Public health across the life course time: time to renew the debate?

Colours and textures in paintings and sculptures often result from deliberate layering of paint and clay.  Great oaks derive strength from their growth counted by their growth rings that build up over many seasons and years. Health, ill-health and health inequalities also develop in complex ways.

This needs to be reflected in efforts to achieve a fairer distribution of health across the island of Ireland, and IPH wishes to renew debate of these issues and welcomes your contribution to this blog.

Many factors operating at different levels

WHO defines health as a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.

Health, ill-health and health inequalities are the consequence of a wide range of factors that operate at a number of different levels. Dalgren and Whitehead’s framework conceives individual health status as the result of many factors operating at a number of different levels. These factors range from societal and social influences to individual lifestyle factors to those operating at molecular and sub-molecular levels.

Dahlgren, G and Whitehead, M (1991) Rainbow model of health in Dahlgren, G (1995) European Health Policy Conference: Opportunities for the future. Vol 11 – Intersectoral Action for Health. Copenhagen: WHO Regional Office for Europe.

 
The healthy settings approach, consideration of ecological influences such as the “obesogenic environment” and social capital, debate about the individual and area influences; all reflect this widely held view. Some social epidemiologists argue an individual’s heath status can be best viewed as the body’s “embodiment” of these factors (Reference: N. Krieger).

Inter-connectedness and combined effects

Experience highlight how these factors operate in combination. Without consideration of relevant factors and how they work in combination in different contexts, our understanding of how health, ill-health and inequalities develop will be erroneous.  

The most comprehensive illustration of this can be found in the systems maps, included in Foresight’s recent obesity report, that highlight the inter-connectedness of many factors in the “obesogenic environment”:

Effects accumulate over time

The MRC’s Lifecourse Epidemiology Unit recognizes how factors operate in different ways at different life stages and their effects accumulate over the life course and can be transferred from one generation to the next:  

 
MRC Lifecourse Epidemiology Unit

A system approach delivered across the life course
 
To maximize impact, efforts to develop and maintain a fair distribution of health must reflect these complexities and incorporate a systems approach that delivered across the life course.

During difficult economic times, emphasis is shifting from wider influences and collective responsibility to greater individual responsibility, and austerity measures affect the most vulnerable. Work pressures might lead us to forget or ignore these complexities. We need greater debate on how to respond.

Prof Kevin P Balanda, PhD FFPH
Associate Director