Health and Well-Being across the Life Course

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Mary Larkin

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    Acknowledgements

    This book is dedicated to a true life course friend, Molly Brewer Hoeg

    About the Author

    Dr Mary Larkin is a Principal Lecturer in the Faculty of Health and Life Sciences at De Montfort University, Leicester. She is also Programme Leader for the BA Health Studies and BSc Public and Community Health. She has published widely in her main research areas of health and well-being and health and social care.

  • Postscript

    The unique synthesis of the existing body of national and international literature on health and well-being across all the life stages undertaken in this book from a life course perspective provides the most comprehensive account of health and well-being from a life course perspective that exists to date. Furthermore, it unequivocally supports the main argument put forward within the life course approach that risks to health and well-being accumulate across the whole life course – from conception, through to infancy, childhood, adolescence, adulthood and old age. Other aspects of the life course perspective that were endorsed were its emphasis on the importance of other influences in each life stage of the life course and the way that positive experiences over the life course can offset exposure to negative events and risk factors.

    However, there was little support for the emphasis placed by those who adopt an epidemiological approach on the importance of the timing of exposure to events in our lives determining their eventual impact on our health and well-being. Similarly, Graham's assertion that ‘pregnancy, childhood and adolescence’ are more significant in terms of ‘an individual's health and well-being across their whole life’ (Graham, 2009: 26) remained unproven. As pointed out in Chapter 1, identifying all the processes that can affect our health and well-being throughout our lives raises ‘formidable methodological challenges’ (Graham, 2007: 145). Moreover, research in this area is rapidly gathering momentum and capturing the latest findings can be problematic even for the most enthusiastic researchers. Therefore the lack of corroboration of some aspects of the life course approach to health and well-being does not detract from its value in understanding the patterning of health and illness over the life course and its subsequent role in the contemporary public health movement. Nonetheless it does highlight areas which need further research in order to develop the strengths of the life course approach more generally. In addition, research for this book foregrounded other national and international developments that will need to be considered in future theoretical models of life course processes; at the time of writing, we are in the middle of a global recession. Serious concerns are being raised about the implications for health and well-being of issues such as rising poverty levels amongst children and working-age poverty (Brewer et al., 2012). Examples of other matters high on the global agenda are widening health inequalities, the incidence of chronic diseases and the world-wide obesity pandemic (Busse et al., 2010; Marmot, 2010; Swinburn et al., 2011). Therefore, whilst the life course approach currently provides us with invaluable insights, it does require ongoing targeted research and needs to respond to local, national and global changes in order to maximise its contributions to the understanding of health and well-being and the development of effective policies.

    Glossary

    Acquired Immune Deficiency Syndrome (AIDS):

    caused by the Human Immunodeficiency Virus, it results in the progressive failure of the immune system. This in turn leads to life-threatening infections and cancers. As yet, there is no known cure

    acute illness:

    a short-term illness, such as a sickness bug or a chest infection

    ageism:

    when a person is discriminated against on the grounds of age

    age-related macular degeneration (AMD):

    an eye disease that involves deterioration of the retina. It mainly affects the elderly and is hard to treat. Whilst it eventually leads to legal blindness, individuals affected are not completely sightless

    Alzheimer's disease:

    this is the most common form of dementia (see below) and is characterised by gradual deterioration of memory and personality

    anorexia nervosa:

    an eating disorder that means that sufferers have a morbid fear of gaining weight. Their body image is distorted, with the result that they dramatically restrict their eating, lose significant amounts of weight and for females menstruation ceases

    attention deficit hyperactivity disorder (ADHD):

    often referred to as ADHD, this is a group of behavioural symptoms that include inattentiveness, hyperactivity and impulsiveness. Common symptoms include a short attention span, restlessness, being easily distracted and constant fidgeting. Many people with ADHD also have additional problems, such as sleep disorders or learning difficulties

    binge drinking:

    the purposeful consumption of alcohol over a short period of time with the primary intention of becoming intoxicated. It is more common in males during adolescence and young adulthood

    biomedical approach to health:

    this rests on an assumption that all causes of disease (both mental disorders and physical disease) can be understood in biological terms. It also views disease and sickness as deviations from normal functioning that medicine has the power to put right with its scientific knowledge and understanding of the human body

    blood pressure:

    the pressure exerted by circulating blood on the walls of blood vessels. Although average values for this pressure have been computed with their relevance to general health, there is often a large variation from person to person and it also varies in individuals from moment to moment

    body mass index (BMI):

    often referred to as BMI, this is a measurement of a person's weight in kilograms divided by their height in metres squared

    bulimia nervosa:

    an eating disorder involving frequent compulsions to eat large quantities of food over a relatively short period of time. These episodes of binge eating are preceded by intense feelings of anxiety and tension and often end with self-induced vomiting and/or excessive use of laxatives

    cataracts:

    this is an eye disease that is common amongst the elderly and involves a thickening of the lens in the eye with the result that vision becomes cloudy and distorted

    chronic illness:

    a long-term health disorder that interferes with social interaction and role performance. Examples are multiple sclerosis, arthritis and Alzheimer's disease

    conduct disorders:

    these are recognised psychiatric conditions and involve persistent disobedience and defiance. Typical behaviours are frequent and severe temper tantrums (beyond the usual age for these), excessive levels of fighting and bullying, cruelty to others and to animals, criminal activities and running away from home

    congenital heart defect (CHD):

    this is a defect in the heart that is present at birth and can obstruct blood flow in the heart or vessels near it, cause blood to flow through the heart in an abnormal pattern or affect the heart's rhythm. Some defects go undetected throughout life but symptoms of CHDs in childhood are shortness of breath, underdeveloping of limbs and muscles, skin discolouration, poor feeding or growth and respiratory infections

    dementia:

    the irreversible loss of brain functioning caused by brain damage or disease. It becomes more common with age and leads to impaired judgement, memory and problem-solving ability. The main types of dementia are Alzheimer's disease, vascular dementia, fronto-temporal dementia, dementia with Lewy bodies and mixed dementia

    discourse:

    groups of ideas or patterned ways of thinking that shape the understanding about a particular subject in society. Use of language is central to the construction of discourses. A variety of discourses can exist at any one time; some discourses are more powerful than others and often reflect the interests of dominant and/or political groups

    discrimination:

    when members of a particular group in society are denied resources, rewards and opportunities that are available to and can be obtained by others in society

    dysporia:

    a medically recognised transient psychological condition in which a person experiences intense feelings of sadness, sorrow and anguish, anxiety and discontent. It is also accompanied by irritability and indifference to the world

    empty nest syndrome:

    refers to the negative reactions that parents experience when their children leave the parental home and the difficulties that they have in making the adjustments required. However, some parents enjoy their newfound sense of freedom

    encephalopathy:

    injury to the brain that may cause irreversible damage to the brain, resulting in a variety of brain disorders such as loss of cognitive function, seizures and respiratory abnormalities

    epidemiology:

    the study of patterns of disease within a population over time. It involves statistical measures to establish the risk factors of diseases as well as their social origins and transmission

    exercise referral schemes:

    these aim to identify inactive adults in the primary care setting. They involve referral to a third-party service that takes responsibility for prescribing and monitoring an exercise programme tailored to the needs of individual patients

    externalising behaviour problems:

    childhood behaviour problems that are manifested in outward behaviour and reflect the child negatively acting on the external environment. Examples are disruptive, hyperactive and aggressive behaviours. Studies show that childhood externalising behaviour problems are strong predictors of adult crime and violence

    Female Athlete Triad (FAT):

    this is most common amongst young women who take part in sports that emphasise low body weight (for example, ballet dancing and ice-skating) and is the physical manifestation of the pathological pursuit of exercise regimes. It is often coupled with an inappropriate diet

    Fetal Alcohol Spectrum Disorders (FASD):

    these occur because of the way that alcohol damages fetal brain development and the central nervous system. This damage can result in facial deformities, physical and emotional developmental problems, memory and attention deficits, as well as cognitive and behavioural problems

    gestational diabetes:

    high blood glucose (hyperglycaemia) during pregnancy. In most cases it can be controlled through diet and exercise and does not continue beyond pregnancy. However, women with gestational diabetes are at increased risk of developing Type 2 diabetes mellitus in later life

    glaucoma:

    an eye disease that involves pressure resulting from a buildup of fluid within the eye which causes damage to the optic nerve. It can be successfully treated but if left untreated it can destroy vision

    health-related quality of life:

    a broad, multidimensional concept that encompasses physical and mental health, social and role functioning and general well-being.

    Human Immunodeficiency Virus (HIV):

    a virus that causes Acquired Immune Deficiency Syndrome (AIDS). The latter is a condition that results in the progressive failure of the immune system that in turn leads to life-threatening infections and cancers. HIV infections can be transferred during unsafe sex, use of contaminated needles, through breast milk and from an infected mother to her baby at birth. Although HIV is still incurable, treatment with antiretroviral drugs usually reduces both the mortality and the morbidity of those infected with the virus

    hypertension:

    this is also known as high blood pressure and occurs when the heart has to work harder than it should to pump the blood around the body. This puts a strain on the arteries and the heart and persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure, arterial aneurysm and chronic kidney failure. Moderate hypertension can also shorten life expectancy. Although dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, drug treatment is often necessary for patients for whom lifestyle changes prove ineffective or insufficient

    in utero:

    this literally means ‘in the uterus’. It has different meanings in different contexts; in biology, the phrase is used to describe the state of an embryo or fetus. In legal contexts, it is used to refer to unborn children

    ischaemic heart disease:

    a disease characterised by reduced blood supply to the heart muscle. Symptoms include chest pain on exertion and decreased exercise tolerance. It is a major cause of hospital admissions and the most common cause of death in most Western countries

    lone parent family:

    usually defined as a divorced, separated, single or widowed mother or father living without a spouse (and not cohabiting) with his or her never-married dependent child or children

    low birth weight:

    this refers to a baby who weighs less than 2500 grams (5 lbs) at birth

    menarche:

    the beginning of a woman's reproductive life that coincides with the onset of menstruation

    menopause:

    typically occurs in women between the ages of 42–58 and is officially defined as being reached a year after a woman's last period. It involves a set of changes over a number of years: the ovaries slowly produce less oestrogen and progesterone, which leads to irregular menstruation and its eventual complete cessation. Menopausal symptoms include vaginal dryness, night sweats, hot flushes, increased stress, breast tenderness, forgetfulness and mood changes. Women are at a much higher risk of osteoporosis after the menopause as lowered oestrogen levels lead to bone loss

    morbidity rates:

    the number and patterns of physical and mental illnesses within a designated group at a given time, expressed as a rate per 100,000 of the population

    mortality rates:

    the number and causes of deaths within a designated group at a given time, expressed as a rate per 100,000 of the population

    motherchild attachment:

    the bond between a mother and child. This requires continuity and sensitivity in care-giving from babyhood, and plays an important role in a child's future development in general but particularly in their mental health

    neuroendocrine systems:

    the interactions that take place between the nervous system and the endocrine system that control essential physiological functions such as reproduction in all of its aspects, metabolism, blood pressure and the body's response to stress and infection

    non-accidental injury:

    the deliberate physical or psychological/emotional mistreatment or neglect of a vulnerable person, such as a child or an old person, that results in harm, potential for harm or threat of harm to that person

    obesity:

    a level of body fat that is harmful. A person is considered obese if they have a Body Mass Index (BMI) of 30 or more

    obsessive compulsive disorder (OCD):

    an anxiety disorder characterised by recurrent urges to repeat certain behaviours or avoid certain situations. Examples are repeated checking and excessive washing or cleaning

    overweight:

    this involves an excess of body fat and having a Body Mass Index (BMI) of 25 or more

    perinatal asphyxia:

    this is the medical condition resulting from deprivation of oxygen during labour. It can lead to brain damage and long-term physical and cognitive impairment

    poor fetal growth:

    definitions are controversial and there are many influences on fetal growth. Poor fetal growth is most commonly said to be occurring when a fetus is small for its gestational age

    pre-eclampsia:

    affects 2 to 5 per cent of pregnancies. It is usually diagnosed from around 20 weeks and is most common in the third trimester of pregnancy. There are usually no symptoms apart from protein in the urine and a high blood pressure reading. If untreated, pre-eclampsia can have serious consequence for the mother and her unborn child

    pregnancy trimesters:

    pregnancy is typically broken into three trimesters to describe the changes that take place. Each trimester is about three months: the first trimester is weeks 1 to 12, the second is weeks 13 to 27, and the third is weeks 28 to 42

    presbycusis:

    age-related hearing loss that affects around 40 per cent of those over 65

    preterm birth:

    refers to the birth of a baby at less than 37 weeks gestation. Births at less than 32 weeks gestation are known as ‘very preterm births’ whilst those between 32 and 36 weeks gestation are called ‘moderately preterm birth’

    psychopathology:

    a generic term used to describe mental illness, mental distress and abnormal/maladaptive behaviour

    public health:

    this movement aims to improve lives by reducing inequalities in the incidence of ill health and diseases (such as heart disease and mental illness) at population and community level, rather than at an individual level. The focus of public health intervention is the prevention of health problems and identifying illness at a stage where treatment is more likely to be effective. It makes extensive use of the life course approach to track the causes, progression and pattern of health problems in order to identify the most effective ways of preventing them from developing at different life stages

    puerperal psychoses:

    also known as postpartum psychoses and refers to a group of mental illnesses that start suddenly following childbirth. Some patients have manic symptoms, such as euphoria, hyperactivity, irritability, violence and grandiose delusions. Others have severe depression, with delusions, verbal hallucinations and stupor. There are also those who switch from mania to depression (or vice versa) within the same episode

    reconstituted family:

    a household unit including a stepparent as a consequence of divorce, separation and remarriage. This type of family is created when a new partnership is formed by a mother and/or father who already have dependent children. Since most children remain with their mother following divorce or separation, stepfamilies are more likely to have a stepfather than a stepmother

    sexually transmitted diseases (STDs):

    these are illnesses that are usually transmitted between humans by means of human sexual behaviour, including vaginal intercourse, oral sex and anal sex. Some STDs can also be transmitted via the use of intravenous (IV) drug needles after their use by an infected person, as well as through childbirth or breastfeeding. Examples are chlamydia, gonorrhea and genital warts. STDs are also known as sexually transmitted infections (STIs)

    social construction:

    this refers to the way that aspects of society or behaviour are ‘constructed’ in a particular way as a result of social relations and human agency rather than being ‘natural’ or biological in origin. Social constructions vary historically, socially and culturally and are therefore essentially contestable

    social support:

    this is provided by positive involvement in social networks. It has been shown to act as a buffer to stress and mental ill health, particularly if intimate and confiding relationships are involved

    status inconsistency:

    where someone ranks high on one status indicator, such as education, but low on another, such as occupation or income

    substance use disorder:

    the pathological overindulgence in and dependence on a non-medical drug or other chemical. This disorder has detrimental effects on physical and mental health as well as having adverse social consequences, such as failure to meet school, work and family commitments, interpersonal conflicts and legal problems

    suicidal ideation:

    a term for thoughts about suicide, which may involve a detailed plan. Whilst most people who engage in suicidal ideation do not commit suicide, some do go on to attempt suicide

    teenage birth rate:

    the number of births per 1000 women aged 15 to 19

    Type 1 diabetes:

    this occurs when the body does not produce any insulin at all and involves insulin injections for life. It is therefore often referred to as insulin-dependent diabetes. Those with Type 1 diabetes also have to make sure that their blood glucose levels stay balanced by eating a healthy diet and carrying out regular blood tests

    Type 2 diabetes:

    this is far more common than Type 1 diabetes and is often associated with obesity. It occurs when not enough insulin is produced by the body for it to function properly, or when the body's cells do not react to insulin. Those with Type 2 diabetes are usually able to control their symptoms by eating a healthy diet and monitoring their blood glucose level. However, as Type 2 diabetes is a progressive condition, they may eventually need to take insulin medication, usually in the form of tablets

    venous thrombosis:

    a blood clot in the vein is called a venous thrombosis, and an example of this is deep vein thrombosis (DVT) when a blood clot occurs in a deep vein, usually in the leg. The usual symptoms of deep vein thrombosis include pain, tenderness, swelling of the leg and possible discolouration. If the thrombosis is in the thigh veins the whole leg may be swollen

    vital organs:

    these are the cardiovascular, respiratory, digestive, lymphatic and renal/urinary organs. They are vital to the human body because they work together to do necessary jobs needed for our survival

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