特別演講1:2022台灣醫學週台灣聯合醫學會學術演講會
       開幕典禮及大會特別演講節目程序表

程 序 表

P-2
Earlier, Deeper, Upstream: A Life-Course Approach to Improving Population Health
Michael C Lu, MD, MS, MPH
Dean School of Public Health,
University of California, Berkeley USA

Background. The author presents a theoretical framework for understanding the origins of health and disease from a life-course perspective. He then discusses the implications of this framework for preventing chronic diseases and improving population health in Taiwan.
Methods. The author reviews the literature on two longitudinal models of health and disease development, and presents a unified framework which reconceptualizes the origins of health and disease from a life-course perspective.
Results. Two leading longitudinal models of health development were presented. The early programming model posits that early life exposures can influence future health outcomes. Recent evidence for developmental (including periconceptional) origins of future reproductive outcomes was reviewed. Epigenetic modifications as a possible mechanism for early programming was examined. The cumulative pathways model reconceptualizes decline in health resulting from chronic wear and tear to the body’s allostatic systems. The impact of chronic stress and racism on reproductive health was discussed.
Conclusions. The life-course perspective suggests that clinical and public health efforts to prevent chronic diseases and improve population health must intervene earlier, deeper, and more upstream than previously thought. Future chronic disease prevention research should focus on elucidating early and long-term biological, behavioral, psychological, and social precursors to disease, and identifying windows along the pre-disease pathways most amenable to interventions. For example, prevention of neurodegenerative diseases may need to begin decades prior to the onset of cognitive symptoms. Preventing chronic diseases and improving population health in Taiwan will also require multilevel societal efforts to address the root cause of chronic stress and poor health, as well as upstream social, economic, and political determinants of health and disease.