A Life-Course Approach to Health: Synergy with Sustainable Development Goals
Introduction to the Life-Course Approach to Health
The right to health: Enshrined in the World Health Organization’s (WHO) constitution, which declares health as a fundamental human right, and further elaborated in the United Nations (UN) human rights framework, particularly the International Covenant on Economic, Social and Cultural Rights (ICESCR).
Health is deeply interconnected with peace (as conflict undermines health systems and social determinants), development (healthy populations are more productive and drive economic progress), and the environment (environmental degradation directly impacts health outcomes through pollution, climate change, etc.) (References 1, 2).
UN Sustainable Development Goal 3 (SDG 3), titled "Good Health and Well-being," aims to ensure healthy lives and promote well-being for all ages by 2030, encompassing a wide range of health targets from maternal mortality and infectious diseases to non-communicable diseases and mental health (Reference 7).
The global adoption of the SDGs presents a unique opportunity for a holistic, people-centered, multisectoral approach that strongly aligns with a life-course approach to health. This approach systematically considers how health determinants, risks, and interventions interact dynamically throughout an individual's entire life.
A life-course approach, by focusing on opportunities and challenges at each stage, optimizes health across various life stages, ensuring universal health coverage (UHC) and promoting health and well-being for all by addressing cumulative impacts and building resilience over time.
Barriers to Implementing a Life-Course Approach
Despite the potential benefits, several significant barriers hinder the widespread and effective implementation of a life-course approach:
Current focus on single diseases or specific age groups rather than a holistic approach to health often leads to fragmented healthcare services, siloed funding, and missed opportunities for early intervention or preventative care that could profoundly impact later life stages.
Operational constraints are significant: shifts in political priorities, often driven by short electoral cycles, tend to result in short-term policy and funding commitments, undermining the long-term, sustained strategies required for a life-course perspective. There is also frequently poor coordination and collaboration across sectors (e.g., health, early childhood education, social welfare, environment) that collectively address health determinants.
Limited measurement of health outcomes across individuals' lives and generations makes it difficult to track long-term impacts of interventions, evaluate cumulative benefits, and demonstrate the cost-effectiveness and societal value of a life-course perspective.
Predominance of studies on noncommunicable diseases (NCDs) and healthy aging in high-income countries means there is significantly less research, evidence-based policy focus, and data on younger populations and low- to middle-income countries, creating crucial knowledge gaps where interventions are often most critically needed.
An emphasis on theoretical and clinical themes often results in academic and research outputs with limited direct and actionable policy implications, making it challenging to translate scientific insights into robust public health strategies.
Conceptual Framework for a Life-Course Approach
A life-course approach to health offers a robust conceptual framework that systematically examines the complex interplay of individual biological, psychological, and social factors, alongside diverse environmental determinants, that collectively enable and hinder well-being across the lifespan.
The main outcome emphasized in this framework is functional ability, which reflects an individual's capacity to perform valued actions, such as learning, working, socializing, forming relationships, or caring for themselves independently. This ability is dynamically influenced by two core components:
Functional ability: Defined as the dynamic sum of individual resources (e.g., skills, knowledge, health status) and external environmental attributes (e.g., accessible infrastructure, supportive social policies, assistive technologies) that collectively enable one to be or do what they value, fostering independence and participation in society (Reference 10).
Intrinsic capacity: Encompasses all of an individual’s physical and mental abilities, including but not limited to mobility, cognition, sensory functions (vision, hearing), psychological resources, vitality, and the presence or absence of health conditions (Reference 10). The continuous interaction between intrinsic capacity and the external environment dictates an individual's functional ability.
Well-being dynamics, distinct from merely the absence of disease, are comprehensively defined across three key dimensions:
Perceived life satisfaction: A subjective, cognitive evaluation of one's life as a whole.
Emotional experiences: The frequency and intensity of positive and negative emotions experienced daily.
Self-realization and meaningfulness: The pursuit of personal growth, purpose, and contribution to society, often through achieving one's potential (Reference 22).
Life stages are recognized as distinct yet interconnected periods, with critical events (e.g., birth circumstances, early education, major illnesses, employment status, family formation, migration, bereavement) influencing health trajectories. Resilience, defined as the ability to adapt and recover from adversity, consistently forms and evolves throughout life, often shaped by early experiences, cumulative protective factors, and supportive social environments.
Life Stages and Health Implications
Four main, interconnected life stages are identified for targeted health programming and policy interventions, each presenting unique risks and opportunities for health promotion and disease prevention:
Birth, neonatal period, and infancy: This is a critical window for foundational biological and neurological development, heavily influenced by maternal health, nutrition, and early childhood care. Interventions here have profound lifelong impacts.
Early and later childhood and adolescence: Periods of rapid physical, cognitive, and social development, where health behaviors, educational attainment, and exposure to social determinants of health begin to solidify, significantly impacting future health and well-being.
Youth and adulthood (employment and reproductive years): Characterized by peak productive capacity, family formation, and often increased exposure to occupational and lifestyle risks, alongside critical considerations for sexual and reproductive health.
Older adulthood: A stage often associated with the onset of multimorbidity and declining intrinsic capacity, but also recognized for opportunities for active aging, continued social contribution, and maintaining functional independence and quality of life.
Risks for chronic diseases are strongly linked to behaviors and exposures established and accumulated early in life. For example, unhealthy dietary patterns, physical inactivity, tobacco use, and excessive alcohol consumption formed in adolescence or early adulthood can significantly increase the likelihood of developing heart disease, type 2 diabetes, certain cancers, and other noncommunicable diseases in later adulthood.
For example, a staggering 70% of preventable adult deaths from noncommunicable diseases are associated with risk exposures during adolescence; similarly, approximately 50% of all mental health issues manifest by age 14, underscoring the critical need for early intervention, mental health promotion, and supportive environments in these formative years to prevent lifelong consequences (References 26, 27).
Social and Environmental Determinants of Health
Health and well-being are profoundly shaped by a wide array of social and environmental determinants, extending far beyond the traditional healthcare setting. These factors include:
Health systems: Encompassing not just hospitals and clinics, but also robust primary healthcare infrastructure, comprehensive public health programs, equitable access to essential medicines and technologies, and a well-trained, distributed health workforce capable of delivering continuous, people-centered care.
Multisectoral actions: Involving coordinated efforts beyond the health sector, such as poverty reduction initiatives, equitable access to quality education, provision of clean water and sanitation, promotion of safe and healthy food systems, urban planning for accessible housing and safe public spaces, and policies that address social inequities.
A comprehensive understanding of the interdependence between individual good and social good is essential for designing and implementing effective health policies. Recognizing that an individual's health is intrinsically linked to the health of their community and the broader societal and environmental context enables more holistic, equitable, and impactful interventions.
Implementation of the Life-Course Approach
Effective implementation of the life-course approach requires coordinated, sustained efforts across several key areas:
Policy and investment: This requires the development of long-term, sustainable strategies that transcend short-term political cycles, designed to promote health equity and address systemic determinants of health across the entire lifespan. Investments in early health interventions, such such as comprehensive maternal and child nutrition programs, early childhood development initiatives, or school-based health services, can yield exceptionally high returns (e.g., values showing substantial economic benefits over time), significantly reducing lifelong health risks, improving educational attainment, and enhancing mental health and productivity later in life (References 26, 33). These returns often represent a wise economic and social investment, not just a social expenditure.
Health services and systems: A fundamental shift towards integrating people-centered health services is crucial. This means providing continuous, coordinated, and holistic care that adapts dynamically to an individual's changing needs at different life stages, thereby contributing significantly to achieving universal health coverage (UHC) and better overall population health outcomes (Reference 39). This includes a strong emphasis on primary healthcare, seamless transitions of care, prevention, health promotion, rehabilitation, and palliative care.
Local multisectoral action: It is essential for practical, local actions to translate broader national strategies and policies into tangible and equitable health improvements within communities. This could involve, for instance, local initiatives for creating safe walking paths and cycle lanes, establishing community gardens for food security, promoting school-based health education and nutrition programs, or fostering intergenerational activities that combat social isolation, all requiring collaboration between local government, civil society organizations, community members, and businesses (Reference 44).
Measurement and research: Establishing and utilizing robust indicators for evaluating health and well-being at various stages of life, including the collection of longitudinal data, conducting cohort studies across generations, and developing health equity metrics, is paramount. This enables the precise tracking of health trajectories, identification of critical transition points, assessment of the effectiveness and cost-effectiveness of interventions, and provides the necessary evidence base for continuous improvement and the development of better, more targeted policies.
Implications for Policy and Investment
The life-course approach provides compelling implications for modern policy and investment frameworks:
Long-term health strategies are vital as they intrinsically promote equality by addressing systemic health inequities and disadvantages that accumulate over time. Prioritizing health across all life stages can lead to more resilient populations, reduced healthcare costs in the long run, and more stable societies (References 30, 32).
The Australia Longitudinal Study on Women’s Health provides robust empirical evidence, demonstrating a significant and lasting impact of financial struggles and socioeconomic disadvantage experienced at earlier life stages on adverse health outcomes, including increased risk of chronic illness, poorer mental health, and reduced quality of life, in later years. This highlights the cumulative nature of social determinants.
Economic growth is not merely a precursor to health improvements but is often directly driven by them. For instance, reductions in preventable deaths, particularly in productive age groups, have been directly attributed to contributing an estimated 11% of overall economic growth in low- and middle-income countries, clearly highlighting health as a critical development investment and an economic asset (Reference 32).