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Health Matters: Prevention – A Life Course Approach

Published 23 May 2019 by Public Health England

Summary

This report emphasizes a life course approach to preventing ill health, aligning closely with the Sustainable Development Goals (SDGs) by addressing health and wellbeing throughout all stages of life. It highlights evidence-based interventions, tools, and evaluation methods to support NHS and public health professionals in promoting health equity and sustainable development.

A Life Course Approach

Health and wellbeing are influenced by a broad range of social, economic, and environmental determinants, alongside behavioral risk factors. These determinants can be protective or risk factors that impact individuals throughout their lifespan.

Key Principles

• Health is shaped by protective and risk factors interacting over the life span.
• Maintaining good functional ability is central to the life course approach.
• Supportive environments enhance functional ability at all life stages.
• Policy and societal changes can reduce inequalities, benefiting current and future generations.

The World Health Organization’s conceptual framework illustrates how intrinsic capacity and functional ability vary across life stages, underscoring the importance of supportive environments to improve health outcomes.

Alignment with Sustainable Development Goals

• SDG 3: Ensure healthy lives and promote wellbeing for all at all ages by focusing on prevention and health promotion.
• SDG 10: Reduce inequalities by addressing social determinants of health and promoting equity across populations.
• SDG 11: Create inclusive, safe, resilient, and sustainable communities through supportive environments.

Health Inequalities in the Life Course Approach

Social inequalities in protective and risk factors lead to disparities in life expectancy and healthy life expectancy. For example, in England, the life expectancy gap between the least and most deprived areas is significant, with deprived populations experiencing shorter and less healthy lives.

• Addressing social determinants is crucial to reducing health inequalities.
• Whole-of-society approaches, such as Health in All Policies, are essential to tackle these disparities.

Investing in the Life Course Approach

Long-term investment in prevention across the life course yields high returns in health, social, and economic benefits, contributing to sustainable development.

1. Childhood and Adolescence: Early investment yields a 10:1 benefit-to-cost ratio, reducing mental health disorders and noncommunicable diseases later in life.
2. Working Age Adults: Sustainable employment improves financial outcomes for individuals and society.
3. Older People: Older adults contribute economically and socially; maintaining their health supports continued engagement and productivity.

Interventions Across the Life Course

Recommended interventions target key life stages to minimize risks and enhance protective factors, supporting SDG 3 and SDG 10.

Preconception and Becoming a Parent

• Promote healthy behaviors including vaccination, nutrition, physical activity, smoking cessation, and alcohol reduction.
• Screening and antenatal care to optimize maternal and child health outcomes.

Infancy and Early Years (0 to 5)

• Support sensitive parenting, early education, and socio-economic improvements.
• Enhance speech, language, and communication skills to improve lifelong wellbeing.
• Implement early intervention programs and maintain high vaccination coverage.

Childhood and Adolescence (5 to 19)

• Address risky behaviors and adverse childhood experiences (ACEs) to prevent poor health outcomes.
• Support mental health and emotional wellbeing to build resilience.
• Improve educational attainment and reduce tobacco, alcohol, and drug use.
• Reduce teenage pregnancies and support young parents.
• Vaccination programs including HPV and boosters.

Working Age (16 to 64)

• Promote good quality employment and workplace health to improve wellbeing.
• Support mental health through workplace programs and social activities.
• Address musculoskeletal health and provide screening to reduce premature mortality.

Ageing Well

• Promote productive healthy ageing with improved health, independence, and social engagement.
• Ensure access to good employment, age-friendly housing, and vaccination.
• Prevent dementia and depression through lifestyle interventions.
• Prevent falls and reduce social isolation to maintain functional ability.

Actions Across the Life Course

1. Build healthy and resilient communities.
2. Adopt place-based approaches to health.
3. Tackle housing and fuel poverty.
4. Take action on poverty and health.
5. Address health and justice issues.

Prioritising Prevention of Ill Health

Prevention requires coordinated action by the NHS, government, local authorities, and partners, emphasizing early, appropriate, and collaborative interventions that promote health equity and align with the SDGs.

• Ensure interventions fit the life course framework.
• Consider intra- and intergenerational impacts.
• Minimize risk factors and enhance protective factors.
• Strive for health equity and reduce inequalities.
• Evaluate and monitor interventions to build evidence.

Resources

• Expanded interventions table
• Supporting references
• Health matters infographics
• Health matters blog
• Health inequalities chart

Case Studies

• Stoke Speaks Out: supporting speech, language and communication
• Family safeguarding in Hertfordshire

1. Sustainable Development Goals (SDGs) Addressed or Connected to the Issues Highlighted in the Article

1. SDG 3: Good Health and Well-being
   • The article focuses extensively on health promotion, prevention of ill health, mental health, vaccination, and reducing health inequalities.
2. SDG 4: Quality Education
   • Improving educational attainment and early childhood development are discussed as critical to long-term health and wellbeing.
3. SDG 8: Decent Work and Economic Growth
   • Employment opportunities, workplace health, and the economic benefits of good work are highlighted.
4. SDG 10: Reduced Inequalities
   • The article emphasizes tackling health inequalities and social determinants of health across the life course.
5. SDG 11: Sustainable Cities and Communities
   • Healthy places, housing, and the built environment are discussed as important determinants of health.
6. SDG 16: Peace, Justice and Strong Institutions
   • Safeguarding children and tackling vulnerabilities, including exploitation and abuse, relate to this goal.

2. Specific Targets Under Those SDGs Identified Based on the Article’s Content

1. SDG 3: Good Health and Well-being
   • Target 3.4: Reduce premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Target 3.7: Ensure universal access to sexual and reproductive health-care services.
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services.
   • Target 3.b: Support research and development of vaccines and medicines for communicable and non-communicable diseases.
   • Target 3.c: Substantially increase health financing and recruitment, development, training and retention of the health workforce.
2. SDG 4: Quality Education
   • Target 4.2: Ensure that all children have access to quality early childhood development, care and pre-primary education.
   • Target 4.5: Eliminate gender disparities and ensure equal access to all levels of education and vocational training.
3. SDG 8: Decent Work and Economic Growth
   • Target 8.5: Achieve full and productive employment and decent work for all women and men.
   • Target 8.8: Protect labour rights and promote safe and secure working environments.
4. SDG 10: Reduced Inequalities
   • Target 10.2: Empower and promote social, economic and political inclusion of all.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome.
5. SDG 11: Sustainable Cities and Communities
   • Target 11.7: Provide universal access to safe, inclusive and accessible green and public spaces.
6. SDG 16: Peace, Justice and Strong Institutions
   • Target 16.2: End abuse, exploitation, trafficking and all forms of violence against and torture of children.

3. Indicators Mentioned or Implied in the Article to Measure Progress Towards the Identified Targets

1. Health Outcomes and Life Expectancy
   • Life expectancy gap between least and most deprived areas (e.g., 9.4 years for males, 7.4 years for females).
   • Healthy life expectancy differences (e.g., 19.1 years for males, 18.8 years for females).
2. Vaccination Coverage
   • Immunisation rates for various vaccines (e.g., MMR, HPV, flu, pneumococcal, shingles).
3. Screening Program Outcomes
   • Number of deaths prevented by cervical, bowel, and breast cancer screening.
   • Number of people referred for urgent treatment for diabetic retinopathy.
4. Mental Health Indicators
   • Prevalence of clinically diagnosable mental health problems in children and young people (1 in 10).
   • Percentage of older adults affected by depression (22% men, 28% women aged 65+).
   • Use of Mental Health Profiling Tools and JSNA profiles.
5. Educational Attainment and School Readiness
   • Speech and language development data as part of school readiness evaluation.
   • Link between pupil health and academic attainment.
6. Employment and Economic Indicators
   • Financial benefits to individuals and society from sustainable employment.
   • Employment rates and retention for older people.
7. Health Inequalities Dashboards and Profiles
   • Public Health Outcomes Framework (PHOF).
   • Health Inequalities Dashboard.
   • Wider Determinants of Health Profile.
8. Falls and Injury Prevention
   • Number of falls-related emergency hospital admissions among older adults.
   • Return on investment for falls prevention programs.
9. Social Isolation and Loneliness
   • Number of older people experiencing chronic loneliness.
   • Impact of social isolation on premature mortality risk.

4. Table: SDGs, Targets and Indicators

Source: gov.uk