Life Course Health Development Framework

The Emerging Theoretical Framework of Life Course Health Development: An LCRN Webinar with Neal Halfon & Christopher Forrest

This webinar, part of the LCRN’s series based on the Handbook of Life Course Health Development, features Neal Halfon, MD, MPH – director of the Life Course Research Network (LCRN) – and Christopher B. Forrest, MD, PhD – pediatrician at Children’s Hospital of Philadelphia.

In this webinar, Drs. Halfon and Forrest will present the 7 principles that comprise their life course health development framework, including the empirical evidence that underlies each principle and the implications for future research. By shining a light on how early experience conditions future biological responses and influences health development pathways, the presenters hope to encourage theory building and testing, inspire innovative transdisciplinary research, and lead to future discussions that can help to mature the framework into a scientific model with descriptive, explanatory, and predictive utility.

Reproduced from:

Table1. Principles of the Life Course Health Development Framework


Brief description

1. Health Development

Health development integrates the concepts of health and developmental processes into a unified whole

2. Unfolding

Health development unfolds continuously over the lifespan, from conception to death, and is shaped by prior experiences and environmental interactions

3. Complexity

Health development results from adaptive, multilevel, and reciprocal interactions between individuals and their physical, natural, and social environments

4. Timing

Health development is sensitive to the timing and social structuring of environmental exposures and experiences

5. Plasticity

Health development phenotypes are systematically malleable and enabled and constrained by evolution to enhance adaptability to diverse environments

6. Thriving

Optimal health development promotes survival, enhances well-being, and protects against disease

7. Harmony

Health development results from the balanced interactions of molecular, physiological, behavioral, cultural, and evolutionary processes

Fig. 1 The evolution of conceptual models of health development

Fig. 1 The evolution of health development: this figure diagrams the evolution of two converging and interacting streams of scientific inquiry and conceptual model building. The first stream of Biological System Ideas and Theories charts the development of major conceptual constructs in relation to new ways of understanding how biological systems function. It shows how Darwinian notions of evolution and Mendelian notions of genetics were influenced by other fields of biology but eventually resulted in the Neo-Darwinian synthesis that forms the basis of modern molecular biology. This stream has continued to evolve under the influence of new discoveries in systems biology, genomics, epigenetics, and the application of complex systems science to biological systems. The Medical and Health System Ideas and Theories charts the evolution of the simple, linear and mechanistic biomedical model, and how the biomedical model of health and disease was transformed into a more hierarchical, dynamic and multiply determined biopsychosocial model, which has subsequently evolved into a complex, relational model of LCHD. The Eras of Modern Health Care suggest the approximate timing of these conceptual changes in relationship to how health care has been organized and delivered.



Halfon N, Hochstein M. Life Course Health Development: An Integrated Framework for Developing Health, Policy, and Research. The Milbank Quarterly. 2002;80(3):433-479. doi:10.1111/1468-0009.00019.

This article describes the Life Course Health Development (LCHD) framework, which was created to explain how health trajectories develop over an individual’s lifetime and how this knowledge can guide new approaches to policy and research. Using recent research from the fields of public health, medicine, human development, and social sciences, the LCHD framework shows that

  • Health is a consequence of multiple determinants operating in nested genetic, biological, behavioral, social, and economic contexts that change as a person develops.
  • Health development is an adaptive process composed of multiple transactions between these contexts and the biobehavioral regulatory systems that define human functions.
  • Different health trajectories are the product of cumulative risk and protective factors and other influences that are programmed into biobehavioral regulatory systems during critical and sensitive periods.
  • The timing and sequence of biological, psychological, cultural, and historical events and experiences influence the health and development of both individuals and populations.

Based on the relationship between experience and the biology and psychology of development, the LCHD framework offers a conceptual model for health development and a more powerful approach to understanding diseases. Throughout this article, we illustrate how risk factors, protective factors, and early-life experiences affect people’s long-term health and disease outcomes. A better understanding of health development should enable us to manipulate early risk factors and protective factors and help shift our emphasis on treatment in the later stages of disease to the promotion of earlier, more effective preventive strategies and interventions focused on maximizing optimal health development.

Halfon N, Larson K, Lu M, Tullis E, Russ S. Lifecourse Health Development: Past, Present and Future. Maternal and Child Health Journal. 2014;18(2):344-365. doi:10.1007/s10995-013-1346-2.


During the latter half of the twentieth century, an explosion of research elucidated a growing number of causes of disease and contributors to health. Biopsychosocial models that accounted for the wide range of factors influencing health began to replace outmoded and overly simplified biomedical models of disease causation. More recently, models of lifecourse health development (LCHD) have synthesized research from biological, behavioral and social science disciplines, defined health development as a dynamic process that begins before conception and continues throughout the lifespan, and paved the way for the creation of novel strategies aimed at optimization of individual and population health trajectories. As rapid advances in epigenetics and biological systems research continue to inform and refine LCHD models, our healthcare delivery system has struggled to keep pace, and the gulf between knowledge and practice has widened. This paper attempts to chart the evolution of the LCHD framework, and illustrate its potential to transform how the MCH system addresses social, psychological, biological, and genetic influences on health, eliminates health disparities, reduces chronic illness, and contains healthcare costs. The LCHD approach can serve to highlight the foundational importance of MCH, moving it from the margins of national debate to the forefront of healthcare reform efforts. The paper concludes with suggestions for innovations that could accelerate the translation of health development principles into MCH practice.

Keywords: Lifecourse health development, LCHD, Epigenetics, Systems biology, Genomics, Biopsychosocial, DOHaD, Complexity

Reproduced from:

Handbook of Life Course Health Development – 2018


Neal Halfon

Christopher B. Forrest

Richard M. Lerner

Elaine M. Faustman

This book is open access under a CC BY 4.0 license.

This handbook synthesizes and analyzes the growing knowledge base on life course health development (LCHD) from the prenatal period through emerging adulthood, with implications for clinical practice and public health. It presents LCHD as an innovative field with a sound theoretical framework for understanding wellness and disease from a lifespan perspective, replacing previous medical, biopsychosocial, and early genomic models of health. Interdisciplinary chapters discuss major health concerns (diabetes, obesity), important less-studied conditions (hearing, kidney health), and large-scale issues (nutrition, adversity) from a lifespan viewpoint.  In addition, chapters address methodological approaches and challenges by analyzing existing measures, studies, and surveys. The book concludes with the editors’ research agenda that proposes priorities for future LCHD research and its application to health care practice and health policy.

Topics featured in the Handbook include:

  • The prenatal period and its effect on child obesity and metabolic outcomes.
  • Pregnancy complications and their effect on women’s cardiovascular health.
  • A multi-level approach for obesity prevention in children.
  • Application of the LCHD framework to autism spectrum disorder.
  • Socioeconomic disadvantage and its influence on health development across the lifespan.
  • The importance of nutrition to optimal health development across the lifespan.

The Handbook of Life Course Health Development is a must-have resource for researchers, clinicians/professionals, and graduate students in developmental psychology/science; maternal and child health; social work; health economics; educational policy and politics; and medical law as well as many interrelated subdisciplines in psychology, medicine, public health, mental health, education, social welfare, economics, sociology, and law.


  • ACEs and health development science
  • Adverse childhood experiences and health development science
  • Autism and health across the life course
  • Biological embedding and health outcomes
  • Chronic kidney disease across the life course
  • Community and heath development
  • Developmental origins of chronic illnesses
  • Diabetes and life course health
  • Family and health development
  • Fetal programming and health development
  • Health disparities across the lifespan
  • Hearing loss and health development
  • Life course health development science
  • MCH and health development science
  • Maternal and child health over the life course
  • Nutrition and health across the lifespan
  • Obesity and health
  • Oral health across the life course
  • Self-regulation and health
  • Spina Bifada across the life course

Editors and affiliations

  • Neal Halfon
    • 1
  • Christopher B. Forrest
    • 2
  • Richard M. Lerner
    • 3
  • Elaine M. Faustman
    • 4
  1. Department of Pediatrics David Geffen School of Medicine, UCLA Los Angeles USA
  2. Applied Clinical Research Center Children’s Hospital of Philadelphia Philadelphia USA
  3. Tufts University Medford USA
  4. Institute for Risk Analysis and Risk Communication, Department of Environmental and Occupational Health Sciences, School of Public Health University of Washington Seattle USA

Bibliographic information

  1. Front Matter

    Pages i-xxiv
  2. Neal Halfon, Christopher B. Forrest, Richard M. Lerner, Elaine M. Faustman, Ericka Tullis, John Son
    Pages 1-16 Open Access
  3. Emerging Frameworks

    1. Front Matter

      Pages 17-17
    2. Neal Halfon, Christopher B. Forrest
      Pages 19-43 Open Access
  4. Life Stages

    1. Front Matter

      Pages 45-45
    2. Guoying Wang, Tami R. Bartell, Xiaobin Wang
      Pages 47-59 Open Access
    3. Marco DelGiudice
      Pages 95-107 Open Access
    4. Richard M. Lerner, Claire D. Brindis, Milena Batanova, Robert Wm. Blum
      Pages 109-121 Open Access
    5. David Wood, Tara Crapnell, Lynette Lau, Ashley Bennett, Debra Lotstein, Maria Ferris et al.
      Pages 123-143 Open Access
    6. Abigail Fraser, Janet M. Catov, Deborah A. Lawlor, Janet W. Rich-Edwards
      Pages 145-165 Open Access
  5. The Life Course Origins and Consequences of Select Major Health Conditions and Issues

    1. Front Matter

      Pages 167-167
    2. Summer Sherburne Hawkins, Emily Oken, Matthew W. Gillman
      Pages 169-196 Open Access
    3. Pamela Salsberry, Rika Tanda, Sarah E. Anderson, Manmohan K. Kamboj
      Pages 197-236 Open Access
    4. Irene E. Drmic, Peter Szatmari, Fred Volkmar
      Pages 237-274 Open Access
    5. Megan McClelland, John Geldhof, Fred Morrison, Steinunn Gestsdóttir, Claire Cameron, Ed Bowers et al.
      Pages 275-298 Open Access
    6. James J. Crall, Christopher B. Forrest
      Pages 299-320 Open Access
    7. Shirley A. Russ, Kelly Tremblay, Neal Halfon, Adrian Davis
      Pages 349-373 Open Access
    8. Patrick D. Brophy, Jennifer R. Charlton, J. Bryan Carmody, Kimberly J. Reidy, Lyndsay Harshman, Jeffrey Segar et al.
      Pages 375-401 Open Access
  6. Crosscutting Topics in Life Course Health Development

    1. Front Matter

      Pages 403-403
    2. Amanda Mummert, Meriah Schoen, Michelle Lampl
      Pages 405-429 Open Access
    3. Pilyoung Kim, Gary W. Evans, Edith Chen, Gregory Miller, Teresa Seeman
      Pages 463-497 Open Access
    4. Kandyce Larson, Shirley A. Russ, Robert S. Kahn, Glenn Flores, Elizabeth Goodman, Tina L. Cheng et al.
      Pages 499-520 Open Access
  7. Methodological Approaches

    1. Front Matter

      Pages 521-521
    2. Stephen L. Buka, Samantha R. Rosenthal, Mary E. Lacy
      Pages 541-560 Open Access
    3. Narayan Sastry, Paula Fomby, Katherine McGonagle
      Pages 579-599 Open Access
    4. Amanda Geller, Kate Jaeger, Garrett Pace
      Pages 601-620 Open Access
  8. Future Directions

    1. Front Matter

      Pages 621-621
    2. Neal Halfon, Christopher B. Forrest, Richard M. Lerner, Elaine M. Faustman, Ericka Tullis, John Son
      Pages 623-645 Open Access
  9. Neal Halfon, Christopher B. Forrest, Richard M. Lerner, Elaine M. Faustman
    Pages E1-E1 Open Access
  10. Back Matter

    Pages 647-664

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