10.2.5. Developmental factors and age
physical and mental health is linked to childhood developmental risk factors.
There is evidence for links between nutritional and psychological factors
during childhood and adult health. Identification of early developmental
factors offers possibilities for health promotion
activities already during foetal life and early infancy.
Environmental influence on health during foetal life and
infancy is significant (Seckl, 2008). Early life environmental events have
persisting effects on tissue structure and function, a phenomenon called
developmental programming. Although many developmental factors influence
health, the long-term effects of foetal nutrition and early psychological
attachment are linked with the strongest evidence from longitudinal studies
Data on developmental determinants of health are not
readily available in Europe. The European Community Health Indicator (ECHI)
long list includes the indicator “Pregnant women smoking”, but data collection
has not been implemented. The ECHI long list does not include indicators on
foetal nutrition or early attachment.
Neither the WHO Health for All database nor the Eurostat
statistics provide any information on developmental determinants of health. The
present section is built on scientific papers published in the open literature
and quoted in the relevant section.
The European Early Promotion Project (EEPP) was a research
project for developing and evaluating early mother and child interaction to
promote child health and prevent psychosocial problems (Puura et al, 2002). The
research was conducted in Finland, Great Britain, Greece, Cyprus and the former
Federal Republic of Yugoslavia, and it provides the only comparative European
data on early mother-child interaction.
description and analysis
The Barker theory links foetal malnutrition with risk for
physical diseases later in life. Empirical longitudinal cohort studies in
Europe have evidenced the association between low birth
weight or height and adult risk for high blood pressure, type 2
diabetes, and cardio-vascular death (Barker et al, 2005, Eriksson et al, 2006).
Longitudinal cohort studies from Finland, the Netherlands and UK have linked
low birth weight to mental disorders like schizophrenia
(Wahlbeck et al, 2001) and depression (Gale and Martyn, 2004). Therefore, it is
likely that impaired neurodevelopment during foetal life, due to malnutrition,
increases susceptibility to mental disorders. Foetal malnutrition can be due to
maternal malnutrition (being rare these days), placental dysfunction, gestational
diabetes or even maternal smoking. Longitudinal data from birth cohorts in
Europe indicate that maternal smoking during pregnancy is also associated with
psychological symptoms later in life (Bastra et al, 2003, Indredavik et al,
Human brain development is vulnerable. Environmental factors, in other words
divergent stimulus and the infant's emotional experiences from a relationship
with caregiver(s) are involved in formation of the mind. Some of this
development is experience-expectant, in other words, certain stimulus is needed
for normal development at a certain time. Some development on the other hand is
experience-dependent, less dependant of the time and quality of the stimulus
(Black 1998). Even though brain continues maturation till late adolescence, the
most important developmental period occurs during foetal life and childhood.
Infant's early relationship with the caregiver(s) (usually mother) i.e,
attachment relation, is associated with the child's social functioning and
adaptation in childhood and later in life. Caregiver's capability to respond to
the infant's needs gives the child emotional experience, which affects the
development of the infant's brain and even formation of permanent models of
behaviour. A multitude of research has linked early attachment problems with
psychological symptoms and disorders in childhood (Madigan et al, 2007) and
adolescence (Allen et al, 2007) and health problems of childhood (Mäntymaa et
However, early psychological development is also linked to
physical health. Early developmental experiences affect social processes,
associated physiological stress responses, and ultimately, health across the
lifespan. A recent study (Gallo and Matthews 2006) evidenced that adolescents
with higher avoidant attachment showed augmented blood pressure in conjunction
with interactions with friends. Early attachment problems.
A complicating factor when assessing impact of chemical,
biological and physical stressors on human health is that human vulnerability
differs over age. An increasing number of scientific studies indicate the role
of exposure during early life stages for later development of disease in adult
life (window of vulnerability).
For example exposure to chemicals during early fetal
development can cause brain injury at doses much lower than those affecting
adult brain function. Recognition of these risks has led to evidence-based
programmes of prevention, such as elimination of lead additives in petrol.
Although these prevention campaigns are highly successful, most were initiated
only after substantial delays. About 200 chemicals are known to cause clinical
neurotoxic effects in adults. Despite an absence of systematic testing, many
additional chemicals have been shown to be neurotoxic in laboratory models. The
toxic effects of such chemicals in the developing human brain are not known and
they are not regulated to protect children. Main obstacles to prevention of
neuro-developmental deficits of chemical origin are the great gaps in testing chemicals
for developmental neuro-toxicity and the high level of proof required for
regulation”. Several adult cancer forms can be traced back to environmental
exposures early in life. Unfortunately human data is scarce and we have to rely
on animal data. A meta-analysis of animal data identified more than 50
chemicals causing cancer in adult life after peri-natal exposure. It is
concluded that exposure to chemicals with a mutagenic mode of action during
early life increases the susceptibility for developing tumours in later life.
Endocrine disrupters represent a case when mutagenesis is not involved. Early
life exposure to substances with estrogenic and androgenic activity have been
indicated in certain, hormone dependent, cancer forms such as breast cancer in
women and testicular- and prostate cancer in men. Testicular cancer is
increasing in the European population. The cancer appears in young men aged
20-40, but the cancer process probably already starts during the foetal period
or the early years of life which is indicated in an epidemiological study based
on men from Sweden and Finland hinting at that environmental exposures early in
life, probably via the mother, are likely to be major determinants of this
Moreover, it should also be mentioned that the human body
and its physiology change remarkably over the years also as a consequence of a
long series of small biological alterations induced, in spite of the
considerable recovery ability of the organism, by exposure to toxic and
carcinogenic chemicals, biological pathogens and other stressors together with
a reduction of the immunological function and the increase of genetic
instability. Typical body changes of the elderly include an increase of fat
mass and a reduction of lean mass and total water content of the body; such
changes lead to a reduction of body distribution volume of water-soluble
substances and to an increase of distribution volume of fat-soluble substances.
Moreover, characteristic of old age, are:
blood levels of free fractions of many substances that would have been
otherwise combined with plasma albumin, due to a reduction of plasma levels of
motility and gastro-intestinal blood flow as well as gastric secretion and of
mucosal surface, which may affect nutrient absorption and bioavailability of
kidney haematic flow (about 1% each year after 50 years of age) and glomerular
filtration speed (about 1 ml/minute each year after 40 years of age) due to a
reduced number of nefrons; and
reduced hepatic metabolism of xenobiotics, due to a reduction of competent
The progressive exhaustion of functional reserves of
organs and apparatuses and the associated farmaco-kinetic and farmaco-dynamic
modifications, which induce an increased susceptibility to xenobiotics, are
gradual processes depending on individual characteristics. Such consideration
explains why a classification of old people only based on age (i.e. young old
between 65 and 75 years: old old between 76 and 85 years of age; and oldest old
with more than 86 years) is inadequate to evaluate the individual health
For a detailed analysis of diseases prevalent in different
age groups see Chapter 9.
tools and policies
The developmental determinants of health have been
addressed in health policies in a few Member States. Increasing knowledge about
developmental determinants of health supports the notion of early intervention
to promote health, i.e. health promoting interventions during pregnancy and
early childhood. Interventions include health promotion in
maternity care to ensure adequate foetal nutrition and reduce smoking, and
interventions to support an early and nurturing interaction between caregivers
and toddler. In Finland, a nationwide training programme for staff in child
health clinics has been implemented to support early interaction between mother
and child. A controlled evaluation of the programme indicated that staff
capacity improved and that family satisfaction was higher in the intervention
group, but effects on child development were more ambiguous.
Current health promotion activities
tend to oversee the fundamental developmental determinants of health, and there
is a need to re-evaluate health promotion policies in light
of research findings in the rapidly-developing field of developmental health.
Porter M, McFarland C (2007): The relation of attachment security to
adolescents‘ paternal and peer relationships, depression, and externalizing
behavior. Child Dev 2007;78:1222-39.
Barker DJP, Osmond C, Forsén TJ, Kajantie E, Eriksson JG
(2005): Trajectories of growth among children who have coronary events as
adults. N Engl J Med 2005;353:1802-909.
Bastra L, Hadders-Algra M, Neeleman J (2003): Effect of
antenatal exposure to maternal smoking on behaviournal problems and academic
achievement in childhood: prospective evidence from a Dutch birth cohort. Early
human development 2003;75:21-33.
Black J (1998): How a child builds its brain: Some lessons from animal studies
of neural plasticity. Prev Med 1998;27:168-71.
Eriksson JG, Osmond C, Kajantie E, Forsén TJ, Barker DJP
(2006): Patterns of growth among children who later develop type 2 diabetes or
its risk factors. Diabetologia 2006;49:2853 - 8
Gale CR, Martyn CN (2004): birth
weight and later risk of depression in a national birth cohort. Br J
Gallo LC, Matthews KA (2006): Adolescents' attachment
orientation influences ambulatory blood pressure responses to everyday social
interactions. Psychosom Med 2006;68:253-61.
Indredavik M, Brubakk AM, Romundstad P, Vik T (2007):
Prenatal smoking exposure and psychiatric symptoms in adolescence. Acta
Madigan S, Moran G, Schuengel C (2007): Unresolved maternal attachment
representations, disrupted maternal behavior and disorganized attachment in
infancy: Links to toddler behavior problems. J Child Psychol Psychiatry
Mäntymaa M, Puura K, Luoma I, Salmelin R, Davis H,
Tsiantis J, Ispanovic-Radojkovic V, Paradisiotou A, Tamminen T (2003):
Infant-mother interaction as a predictor of child's chronic health problems.
Child Care Health Dev 2003;29(3):181-91.
Puura K, Davis H, Papadopoulou K, Tsiantis J,
Ispanovic-Radojkovic V, Rudic N, Tamminen T, Turunen M-M, Dragonas T,
Paradisiotou A, Vizakou S, Roberts R, Cox A, Day C (2002) The European Early
Promotion Project: A new primary health care service to promote children's
mental health. Infant Mental Health Journal 2002;23(6):606-24. Available at http://www3.interscience.wiley.com/cgi-bin/fulltext/99520435/PDFSTART
Wahlbeck K, Forsen T, Osmond C, Barker D, Eriksson J
(2001): Association of schizophrenia with low maternal body mass index, small
size at birth and thinness during childhood. Arch Gen Psychiatry