Life Course Theory and Social

Determinants of Health (LCT-

SDH)

Jenean Castillo, PhDOctober 28th, 2021

Learning objectives for this seminar

By completing the assignments and participating in this seminar,

trainees will:

• Describe key elements of Life Course Theory and Social Determinants

of Health* (LCT-SDH)

• Discuss the impact of stressors and adversity on children and families

we serve and our work with them

• Consider how the Covid-19 pandemic exacerbates the impact of

adverse life circumstances on children’s health

• Apply LCT-SDH to work with and for children with developmental

disabilities and their families

*Remember: “Health” includes mental health, emotional health,

attainment of developmental milestones

KEY

ELEMENTS

LCT/SDOH

Life Course Theory

• Life Course is a theory or perspective that

seeks to understand, explain, and improve

health and disease patterns across population

groups

• Theory is not new but the science supporting

it and its application are expanding

Life Course Core Concepts: “T2E2”

• Today’s experiences and exposuresdetermine tomorrow’s health (Timeline)

• Health trajectories are particularlyaffected during critical or sensitiveperiods (Timing)

Fine, Kotelchuck, Addess, Pies 2009

• The broader environment –biologic, physical, and social–strongly affects the capacity to be healthy (Environment)

• Inequality in health reflects more than

genetics and personal choice (Equity)

Fine, Kotelchuck, Addess, Pies 2009

Life Course Core Concepts: “T2E2”

Life Course Research focuses on 2 key issues

• Why do health disparities exist and persist

across population groups?

• What are the factors that influence the

capacity of individuals or populations to reach

their full potential for health and well-being?

Social Determinants of Health (SDH):an integral component of Life Course Theory

• SDH are elements of the “broader environment” –

circumstances in which people are born, grow up, live,

work, and age; systems of care- that can influence

developmental and health outcomes.

• SDH include: the family, education and income,

interpersonal relationships, adequacy of housing, air

quality and other environmental influences, and health

care coverage.

• SDH are shaped by a wider set of forces: economics,

social policies, and politics

Social Determinants of Health

• Where we live, learn, work and play can have

a greater impact on how long and well we live

than medical care.

• A person’s health and chances of becoming

sick and dying early are greatly influenced

by powerful social factors such as

education, income, nutrition, housing and

neighborhoods.Robert Wood Johnson Foundation Commission to Build a Healthier America; Issue Brief 7; December 2009

• “This new perspective does not negate the importance of medical care but recognizes the need to look beyond it to the circumstances in which people live, work,learn and play.”

Braverman and Barclay. Health Disparities Beginning in Childhood: A Life-Course Perspective. Pediatrics 2009; 124; S163-S175

The “Healthy People 2030” initiative of thefederal government incorporates consideration of social determinants:

SDOH can be grouped into 5 domains:

Economic Stability

Education Access and Quality

Health Care Access and Quality

Neighborhood and Built Environment

Social and Community Context

How does “HealthyPeople 2030” addresses SDH?

• One of Healthy People 2030’s 5 overarching goals is

specifically related to SDOH: “Create social, physical, and

economic environments that promote attaining the full

potential for health and well-being for all.”

• HP2030 features many objectives related to SDOH: “These

objectives highlight the importance of "upstream"

factors — usually unrelated to health care delivery — in

improving health and reducing health disparities.”

• HP2030 developed a workgroup focusing solely on SDOH

with subject matter experts with different backgrounds and

areas of expertise.

Find more information at HP2030 SDOH efforts:

https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Examples of SDOH from The

“Healthy People 2030” initiative

• Safe housing, transportation, and neighborhoods

• Racism, discrimination, and violence

• Education, job opportunities, and income

• Access to nutritious foods and physical activity

opportunities

• Polluted air and water

• Language and literacy skills

“Unquestionably, individuals must takepersonal responsibility for their health andthe health of their families, but individuals donot act in a vacuum. The contexts in whichpeople live, learn, work, and play influenceboth the choices available to them and theirability to choose paths leading to health…

Balance between individual responsibility

and societal responsibility

Balance between individual responsibility

and societal responsibility, cont.

“…. In many instances, the barriers to good health exceed an individual’s abilities, even with thegreatest motivation, to overcome these obstacles on his or her own. Children—who cannot choose their environments—are particularly vulnerable to thehealth damaging effects of harmful physical and social conditions, and childhood adversity oftenresults in seriously diminished health in adulthood.”

Braverman, Egerter and Williams. The Social Determinants of Health: Coming of Age. Ann RevPublic Health.2011.32:381-398

Can the impact of adverse circumstancesbe modified?• “Substantial evidence indicates that pathways initiated by childhood

adversity can be interrupted. Studies show that high-quality earlychildhood development interventions…greatly ameliorate the effects ofsocial disadvantage in children’s cognitive, emotional/behavioral, andphysical development.”

• Examples:

• Parenting skills training

• Family supports/networks

• Supplemental nutrition

• Home visiting

• Early intervention

Braverman, Egerter and Williams. The Social Determinants of Health: Coming of Age. Ann Rev Public Health.2011.

32:381-398

In breakout groups:• Read discussion prompts and questions.

• Elect a note-taker who will report out for the group based on one or

more of the numbered questions.

(You may create a word doc of bullet points to screen- share during

your report out or you may choose to simply report out orally.)

• Elect a discussion leader to keep the discussion on track.

• Work for 30 minutes using the bulleted prompts and questions to guide

discussion.

Report out: • Each group will have 5 minutes to report back.

For Discussion…