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A life course approach to women’s health
  1. T R B Johnson

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    D Kuh, R Hardy. (Pp 419; £37.50). Oxford University Press, 2002. ISBN 0-19-263289-2

    I am grateful to have had the opportunity to review this book. By combining “life course epidemiology,” which the authors define as “the study of biological and social factors acting independently, interactively and cumulatively during gestation, childhood, adolescence, and adult life on health outcomes in later life” with the study of women’s health, they have given us a major contribution. Many of the chapters were first presented at a September 2001 conference in Oxford, England, but the book is much richer, more complete, and more comprehensive than usual for this format.

    The first chapter describes in detail the life course approach and asks “whether the emerging life course models of health provide explanations for long-term disease trends, and whether they are relevant for understanding the future health of women now reaching middle-age in developed and less developed countries.” Subsequent chapters richly expand on the life course approach as applied to particular healthcare problems of women including reproductive health, breast cancer, menopause, stroke, diabetes, musculoskeletal disorders, and depression. Chapters on overweight and obesity, sexually transmitted infections, and a notable chapter on issues relevant to women in the developing world deserve careful reading. The various links of biological and social pathways from childhood to adult life are considered in detail.

    The authors recognise the challenge and emphasise the need to investigate whether childhood risk factors operate mainly through their effects on conventional adult risk factors, whether they add to independent risk, or whether they interact with later life factors to affect adult disease. As they rightly state, “identification of the pathways across the life course may have important policy implications.” This book would be very useful to those who want to understand “life course” methodology and to integrate it into their own clinical or research practice. The book does a particularly good job of describing the current state of knowledge (beginning with the “Barker hypothesis”) and the multiple interdisciplinary and transdisciplinary applications of the methodology. It also provides up to date references and concrete recommendations on future lines of clinical, scholarly, and public policy research.