The route from 0 to 60

Tracking the lives of human beings through time is not a new concept. Michael Apted’s long-running Up series documented the lives of twenty children born in 1957, from the age of seven in 1964 to when they were 56 in 2012. Merely turning the camera on and speaking to these individuals at different points in time provides a fascinating glimpse into the ways in which their lives have changed in parallel with society across six decades.

The National Child Development Study (NCDS) went even further, rigorously documenting the lives of more than 17,000 people born in one week in 1958 in England, Scotland and Wales. 60 years on, the scale of this work has contributed to the UK’s position as a world leader in longitudinal cohort studies and holds special significance for participants and researchers alike; the participants who have recorded their lives through repeated surveys and the researchers tasked with telling the rest of the world something meaningful about them, their development, education, health and home lives. The NCDS goes beyond entertainment and empirically proves that what happens to us in childhood echoes across the decades.

A survey that changes with time

Researchers have gone back to participants nine times since the original survey. When these children were born in 1958, the study was known as the ‘Perinatal Mortality Study’ and focused on investigating the factors associated with good and poor health amongst mothers and new-born babies. The breadth of variables has since expanded to include information about the participants’ physical and educational development, economic circumstances, family life, employment, health behaviour, social participation and attitudes. In 2003, the NCDS took on an extra dimension by including biomarker data. The most recent survey, when participants were 55, was the first time it had moved online – a far cry from earlier in the study’s history, in the pre-computer age, when mountains of paper records were kept in the researchers’ garages.

At a 60^th anniversary conference in celebration of the study – and hearing presentations on a range of papers published from analyses of the study data – I was struck by the seemingly limitless links that can be made between factors at various time points and outcomes later in life. Whether it’s testing the validity of claims that low to moderate alcohol consumption has health benefits (it seems not) or demonstrating the long-term impact of bullying in childhood (children bullied at school continue to be at risk of poor health and other outcomes nearly four decades later), the study has boundless potential and interdisciplinary relevance.

How do adverse childhood experiences affect future prospects?

The conference underlined the significance of whole life course approaches and the wider determinants of health. A well-known measure of early-life disadvantage is adverse childhood experiences (ACEs). These include parental separation, mental illness, substance abuse and child neglect – and they can correlate with a range of health outcomes later in life such as ischaemic heart disease, obesity, perceived health, and greater risk of mortality in adulthood. ACEs are not just linked to poor health; multiple ACEs are also associated with lower earnings into middle age. NCDS research has revealed the ‘scar’ that youthful experiences can leave later in life: unemployment between the ages of 16 and 23 has a longer-term impact with lower overall wages at 23 and 42 years of age. It raises questions about what else can ‘scar’ someone’s life in terms of their future health prospects and other aspects of their lives – and what we can do to prevent scarring and build resilience.

Going beyond linking the impact of specific exposures at certain points in the life course, several conference papers also illustrated the cumulative effects of wider factors, such as poverty and unemployment, on health. The 2003 biomarker data provided a measure of allostatic load, the persistent physiological stress experienced over the life course by an individual. Michelle Kelly-Irving’s work has used the cohort data to trace the circumstances in childhood (through ACEs) through to allostatic load as the person ages and ultimately to health outcomes. The study found – rather starkly – that the risk of mortality is three times higher for those with a high allostatic load compared to those with a low allostatic load. This suggests that ACEs become embodied in the individual through the stress response system, and for those encountering persistent insecurity and uncertainty, their allostatic load will be higher. This is important not just for those at risk in childhood but for the repeated and chronic stress that has become intrinsic to modern life.

The maxim of the Up series was, ‘Give me a child until he is seven and I will give you the man’. Clearly what happens in these early years resonates through time, but it is much more complex than that and there are further opportunities to shape outcomes. Interventions at various points across the life course have the potential to make life a little more manageable for the individual, reduce distress and ultimately keep them from harm.

Matthew Jordan is Programme Officer in the Healthy Lives team at the Health Foundation