Life Course Approach
by Natasha Viveiros (Fall 2016) & Sean Wiedemeier (Spring 2015)
The life course approach focuses on the effects of context and circumstance on human development and health across the lifespan. It examines how health is influenced by a subscribed time period, society, and social group (3).
It can be broken down into five distinct components:
Socio-historical and geographical location: A life’s course is part of, and is altered by, the circumstances and events in a given time and location. Whether consciously or not, political environment (war, peace, conflict), economic cycles, and social factors (culture, religion, hierarchies) all influence an individual’s path in life (4). For example, during civil unrest and economic instability, a Syrian refugee named Amira engages in transactional sex to cross international borders. This exposure can cascade into negative psychological and health effects, and can later perpetuate physical and sexual abuse (5).
Timing of lives: A life is demarcated by transitions and trajectories. Transition are changes in roles, such as when a woman becomes pregnant and assumes the role of a mother. Trajectories follow a sequence. For example, before completing a masters in Global Health, one must successfully complete their baccalaureate degree. Major life events often occur at culturally prescribed times given defined normative behavior. There is a degree of variability or heterogeneity; as not all individuals within a cohort will follow the same sequence of events.
Time is compartmentalized into three strata:
*Individual time: chronological age, and how it affects an individual’s societal rights;
*Generational time: the individual’s generation or cohort (e.g. Millennials); and
*Historical time: the relevant political, economic, societal period (eg. war).
"Linked lives" and social ties to others: The actions and personalities of others affect the individual, often in conjunction with macro events. This interdependence will guide an individual’s ability to cope, determine their level of vulnerability and resilience, as well as their overall well-being (3). For instance in some cultures it is commonplace for multiple generations to live in one home. This can be due to stronger familiar ties which discourage personal independence, and/or financial hardships which allow sharing resources more economically feasible (1). The atmosphere within this shared space can be influenced by stressful historical events, and either promote positive adaptive behaviors or trigger patterns of stress (3).
Human agency: Individuals have a certain extent of personal control over their lives through decision making. Human agency is the use of personal power to determine trajectory, which governs self-efficacy and personal competence (1). Factors such as governing laws, cultural norms, age, and social pressures can limit human agency. For example, Amira is fifteen years old, and her mother decides to marry her to an older man. She does not possess a high level of personal control over her life due to the pressing economic hardships and cultural forces which deem acceptable.
How the past shapes the future: An individual’s future is affected not only by personal actions, but also by the life course decisions, opportunities, and conditions of their forebears (1). This is similar to “linked lives,” but instead of examining social ties it looks to past exposure to determine succeeding events. It can be useful for understanding social inequalities, and implementing effective social policies which break harmful patterns (4). For example Amira becomes pregnancy at a young age, which can have negative affects on fetal development. This development will afford her child with limited educational and economic opportunities, and might perpetuate the level of poverty within the family.
The four following risks and periods are considered when examining the implications of this approach:
Critical period: an experience during a crucial period of development that has long-lasting biological effects (4); e.g. Amira take drugs while pregnant leading to poor language development for her child
Critical period with later effect modifiers: later factors play a role in modifying the impact of the affects of the critical period; for instance, an individual infected with viral Hepatitis may consume alcohol, increasing his risk of liver disease.
Accumulation of risk with independent and uncorrelated results: a confluence of several unrelated risk factors accumulating to create biological change in an individual over time. For example, Amira’s child is exposed to both lead paint and high levels of stress, both of which may increase risk of cognitive deficits.
Accumulation of risk with correlated results: a combination of related risk factors that may work in conjunction with their own originating factors. For instance, chronic childhood asthma may lead to absence from school, leading to missed school-provided vaccinations, leading to respiratory infection and asthma complications.
The life course approach is commonly attributed to sociologist Glen Elder Jr., who studied the historical impact of the Great Depression on the lives of children. The longitudinal studies focused on how family dynamics adapt to changing social conditions (1).
Limitations and Applications
The Life Course approach is sometimes limited in application at the population level because of the mixing of cultures within geographic borders. The model’s time-base component also creates an obstacle for specific clinical interventions to show measurable impact (e.g. historical events which can not be altered).
The Life Course approach provides a conceptual framework to identify “chains of risk” (4) that can be broken using public health tools. This perspective has a unique emphasis on historical implication and social change on behavior. While integrating social determinants of health, this perspective can be utilized to interrupt the adverse effects of identified risk factors (3). Public health professionals are now finding evidence for the malleability of risk factors, and offering initiatives at appropriate times to upset this chain of risks. For example, Amira had a high risk for child marriage due to her family’s economic hardships. A public health programs which offers students money for school attendance might have been useful in delaying her marriage (5).
Useful Resources for Future Learning:
World Health Organization video
Pan American Health Organization
(1) Alwin, D. F. (2012, March 01). Integrating Varieties of Life Course Concepts. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 67B(2), 206-220. doi:10.1093/geronb/gbr146
(2) Halfon, Neal, and Miles Hochstein. "Life Course Health Development: An Integrated Framework for Developing Health, Policy, and Research." Milbank Quarterly 80.3 (2002): 433-79. Web. 16 Dec. 2016.
(3) Hutchison ED. Dimensions of human behavior: The changing life course. 4th ed. Los Angeles: Sage Publications; 2010. Chapter 1, A life course perspective; p. 11.
(4) Life course theory – Key principles and concepts [Internet] nd [cited 16 March 2015]. Available from: http://family.jrank.org/pages/1072/Life-Course-Theory-Key-Principles-Concepts.html
(5) "A Girl No More: The Changing Norms of Child Marriage in Conflict." Women's Refugee Commission (WRC) (2016): n. pag. Web. 20 Dec. 2016. <file:///Users/natashaviveiros/Downloads/Changing-Norms-of-Child-Marriage-in-Conflict.pdf>.