06.09.2016 People should be able to enjoy the best possible health in every phase of their lives
Life-course approach. The life-course approach is attracting growing interest among health professionals. Comprehensive overviews such as the UN's "Agenda 2030" Strategy on Sustainable Development, the WHO European Region's "Health 2020" framework or the Swiss government's health policy strategy of the same name are geared in part to the life-course approach. Moreover, the WHO European Region hosted a ministerial conference on the topic of the life-course approach last autumn. What is behind this approach and what makes it so interesting for prevention experts?
The life-course approach is characterised by its very broad viewpoint. It employs a perspective on the health of the individual that takes both time and societal aspects into account and also includes cross-generational determinants of health. It views health as a process influenced by a wide range of factors rather than as a state. These factors include genetic material and the setting into which we are born and/or in which we live. This setting is shaped in part by our parents' socio-economic circumstances and educational background, environmental factors, working conditions, societal norms and general political and cultural conditions. In April, the Federal Office of Public Health (FOPH), the cantons and the Swiss Health Promotion Foundation presented their Strategy for the Prevention of Non-communicable Diseases (NCD Strategy). The strategy features the life-course approach – besides the setting and the target group approaches – as one of the three approaches to promoting protective factors and reducing those that represent a risk.
Investing in a lifetime's health and wellbeing
The life-course approach takes the entire life-span and divides it into different life segments that are of particular rele-vance to health. In childhood the focus is on healthy growth and development, while in adolescence the development of a healthy lifestyle is key. In adulthood the focus is on safeguarding health and avoiding illnesses in general, but also on maintaining fitness to work and protecting social participation. In advanced age the emphasis is on maintaining quality of life and independence. This includes learning to live with limitations and thereby staying able, as much and for as long as possible, to hold on to independence and cultivate a social setting despite the loss of family members and friends. It is therefore important to invest in health and wellbeing in all life segments.
A multidimensional approach
The life-course approach therefore requires us to understand which factors harm health in the different life segments, which protect it and which promote it – and this all the way from birth to advanced age. To achieve this goal, it draws on a wealth of findings from a broad spectrum of scientific disciplines and political fields. These range from all medical specialities, psychology, sociology and ecology to law and political sciences. Thus, a health policy committed to the life-course approach aims not only to examine specific needs and illnesses of individuals in narrowly defined life phases, but also to cover the entire life-span prospectively and create general health-promoting conditions that also benefit subsequent generations. Depending on the life phase, various life settings (family, school, workplace, etc.) have an important bearing on people's health, as do professionals and those close to them. These can have a beneficial influence on lifestyle and general health-promoting conditions. For infants and toddlers, for instance, midwives, parenting counsellors, pediatricians or people from the immediate personal environment are key contacts for advice on questions of nutrition and child care, while the equivalents for ado-lescents tend to be found in schools and leisure-time organisations.
A healthy start in life
One of the most important phases for people’s subsequent health course is their start in life. Many studies show that environmental factors already play a key role in the conception and development of the child in the mother's womb. For instance, the father's alcohol consumption and the mother's eating habits prior to conception or during pregnancy can have an effect on the child's genetic material. Likewise, a child that is well cared for physically, materially and emotionally in the first few months of life and can develop in a stimulating environment has a better chance of living a healthy life. Furthermore, the majority of brain cells are formed in the first three years of life – a further indication that measures to promote healthy development need to be taken as early as possible. Thus, investment in health promotion in general and in parenting and pregnancy in particular is of exceptional importance. Measures undertaken in early childhood (early promotion of development) are also among the most (cost-)effective approaches used in health policy and also in social and educational policies. However, for such measures to be able to work, they must be implemented in a health-promoting environment and be accepted by those closest to the young children. This means that health literacy needs to be strengthened in all life phases. Development in early childhood is not simply the responsibility of the mother and father; it is a task for society as a whole.
Focus on transitional phases
The life-course approach assumes that the current health of individuals, prevailing general conditions and current lifestyle have far-reaching consequences for future health. Particular attention needs to be paid to critical transitional phases in the life-course, which often predetermine developments in later life. Puberty, for instance, is one of these transitional phases. It provides an opportunity to strengthen young people's health literacy and thereby help them make decisions that have positive consequences for their health. This includes the adoption or avoidance of risk-related or addictive behaviour or the development of powers of resistance and the ability to overcome adverse conditions. Additional far-reaching transitions that are of relevance to health (founding a family, settling into a career, dealing with work-related crises, etc.) also occur when individuals become working adults. In later life, transitions such as retirement from work or the onset of physical or mental handicaps are among the critical phases in which people can be given targeted support in maintaining their health and quality of life as much and as long as possible. Longer life expectancy is steadily prolonging the post-retirement life-phase, and growing numbers of people are being given an opportunity to shape their lives during these years and decades in good health. Good retirement provision makes this easier! In addition, specific events in people's lives, such as traumatic childhood experiences, job loss, separation, life crises or the death of close relatives or friends, can have long-term consequences for their health. Life transitions – and also profound experiences – require effective coping strategies. Health promotion and prevention can offer measures that help people to overcome difficult life situations and maintain or regain a healthy lifestyle.
Consequences for health policy
Swiss health policy in the fields of prevention and health promotion focuses on two aspects: personal responsibility for health and the personal behaviour this requires, and the creation of general health-promoting conditions. The well informed are able to maintain and protect their health. But favourable general conditions are important because they help "make the healthy choice the easier choice". Rather than people having decisions taken out of their hands, they should be supported in finding a lifestyle that is conducive to health. After all, not all people are equally able to shape their lives in a health-conscious way in every life phase. Health is influenced not only by personal decisions but also by a range of determinants such as living conditions, education, working conditions and the organisation of the healthcare system and social security. These health determinants can change over a life-course, gaining or losing importance.
Activities on an international level: WHO declaration of intent signed
In autumn 2015, a Ministerial Conference organised by the WHO European Region was held on the topic of the life-course approach. A Swiss delegation participated in the event. At the professional level, the conference was an opportunity for Switzerland to keep abreast of current approaches in this field. At the end of the conference, all participating states, including Switzerland, signed a declaration of intent. Among other things, they committed to evaluate their programmes and policies focused on the life-course approach and to define vulnerability groups and to select and deliver high-impact interventions.
Markus Jann, Head, Drugs Section, email@example.com