Better health during childhood has increased life expectancy and diminished disability among U.S. elders. At the same time, the burden of chronic and mental disorders among older Americans has increased dramatically, note Christopher B. Forrest, M.D., Ph.D., and Anne W. Riley, Ph.D., of the Johns Hopkins Bloomberg School of Public Health. In a recent article, they describe the life-course model of health. It focuses on preventing the precursors of future disorders such as childhood obesity and adolescent smoking.
The model suggests that health is produced across the life span, but that childhood is a critical period. For example, sexual abuse of children greatly increases their risk of major depressive disorder, anxiety, and substance abuse as adults. Abuse appears to alter the structures and functions of a child's brain and the body's reactivity to stress. Preventing these and other toxic environmental exposures such as tobacco smoke, as well as curtailing risky behaviors, are important for preventing adult problems. The model emphasizes the importance of early identification and treatment of childhood high blood pressure, overweight/obesity, high cholesterol, glucose intolerance, and other health conditions that place individuals at risk for health problems in later life.
Fully 15 percent of young people are overweight by the time they reach adulthood, a rate that has increased by 50 percent since 1990 and is associated with increasing blood pressure in U.S. children. Many child health policies, like addressing obesity, must be crafted at multiple levels: family, school, and community, even though child care practitioners cannot bill for their work with communities to promote healthier home and school environments. This study was supported in part by the Agency for Healthcare Research and Quality (K02 HS00003).
See "Childhood origins of adult health: A basis for life-course health policy," by Drs. Forrest and Riley, in the September 2004 Health Affairs 23(5), pp. 155-164.
Editor's Note: A second article by Dr. Forrest proposes priorities for research studies focused on child health care outcomes based on special characteristics of childhood: developmental change, dependency on adults, differences in disease epidemiology from adults, and unique demographic characteristics.
For more details, see Forrest, C.B. (2004, April). "Outcomes research on children, adolescents, and their families: Directions for future inquiry." (AHRQ grant K02 HS00003). Medical Care 42(4 Suppl), pp. III-19-III-23.