The UK Working Group on NCDs (UKWG) is pleased to present findings from a piece of work drawn up by members (the Global Alliance for Chronic Diseases, NCD Child and the Worldwide Hospice Palliative Care Alliance) focusing on a ‘life course approach’ to reducing the burden of non-communicable disease (NCD) in low- and middle-income countries (LMICs). The full report is available for download at the foot of this post.
The World Health Organization (WHO) advocates that policies and programmes take a life course approach to addressing the rising global burden of NCDs, but despite the ubiquity of this term in public health literature, the WHO and others do not provide a consistent definition. In January 2022, the UKWG conducted a survey of representatives from organisations addressing NCDs in LMICs through direct service delivery, research, and/or advocacy initiatives. Of the 16 respondents, we found that only 25% indicated that they were ‘very confident’ that they understood the definition.
In response to the lack of clarity around the term, the UKWG has developed a description of a life course approach as it relates to preventing and managing NCDs:
A life course approach to NCDs involves maximising people’s health and/or wellbeing throughout their lifespan, using holistic measures that aim to improve these factors. Such measures typically target a combination of social, environmental, economic, and lifestyle determinants of health.
A life course approach involves adapting health and/or wellbeing-promoting interventions to facilitate their effectiveness and acceptability within certain life stages (e.g. adolescence, older age), or during key transitions within or between life stages (e.g. high school graduation, retirement). The targeted life stage(s) or transition(s) are key periods when health-impacting behaviours are established, and/or when environmental exposures are more likely to affect health. The targeted life stage(s) are thus inflection points for future health and/or wellbeing across the rest of the individual’s life, with potential intergenerational effects.
The report includes seven examples that demonstrate real-world application of a life course approach at distinct life stages with the aim of reducing the burden of NCDs in LMICs. Key themes emerged from these case studies:
1. Adapting an intervention to a particular life stage may create opportunities for influencing health at other life stages, even if the intervention is not delivered directly to individuals in these other life stages. For example, behavioural interventions that target children and young people may also influence behaviour in those close to them, such as older siblings, parents, and grandparents. As another example, interventions targeting mothers during pregnancy can also impact the baby’s lifelong health. (Case studies 1, 2, and 4).
2. Life stage is not the only important factor in tailoring an intervention to a specific population; consideration of gender, sexual orientation, and other protected characteristics is often necessary to deliver effective interventions. (Case studies 1, 3).
3. NCDs do not exclusively appear in middle-aged and older adults. This means that treatment options, including affordable and accessible medications and behavioural change interventions, also must be tailored to children and young people. (Case studies 2–4).
4. Interventions to prevent NCDs should be delivered throughout the life course, including in older adults with existing NCDs. (Case studies 1–7).
5. Due to the longitudinal outlook associated with the term ‘life course approach,’ it is debatable about whether this term can apply to end-of-life care. We argue that it can be; even if the timeline between advanced disease and death is short, end of life nevertheless marks a key transitionary period in the life course. (Case study 7).
We hope that the clarification of life course approach terminology and examples of its application will drive the adoption of this approach among policymakers, researchers, and implementers, thereby strengthening policy and programmes that target NCDs and improve global health equity.