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Lifecycle thinking for health

Watch Professor Joy Lawn describe the importance of health through the lifecycle and the major themes that apply throughout it.
JOY LAWN: The lifecycle is really central to all our learning throughout this course. And here we are the London School of Hygiene & Tropical Medicine. You might think we only care about the lifecycles of worms and parasites. But in this particular case this is the lifecycle of the human. And it’s based, also, in science, just like our study of parasites and worms. And over the last 100 years or so we now have a wealth of cohort data, particularly from high income countries.
So for example, in the UK, studies in the early 20th century looking at the birth weight of humans and following them through has shown that your birth weight is a huge and important predictor of your health in old age of the onset of hypertension and diabetes. And one of the terms that has been applied to this is life course epidemiology, coined by Professor Di Kuh. And you can get more information on this from the MARCH YouTube channel what we have a great video with her talking about the 1946 birth cohort in the US. They’re now over 60.
And remarkably 84% follow up in those cohort studies, which is showing us more and more about this life course implications of your health in utero. So Barker is another name that’s strongly associated with this life course epidemiology. The point of foetal programming, so in utero exposures really determining long-term health. However, this wealth of data from high income countries we can see in a compressed form from middle income countries. So people like Professor Cesar Victora from Brazil, the tip of Brazil in Pelotas where he now has 30 years of cohort studies.
And you can also get more details on this for the MARCH YouTube channel where we have a fantastic video explaining that 30 years of history looking at the incredible epidemiological and demographic transition in this setting, which shows us a massive shift from infectious diseases through to non-communicable from under-nutrition through to obesity. And in this science what we learn is that there are important and critical issues that we still have more to learn about. So in the course when we look back at the week on child health Andrew Prentice also talked about the inter-generational effect, how even the epigenetic conception status of your grandparents may have an effect on your health now.
So in this we know that the life course and that human life course is an important predictor based in science of how your health will be long-term. So why does the life cycle matter particularly for women’s and children’s health, the topic of this course? Well, in many ways the face of the lifecycle is the face of a girl growing into a woman. And through this course we have seen adolescents and the face of that, particularly the girl and her choices and being empowered to have her choices when she becomes pregnant or not, growing into a woman, and the desire there to have a healthy birth and outcome both for the woman and for the baby.
And then the face the lifecycle changes into two faces, or maybe more than two if the woman has triplets or twins. And in those the baby also then has health needs and rights going forward through the lifecycle. So this course has been organised by MARCH, Maternal, Adolescent, Reproductive, and Child Health Centre. And we are organised around three points in the lifecycle A for adolescents, B for births, and C for children. But what we see in the data and evidence throughout these modules is that not every point in the lifecycle is of equal risk for survival, for disability, and for opportunity. The most critical moments for risk are the moments of birth and also your transition as an adolescent.
And the negative perspective is that those are the greatest moments of risk. But they’re also the greatest moments of opportunity. And so taking out of this course we believe going forward that a greater focus on the time of birth and the time of healthy transition for adolescents is critical. And this is an area that we particularly focus on here in MARCH. This course has been about the lifecycle. And while we’ve focused on the adolescents, the birth, the children, the different aspects throughout that lifecycle there are themes that go throughout the lifecycle. And those themes include science, for example, looking at the epidemiology or the basic science the delivery science.
But they also include particular aspects we’d like to pull out and discuss in more detail in the next steps. So firstly, as we go through the lifecycle there has been a transition between survival, moving to the need to survive and thrive, so beyond survival. And this isn’t the same throughout each point of the lifecycle. There are moments of particular risk and moments maybe where less progress has been made on survival. So that’s one theme that we would like to pick out. Another critical theme is access to health care. So throughout the lifecycle there are important lifesaving interventions both preventative and curative.
And actual access to those, and particularly the dimension of quality of care which is becoming more and more fundamental as we increase coverage the gap with quality is really important. And the third important and cross-cutting theme that we would like to highlight is the interaction between health and society. Your wider environment that interacts with health and with the health, particularly of women and of children, have social norms and expectations and empowerment, particularly of girls, can have a big influence on health. And throughout all of these we have a great need for more data for more evidence, but also to act on the data and the evidence that we have.
So we will in the next few steps look at these cross-cutting themes in more detail.

Where does the lifecycle concept come from? Epidemiology and epigenetic science has helped us to understand the importance of health through the life course, but the lifecycle is not just a concept for epidemiology and science. It is a reality for each of us as humans and especially women, who in many ways are the face of the lifecycle. In the video, Professor Joy Lawn discusses the importance of lifecycle thinking.

Themes that apply throughout the lifecycle

Many themes run throughout the lifecycle but three we would like to highlight are:

  1. Surviving and thriving throughout the lifecycle, the moments of greatest risk, and the general transition in burden of disease from deaths to disability, from acute infections to chronic, non-communicable conditions. However, there are places in the lifecycle, notably at birth, where this transition is yet to be fully realised
  2. Access to health care throughout the lifecycle and common themes of inequitable access, and of gaps in quality of care. With the poorest getting the least care and the lowest quality of care
  3. The crucial interplay of society and environment on the health of women and children through the lifecycle, particularly the empowerment of girls and women.

At every point in the lifecycle there is need for improved data, and innovative research that leads to action. These themes will be the focus of the steps that follow.

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Improving the Health of Women, Children and Adolescents: from Evidence to Action

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