Halfon Neal, Forrest Christopher B.
Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
Concepts of what constitutes health, and theories about how health is produced and optimized, are constantly evolving in response to myriad social and cultural expectations shaped by our contemporary worldview, scientific advances, improvements in health interventions, and the changing capacity of the health system. Stimulated originally by a series of studies demonstrating how growth during early life is related to chronic health conditions that emerge many decades later, new research is demonstrating how complex developmental processes integrate a range of biological, behavioral, social, and environmental influences that modify gene expression, modulate physiologic and behavioral function, and dynamically shape different pathways of health production. These empirical findings are highlighting the limitations of the more mechanistic biomedical and biopsychosocial models of health, which fail to offer comprehensive explanations about such phenomena as the developmental origins of health, how stress affects current and future health, and the consequences of dynamic interactions between individuals and their environments over time. The comfort and certainty of simple, linear, and deterministic causal pathways are giving way to the uncomfortable uncertainty of nonlinear causal clusters that are networked together into complex, multilevel, interactive, and relational systems. Informed by new theoretical perspectives emerging from such fields of study as developmental psychology, systems biology, epigenetics, the developmental origins of chronic disease, and evolutionary developmental biology, a coherent transdisciplinary framework is emerging which we call Life Course Health Development (LCHD) and which is presented in this chapter as a set of seven principles: (1) health development, (2) unfolding, (3) complexity, (4) timing, (5) plasticity, (6) thriving, and (7) harmony. LCHD offers a new perspective that will guide future scientific inquiry on health development and facilitate synthesis of medicine and public health that links treatment, prevention, and health promotion and catalyzes more integrated and networked strategies for designing, organizing, and implementing multilevel health interventions that transcend individual and population dichotomies. We hope that the LCHD framework presented here, coupled with our explanatory narrative, will encourage theory building and testing, inspire innovative transdisciplinary research, and mature the framework into a scientific model with descriptive, explanatory, and predictive utility. Furthermore, we hope that LCHD will shine a light on the conundrum of how little attributable risk is explained in many studies of chronic disease, how early experience conditions future biological response patterns, and how these early experiences play through complex, environmentally influenced, and developmentally plastic health development pathways.
关于健康的构成概念，以及有关如何产生和优化健康的理论，正在不断演变，以回应受我们当代世界观、科学进步、健康干预措施的改进以及卫生系统不断变化的能力所塑造的无数社会和文化期望。最初受到一系列研究的启发，这些研究表明生命早期的生长如何与数十年后出现的慢性健康状况相关，新的研究正在揭示复杂的发育过程如何整合一系列生物、行为、社会和环境影响，这些影响会改变基因表达、调节生理和行为功能，并动态塑造不同的健康产生途径。这些实证研究结果凸显了更为机械的生物医学和生物心理社会健康模型的局限性，这些模型无法对诸如健康的发育起源、压力如何影响当前和未来健康，以及个体与其环境随时间的动态相互作用的后果等现象提供全面解释。简单、线性和确定性因果路径所带来的舒适和确定性，正让位于非线性因果簇所带来的令人不安的不确定性，这些因果簇相互连接成复杂、多层次、交互式和关系性的系统。受发育心理学、系统生物学、表观遗传学、慢性病的发育起源以及进化发育生物学等研究领域中出现的新理论观点的启发，一个连贯的跨学科框架正在形成，我们将其称为生命历程健康发展（LCHD），本章将其作为一组七条原则呈现：（1）健康发展，（2）展开，（3）复杂性，（4）时机，（5）可塑性，（6）蓬勃发展，（7）和谐。LCHD提供了一个新的视角，将指导未来关于健康发展的科学探究，并促进医学与公共卫生的整合，将治疗、预防和健康促进联系起来，并催化更综合和网络化的策略，以设计、组织和实施超越个体与人群二分法的多层次健康干预措施。我们希望这里呈现的LCHD框架，连同我们的解释性叙述，将鼓励理论构建和检验，激发创新性的跨学科研究，并使该框架成熟为一个具有描述性、解释性和预测性效用的科学模型。此外，我们希望LCHD将阐明许多慢性病研究中可归因风险解释甚少的难题，早期经历如何塑造未来的生物反应模式，以及这些早期经历如何通过复杂的、受环境影响的和具有发育可塑性的健康发展途径发挥作用。
