Childhood adversity still matters for adult health outcomes

Abstract

That conditions experienced early in life have a long-lasting influence on adult health is not a new idea. But only recently has the entire lifecourse become a major focus of epidemiological research, with the objective of understanding when as well as how particular exposures act on later health outcomes. 1 Kuh D Ben-Shlomo Y A lifecourse approach to chronic disease epidemiology. Oxford University Press, Oxford1997 Google Scholar , 2 Keating DP Hertzman C Developmental health and the wealth of nations: social, biological and educational dynamics. Guilford Press, New York1999 Google Scholar One approach to yield valuable clues as to when influences might be acting has been to evaluate associations with socioeconomic circumstances at different stages of life. In adulthood, socioeconomic differences in health are well-established, 3 Drever F Whitehead M Health inequalities-decennial supplement. Series DS No 15. HM Stationery Office, London1997 Google Scholar but the impact of socioeconomic circumstances earlier in life on adult health is less well documented. A study of men born in Scotland in the 1920s suggested that some adult diseases were affected by socioeconomic conditions in childhood. 4 Davey-Smith G Hart C Blane D Gillis C Hawthorne V Adverse socioeconomic conditions in childhood and cause specific mortality: prospective observational study. BMJ. 1998; 316: 1631-1635 Crossref PubMed Scopus (494) Google Scholar Men who had manual social-class origins had increased risk of mortality from stroke and stomach cancer in adulthood; whereas mortality risk for lung cancer, other cancers, accidents, and violence was influenced predominantly by adult social circumstances. For some adult diseases, including coronary heart disease and respiratory disease, socio-economic conditions in both childhood and adulthood appeared to exert an effect. 4 Davey-Smith G Hart C Blane D Gillis C Hawthorne V Adverse socioeconomic conditions in childhood and cause specific mortality: prospective observational study. BMJ. 1998; 316: 1631-1635 Crossref PubMed Scopus (494) Google Scholar A similar pattern has been reported in a younger generation, all born in 1958, at an earlier life-stage when mortality and serious morbidity are less common. 5 Power C Manor O Matthews S Duration and timing of exposure: effects of socio-economic environment on adult health. Am J Public Health. 1999; 89: 1059-1065 Crossref PubMed Scopus (130) Google Scholar Self-rated health (a marker of future health status) at 33 years showed that the risk of poor health increased the longer that they had lived in disadvantaged socioeconomic conditions. 5 Power C Manor O Matthews S Duration and timing of exposure: effects of socio-economic environment on adult health. Am J Public Health. 1999; 89: 1059-1065 Crossref PubMed Scopus (130) Google Scholar Association between children's experience of socioeconomic disadvantage and adult health: a life-course studyProtecting children against the effects of socioeconomic adversity could reduce the burden of disease experienced by adults. These findings provide strong impetus for policy makers, practitioners, and researchers to direct energy and resources towards childhood as a way of improving population health. Full-Text PDF