Life course health development: an integrated framework for developing health, policy, and research

Abstract

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.

fig. 1

Principle components of the LCHD and their influence on health outcomes. (1) Multiple nested contexts make up the macro-context or environments of health development. These macrocontexts interact with each other and influence and modify (2a) the microcontext. The microcontext includes design features, strategies, and pathways of the health development process. These (2b) regulatory processes that are developmentally programmed mediate and modify the microcontext of health development. Overarching this process are multiple timeframes and specifically timed experiences whose relationships function to integrate and synchronize macro- and microcontexts and to produce variation in (3) developmental health outcomes. Source: Adapted from Worthman 1999, 91.

fig. 2

Pathways of communication and information transfer between the brain, hypothalamic-pituitary-adrenal axis, and immune system. This figure depicts how external influence triggers response patterns across systems promoting integrated patterns of response. Source: Brunner and Marmot 1999, 30.

fig. 3

Diagrams demonstrating similarities in the pattern of developmental functional trajectories across physiological systems. Sources: (a) Strachan 1997, 104; (b) Lamberts, van den Beld, and van der Lely 1997, 421; (c) Ramey and Ramey 2000, 132.

fig. 4

How risk reduction and health promotion strategies influence health development. This figure illustrates how risk reduction strategies can mitigate the influence of risk factors on the developmental trajectory, and how health promotion strategies can simultaneously support and optimize the developmental trajectory. In the absence of effective risk reduction and health promotion, the developmental trajectory will be suboptimal (dotted curve). Source: Halfon, Inkelas, and Hochstein 2000, 455.

fig. 5

Blue Shield of California advertising campaign marketing their health insurance products using a life course approach. Printed with permission.