Lifecourse health development: past, present and future

Abstract

During the latter half of the twentieth century, an explosion of research elucidated a growing number of causes of disease and contributors to health. Biopsychosocial models that accounted for the wide range of factors influencing health began to replace outmoded and overly simplified biomedical models of disease causation. More recently, models of lifecourse health development (LCHD) have synthesized research from biological, behavioral and social science disciplines, defined health development as a dynamic process that begins before conception and continues throughout the lifespan, and paved the way for the creation of novel strategies aimed at optimization of individual and population health trajectories. As rapid advances in epigenetics and biological systems research continue to inform and refine LCHD models, our healthcare delivery system has struggled to keep pace, and the gulf between knowledge and practice has widened. This paper attempts to chart the evolution of the LCHD framework, and illustrate its potential to transform how the MCH system addresses social, psychological, biological, and genetic influences on health, eliminates health disparities, reduces chronic illness, and contains healthcare costs. The LCHD approach can serve to highlight the foundational importance of MCH, moving it from the margins of national debate to the forefront of healthcare reform efforts. The paper concludes with suggestions for innovations that could accelerate the translation of health development principles into MCH practice.

Fig. 1

The evolution of health development: this figure diagrams the evolution of two converging and interacting streams of scientific inquiry and conceptual model building. The first stream of Biological System Ideas and Theories charts the development of major conceptual constructs in relation to new ways of understanding how biological systems function. It shows how Darwinian notions of evolution and Mendelian notions of genetics were influenced by other fields of biology but eventually resulted in the Neo-Darwinian synthesis that forms the basis of modern molecular biology. This stream has continued to evolve under the influence of new discoveries in systems biology, genomics, epigenetics, and the application of complex systems science to biological systems. The Medical and Health System Ideas and Theories charts the evolution of the simple, linear and mechanistic biomedical model, and how the biomedical model of health and disease was transformed into a more hierarchical, dynamic and multiply determined biopsychosocial model, which has subsequently evolved into a complex, relational model of LCHD. The Eras of Modern Health Care suggest the approximate timing of these conceptual changes in relationship to how health care has been organized and delivered

Fig. 2

Variable health trajectories: these two figures suggest how health trajectories can be used to illustrate the impact of various risk, promoting and protective factors on health development. In a, higher or lower health development trajectories are influenced by the relative number and magnitude of risk and protective factors. b Trajectories are not straight, linear, overly determined, or immutable but can be in a constant state of flux relative to different influences at different points in time