A new Supplement released today in the journal Pediatrics suggests that although we are starting to connect the dots between events and experiences early in life and later adult health challenges, we are not doing nearly enough to intervene in childhood to optimize later health outcomes. At a time when there are increasing concerns about youth, young adult mental health and well-being, researchers find this lack of attention to building health reserves and resilience early in life "deeply troubling" and are calling for a major new focus on support for children's positive health development and sense of well-being.
The series of articles is published as a supplement to Pediatrics by the Life Course Intervention Research Network (LCIRN), whose National Coordinating Center is housed at UCLA within the Center for Healthier Children Families and Communities.
The current situation is deeply troubling for providers and families alike and represents a profound failure of our health care systems to adapt to rapidly changing epidemiology and to respond to new scientific evidence with health system reforms and improvements. Immediate action is needed if we want to improve the health of children and the adults they will become."
Neal Halfon, MD, MPH, Director of the Life Course Intervention Research Network, and Professor of Pediatrics, Public Policy and Health Policy and Management, University of California-Los Angeles Health Sciences
The authors write that in the existing system of care, child health providers are limited by short appointment times and the inability to tackle looming social and structural issues that likely contribute to issues that persist into adulthood, such as mental health challenges, sub-optimal nutrition and chronic stress. They write that the current system and approach was designed to treat disease at a time when there was little understanding of epigenetics – how environment influences and the experiences that children have can affect the expression of their genes. In fact for many children, it may be a "mismatch" between what would be an "ideal" set of environments and experiences for them early in life versus the reality of those environments and experiences that is driving many of our later life health challenges.
The 17 articles in the special supplement focus on several areas where new intervention approaches have the potential to improve health across a lifetime and even across generations. Article topics range from a framework for researchers to establish best practices for life course intervention work, to the case for positioning youth to collaborate directly with researchers at all stages of intervention development and testing, to early childhood mental health interventions, and interventions in physical and virtual spaces such as schools and telehealth. Throughout, the researchers stress that incorporating the role of family and community is key to improving a child's well-being.
The series says that despite awareness of the potential for early interventions to improve health later in life, the shift to a health system designed to keep people healthy across their entire life span has been slow.
"This message is important for everyone, but especially for individuals and institutions that fund health research, child health providers and researchers and for policymakers who must understand that it will be very difficult and expensive to achieve health equity later in life without equity from the start," said Dr. Halfon. "We must intervene early in the pathways that link events and experiences in the first years of life with later life health and find ways to optimize essential outcomes."
The LCIRN is a collaborative network of more than 75 researchers from 25 institutions, service providers, family and community representatives, and thought leaders committed to improving life course health trajectories and outcomes for children and families. In addition to the UCLA center, the LCIRN comprises two research cores focused on the themes of family and community engagement and of race, place, class, and gender; and nine current research nodes that tackle adversity and resilience, attention-deficit/hyperactivity disorder, early childhood mental health, family health development, measurement of family functioning, school health, success after prematurity, youth justice and youth-led participatory action research.
FUNDING: This project is supported by the Health Resources and Services Administration of the US Department of Health and Human Services under award UA6MC32492, the Life Course Intervention Research Network. The information, content, and/or conclusions are those of the authors and should not be construed as the official position or policy of, or should any endorsements be inferred by, the Health Resources and Services Administration, Department of Health and Human Services, or US government.
Halfon, N., et al. (2022) The Emergence of Life Course Intervention Research: Optimizing Health Development and Child Well-Being. Pediatrics. The Emergence of Life Course Intervention Research: Optimizing Health Development and Child Well-Being. doi.org/10.1542/peds.2021-053509C.