Life Course Health Development: A Transformative Framework To Improve Childrens Health - PowerPoint PPT Presentation

Loading...

PPT – Life Course Health Development: A Transformative Framework To Improve Childrens Health PowerPoint presentation | free to view - id: 1ae701-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Life Course Health Development: A Transformative Framework To Improve Childrens Health

Description:

UCLA Center for Healthier Children, Families and Communities ... Connecting the disparate parts of MCH. Connecting MCH to rest of health and human development ... – PowerPoint PPT presentation

Number of Views:104
Avg rating:3.0/5.0
Slides: 90
Provided by: jane257
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Life Course Health Development: A Transformative Framework To Improve Childrens Health


1
Life Course Health Development A Transformative
Framework To Improve Childrens Health
  • Neal Halfon, MD, MPH
  • UCLA Schools of Public Health, Medicine, Public
    Affairs
  • UCLA Center for Healthier Children, Families and
    Communities
  • National Center for Infancy Early Childhood
    Health Policy
  • MCHB-AIM Child Adolescent Policy Support Center

CityMatCH 08, Albuquerque September 21, 2008
2
Goals of this Presentation
  • To review the evidence, importance and potential
    impact of the developmental origins of health and
    disease
  • To consider the strategic role that the emerging
    Life Course Health Development approach can play
    in
  • Advancing a progression Health Policy Agenda
  • Enabling significant Health Systems Reform in
    the US

3
Take home Points Power of LCHD
  • Life Course Health Development (LCHD) is
    different than a life course approach
  • LCHD integrating framework
  • Connecting the disparate parts of MCH
  • Connecting MCH to rest of health and human
    development
  • Leverages MCH and Positions and Prioritizes MCH
    policy
  • Provides a new Operating Logic for Transforming
    the Health System
  • Powerful analytic model for solving MCH problems

4
From Lifespan to LCHD
  • Lifespan models connect the dots- linking early
    life to later life
  • Life stage models periods of psychological
    development
  • Life-course models are concerned with patterns
    and pathways that connect the dots between early
    and later life
  • Life Course Health Development models-
  • Connect the dots
  • Describe the pathways or heath trajectories
  • Address the mechanisms that determine or
    influence health trajectories

5
Reasons to link Health and Human Development
across the life span
  • Health policy needs to better reflect our
    knowledge of what influences health development
    across the life course
  • The converging goals of medicine and public
    health requires a framework that can integrate
    personal and population health production models
  • The dynamics of health production need to be
    understood in era of genomics driven medicine
  • The developmental origins of disparities need to
    be better understood

6
(No Transcript)
7
LCHD
  • Where We Have Been

8
Figure 22. Life expectancy at birth and at 65
years of age by sex United States, 1901-2001
100
NOTE See Data Table for data points graphed and
additional notes.
Females
80
SOURCE Centers for Disease Control and
Prevention, National Center for Health
Statistics, National Vital Statistics System.
Life Expectancy at birth
Males
Centers for Disease Control and Prevention,
National Center for Health Statistics. Health,
United States, 2004
60
Life expectancy in years
40
Females
Life expectancy at 65 years
20
Males
0
1901
1910
1920
1930
1940
1950
1960
1970
1980
1990
2001
Year
9
Life Span
Health Span
Health / functional Status
Performance Span
0 years
20 years
80 years
10
Social/Nutritional/Epidemiological/ Developmental
Shift
  • Social Conditions dramatically changes over this
    time period
  • Nature, Array, and Prevalence of Risk, Protective
    and Health Promoting factors
  • Nutritional Conditions change- high sugar, high
    fat diets
  • Types, prevalence, distribution of acute and
    chronic disease changes dramatically
  • Developmental expectancies change
  • Capacity of Medical Care to intervene, modify
    risk and treat disease

11
The Evolving Health Care System
The First Era (Yesterday)
  • Focused on acute and infectious disease
  • Germ Theory
  • Medical Care
  • Insurance-based financing
  • Reducing Deaths
  • Increasing focus on chronic disease
  • Multiple Risk Factors
  • Chronic Disease Mgmt Prevention
  • Pre-paid benefits
  • Prolonging Disability free Life
  • Increasing focus on achieving optimal health
    status
  • Complex Causal Pathways
  • Investing in population-based prevention
  • Producing Optimal Health for All

Health System 2.0
Health System 1.0
Health System 3.0
12
2004 National Research Council and Institute of
Medicine Report
13
IOM/NRC Definition of Childrens Health (2004)
  • Childrens health is the extent to which
    individual children or groups of children are
    able or enabled to (a) develop and realize their
    potential, (b) satisfy their needs, and (c)
    develop the capacities that allow them to
    interact successfully with their biological,
    physical, and social environments.
  • From Childrens Health, the Nations Wealth,
    National Academies Press, 2004.

14
LCHD
  • Defines Health as a developmental process
  • Builds upon Ecological and Transactional models
    of Life Span Development
  • Utilizes a rapidly Expanding Evidence Base
  • Life Course Chronic Disease Epidemiology
  • Neurobiology
  • Early Intervention Research
  • Economics of Human Capital Formation
  • Gene-Environment/ Social Epidemiology

15
Health as a Developmental Process
  • Health is a developmental process
  • Health develops across the life course
  • Health development can be represented by health
    trajectories
  • Critical/ Sensitive periods
  • Gene - Environment Interaction have different
    impacts during different periods
  • Macro and Micro pathways delineate how toxic
    environments and risky families get under the skin

16
How Risk Reduction and Health Promotion
Strategies influence Health Development
FIGURE 4 This figure illustrates how risk
reduction strategies can mitigate the influence
of risk factors on the developmental trajectory,
and how health promotion strategies can
simultaneously support and optimize the
developmental trajectory. In the absence of
effective risk reduction and health promotion,
the developmental trajectory will be sub-optimal
(dotted curve). From Halfon, N., M. Inkelas,
and M. Hochstein. 2000. The Health Development
Organization An Organizational Approach to
Achieving Child Health Development. The Milbank
Quarterly 78(3)447-497.
17
Fig.
From Lamberts SWJ, van den Beld AW, van der lely
A. The endocrinology of aging. Science.
1997278419-424.
18
From Kuh D, Ben-Shlomo Y. A life course approach
to chronic disease epidemiology. New York Oxford
University Press. 1997.
19
Strategies to Improve Health Development
Trajectories
Back to Overall Model
Healthy Trajectory
At Risk Trajectory
Delayed/Disordered Trajectory
Graphic Concept Adapted form Neal Halfon , UCLA
20
Risk and protective factors
Risk Factors Child Family Community School
Protective Factors Child Family Community School
Outcome
Negative vulnerability
Positive resilience
21
LCHD
  • Connecting the Dots

22
Adverse childhood events and adult depression
Odds Ratio
Adverse Events
Chapman et al, 2004
23
Adverse childhood events and adult ischemic heart
disease
Odds Ratio
Adverse Events
Dong et al, 2004
24
Adverse childhood events and adult substance abuse


Dube et al, 2002
Dube et al, 2005
Self-Report Alcoholism
Self-Report Illicit Drug Use
25
LCHD
  • Actionable Mechanisms for Intervention

26
Cumulative, Programming and Pathway Mechanisms
Influence LCHD
  • Three basic mechanisms influence LCHD
  • Cumulative - additive effect of multiple risks
    and protective factors, weathering
  • Programming - time specific influence of stimulus
    or insult during a critical or sensitive period
    on selection, adaptation, compensatory processes
  • Pathways-chains of (eco-culturally constructed)
    linked exposures that create a constrained
    conduit of gene-environment transactions

27
Cumulative SES (birth - 33 yrs) poor health, age
33
fair/poor health
4 5 6 7 8 9 10 11 12 13
14 15 16
best
worst
Lifetime SES score
Source Power et al, 1999
28
LCHD
  • Programming

29
(No Transcript)
30
(No Transcript)
31
Life Course Chronic Disease Epidemiology Barker
Hypothesis
  • Affiliation MRC Environmental epidemiology unit
    in South Hampton
  • Design Historical Cohort
  • Key Finding Fetal growth and development, and
    other factors, in first year(s) of life related
    to cardiovascular and other chronic disease in
    the fifth and sixth decade

32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
Barker HypothesisBirth Weight and Coronary Heart
Disease
Age Adjusted Relative Risk
Rich-Edwards 1997
36
Birthweight and CVD OutcomesNurses Health Study
Curhan et al., Rich-Edwards et al.
37
(No Transcript)
38
Smoking During Pregnancy Offspring Obesity
Pooled AOR 1.46 (1.33, 1.59)
Oken et al., unpublished
39
(No Transcript)
40
Odds ratio of obesity breast versus formula fed
0.87 (95 CI 0.85, 0.89)
Owen et al, Pediatrics , 2005 (From Gilman)
41
LCHD
  • Programming leads to Latent Effects

Long time horizons between exposure and outcomes
42
Cumulative, Programming and Pathway Mechanisms
Influence LCHD
  • Three basic mechanisms influence LCHD
  • Cumulative - additive effect of multiple risks
    and protective factors, weathering
  • Programming - time specific influence of stimulus
    or insult during a critical or sensitive period
    on selection, adaptation, compensatory processes
  • Pathways- chains of (eco-culturally constructed)
    linked exposures that create a constrained
    conduit of gene-environment transactions

43
Poverty ECD
Parent- and Family-Level Predictors of Income
And Hardship ? Parent Work Status ? Job
Prestige ? Education Level ? Parent Marital
Status ? Race-Ethnicity
44
(No Transcript)
45
(No Transcript)
46
(No Transcript)
47
LCHD Childhood Antecedents of later Childhood
and Adult Health
Early social and material deprivation (financial,
educational, environmental)
Prior poor health, fetal nutrition, case-mix
Immunologic physiologic moderators
Current poor health/ premature mortality
Prior poor physical activity
Current poor physical activity
Prior adverse behavior
Current adverse behavior
Current social and material deprivation
Source van de Mheen et al, IJE 1998
From Starfield 02/03
48
LCHD New Approaches to Old Problems
49
How are LCHD concepts being used
  • Health System Reform (US)
  • Adays Reinventing Public Health
  • Breslows 3rd Era of Health and Health Care
  • Snydermans Future Medical/Health System analysis
  • Health System Reform ( Intl)
  • UK Acheson Report, Sure Start, Health
    Development Agency
  • Canada CIAR, Major Measurement Strategy focused
    on curve shifting across the life course
  • WHO- ECD initiative, Commission on Social
    Determinants of Health

50
Disease Progression
1 current practice 2 current capability 3
future capability
1
Symptoms
Cost
3
2
Years
Source Snyderman R. AAP presidential address
the AAP and the transformation of medicine.
Journal of Clinical Investigation.
2004114(8)1169-1173 (suppl)
51
Paradigm Shift
Source Snyderman R. AAP presidential address
the AAP and the transformation of medicine.
Journal of Clinical Investigation.
2004114(8)1169-1173 (suppl)
52
Risk Assessment for Prospective Health
Risk assessment decision support
Late chronic
Symptoms
Cost
Early chronic
Low risk
High risk
Years
Wellness education and Internet and health
provider guided planning for all
Wellness education and Internet and health
provider guided planning for all
Individual-focused integrated provider systems.
Focus on quality of life and palliation at
appropriate late stages
Source Snyderman R. AAP presidential address
the AAP and the transformation of medicine.
Journal of Clinical Investigation.
2004114(8)1169-1173 (suppl)
53
(No Transcript)
54
LCHD and Birth Outcomes
White
Reproductive Potential
African American
Pregnancy
Age
55
LCHD and Birth Outcomes
White
Reproductive Potential
African American
Pregnancy
Age
56
Life Course Health Development
White
Poor Nutrition Stress Abuse Tobacco, Alcohol,
Drugs Poverty Lack of Access to Health
Care Exposure to Toxins
African American
Poor Birth Outcome
0
5
Puberty
Pregnancy
Age
57
LCHD AA White Birth outcomes
White
African American
Primary Care for Children
Early Intervention
Prenatal Care
Prenatal Care
Internatal Care
Primary Care for Women
Poor Birth Outcome
0
5
Age
Pregnancy
Puberty
58
LCHD FrameworkService Delivery System
Applications
  • Health Services
  • Moving from health maintenance to health
    development organizations
  • Integration strategies for newly engineered
    health systems
  • Vertical Primary, Secondary, Tertiary
  • Horizontal Biological, Behavioral, Social, Env.
  • Longitudinal Life-course/Lifespan

59
Source Wise PH. The transformation of child
health in the United States. Health Affairs.
23, No. 5 (2004) 9-25.
60
(No Transcript)
61
Changing Pattern of Childhood Morbidity
  • Increase in chronic health problems (10-14)
  • Greater recognition of mental health problems
    (15-20)
  • Greater appreciation of role and impact of
    developmental health problems learning,
    language (10-17)

62
(No Transcript)
63
Children Youth at Risk
4-6 Severe Disabilities 12-16 Special
Health Care Needs 30-40 Behavioral, Mental
Health Learning Problems 50-60 Good Enough
What are thriving ? 30 ? 40 ? 50 ?
64
How well is the 2.0 Child Health System
Performing?
65
The existing child health service system
  • Demand greater than services available
  • Families have complex needs - often beyond
    capability of any single service
  • Difficulty accessing services
  • Socio-economic gradient of access
  • Focus on treatment rather than prevention/early
    intervention
  • Episodic contact
  • Poor quality of Well Child Care

66
The existing child health service system
  • Fragmented service delivery
  • Different sectors (health, public health,
    population health, civic)
  • Different funding streams
  • Different cultures
  • Lack of co-ordination
  • Narrow programmatic criteria for eligibility
  • Variable understanding of child health issues
  • Local community generally has limited
    accountability or responsibility

67
How do we get the health system that children
need?
  • Incremental vs. Transformational
  • Reforms

68
Transforming the Child Health System New
Paradigm vs. Old System
  • Child health system was designed for the first
    era of health care ( acute, infectious disease
    model)
  • It was upgraded a bit for the 2nd era, with more
    regionalization, chronic disease care
  • Ill equipped for this new era
  • Under-performing
  • Facing many new challenges

69
Child Health 3.0 the New Improved approach
  • Integrated and comprehensive approach -
    broadbanding of services to achieve curve
    shifting outcomes
  • Greater flexibility of services and improved
    coordination at local community level
  • Increased community and consumer participation
  • Prevention, health promotion, early
    intervention, developmental optimization focus
  • Focus on outcomes through improved systems
    performance
  • Innovative funding and accountability
    arrangements

70
(No Transcript)
71
Transformation Framework
72
Transformation Framework
73
NUMBER OF CHILDREN
FUNCTION
74
Universal Curve Shift
Low income
Median
High income
NUMBER OF CHILDREN
FUNCTION
VULNERABLE
75
Includes Physicians, dentists Schools Child Care
POLICY
COMMUNITY
NEIGHBORHOOD SERVICES
Education
FAMILY
CHILD
Child Health
Family Support
76
Pediatric Office 2.0
Preventive Care
Acute Care
Pediatric Office
Chronic Care
Developmental Services
77
18 month visit
  • Pediatric Care 2.0
  • C.D Disability
  • Screen 4-6 w/ disability
  • Screening tools Pathway
  • Pediatric Office connected to Regional Center
  • Pediatric Care 3.0
  • Optimize Developmental Health
  • I.D 30-40 developmental risk
  • Screening tools Pathway
  • Pediatric Office connected
  • Child care
  • Many other programs
  • Coordination
  • Regional center

78
DS Community Services Pathway
Evaluation (IDEA Sector
Screening Pediatric Services Sector
Surveillance Community Services and Resource
Sector
Assessment Peds/HPlan/PHSector
IDEA Regional Center for Developmental Disabilitie
s
Mid-Level Assessment Center
Preventive Care
Other Specialized Services
Acute Care
Developmental Services
Chronic Care
COORDINATION CENTER
Child Care/Family Resource Center
Program
Surveillance
Program
79
Optimal Health Development
Trajectory Optimizing Service Linkage Pathway
Lower Health Development Trajectory
Development
Pediatric Continuity
Network Connections
0
1
3
5
7
Years
80
Optimizing Trajectories Multisector Multilevel
Strategies
81
Early Childhood System Building Blocks
Desired Outcomes at School Entry
A.
Family Capacity and Function
Emotional / Social / Cognitive Development
Physical Health Development
Trajectory of Child Development and Family
Function
B.
C.
Child Health Services
82
Early Childhood System 2.0 Building Blocks
Desired Outcomes at School Entry
A.
Family Capacity and Function
Emotional / Social / Cognitive Development
Physical Health Development
B.
Universal Preschool
Head Start Family Literacy
Early HS
Family Resource Centers
C.
Early Care Education
Family Support Services
Child Health Services
83
Child Health Services Building Blocks
Desired Outcomes at School Entry
Family Capacity and Function
Emotional / Social / Cognitive Development
Physical Health Development
.
Child Health Services
84
Child Health Services Building Blocks
Desired Outcomes at School Entry
Family Capacity and Function
Emotional / Social / Cognitive Development
Physical Health Development
.
Child Health Services
85
Early Childhood System 3.0
Desired Outcomes at School Entry
Family Capacity and Function
Emotional / Social / Cognitive Development
Physical Health Development
.
Assessment
Health Center
Screening
ECE Center
Family Resource Center
Surveillance
Co-located or virtually connected service centers
creating new pathways
86
Systematic Data CollectionFor tracking Health
Development Trajectories
Preschool Assessment
Pediatric Early Child Assessment
Birth Certificate
School Readiness
  • Physical Wellbeing motor devt
  • Social emotional devt
  • Approaches to learning
  • Language devt
  • Cognition general knowledge

87
What does LCHD New Synthesis Provide to the
Discourse on Health System Reform?
  • Big Idea Forward looking
  • Integrative Framework
  • Connect up an increasingly balkanized field
  • Reframe for health system reform goals
  • Positions child/MCH in Vanguard of New Era in
    Health and Health Care Reform
  • New Rational for current and future activities

88
Take home Points Power of LCHD
  • Life Course Health Development (LCHD) is
    different than a life course approach
  • LCHD integrating framework
  • Connecting the disparate parts of MCH
  • Connecting MCH to rest of health and human
    development
  • Leverages MCH and Positions and Prioritizes MCH
    policy
  • Provides a new Operating Logic for Transforming
    the Health System
  • Powerful analytic model for solving MCH problems

89
LCHD Framework Think Different!
  • Developmentally - in order to optimize outcomes
  • Population and upstream determinants of the
    outcomes that we want to achieve
  • How to shift population risk curves and not just
    work at the individual level
  • How to use alignment, connection, networking
    strategies to join up people, sectors, systems
    into a more functional approach - open source for
    a flatter health policy world
  • How to change the culture of the system we work
    in
  • To frame health in terms of its life long impacts

90
UCLA Center for Healthier Children,
Families and Communities National Center for
Infancy and Early Childhood Health
PolicyAIM-MCHB Child and Adolescent Policy
Support Center
  • Http.//healthychild.ucla.edu
About PowerShow.com