Title:
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Assessing the influence of early life on adult health.
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Throughout the twentieth century there has been academic
debate about the relationship between early life experience
and adult health. This thesis examines the origins of
that debate, its manifestation in different scientific
fields of inquiry, and its recent re-emergence in
epidemiological research. It shows how the changing
nature of the debate was inextricably related to changes in
the notion of adult health, the development of methods of
empirical investigation, and the consequent availability of
scientific evidence. The thesis therefore spans a number
of disciplines and draws on the relevant knowledge from
each.
During the first forty years of this century the debate was
policy-led. Adult health was assumed to depend on child
health but empirical investigations of the link were
limited. Research concentrated on early life factors,
such as the behaviour of the mother, which were thought to
influence morbidity and mortality in infancy and childhood.
The focus of the academic debate was whether these factors
were environmental or genetic in origin. This debate had
important policy implications. Public acceptance of the
significance of the early environment provided the
rationale for the emerging infant and child health
services.
More recent interest in the influence of early life on
adult health sprang from two different hypotheses about the
basis of adult health, both of which focus on adult chronic
disease. The first hypothesis puts forward the view that
adult lifestyle is the main source of risk for chronic
disease, and considers early life factors only to the extent that they are associated with the development of
healthy and unhealthy lifestyles. The interdisciplinary,
American dominated debate associated with this hypothesis
is policy-led, and lacks a common conceptual model for
understanding the risk processes that may be involved in
the lifetime development of health related behaviour. In
contrast the second hypothesis gives a causal and dominant
role to environmental factors during critical periods of
growth in utero and infancy which affect particular body
systems, with long term consequences for adult chronic
disease. This epidemiological research is science-led
and dominated by one British investigator (Professor DJP
Barker) and his research team who have developed the
concept of 'environmental programming'. The academic
debate associated with this hypothesis concerns the
interpretation that is given to research findings which
show associations between early life and adult chronic
disease. Whereas for Barker they are evidence of a
biological process occurring at the beginning of life, for
others they reflect continuity of social deprivation
throughout life. It is the relative influence of the
intrauterine, childhood and adult environment which is in
dispute.
The thesis addresses these questions in respect of
cardiovascular and respiratory disease by drawing on data
from the Medical Research Council's National Survey of
Health and Development, a unique prospective study of the
health and development of over 5000 men and women followed
up since their birth in March 1946. Evidence is
presented which suggests that the effect of early life
factors on adult blood pressure, lung function and overall
health status is irrespective of later socioeconomic
experiences, thus providing support for the environmental
programming model. A second model, based on Rutter's
concept of 'chains of risk' is put forward to explain the lifetime development of health related behaviour, and is
used to account for the links between adult physical
activity and early social, educational and individual
characteristics which are found in data from the National
Survey.
In the recent debate there has been little engagement with
the policy process, although Barker's new theories have
attracted considerable public attention. The thesis draws
on its historical reviews of epidemiological research and
child health services to consider what effects the evidence
presented may have on health and social policies for
children in the 1990s.
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