creating HDOs is a growing body of evidence in chronic disease epidemiology, developmental psychopathology, early intervention research, and life course cohort studies that point to childhood as the period of life during which adult health status is determined and the opportunities for health capital formation are highest. Thus, a new kind of health care organization or framework, like the HDO, is needed to integrate a full range of critical services for promoting children’s development.

/pdf/the-health-development-organization-an-organizational-10ehemq7h8.pdf

The Health Development Organization: An Organizational Approach to Achieving Child Health Development

We analyzed data on 3,449 children under age 3 representing 15.7 million children from the United States, using the 1997 National Health Interview Survey. Our findings show that although most children under age 3 had a usual source of care, children at risk because of low income, minority status, or lack of insurance were 3 to 12 times more likely than children in the reference group (higher income, White, and insured) to be without a usual source of care, and 2 to 30 times more likely to have unmet needs for health care. Furthermore, young children in the at-risk groups had fewer visits to health professionals. We conclude that children in the at-risk groups continue to face substantial barriers in accessing basic health services.

Miles Hochstein

Papers

Life Course Health Development: An Integrated Framework for Developing Health, Policy, and Research

The Health Development Organization: An Organizational Approach to Achieving Child Health Development

Access to Health Care for Disadvantaged Young Children

Brain Development in Early Childhood. Building Community Systems for Young Children.

Barriers to the provision of developmental assessments during pediatric health supervision