Abstract
A life-course approach to health encompasses strategies across individuals’ lives that optimize their functional ability (taking into account the interdependence of individual, social, environmental, temporal and intergenerational factors), thereby enabling well-being and the realization of rights. The approach is a perfect fit with efforts to achieve universal health coverage and meet the sustainable development goals (SDGs). Properly applied, a life-course approach can increase the effectiveness of the former and help realize the vision of the latter, especially in ensuring health and well-being for all at all ages. Its implementation requires a shared understanding by individuals and societies of how health is shaped by multiple factors throughout life and across generations. Most studies have focused on noncommunicable disease and ageing populations in high-income countries and on epidemiological, theoretical and clinical issues. The aim of this article is to show how the life-course approach to health can be extended to all age groups, health topics and countries by building on a synthesis of existing scientific evidence, experience in different countries and advances in health strategies and programmes. A conceptual framework for the approach is presented along with implications for implementation in the areas of: (i) policy and investment; (ii) health services and systems; (iii) local, multisectoral and multistakeholder action; and (iv) measurement, monitoring and research. The SDGs provide a unique context for applying a holistic, multisectoral approach to achieving transformative outcomes for people, prosperity and the environment. A life-course approach can reinforce these efforts, particularly given its emphasis on rights and equity.
Highlights
A life-course approach can help realize the vision of sustainable development goals (SDGs) 3, ensure universal health coverage (UHC) and achieve health and well-being for all at all ages
To take advantage of this unique opportunity, we commissioned two reports on the evidence supporting a life course approach to health to inform policy and practice in the SDG era
The evidence syntheses found that most studies of the life-course approach focused on noncommunicable diseases and healthy ageing in high-income countries – few considered other health topics, younger age groups or low- and middle-income countries.[13]
Summary
The right to the highest attainable standard of health for all people, is enshrined in the World Health Organization’s (WHO) constitution and in the United Nations’ (UN’s) human rights framework.[1,2] Subsequent international declarations emphasize that health is interlinked with peace, development and the environment.[1,3,4,5,6] The UN’s Sustainable Development Goal 3 (SDG 3) for 2030 is to “ensure healthy lives and promote well-being for all at all ages”.7 Adoption of the SDGs provides a unique opportunity to apply a holistic, people-centred, multisectoral approach to health and development, which is well aligned with a life-course approach to health.[8,9,10,11,12] Properly applied, a life-course approach can help realize the vision of SDG 3, ensure universal health coverage (UHC) and achieve health and well-being for all at all ages. Policy and implementation efforts across different sectors can be coordinated by applying, for example, the Health in all Policies approach[25] and multistakeholder policy dialogue.[45] These techniques can help promote accountable and participatory governance and the institutionalization of crosssectoral programmes and multistakeholder partnerships, in alignment with the SDGs. Political leadership is critical for assuring an integrative, multisectoral approach.[7,25] Many countries have made progress towards achieving UHC and improving health and sustainable development using strategies aligned with these implementation techniques: Brazil, Chile, China, Cuba, Rwanda, Thailand and subnational regions such as Kerala in India have strengthened health systems, broadened access to health services and provided progressive financing to expand UHC.[28,46] These countries and others made progress by addressing inequities in, and the social and environmental determinants of, health.[7,25,28,46]. Such studies are needed to gain an insight into the context-specific, individual, sociopolitical, cultural, economic and environmental factors that influence health and well-being throughout life, some of which may otherwise be overlooked or poorly understood.[13]
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