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Lifecourse approaches

The lifecourse perspective on adult health and on health inequalities in particular, is one of the most important recent developments in epidemiology and public health. This book brings together, in a single volume, the work of one of the most distinguished academics in the field. It is the first to specifically take a lifecourse approach to health inequalities and will be essential reading for academics, students and policy makers with an interest in public health, epidemiology, health promotion and social policy.

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Discussions of health inequalities often begin with the statement that such inequalities are ubiquitous: the less affluent have always had worse health, they have worse health wherever they live, and they suffer more from all forms of ill-health. I entered the field thinking along these lines, but, as with most generalisations, a more than superficial acquaintance with empirical studies revealed that there were important exceptions; indeed it seemed to me that we could perhaps learn more about the processes generating inequalities in health by considering the exceptions, rather than carrying out more and more studies to prove the rule.

The lifecourse perspective offered one way of moving beyond simple generalisations about health inequalities. In Britain a major stimulus for embracing lifecourse approaches within epidemiology was the work of David Barker and colleagues on the early-life origins of adult disease. To me, and perhaps to other contemporary readers, Barker’s initial 1986 Lancet publication in this area1 appeared to develop the earlier ideas of Anders Forsdahl on how adverse environmental conditions in infancy and early childhood could increase the risk of cardiovascular disease in late adult life 2,3. Forsdahl was concerned with the high mortality in the Norwegian county of Finnmark, and drew attention to a possible cause “which has not been discussed earlier, namely that the considerably high mortality today is a late consequence of the adverse circumstances to which a large part of the population was exposed during their childhood and adolescence”2.

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