Published online October 27, 2009
PEDIATRICS Vol. 124 Supplement November 2009, pp. S163-S175 (doi:10.1542/peds.2009-1100D)
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SUPPLEMENT ARTICLE


Health Disparities Beginning in Childhood: A Life-Course Perspective

Paula Braveman, MD, MPH and Colleen Barclay, MPH

Center on Social Disparities in Health and Department of Family and Community Medicine, University of California, San Francisco, California

In this article we argue for the utility of the life-course perspective as a tool for understanding and addressing health disparities across socioeconomic and racial or ethnic groups, particularly disparities that originate in childhood. Key concepts and terms used in life-course research are briefly defined; as resources, examples of existing literature and the outcomes covered are provided along with examples of longitudinal databases that have often been used for life-course research. The life-course perspective focuses on understanding how early-life experiences can shape health across an entire lifetime and potentially across generations; it systematically directs attention to the role of context, including social and physical context along with biological factors, over time. This approach is particularly relevant to understanding and addressing health disparities, because social and physical contextual factors underlie socioeconomic and racial/ethnic disparities in health. A major focus of life-course epidemiology has been to understand how early-life experiences (particularly experiences related to economic adversity and the social disadvantages that often accompany it) shape adult health, particularly adult chronic disease and its risk factors and consequences. The strong life-course influences on adult health could provide a powerful rationale for policies at all levels—federal, state, and local—to give more priority to investment in improving the living conditions of children as a strategy for improving health and reducing health disparities across the entire life course.

Key Words: adult • child • chronic disease • educational level • Europe/epidemiology • health status • health status disparities • longitudinal studies • morbidity • mortality • social class • socioeconomic factors • United States/epidemiology

Accepted Jul 20, 2009.


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