Please wait a minute...
浙江大学学报(医学版)  2021, Vol. 50 Issue (4): 411-419    DOI: 10.3724/zdxbyxb-2021-0155
医学与社会     
生命历程健康发展模型及其启示
柯玉叶1,2(),柴晓运3,*()
1.湖北医药学院卫生管理与卫生事业发展研究中心,湖北 十堰 442000
2.湖北医药学院护理学院,湖北 十堰 442000
3.湖北医药学院应用心理学系,湖北 十堰 442000
The life course health development model: a new approach to understanding human health
KE Yuye1,2(),CHAI Xiaoyun3,*()
1. Center of Health Administration and Development Studies, Hubei University of Medicine, Shiyan 442000, Hubei Province, China;
2. School of Nursing, Hubei University of Medicine, Shiyan 442000, Hubei Province, China;
3. Department of Applied Psychology, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
 全文: PDF(2336 KB)   HTML( 34 )
摘要:

生命历程健康发展模型作为健康科学领域前沿的理论模型,超越了先前的生物医学和生物心理社会模型,其从“过程”、“关系”、“系统”等多个角度,将健康视为一种在生命历程中不断动态变化的能力,并突出了优化个体健康发展轨迹和健康促进的重要性。该模型认为,应该从发展的角度去理解健康,健康发展具有展开性、复杂性、时机性、可塑性、充分性以及和谐性等特征。因此,健康研究及实践应转变思路,由过去仅仅关注精准诊断和治疗、疾病溯源等转变为充分利用人类发展的相对可塑性,通过在生命历程的各个阶段,增强健康发展能力和丰富健康资源,促进生理、心理、行为和文化等健康发展系统和谐平衡。基于上述理论,建议我国现阶段卫生事业:①加强生命全周期的健康教育,构建符合我国实际的健康促进模式;②重视生命早期的健康促进和疾病预防;③加大对健康促进和健康教育的投入,而不仅仅是疾病治疗的投入。

关键词: 生命历程健康发展模型健康健康促进疾病预防公共卫生    
Abstract:

The life course health development (LCHD) model is a cutting-edge theoretical model for the health science, which moves beyond the previous biomedical and biopsychosocial model. From the perspectives of “process, relationship and system”, it recognizes health as a dynamic ability to change over the course of life, and highlights the importance of optimizing individual health trajectories and health promotion. According to LCHD model, we should understand health from the perspective of development, which is characterized by unfolding, complexity, timing, plasticity, thriving and harmony. Health research and practice, therefore, should change ideas from the focus on accurate diagnosis, treatment and etiology previously to full using the relative plasticity of human development to enhance health development ability, enrich health resources and promote the healthy development of physiology, psychology, behavior and culture system; and to achieve a harmonious balance in the different stages of the life course. Based on the LCHD model, it is suggested for our country’s health service system (1) to strengthen the health education across the life-span and construct the health promotion model based on the social system; (2) to pay more attention to health promotion and disease prevention in early life; (3) to increase government spending on health promotion and prevention, not just on disease treatment.

Key words: Life course health development model    Health    Health promotion    Disease prevention    Public health
收稿日期: 2020-12-20 出版日期: 2021-11-01
CLC:  R19-0  
基金资助: 湖北省普通高等学校人文社会科学重点研究基地基金(湖北医药学院,2017YB006);湖北医药学院人才启动基金(2019QDJRW03)
通讯作者: 柴晓运     E-mail: jadeleaf_ke@163.com;xy_chai@hbmu.edu.cn
作者简介: 柯玉叶,讲师,主要从事健康教育、护理教育研究;E-mail:jadeleaf_ke@163.com;https://orcid.org/0000-0003-2871-6716
服务  
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章  
柯玉叶
柴晓运

引用本文:

柯玉叶,柴晓运. 生命历程健康发展模型及其启示[J]. 浙江大学学报(医学版), 2021, 50(4): 411-419.

KE Yuye,CHAI Xiaoyun. The life course health development model: a new approach to understanding human health. J Zhejiang Univ (Med Sci), 2021, 50(4): 411-419.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0155        http://www.zjujournals.com/med/CN/Y2021/V50/I4/411

图 1  健康发展概念模型的演化健康及其相关概念的演变路径(黑色实线箭头)历经了生物医学模型到生物心理社会模型,再到更整合的生命历程健康发展模型的过程,在哲学认识论上反映了从最初的简单还原论,到复杂的系统论、关系论的变化. 这些变化的根本在于多学科视角对健康研究的影响(灰色实线箭头),如流行病学、生命历程社会学、表观遗传学、人类毕生发展心理学和神经发育学等.
1 HALFON N, FORREST C B. The emerging theoretical framework of life course health development[M]//HALFON N, FORREST C B, LERNER R M, et al. Handbook of life course health development. Cham, Switzerland: Springer, 2018: 18-43
2 WHO. Constitution of the World Health Organization[A/OL]. (2006-10)[2021-05-26]. https://www.who.int/governance/eb/who_constitution_en.pdf
3 朱素蓉, 王娟娟, 卢 伟. 再谈健康定义的演变和认识[J]. 中国卫生资源, 2018, 21(2): 180-184
ZHU Surong, WANG Juanjuan, LU Wei. Re-recognition of health: evolution and definition[J]. Chinese Health Resources, 2018, 21(2): 180-184. (in Chinese)
4 HUBERM, KNOTTNERUSJ A, GREENL, et al.How should we define health?[J]BMJ, 2011, d4163.
doi: 10.1136/bmj.d4163
5 ZAUTRA A J, HALL J S, MURRAY K E. Resilience: a new definition of health for people and communities [M]//REICH J W.Handbook of adult resilience. New York: Guilford Press, 2010: 3-29
6 HALFONN, LARSONK, LUM, et al.Life course health development: past, present and future[J]Matern Child Health J, 2014, 18( 2): 344-365.
doi: 10.1007/s10995-013-1346-2
7 HALFONN, HOCHSTEINM. Life course health development: an integrated framework for developing health, policy, and research[J]Milbank Q, 2002, 80( 3): 433-479.
doi: 10.1111/1468-0009.00019
8 FORRESTC B. A living systems perspective on health[J]Med Hypotheses, 2014, 82( 2): 209-214.
doi: 10.1016/j.mehy.2013.11.040
9 LERNER R M, BRINDIS C D, BATANOVA M, et al. Adolescent health development: a relational developmental systems perspective[M]//HALFON N, FORREST C B, LERNER R M, et al. Handbook of life course health development. Cham, Switzerland: Springer, 2018: 109-121
10 MCDADET W, HARRISK M. The biosocial approach to human development, behavior, and health across the life course[J]RSF, 2018, 4( 4): 2-26.
doi: 10.7758/RSF.2018.4.4.01
11 DAWBERT R, KANNELW B, GORDONT. Coffee and cardiovascular disease[J]N Engl J Med, 1974, 291( 17): 871-874.
doi: 10.1056/NEJM197410242911703
12 BERKMANL F, SYMES L. Social networks, host resistance, and mortality: a nine-year follow-up study of alameda county residents[J]Am J Epidemiol, 1979, 109( 2): 186-204.
doi: 10.1093/oxfordjournals.aje.a112674
13 ENGELG L. The need for a new medical model: a challenge for biomedicine[J]Science, 1977, 196( 4286): 129-136.
doi: 10.1126/science.847460
14 ELDER JrG H. Time, human agency, and social change: perspectives on the life course[J]Soc Psychol Q, 1994, 57( 1): 4-15.
doi: 10.2307/2786971
15 LERNERR M. Developmental science: past, present, and future[J]Int J Dev Sci, 2012, 6( 1-2): 29-36.
doi: 10.3233/DEV-2012-12102
16 BALTESP B, SMITHJ. Lifespan psychology: from developmental contextualism to developmental biocultural co-constructivism[J]Res Human Dev, 2004, 1( 3): 123-144.
doi: 10.1207/s15427617rhd0103_1
17 KITANOH. Systems biology: a brief overview[J]Science, 2002, 295( 5560): 1662-1664.
doi: 10.1126/science.1069492
18 BOYCEW T, SOKOLOWSKIM B, ROBINSONG E. Toward a new biology of social adversity[J]Proc Natl Acad Sci U S A, 2012, 17143-17148.
doi: 10.1073/pnas.1121264109
19 ELKSC E, LOOSR J F, HARDYR, et al.Adult obesity susceptibility variants are associated with greater childhood weight gain and a faster tempo of growth: the 1946 British Birth Cohort Study[J]Am J Clin Nutr, 2012, 95( 5): 1150-1156.
doi: 10.3945/ajcn.111.027870
20 BARKERD J, OSMONDC, LAWC M. The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis[J]J Epidemiol Community Health, 1989, 43( 3): 237-240.
doi: 10.1136/jech.43.3.237
21 OVERTONW F. A new paradigm for developmental science: relationism and relational-developmental systems[J]Appl Dev Sci, 2013, 17( 2): 94-107.
doi: 10.1080/10888691.2013.778717
22 OVERTON W F. Processes, relations, and relational-developmental-systems[M]//LERNER R M. Handbook of child psychology and developmental science. 7th ed, Hoboken: Wiley, 2015: 9-62
23 DAVIES J. Life unfolding: how the human body creates itself[M]. Oxford: Oxford University Press, 2014: 3-14
24 ELLISB J, BIANCHIJ M, GRISKEVICIUSV, et al.Beyond risk and protective factors: an adaptation-based approach to resilience[J]Perspect Psychol Sci, 2017, 12( 4): 561-587.
doi: 10.1177/1745691617693054
25 HENRICH J. The secret of our success: how culture is driving human evolution, domesticating our species, and making us smarter[M]. Princeton: Princeton University Press, 2015: 34-53
26 MOORE K L, PERSAUD T V N. Before we are born[M]. 6th ed, Philadelphia: Saunders, 2003: 1-5
27 CANTORP, OSHERD, BERGJ, et al.Malleability, plasticity, and individuality: how children learn and develop in context[J]Appl Dev Sci, 2019, 23( 4): 307-337.
doi: 10.1080/10888691.2017.1398649
28 O’RANDA M. The precious and the precocious: Understanding cumulative disadvantage and cumulative advantage over the life course[J]Gerontologist, 1996, 36( 2): 230-238.
doi: 10.1093/geront/36.2.230
29 STILOS A, GAYER-ANDERSONC, BEARDSS, et al.Further evidence of a cumulative effect of social disadvantage on risk of psychosis[J]Psychol Med, 2017, 47( 5): 913-924.
doi: 10.1017/S0033291716002993
30 BELSKYJ, PLUESSM. Beyond risk, resilience, and dysregulation: phenotypic plasticity and human development[J]Dev Psychopathol, 2013, 25( 4 pt 2): 1243-1261.
doi: 10.1017/S095457941300059X
31 BATESON P, GLUCKMAN P. Plasticity, robustness, development and evolution[M]. Cambridge: Cambridge University Press, 2011: 46-62
32 LERNERR M, TIRRELLJ M, DOWLINGE M, et al.The end of the beginning: evidence and absences studying positive youth development in a global context[J]Adolesc Res Rev, 2019, 4( 1): 1-14.
doi: 10.1007/s40894-018-0093-4
33 GESTSDOTTIRS, LERNERR M. Positive development in adolescence: the development and role of intentional self-regulation[J]Human Dev, 2008, 51( 3): 202-224.
doi: 10.1159/000135757
34 王 媛, 曹新西, 侯亚冰, 等. 1990和2017年中国与全球心血管病疾病负担研究[J]. 中国慢性病预防与控制, 2020, 28(11): 10-13, 19
WANG Yuan, CAO Xinxi, HOU Yabing, et al. Studyon Chinese and global cardiovascular diseases burden in 1990 and 2017[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2020, 28(11): 10-13, 19. (in Chinese)
35 曾 见. 论《基本医疗卫生与健康促进法》的健康扶贫政策[J]. 中国卫生事业管理, 2020, 37(11): 827-830
ZENG Jian. Discussing the health poverty alleviation policy based on Basic Health Care and Health Promotion Act[J]. Chinese Health Service Management, 2020, 37(11): 827-830. (in Chinese)
36 程勋杰, 胡国清. 人口老龄化所致健康影响研究进展[J]. 中华流行病学杂志, 2020, 41(11): 1915-1920
CHENG Xunjie, HU Guoqing. Progress in research of burden of disease attributed to population aging[J]. Chinese Journal of Epidemiology, 2020, 41(11): 1915-1920. (in Chinese)
37 李长宁, 李英华, 卢 永. 健康促进与教育事业发展70年巡礼[J]. 中国健康教育, 2019, 35(9): 771-774
LI Changning, LI Yinghua, LU Yong. An overview of 70 years of health promotion and education undertaking development [J]. Chinese Journal of Health Education, 2019, 35(9): 771-774. (in Chinese)
38 李长宁, 卢 永. 健康促进视角下的我国新冠疫情应对[J]. 中国健康教育, 2020, 36(9): 866-869
LI Changning, LU Yong. China’ s response for COVID-19 epidemic from the perspective of health promotion[J]. Chinese Journal of Health Education, 2020, 36(9): 866-869. (in Chinese)
39 HALFONN, LARSONK, RUSSS. Why social determinants?[J]Healthc Q, 2010, 14( sp1): 8-20.
doi: 10.12927/hcq.2010.21979
40 BEN-SHLOMOY, KUHD. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives[J]Int J Epidemiol, 2002, 31( 2): 285-293.
doi: 10.1093/ije/31.2.285
41 PALISANOR J, DI REZZEB, STEWARTD, et al.Life course health development of individuals with neurodevelopmental conditions[J]Dev Med Child Neurol, 2017, 59( 5): 470-476.
doi: 10.1111/dmcn.13402
42 HALFONN. Addressing health inequalities in the US: a life course health development approach[J]Soc Sci Med, 2012, 74( 5): 671-673.
doi: 10.1016/j.socscimed.2011.12.016
43 王晓赞, 杨燕国, 孔 琳, 等. 历史演进与政策嬗变: 从“增强体质”到“体教融合”——中国儿童青少年体育健康促进政策演进的特征分析[J]. 中国体育科技, 2020, 56(10): 3-10
WANG Xiaozan, YANG Yanguo, KONG Lin, et al. Historical evolution and policy change: from strengthening physical fitness to integration of sports and education——a characteristic analysis of the evolution of physical education and health promotion policies for children and adolescents in China[J]. China Sport Science and Technology, 2020, 56(10): 3-10. (in Chinese)
[1] 宋林阳,温文智,刘靖,金小宝,杨俊华. 孕期多种低剂量化学物质暴露诱发子代炎症状态和自闭症样行为的实验研究[J]. 浙江大学学报(医学版), 2021, 50(3): 279-289.
[2] 陈云燕,吴琪,张丽霞,陈丹青,梁朝霞. 妊娠糖尿病孕妇孕中期口服葡萄糖耐量试验异常项数及孕期增重与不良妊娠结局的关系[J]. 浙江大学学报(医学版), 2021, 50(3): 313-319.
[3] 秦建芬,潘红英,张熔熔,汤磊雯,毛霞文. 实施标准化痰标本采集法可提高人群痰标本获取率[J]. 浙江大学学报(医学版), 2020, 49(5): 614-617.
[4] 王维丹,徐方忠,徐松泉,章健民,张宁. 突发公共卫生事件对公众心理的影响:2019冠状病毒病疫情期间浙江省心理援助热线来电分析[J]. 浙江大学学报(医学版), 2020, 49(4): 409-418.
[5] 杨盛旭,魏晶娇,何凡. 赤潮所致贝类毒素中毒事件风险评估指标体系及应用研究[J]. 浙江大学学报(医学版), 2018, 47(2): 111-117.
[6] 吴家兵,龚磊,陈芳,宋丹丹,马婉婉,侯赛. 洪涝灾害公共卫生风险评估指标体系的构建及应用[J]. 浙江大学学报(医学版), 2018, 47(2): 118-123.
[7] 戚小华,王心怡,何凡,刘碧瑶,章涛,李傅冬,翟羽佳,林君芬. 大型活动期间举办地外围地区突发传染病事件公共卫生风险评估[J]. 浙江大学学报(医学版), 2018, 47(2): 124-130.
[8] 陈蓉,何永超,张放,陆殷昊,何懿. 疾病预防控制机构卫生应急能力评估指标体系构建[J]. 浙江大学学报(医学版), 2018, 47(2): 137-142.
[9] 何苗 等. 特殊疾病医疗保险对糖尿病患者治疗费用的影响及相关因素分析[J]. 浙江大学学报(医学版), 2016, 45(3): 323-329.
[10] 杨兴娄;葛行义;胡犇;石正丽. 埃博拉病毒病流行病学[J]. 浙江大学学报(医学版), 2014, 43(6): 621-645.
[11] 王倩倩;朱依敏;吴明远. 体外受精母亲与子代健康状况分析[J]. 浙江大学学报(医学版), 2009, 38(5): 515-520.
[12] 沈正荣, 彭淑牖. 采用急性生理学和慢性健康估计评分法判别严重腹膜炎的预后[J]. 浙江大学学报(医学版), 1996, 25(2): 77-79.