Life Course Investments at the Maternal and Child Health Bureau.

Abstract

The Life Course Health Development (LCHD) framework posits that an individual’s health is the result of dynamic and continuous interactions among biological, social, environmental, and behavioral risk and protective factors throughout their lifetime.1 The early years represent a time of particular sensitivity to various genetic and environmental contributing factors2 and David Barker’s pioneering work on the connections between birth weight and health later in life shows that there is a considerable “front-loading” of the way in which events and experiences influence life-long health. The LCHD framework also emphasizes the importance of multiple levels and conditions of the surrounding environment on maternal and child health (MCH), including health care access and quality, along with a range of other factors that, all together, broadly constitute the social determinants of health.3 Consequently, there is a need for broad and diverse approaches to adopting life course interventions in MCH research, with thoughtful consideration of the type, level, and mode of delivery of those interventions, their timing, and the plan to study their efficacy and effectiveness. The current challenge is how to advance life course research through rigorously testing hypotheses with longitudinal data when available, and through innovative approaches to shorter-term studies and analysis of cross-sectional data when it is not. By considering the health and well-being of the whole person in the context of the family and ecosystem, and identifying strategic points and ways to intervene, life course intervention research aims to have a greater collective impact on MCH, and to accelerate the translation of life course theory to practice.The Maternal and Child Health Bureau (MCHB) within the Health Resources and Services Administration of the US Department of Health and Human Services supports health care and public health services for an estimated 60 million people nationwide. Its mission is to give children and families a fair shot at reaching their full potential by creating opportunities that foster optimal health and allow them to live long, healthy lives regardless of their income, education, or racial or ethnic background. Prevention and early intervention are critical to this mission. MCHB has made a long-term investment into the LCHD approach and its application to practice through the administration of programs, support of research, and investment in training of the next generation of researchers from a life course perspective.4 MCHB has a deliberate focus on, and support for, advancing equity within MCH life course research and supports the study of social determinants of health and health equity, which reflect part of the life course framework on the interactions among biological, social, environmental, and behavioral risk and protective factors.MCHB first supported the Life Course Research Network beginning in 2010, which allowed groups across the nation to continue to develop the LCHD Model5 and its application to research, policy, and practice. This led to the publication of several articles,6 the creation of an initial MCH life course research agenda, and the Handbook of LCHD7 which has informed teaching, research development, and healthcare practice both in the United States and abroad. There has been sustained interest in research to better understand life course influences on health and to identify the best ways to translate this knowledge into practice to benefit the health of mothers and children.MCHB has expanded the scope of the investment on life course research to provide funding for the Life Course Intervention Research Network (LCI-RN) beginning in 2018 for a 5-year project period. This support allows the LCI-RN to build an infrastructure for researchers, practitioners, policymakers, and stakeholders to promote the development, translation, implementation, and dissemination of the Life Course Intervention Research Agenda; the latter will serve as a roadmap by identifying short-term and long-term research priorities. The LCI-RN also serves as a mechanism for interacting, sharing information, and engaging in collaborative and innovative projects and multisite life course intervention research studies that advance LCHD research and inform evidence-based practice and policymaking.The LCI-RN consists of a national coordinating center; two research cores that focus on cross cutting themes in life course research: family and community engagement and race, place, class and gender; and 9 research nodes, each of which focuses on a priority topic for children’s health development: adversity, adaptation and resilience; attention deficit hyperactivity disorder; early childhood mental health; family health development; family measurement; schools; juvenile justice; prematurity; and youth participatory engagement. These nodes encompass the ecosystem in which children live, develop, learn, and grow within the context of the broad LCHD framework. Each node creatively designs new types of interventions to improve health over the life course. Most recently, LCI-RN focused attention to the direct physical effects, as well as the acute and long-term threats to the health and well-being of children resulting from society’s response to the coronavirus disease 2019 (COVID-19) pandemic. A greater understanding of the pathways operating across the life course that might make 1 person more vulnerable than another to the effects of a pandemic, such as COVID-19, has consequently emerged as a research priority; thus, the life course framework guides part of the research agenda and practice for COVID-19.MCHB continues to support new and innovative approaches to advance life-course research; facilitate new partnerships and new interventions that apply the life course framework to inform emerging issues; test and iterate the framework in new settings; and provide the highest possible quality of services and equitable interventions for families and children, improving their health, through infancy into adulthood. The LCI-RN is one of a group of MCHB-funded research programs that focuses on the development of MCH from a life course perspective.8 For example: Autism Longitudinal Data Project supports research that improves understanding of early life origins, signs, and indicators of autism spectrum disorder and other developmental disabilities to maximize health outcomes and trajectories of child development over the life course.Autism Transitions Research Project advances the evidence base on the social determinants and risk factors associated with healthy life (physical, social, mental health, and educational or occupational) outcomes among adolescents and young adults with autism spectrum disorder who are transitioning to adulthood.Autism Intervention Research Network on Physical Health has established a research network to enhance the physical health, well-being, and quality of life for autistic individuals, with a focus on underserved and vulnerable populations, and supporting them across the lifespan.Adolescent and Young Adult Health Research Network focuses on the developmental window of ages 10 to 24 years to study the complex interaction of biopsychosocial factors that shape health trajectories of adolescents, which could influence their health in adulthood.Home Visiting Applied Research Collaborative is a research network that conducts innovative home visiting research as part of the Maternal, Infant, and Early Childhood Home Visiting program, one of the largest MCHB investments, to improve prenatal and early life experiences which lay the foundation for health and development across the lifespan.The papers in this supplement are intended to drive and enhance the field of life course intervention research and pose challenging questions that could be best addressed by using a life course framework to advance the MCH field. For example, the LCHD model recognizes the major importance of families as the creators of the intimate ecosystem in which children develop and grow, and the way in which families function and family health develops over time and opportunities to intervene to improve it. Schools are also an important ecosystem that are critical to children’s educational, cognitive, social and health development trajectories. The contribution of families and schools has not been fully appreciated in existing models. More research is needed to explore the impact of families and schools on each child’s growth and development. The promise of Life Course interventions will only be realized through interdisciplinary collaborations that create new types of partnerships which must always include families and communities. MCHB commends each thoughtful researcher and contributor for collaborating on this supplement to share innovative approaches and for serving as thought leaders in the field.