Traditional approaches to health and disease prevention have a distinctly non-historical here-and-now emphasis. Usually adults, and increasingly adolescents and youth are urged to adopt “healthy lifestyles” as a means of preventing the development of chronic diseases such as heart disease and diabetes, among others.[102][103] In contrast to these approaches, life-course approaches emphasize the accumulated effects of experience across the life span in understanding the maintenance of health and the onset of disease. It has been argued:
“The prevailing aetiological model for adult disease which emphasizes adult risk factors, particularly aspects of adult life style, has been challenged in recent years by research that has shown that poor growth and development and adverse early environmental conditions are associated with an increased risk of adult chronic disease"[citation needed]
More specifically, it is apparent that the economic and social conditions—the social determinants of health—under which individuals live their lives have a cumulative effect upon the probability of developing any number of diseases. This has been repeatedly demonstrated in longitudinal studies—the U.S. National Longitudinal Survey, the West of Scotland Collaborative Study, Norwegian and Finnish linked data—which follow individuals across their lives.[104] This has been most clearly demonstrated in the case of heart disease and stroke.[105] And most recently, studies into the childhood and adulthood antecedents of adult-onset diabetes show how adverse economic and social conditions across the life span predispose individuals to this disorder.[106][107][108]
A recent volume brings together some of the important work concerning the importance of a life-course perspective for understanding the importance of social determinants.[109] Adopting a life-course perspective directs attention to how social determinants of health operate at every level of development—early childhood, childhood, adolescence, and adulthood—to both immediately influence health as well as provide the basis for health or illness during later stages of the life course.
Hertzman outlines three health effects that have relevance for a life-course perspective.[110] Latent effects are biological or developmental early life experiences that influence health later in life. Low birth weight, for instance, is a reliable predictor of incidence of cardiovascular disease and adult-onset diabetes in later life. Experience of nutritional deprivation during childhood has lasting health effects.
Pathway effects are experiences that set individuals onto trajectories that influence health, well-being, and competence over the life course. As one example, children who enter school with delayed vocabulary are set upon a path that leads to lower educational expectations, poor employment prospects, and greater likelihood of illness and disease across the lifespan. Deprivation associated with poor-quality neighbourhoods, schools, and housing sets children off on paths that are not conducive to health and well-being.
Cumulative effects are the accumulation of advantage or disadvantage over time that manifests itself in poor health. These involve the combination of latent and pathways effects. Adopting a life-course perspective directs attention to how social determinants of health operate at every level of development—early childhood, childhood, adolescence, and adulthood—to both immediately influence health and provide the basis for health or illness later in life.
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