May 11 2011 Rethinking MCH Life Course Cliff Notes May 11 2011 Amy Fine Life Course Cliff Notes 1 Acknowledgements May 11 2011 Amy Fine Life Course Cliff Notes 2 Ideas and Slides Freely Adapted ID: 670976
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Amy FineMCAH Action – education dayMay 11, 2011
Rethinking MCH:Life Course “Cliff Notes”
May 11, 2011
Amy Fine: Life Course "Cliff Notes"
1Slide2
Acknowledgements May 11, 2011
Amy Fine: Life Course "Cliff Notes"
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Ideas and Slides Freely Adapted
From MCH Colleagues
Milton
Kotelchuck
Michael Lu
Neal
Halfon
Cheri Pies
Deborah Allen
Deborah Klein WalkerSlide3
What Life Course Is … and Isn’tMay 11, 2011
Amy Fine: Life Course "Cliff Notes"
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Is a theory, perspective, framework
Not a model
No single, definitive text
Reflects a convergence of ideas, informed by multiple sources Slide4
What Life Course Is … and Isn’tMay 11, 2011
Amy Fine: Life Course "Cliff Notes"
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Life Course is a theory or perspective that seeks to understand, explain, and improve
health and disease patterns across population groups.Slide5
Key QuestionsMay 11, 2011
Amy Fine: Life Course "Cliff Notes"
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MCH Life Course literature focuses on 2 key Qs:
Why do health disparities exist and persist across population groups?
What are the factors that influence the capacity of individuals or populations to reach their full potential for health and well-being?Slide6
Social Determinants & Health Equity RootsMay 11, 2011
Amy Fine: Life Course "Cliff Notes"
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How does LC interface with social determinants and health equity models/concepts?
LC literature reflects and incorporates both.
LC inquiry is rooted in both.Slide7
Key TermsPathways and Trajectories
Early Programming Risk and Protective FactorsCumulative Impact
Critical or Sensitive Periods
May 11, 2011
Amy Fine: Life Course "Cliff Notes"
7Slide8
Life Course Perspective
Lu MC,
Halfon
N. Racial and ethnic disparities in birth outcomes: a life-course perspective.
Maternal
Child Health J. 2003;7:13-30.
May 11, 2011
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Amy Fine: Life Course "Cliff Notes"Slide9
Sensitive Periods: Brain Synapse Formation
Conception
Months
Years
AGE
-6
-3
0
3
6
9
1
4
8
12
16
Sensing Pathways (vision, hearing)
Language
Higher Cognitive Function
C. Nelson, in From Neurons to
Neighborhoods
, 2000.
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Amy Fine: Life Course "Cliff Notes"Slide10
Life Course Core ConceptsMay 11, 2011
Amy Fine: Life Course "Cliff Notes"
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Today’s experiences and exposures determine tomorrow’s health .
Health trajectories are particularly affected during critical or sensitive periods .
The broader environment –biologic, physical, and social –strongly affects the capacity to be healthy.
Inequality in health reflects more than genetics and personal choice.
Fine,
Kotelchuck
,
Adess
, Pies 2009Slide11
T2E2: The Real “Cliff Notes”May 11, 2011
Amy Fine: Life Course "Cliff Notes"
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Timeline – health is cumulative and longitudinal, i.e., developed over a lifetime.
Timing
- health and health trajectories are particularly affected during critical/sensitive periods.
Environment
– the broader environment (biologic, social, physical, economic) affects health and development.
Equity
– health inequality reflects more than genetics and personal choice.
Fine and
Kotelchuck
, 2010Slide12
T2E2 - Graphic
Lu MC,
Halfon
N. Racial and ethnic disparities in birth outcomes: a life-course perspective.
Maternal
Child Health J. 2003;7:13-30.
May 11, 2011
12
Amy Fine: Life Course "Cliff Notes"Slide13
Is Life Course Old or New?May 11, 2011
Amy Fine: Life Course "Cliff Notes"
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LCT marries long-term MCH concepts with new scienceBarker Hypothesis – links LBW to increased risk of heart disease, diabetes
Felitti’s
ACE Study – links early childhood adverse events to increased risk of obesity, heart disease, diabetes, depression
Neurons to Neighborhoods, NAS – early environments, nurturing relationships, parents are the “active ingredients” in healthy brain development – from the earliest ages forward.
Lu/
Halfon
– link disparities in birth outcomes to differential developmental trajectories of the mother, based on early life experiences (programming)and cumulative stress.
Epi
-genetics – links environmental triggers to gene expression.
The same science is also informing other fields.
Kotelchuck
, 2010Slide14
Critiques and QuestionsMay 11, 2011
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Early programming - too deterministic?
Too front-loaded? What does LCT tell us about later life stages?
What does LCT tell us about CSHCN?
How does LCT interface with genetic services?
If it is all connected over a life time, how do we make the case for a focus on MCH?Slide15
Additions to Life Course PerspectiveMay 11, 2011
Amy Fine: Life Course "Cliff Notes"
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Interactive processes – The development of health over a lifetime is an interactive process, combining genes, environments and behaviors.
Lifelong development/lifelong intervention
– Throughout life and at all stages, even for those whose trajectories seem limited, risk factors can be reduced and protective factors enhanced, to improve current and subsequent health and well-being.
Fine and
Kotelchuck
, 2010Slide16
Aligning Practice with LCT
LCT tells us that interventions that reduce risks and increase protective factors can change the health trajectory of individuals and populations. These ideas are not inconsistent with the current practice of medicine and of public health.
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Amy Fine: Life Course "Cliff Notes"Slide17
Aligning Practice with LCT
But, LCT also…Greatly expands the opportunities for intervention:a much broader set of venues and partners, over a much longer timeline
Suggests the need for better linkage (vertical, horizontal, temporal)Encourages us to rethink and realign some of the current strategies and add new ones.
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Amy Fine: Life Course "Cliff Notes"Slide18
Aligning Practice with LCTMay 11, 2011
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The work ahead of you for today is to explore how LCT might be applied:
Within MCAH public health programs
Within local health departments as a whole, and
In partnership with others working to improve the health and well-being of women, children and families. Slide19
Aligning Practice with LCTMay 11, 2011
Amy Fine: Life Course "Cliff Notes"
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Life Course is a framework that reflects new & renewed understandings of …
the interplay of genes, environment, and personal choices;
the importance of earliest experiences, and subsequent critical and sensitive periods of development;
the cumulative, and longitudinal nature of risks and protective factors ;
…and how these impact the health and development of individuals and populations
.Slide20
Life Course “Cliff Notes”Amy Fine: Life Course "Cliff Notes"
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Amy FineSenior FellowCenter for the Study of Social Policy
Washington, DC
Cell
: 202-352-8100
afinehome@aol.com
May 11, 2011