A LIFECOURSE APPROACH TO HEALTH example, repeated respiratory disease in childhood may result in increased sick absence from school d lower educational attainment, which in turn leads to a greater likelihood of smoking in adulthood and a manual occupation with greater respiratory hazards CHD Incidence by Birthweight and BMI: The Caerphilly Study D 1st birthweight tertile 2nd birthweight tertile 16 3rd birthweight tertile =0.5 p=0.0005 420 2 BMI TERTILE Source: Frankel et al(1996)Birth weight, Body Mass Index in middle age and incidence of coronary heart disease 348: 1478-80@ by The Lancet Ltd. 1996 Conclusion We are only starting to disentangle the influence of early life factors relative to genetic and later life factors on adult health and ageing: explanations may be cohort and disease specific; factors may be additive or interact synergistically. Caution is required in extrapolating from the past to the present and from one place to another. However, the questions being raised are fundamental. A life course approach provides an essentially optimistic approach to health and raises questions for policy. It helps identify chains of risk that can be broken and times of intervention that may be especially effective. Particularly during key life transitions, e.g. late adolescence to early adulthood, we need to provide not just safety nets but springboards( Bartley et al 1997), which can alter life course trajectories with implications for subsequent health The advantages of using a life course model to study adult health is that it is interdisciplinary and integrates social and biological explanations. It also allows synthesis of other models of health nd chronic disease such as the foetal origins and adult lifestyle models. PAGESIXA LIFECOURSE APPROACH TO HEALTH PAGESIX example, repeated respiratory disease in childhood may result in increased sick absence from school and lower educational attainment, which in turn leads to a greater likelihood of smoking in adulthood and a manual occupation with greater respiratory hazards. 18 16 14 12 10 8 6 4 2 0 123 BMI TERTILE Percent CHD Incidence by Birthweight and BMI: The Caerphilly Study 1st birthweight tertile 2nd birthweight tertile 3rd birthweight tertile p=0.5 p=0.5 p=0.0005 Source: Frankel et al (1996) Birth weight, Body Mass Index in middle age and incidence of coronary heart disease 348: 1478-80 © by The Lancet Ltd. 1996 Conclusion We are only starting to disentangle the influence of early life factors relative to genetic and later life factors on adult health and ageing: explanations may be cohort and disease specific; factors may be additive or interact synergistically. Caution is required in extrapolating from the past to the present and from one place to another. However, the questions being raised are fundamental. A life course approach provides an essentially optimistic approach to health and raises questions for policy. It helps identify chains of risk that can be broken and times of intervention that may be especially effective. Particularly during key life transitions, e.g. late adolescence to early adulthood, we need to provide not just safety nets but springboards (Bartley et al 1997), which can alter life course trajectories with implications for subsequent health. The advantages of using a life course model to study adult health is that it is interdisciplinary and integrates social and biological explanations. It also allows synthesis of other models of health and chronic disease such as the foetal origins and adult lifestyle models