Wise Paul H
Department of Pediatrics, School of Medicine, Stanford University, Center for Policy, Outcomes and Prevention, Lucile Packard Children's Hospital, Stanford, CA 94304-6019, USA.
Pediatrics. 2009 Nov;124 Suppl 3:S203-11. doi: 10.1542/peds.2009-1100H.
The utility of the life-course framework to address disparities in child health is based on its ability to integrate the science of child development with the requirements of effective and just public policy. I argue that the life-course framework is best assessed in a historical context and through 4 essential observations. First, early genetic and environmental interactions are complex and influence outcomes in different settings in very different ways. Second, these early-life interactions are themselves subject to considerable later influences and, therefore, may not be highly predictive of later outcomes. Third, the etiologic nature or timing of early-life interactions does not, per se, determine if their life-course effects are amenable to later interventions. Fourth, a highly deterministic view of early-life interactions is not supported by the science and can generate counterproductive approaches to research and policy development. Finally, an alternative approach is proposed on the basis of a "human-capacity" model of the life course that connects the search for underlying basic mechanisms with a policy-based examination of the comparative effectiveness of influences at different developmental stages. This approach suggests an expanded research and policy agenda that might be more capable of generating urgently needed strategies for reducing disparities in child health. Such an approach could ultimately define more comprehensively the power and limits of life-course effects in shaping the social distribution of health outcomes in the real world.
生命历程框架在解决儿童健康差异方面的效用，基于其将儿童发育科学与有效且公正的公共政策要求相结合的能力。我认为，生命历程框架最好在历史背景下并通过四项基本观察来评估。第一，早期的基因与环境相互作用十分复杂，并且以非常不同的方式在不同环境中影响结果。第二，这些生命早期的相互作用本身会受到相当大的后期影响，因此，可能无法高度预测后期结果。第三，生命早期相互作用的病因性质或时间本身并不能决定其生命历程效应是否适合后期干预。第四，生命早期相互作用的高度决定论观点并未得到科学支持，并且可能会产生适得其反的研究和政策制定方法。最后，在生命历程的“人类能力”模型基础上提出了一种替代方法，该模型将对潜在基本机制的探索与基于政策的对不同发育阶段影响的比较有效性研究联系起来。这种方法提出了一个扩展的研究和政策议程，可能更有能力生成减少儿童健康差异所需的迫切策略。这样一种方法最终可能更全面地界定生命历程效应在塑造现实世界中健康结果的社会分布方面的力量和局限性。
