A life course approach to public health: why early life matters

2018 ◽  
pp. 11-25
Author(s):  
Felicia M. Low ◽  
Peter D. Gluckman ◽  
Mark A. Hanson
Keyword(s):  
Public Health ◽  
Life Course ◽  
Early Life ◽  
Developmental Plasticity ◽  
Disease Risk ◽  
Full Range ◽  
Later Life ◽  
Policy Implications ◽  
Life Course Approach ◽  
Mechanistic Basis

This chapter describes the theoretical and mechanistic basis, and public health implications, of the Developmental Origins of Health and Disease (DOHaD) paradigm, which has emerged from overwhelming epidemiological, clinical, and experimental evidence demonstrating the importance of early life development in influencing an individual’s susceptibility to later life disease risk. DOHaD is underpinned by the evolutionarily conserved processes of developmental plasticity. These enable phenotypic adjustment to match the environment and are effected, in part, by epigenetic mechanisms that modulate patterns of gene expression. This chapter uses obesity and its co-morbidities to illustrate how a life course approach can provide an effective strategy for reducing disease risk and have major policy implications. It focuses on early life as a critical intervention point, and recognizes the importance of taking into consideration the full range of influencial biological, behavioural, and contextual factors that operate across the life course.

scholarly journals Body size throughout the life-course and incident benign prostatic hyperplasia-related outcomes and nocturia

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saira Khan ◽  
K. Y. Wolin ◽  
R. Pakpahan ◽  
R. L. Grubb ◽  
G. A. Colditz ◽  
...  
Keyword(s):  
Body Size ◽  
Benign Prostatic Hyperplasia ◽  
Life Course ◽  
Early Life ◽  
Prostate Volume ◽  
Late Life ◽  
Later Life ◽  
Normal Weight ◽  
Prostatic Hyperplasia ◽  
The Life Course

Abstract Background Existing evidence suggests that there is an association between body size and prevalent Benign Prostatic Hyperplasia (BPH)-related outcomes and nocturia. However, there is limited evidence on the association between body size throughout the life-course and incident BPH-related outcomes. Methods Our study population consisted of men without histories of prostate cancer, BPH-related outcomes, or nocturia in the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (n = 4710). Associations for body size in early- (age 20), mid- (age 50) and late-life (age ≥ 55, mean age 60.7 years) and weight change with incident BPH-related outcomes (including self-reported nocturia and physician diagnosis of BPH, digital rectal examination-estimated prostate volume ≥ 30 cc, and prostate-specific antigen [PSA] concentration > 1.4 ng/mL) were examined using Poisson regression with robust variance estimation. Results Men who were obese in late-life were 25% more likely to report nocturia (Relative Risk (RR): 1.25, 95% Confidence Interval (CI): 1.11–1.40; p-trendfor continuous BMI < 0.0001) and men who were either overweight or obese in late-life were more likely to report a prostate volume ≥ 30 cc (RRoverweight: 1.13, 95% CI 1.07–1.21; RRobese: 1.10, 95% CI 1.02–1.19; p-trendfor continuous BMI = 0.017) as compared to normal weight men. Obesity at ages 20 and 50 was similarly associated with both nocturia and prostate volume ≥ 30 cc. Considering trajectories of body size, men who were normal weight at age 20 and became overweight or obese by later-life had increased risks of nocturia (RRnormal to overweight: 1.09, 95% CI 0.98–1.22; RRnormal to obese: 1.28, 95% CI 1.10–1.47) and a prostate volume ≥ 30 cc (RRnormal to overweight: 1.12, 95% CI 1.05–1.20). Too few men were obese early in life to examine the independent effect of early-life body size. Later-life body size modified the association between physical activity and nocturia. Conclusions We found that later-life body size, independent of early-life body size, was associated with adverse BPH outcomes, suggesting that interventions to reduce body size even late in life can potentially reduce the burden of BPH-related outcomes and nocturia.

scholarly journals A Life Course Approach to Inequality: Examining Racial/Ethnic Differences in the Relationship between Early Life Socioeconomic Conditions and Health in Later Life Among Men

2015 ◽  
Vol 25 (3) ◽  
pp. 313 ◽  
Author(s):  
Taylor W. Hargrove, MA ◽  
Tyson H. Brown, PhD
Keyword(s):  
Life Course ◽  
Mexican American ◽  
White Men ◽  
Later Life ◽  
Adult Health ◽  
Socioeconomic Conditions ◽  
Growth Curve Models ◽  
Life Course Approach ◽  
Race Ethnicity ◽  
Racial Ethnic

<br clear="all" /><p> </p><p> <strong>Objective: </strong>Previous research has docu­mented a relationship between childhood socioeconomic conditions and adult health, but less is known about racial/ethnic dif­ferences in this relationship, particularly among men. This study utilizes a life course approach to investigate racial/ethnic differ­ences in the relationships among early and later life socioeconomic circumstances and health in adulthood among men.</p><p><strong>Design: </strong>Panel data from the Health and Retirement Study and growth curve models are used to examine group differences in the relationships among childhood and adult socioeconomic factors and age-tra­jectories of self-rated health among White, Black and Mexican American men aged 51-77 years (<em>N</em>=4147).</p><p><strong>Results: </strong>Multiple measures of childhood socioeconomic status (SES) predict health in adulthood for White men, while significant­ly fewer measures of childhood SES predict health for Black and Mexican American men. Moreover, the health consequences of childhood SES diminish with age for Black and Mexican American men. The child­hood SES-adult health relationship is largely explained by measures of adult SES for White men.</p><p><strong>Conclusion: </strong>The life course pathways link­ing childhood SES and adult health differ by race/ethnicity among men. Similar to argu­ments that the universality of the adult SES-health relationship should not be assumed, results from our study suggest that scholars should not assume that the significance and nature of the association between child­hood SES and health in adulthood is similar across race/ethnicity among men.<em> Ethn Dis.</em>2015;25(3):313-320.</p>

scholarly journals Early-life circumstances and the risk of function-limiting long-term conditions in later life

2020 ◽  
Vol 11 (2) ◽  
pp. 157-180
Author(s):  
Matthew H. Iveson ◽  
Chris Dibben ◽  
Ian J. Deary
Keyword(s):  
Life Course ◽  
Cognitive Ability ◽  
Early Life ◽  
Economic Status ◽  
Functional Limitation ◽  
Later Life ◽  
Socio Economic Status ◽  
Childhood Cognitive Ability ◽  
The Life Course

Older adults are particularly prone to function-limiting health issues that adversely affect their well-being. Previous work has identified factors from across the life course –childhood socio-economic status, childhood cognitive ability and education – that predict later-life functional outcomes. However, the independence of these contributions is unclear as later-in-the-life-course predictors are themselves affected by earlier ones. The present study capitalised on the recent linkage of the Scottish Mental Survey 1947 with the Scottish Longitudinal Study, using path analyses to examine the direct and indirect associations between life-course predictors and the risk of functional limitation at ages 55 (N = 2,374), 65 (N = 1,971) and 75 (N = 1,534). The odds of reporting a function-limiting long-term condition increased across later life. At age 55, reporting a functional limitation was significantly less likely in those with higher childhood socio-economic status, higher childhood cognitive ability and higher educational attainment; these associations were only partly mediated by other predictors. At age 65, adult socio-economic status emerged as a mediator of several associations, although direct associations with childhood socio-economic status and childhood cognitive ability were still observed. At age 75, only childhood socio-economic status and adult socio-economic status directly predicted the risk of a functional limitation, particularly those associated with disease or illness. A consistent pattern and direction of associations was observed with self-rated health more generally. These results demonstrate that early-life and adult circumstances are associated with functional limitations later in life, but that these associations are partly a product of complex mediation between life-course factors.

A life course approach for understanding later life sustainability

2017 ◽  
pp. 103-110
Author(s):  
Holly Syddall ◽  
Avan Aihie Sayer
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Life Course ◽  
Grip Strength ◽  
Optimal Strategies ◽  
Later Life ◽  
Present Evidence ◽  
Considerable Evidence ◽  
Life Course Approach ◽  
The Life Course

This chapter describes a life course approach for understanding later life sustainability, focusing on grip strength as a marker of physical sustainability, and explaining how a life course approach recognizes that muscle strength in later life reflects not only rate of loss in later life, but also the peak attained earlier in life. We present evidence that risk factors operating throughout the life course have an impact on physical sustainability in later life with particular consideration of the effects of body size, socioeconomic position, physical activity, diet, and smoking. We have shown that low birth weight is associated with weaker grip strength across the life course and that there is considerable evidence for developmental influences on ageing skeletal muscle. Finally, a life course approach suggests opportunities for early intervention to promote later life physical sustainability; but optimal strategies and timings for intervention are yet to be identified.

Life course approach to understanding inequalities in health in later life

2017 ◽  
pp. 69-76 ◽  
Author(s):  
Ruth Bell ◽  
Michael Marmot
Keyword(s):  
Life Course ◽  
Social Functioning ◽  
Later Life ◽  
Older Age ◽  
Cognitive Changes ◽  
Healthy Life ◽  
Inequalities In Health ◽  
Biological Ageing ◽  
Life Course Approach ◽  
The Life Course

A long and healthy life is universally valued. The starkest inequalities in later life are how many years of life remain at an older age such as 65 years, and how many years of life that remain free from disabilities that impede physical, cognitive, and social functioning to the extent that they limit the sense of valuing one’s life. In this chapter we apply the frame of social determinants of health, using the life course approach to understand inequalities in health in later life. Healthy ageing is patterned by degrees of social advantage. Biological ageing, as revealed by physical and cognitive changes, is slower in people in better socioeconomic circumstances. These inequalities in health in later life need to be understood in terms of current social, economic, environmental conditions of living, as well as previous experiences and living conditions across the life course that affect the biological processes of ageing.

scholarly journals Round table: Measuring values: enhancing how WHO monitors and reports on health and well-being

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
Life Course ◽  
Round Table ◽  
Well Being ◽  
Member States ◽  
Life Course Approach ◽  
Qualitative Evidence ◽  
Health Concepts ◽  
Health And Well Being

Abstract Many concepts that are key to public health policy-making are conceptual and often values-based. How such concepts can be implemented by Member States, and how the effectiveness of this implementation can be measured and reported, remains an critical challenge that all major monitoring frameworks are faced with, from Health 2020 (WHO’s European policy framework for health and well-being), to the Sustainable Development Goals for Agenda 2030. In 2016, WHO established a project to interrogate how four key values-based public health concepts can be better measured and reported on, to increase the accountability of Member States towards these concepts. Based on the priority areas of Health 2020, the concepts which were chosen are: resilience;empowerment;life-course approach; andwhole of society approach. Four Health Evidence Network (HEN) synthesis reports were commissioned from leading experts and have now been published, synthesizing the best available evidence and grey literature on these concepts, and proposing a variety of quantitative and qualitative approaches to measuring them. The workshop will be organized as round table workshop. It will bring together the authors of all four reports to provide an overarching thematic discussion on how to enhance the monitoring and reporting of values-based public health concepts. In addition, it will also present an opportunity to discuss the findings of the reports, in particular how qualitative evidence can be deployed to make up for the shortcomings of quantitative indicators. The role of culture in informing these values-based concepts will also be discussed. The session will be chaired by Nick Fahy, who will set the scene and provide some background to the WHO Europe project on enhancing monitoring and reporting. Jane South will then give overview of the HEN synthesis report on measuring resilience, followed Glenn Laverack, who will talk about the HEN report on measuring empowerment. Mark Hanson and Scott Greer will review their respective HEN reports on measuring the life-course approach and whole-of-society approach implementation. Each speaker will be asked to illustrate their presentation with a case study which demonstrates how qualitative evidence can enhance the monitoring and/or reporting of the various concepts. During the discussion, a number of key questions will be discussed by the panel with input from the audience. How can actionable measurement strategies be derived from existing research regarding values based concepts?How can meaningful, country-level reporting mechanisms be expanded to include quantitative and qualitative health information and indicators?What is the role of cultural contexts in mediating these (and other) values-based concepts? Key messages Many key public health concepts are inherently values-based. However, this is often not acknowledged, making it challenging to monitor and report on them. Qualitative evidence can be key to designing more effective ways to measure the implementation of values-based public health concepts. Jane South Contact: [email protected] Glenn Laverack Contact: [email protected] Mark Hanson Contact: [email protected] Scott Greer Contact: [email protected]

scholarly journals Fluctuating environments during early development can limit adult phenotypic flexibility: insights from an amphibious fish

2020 ◽  
Vol 223 (16) ◽  
pp. jeb228304 ◽  
Author(s):  
Giulia S. Rossi ◽  
Paige V. Cochrane ◽  
Patricia A. Wright
Keyword(s):  
Early Life ◽  
Developmental Plasticity ◽  
Environmental Variability ◽  
Later Life ◽  
Developmental Changes ◽  
Locomotor Performance ◽  
Phenotypic Flexibility ◽  
Adult Fish ◽  
Fluctuating Environments ◽  
Ventricle Size

ABSTRACTThe interaction between developmental plasticity and the capacity for reversible acclimation (phenotypic flexibility) is poorly understood, particularly in organisms exposed to fluctuating environments. We used an amphibious killifish (Kryptolebias marmoratus) to test the hypotheses that organisms reared in fluctuating environments (i) will make no developmental changes to suit any one environment because fixing traits to suit one environment could be maladaptive for another, and (ii) will be highly phenotypically flexible as adults because their early life experiences predict high environmental variability in the future. We reared fish under constant (water) or fluctuating (water–air) environments until adulthood and assessed a suite of traits along the oxygen cascade (e.g. neuroepithelial cell density and size, cutaneous capillarity, gill morphology, ventricle size, red muscle morphometrics, terrestrial locomotor performance). To evaluate the capacity for phenotypic flexibility, a subset of adult fish from each rearing condition was then air-exposed for 14 days before the same traits were measured. In support of the developmental plasticity hypothesis, traits involved with O2 sensing and uptake were largely unaffected by water–air fluctuations during early life, but we found marked developmental changes in traits related to O2 transport, utilization and locomotor performance. In contrast, we found no evidence supporting the phenotypic flexibility hypothesis. Adult fish from both rearing conditions exhibited the same degree of phenotypic flexibility in various O2 sensing- and uptake-related traits. In other cases, water–air fluctuations attenuated adult phenotypic flexibility despite the fact that phenotypic flexibility is hypothesized to be favoured when environments fluctuate. Overall, we conclude that exposure to environmental fluctuations during development in K. marmoratus can dramatically alter the constitutive adult phenotype, as well as diminish the scope for phenotypic flexibility in later life.

scholarly journals Can environmental conditions experienced in early life influence future generations?

2014 ◽  
Vol 281 (1785) ◽  
pp. 20140311 ◽  
Author(s):  
Tim Burton ◽  
Neil B. Metcalfe
Keyword(s):  
Early Life ◽  
Developmental Plasticity ◽  
Later Life ◽  
Biomedical Literature ◽  
Adaptive Plasticity ◽  
Natural Systems ◽  
Life Conditions ◽  
Early Life Conditions ◽  
Developmental Conditions ◽  
Early Developmental

The consequences of early developmental conditions for performance in later life are now subjected to convergent interest from many different biological sub-disciplines. However, striking data, largely from the biomedical literature, show that environmental effects experienced even before conception can be transmissible to subsequent generations. Here, we review the growing evidence from natural systems for these cross-generational effects of early life conditions, showing that they can be generated by diverse environmental stressors, affect offspring in many ways and can be transmitted directly or indirectly by both parental lines for several generations. In doing so, we emphasize why early life might be so sensitive to the transmission of environmentally induced effects across generations. We also summarize recent theoretical advancements within the field of developmental plasticity, and discuss how parents might assemble different ‘internal’ and ‘external’ cues, even from the earliest stages of life, to instruct their investment decisions in offspring. In doing so, we provide a preliminary framework within the context of adaptive plasticity for understanding inter-generational phenomena that arise from early life conditions.

What role for the ‘long arm of childhood’ in social gradients in health? An international comparison of high-income contexts

2020 ◽  
Author(s):  
Steven A. Haas ◽  
Zhangjun Zhou ◽  
Katsuya Oi
Keyword(s):  
Life Course ◽  
Early Life ◽  
Economic Status ◽  
Functional Limitation ◽  
Later Life ◽  
High Income ◽  
Childhood Health ◽  
Relative Contribution ◽  
Early Life Factors

Social gradients in health have been a focus of research for decades. Two important lines of social gradient research have examined (1) international variation in their magnitude and (2) their life course / developmental antecedents. The present study brings these two strands together to explore the developmental origins of educational gradients in health. We leverage data spanning 14 high-income contexts from the Health and Retirement Study and its sisters in Europe. We find that early-life health and socio-economic status consistently attenuate educational gradients in multimorbidity and functional limitation. However, the relative contribution of early-life factors to gradients varies substantially across contexts. The results suggest that research on social gradients, and population health broadly, would benefit from the unique insights available from a conceptual and empirical approach that integrates comparative and life course perspectives.<br /><br />Key messages<br /><ul><li>The magnitude of educational gradients in later life health depend, in part, on childhood health and socioeconomic circumstances.</li><br /><li>The role of early life factors in educational gradients in health varies substantially across high income contexts.</li></ul>

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