BOX 3-2

The Life Course Approach to Health

A life course approach refers to how health status at any given age or for any given birth cohort reflects both contemporary conditions and prior living circumstances, from in utero through childhood, adolescence, and adulthood. This perspective views health as the product of these life experiences—both the risks and the protective experiences and environments—and acknowledges that life experiences have a cumulative impact. This approach also recognizes that individuals have developmental trajectories that are both biological and social over time and that they are shaped by the social, economic, political, technological, and ecological contexts of societies. A life course health development framework can be used to understand and address the complex web of interacting risk factors that place individuals and populations at higher risk for health disparities, including childhood obesity. This framework shows the close interaction of risk factors that may initially appear to be unrelated but that resonate across the web of health influences at multiple levels, from the societal level to the community and individual levels. Changes in any of these risks will have long-term effects and implications for the individual into adulthood. The development of health trajectories is characterized by the following features:

  • The multiple determinants of health operate in genetic, biological, behavioral, social, and economic contexts that change throughout the life course.

  • Health development is an adaptive process involving multiple interactions between these contexts and biobehavioral regulatory systems (e.g., the neuroendocrine system).

  • Health trajectories are the cumulative result of risk and protective factors and other influences that can influence biobehavioral regulatory systems during critical periods of development.

  • The timing and sequence of biological, psychological, cultural, and social experiences influence the health and development of children, youth, and populations.

SOURCES: Halfon and Hochstein (2002); Krieger (2001); Yu (2006).


Because the communities and populations that are at higher risk for childhood obesity are often those with larger numbers of ethnically diverse and lower-SES groups, it is important to take into account the collective contexts of these communities as interventions are developed or adapted. As important as the issue of obesity prevention may be, many of these communities are facing problems that have immediate consequences (e.g., unemployment, poor schools, and violence) leaving fewer resources available for obesity prevention. The barriers to the implementation of obesity

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