A LIFECOURSE APPROACH TO HEALTH a life course approach to health A life course approach emphasises a temporal and social perspective, looking back across an individual's or a cohort's life experiences or across generations for clues to current patterns of health and disease, whilst recognising that both past and present experiences are shaped by the wider ocial, economic and cultural context. In epidemiology, a life course approach is being used to study he physical and social hazards during gestation, childhood, adolescence, young adulthood nd midlife that affect chronic disease risk and health outcomes in later life. It aims to identify the underlying biological, behavioural and psychosocial processes that operate across the life span(Kuh and Ben-Shlomo, 1997) A life course approach incorporates, but is broader than, 'the fetal origins hypothesis'(programming) hich links conditions in the intrauterine environment to the later development of adult chronic disease(Barker, 1998). Growing evidence suggests that there are critical periods of growth and development, not just in utero and early infancy but also during childhood and adolescence, when environmental exposures do more damage to health and long-term health potential than they would at other times. There is also evidence of sensitive developmental stages in childhood and adolescence when social and cognitive skills, habits, coping strategies, attitudes and values are more easily acquired than at later ages. These abilities and skills strongly influence life course trajectories with implications for health in later life. Additionally, a life course approach considers the long term health consequences of biological and social experiences in early and mid adulthood, and whether these factors simply add additional risk or act interactively with early life biological and social factors, to attenuate or exacerbate long term risks to health Cumulative effects on later health may occur not only across an individual's life but also across generations(Lumey 1998; Davey Smith 2000). Many animal studies have highlighted the perpetuation of both size at birth and subsequent growth across generations; this may have important nutritional implications especially in the developing world. Further research will assist assessment of how and when to optimally target interventions to cost-effectively improve health ocio-economic conditions throughout the life course shape adult health and disease risk. This because health-damaging exposures or health-enhancing opportunities are socially patterned, and because an individual's response, which may modify their impact or alter the risk of future exposures, will be powerfully affected by their social and economic experience(Kuh et al, 1997). The strength of the relationships between adult disease and socio-economic circumstances at different life stages can hus provide clues to the underlying aetiological processes(Davey Smith et al, 1998). A life course approach is being used in research on social inequalities in health, to investigate how experiences PAGEFOURA LIFECOURSE APPROACH TO HEALTH PAGEFOUR A life course approach to health A life course approach emphasises a temporal and social perspective, looking back across an individual’s or a cohort’s life experiences or across generations for clues to current patterns of health and disease, whilst recognising that both past and present experiences are shaped by the wider social, economic and cultural context. In epidemiology, a life course approach is being used to study the physical and social hazards during gestation, childhood, adolescence, young adulthood and midlife that affect chronic disease risk and health outcomes in later life. It aims to identify the underlying biological, behavioural and psychosocial processes that operate across the life span (Kuh and Ben-Shlomo, 1997). A life course approach incorporates, but is broader than, ‘the fetal origins hypothesis’ (programming) which links conditions in the intrauterine environment to the later development of adult chronic disease (Barker, 1998). Growing evidence suggests that there are critical periods of growth and development, not just in utero and early infancy but also during childhood and adolescence, when environmental exposures do more damage to health and long-term health potential than they would at other times. There is also evidence of sensitive developmental stages in childhood and adolescence when social and cognitive skills, habits, coping strategies, attitudes and values are more easily acquired than at later ages. These abilities and skills strongly influence life course trajectories with implications for health in later life. Additionally, a life course approach considers the long term health consequences of biological and social experiences in early and mid adulthood, and whether these factors simply add additional risk or act interactively with early life biological and social factors, to attenuate or exacerbate long term risks to health. Cumulative effects on later health may occur not only across an individual’s life but also across generations (Lumey 1998; Davey Smith 2000). Many animal studies have highlighted the perpetuation of both size at birth and subsequent growth across generations; this may have important nutritional implications especially in the developing world. Further research will assist assessment of how and when to optimally target interventions to cost-effectively improve health. Socio-economic conditions throughout the life course shape adult health and disease risk. This is because health-damaging exposures or health-enhancing opportunities are socially patterned, and because an individual’s response, which may modify their impact or alter the risk of future exposures, will be powerfully affected by their social and economic experience (Kuh et al, 1997). The strength of the relationships between adult disease and socio-economic circumstances at different life stages can thus provide clues to the underlying aetiological processes (Davey Smith et al, 1998 ). A life course approach is being used in research on social inequalities in health, to investigate how experiences