Justification and Workshops Aims

Empirical studies have shown that exposure to poor conditions in early life influences children’s development and can have negative, long-lasting health consequences. Children exposed to poor conditions in utero are at higher risk for heart disease, stroke and diabetes in later life, and they have lower educational attainment, lifetime earnings and greater disability than healthy cohorts (Almond and Currie, 2011; Barker, 1997; Gluckman et al 2008). Biologists have also been developing evolutionary and life cycle theories to explain these relationships where poor conditions in utero lead to diminished health in early life and to poorer health and socioeconomic outcomes in later life. In turn, the health of one generation contributes to the conditions in which the next develops, adding an intergenerational dimension to early life health (Gluckman and Hanson, 2006; Wells, 2012; Bogin et al., 2007).

These important empirical and theoretical findings demand that health conditions in utero be incorporated into a broader understanding of public health. Because evidence on specific factors influencing conditions in utero is often unavailable, it is necessary to use proxies of early life health to compare the prevalence of deficiencies in utero across populations. Unfortunately, there are relatively few proxy measures for early life health to make this possible. The most commonly used indicator is birth weight, but it is problematic for several reasons. First, developmental plasticity manifests itself in many aspects of human development, not just growth. In addition, weight at birth does not capture information about growth trajectory in utero. Birth weight has also remained fairly constant across generations even when it seems likely that early-life conditions were improving. There are however a number of other proxies for historical and contemporary periods that have not been exploited fully and can provide a starting point for this discussion.

This workshop aimed to bring together a group of researchers with disparate expertise related to early life health to discuss the strengths, weaknesses and complexities of various proxies for early life health conditions: birth weight, neonatal mortality rate, stillbirth rate, childhood growth and final adult height to name a few. We will focus on two crucial questions:

(1) Which early life health proxies could historians, economists and demographers collect and analyse in the nineteenth and twentieth centuries to better understand improvements in health during those centuries? 

(2) Which early life health proxies would be most optimal to adopt in both developing and developed countries today in order to assess and monitor  the profile of early life health?

Different disciplines have crucial strengths to bring to the overall research agenda. Biologists can provide clarity about the biological mechanisms underpinning developmental plasticity. Epidemiologists provide insights from longitudinal and multigenerational cohorts. Economic and demographic historians can produce long-run estimates of early-life health proxies (Ward, 1993; Woods, 2009). Health economists bring empirical rigour and provide models for understanding the interactions between human capital and health (Almond and Currie, 2011). Demographers and sociologists of the family provide insight into how social and cultural factors such as maternal education influence early life health (Monden and Smits, 2013). Finally, health policy makers have a practical understanding of how easily additional or new indicators could be adopted.