A LIFECOURSE APPROACH TO HEALTH Clinical domains the life course Aetiology-clues to mechanisms; links the social to the biological and vice-versa Diagnosis-modes of presentation and lay epidemiology Prognosis-functional reserve and response to disease o Treatment-limited impact for tertiary prevention as mainly primary prevention; may be important in understanding non-compliance e Encourage the early development and integration of a life course perspective into the teaching of public health. e Promote the life course approach beyond the undergraduate curriculum to advanced training and the clinical environment Recommend a life course approach be adopted in the training of all health care workers. e Encourage lessons to be drawn from existing holistic/ interdisciplinary approaches utilised in geriatric training and also encourage geriatric programmes to adopt a life course approach, focusing on healthy ageing as well as specific disease processes. Note the critical importance of staff recruitment and on-going development in implementing this approach e Develop steps and strategies for implementation that involve national bodies, school boards political influencers and general public awareness; "lead by example andsell the approach through facilit down acceptance Encourage the review of admission criteria for medical schools to consider the social context of health; allow greater opportunity for older individuals with more personal life course experience to train in medicine(also recognising increasing life-expectancy and later retirement patterns Cause of death in developing countries 11% □ Communicable 19% diseases 41% □ Non-communicable 70% □ External causes 1990 2020 Source: Murray C and Lopez A The Global Burden of Disease. 1996: OUP PAGETENA LIFECOURSE APPROACH TO HEALTH PAGETEN ● Encourage the early development and integration of a life course perspective into the teaching of public health. ● Promote the life course approach beyond the undergraduate curriculum to advanced training and the clinical environment. ● Recommend a life course approach be adopted in the training of all health care workers. ● Encourage lessons to be drawn from existing holistic/ interdisciplinary approaches utilised in geriatric training and also encourage geriatric programmes to adopt a ‘reverse’ life course approach, focusing on healthy ageing as well as specific disease processes. ● Note the critical importance of staff recruitment and on-going development in implementing this approach. ● Develop steps and strategies for implementation that involve national bodies, school boards, political influencers and general public awareness; ‘lead by example’ and ‘sell’ the approach through facilitating top-down acceptance. ● Encourage the review of admission criteria for medical schools to consider the social context of health; allow greater opportunity for older individuals with more personal life course experience to train in medicine (also recognising increasing life-expectancy and later retirement patterns). Clinical domains & the life course ● Aetiology – clues to mechanisms; links the social to the biological and vice-versa. ● Diagnosis – modes of presentation and lay epidemiology. ● Prognosis – functional reserve and response to disease ● Treatment – limited impact for tertiary prevention as mainly primary prevention; may be important in understanding non-compliance. 11% 19% 70% 2020 9% 41% 50% 1990 Communicable 8 diseases8 Non-communicable 8 diseases8 External causes Cause of death in developing countries Source: Murray C. and Lopez A. The Global Burden of Disease, 1996: OUP