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Four decades of early childhood policy and program development indicate that evidence-based interventions can improve life outcomes, and dramatic advances in the biological and behavioral sciences now provide an opportunity to augment those impacts. The challenge of reducing the gap between what we know and what we do to promote the healthy development of young children is to view current best practices as a starting point and to leverage scientific concepts to inspire fresh thinking. This article offers an integrated, biodevelopmental framework to promote greater understanding of the antecedents and causal pathways that lead to disparities in health, learning and behavior in order to inform the development of enhanced theories …

The utility of the life course framework to address disparities in child health is based on its ability to integrate the science of child development with the requirements of effective and just public policy. I argue that the life course framework is best assessed in a historical context and through 4 essential observations. First, early genetic and environmental interactions are complex and influence outcomes in different settings in very different ways. Second, these early-life interactions are themselves subject to considerable later influences and, therefore, may not be highly predictive of later outcomes. Third, the etiologic nature or timing of early-life interactions does not, per se, determine if their life course …

A scientific consensus is emerging that the origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life. These early experiences can affect adult health in 2 ways—either by cumulative damage over time or by the biological embedding of adversities during sensitive developmental periods. In both cases, there can be a lag of many years, even decades, before early adverse experiences are expressed in the form of disease. From both basic research and policy perspectives, confronting the origins of disparities in physical and mental health early in life may produce greater effects than attempting to modify health-related behaviors or improve access to …

In this paper, we provide an overview of the science underpinning the life course model and explain why life course health policy has not been more widely adopted. We use the examples of childhood obesity (a risk factor) and the importance of the family (a resiliency factor) to show how health policy should be crafted to account for the developmental context of risk exposure, to promote the resilience of the individual and to prevent disorders and their consequences. Read full article  

Despite great strides in improving prenatal care utilization among American women, key perinatal indicators have remained stagnant or worsened in the past decade and the United States continues to rank near the bottom compared to other developed countries.  A new approach is needed if we are to achieve improvements in perinatal health. The authors propose a new framework that integrates a “life span” approach with a multiple determinants model. Read full article

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

Life course analytic frameworks expressly link the determinants of health and illness across the lifespan. Such frameworks could serve as a foundation for integrating child and adult health policies by emphasizing the potential that social and biologic processes early in life can find clinical expression as adult-onset disease. However, there are elements of these frameworks that can be misinterpreted in ways that obscure scientific processes and fragment rather than integrate health policies. First, casting early life influences as determining rather than merely influencing adult health obscures the complexity of social and biological etiologies over a lifetime and diminishes the impact of events in adolescence and adult life. Second, oversimplifying the …

This MCH Journal editorial reflects on a lengthy commentary by Drs. Michael Lu and Neal Halfon proposing a life course perspective on racial and ethnic disparities in birth outcomes. Drs. Lu and Halfon’s theoretical life course perspective has an intuitive appeal, especially given the limited effectiveness of recent short-term pregnancy related interventions. They have captured many of the current trends in reproductive health research and practice. They have encouraged us to“move future research beyond simple pregnancy risk factors to examine the sum of a woman’s life experiences,” and “to move prevailing practice and policy beyond quick fixes during pregnancy to make long-term investments in women’s life course development.” Their model, …

This article describes the Life Course Health Development (LCHD) Framework, which was created to explain how health trajectories develop over an individual’s lifetime and how this knowledge can guide new approaches to policy and research. Using recent research from the fields of public health, medicine, human development and social sciences, the LCHD framework shows that 1) health is a consequence of multiple determinants operating in nested genetic, biological, behavioral, social and economic contexts that change as a person develops; 2) health development is an adaptive process composed of multiple transactions between these contexts and the biobehavioral regulatory systems that define human functions; 3) different health trajectories are the product of …

Over the last few years there has been increasing interest in conceptualizing disease aetiology within a life course framework. This approach is not new to Public Health or unique to epidemiology. However, its current resonance and interest within epidemiology reflects the challenging theoretical framework this approach provides. This issue of the International Journal of Epidemiology has several papers with a life course theme. This accompanying editorial is intended to highlight what we believe are the key conceptual issues around life course epidemiology. We have chosen to use examples from chronic disease epidemiology, but this approach is also applicable within the context of infectious diseases and wider notions of health and …