Over the past two decades, scientific understanding of the role of risk factors and their impact on health has been further informed by studies showing that events and exposures early in life have implications for the risk of disease in adult life. These studies show that both biological and social risks accumulate and interact over the life cycle. Rather than a static view of health and disease, the lifecourse approach recognises the impact of different types of risk exposure at each stage of life, and the cumulative impact of these exposures as a person ages.

This perspective has been particularly important in informing approaches to intervention in the early years, as well as in understanding the factors which best ensure good health in older age. Lifecourse studies have also helped to explain the existence of the socioeconomic differentials in adult health. The differential patterns of health across populations and the unequal experience of mortality and morbidity are the consequence of the operation of social and biological factors interacting with each other at population and individual levels.197

The lifecourse perspective, as it concerns the development of chronic disease and disability, is illustrated in Figure 1, with examples of risk exposures across the lifecourse.

figure 1: lifecourse approach to chronic disease prevention and healthy ageing

There are particular lifecourse transitions that can increase vulnerability to poor health. These include pregnancies, childbirth, school entry, puberty, school leaving, workforce entry, partnering, menopause, and widowhood.

The ALSWH has highlighted the importance of key events in women's lives, such as quitting smoking or childbirth, when women may become more susceptible to weight gain.198 Obesity in pregnancy has trebled in the past decade and the implications are significant for women and their babies. Any pregnancy in an obese woman is high risk, requiring higher levels of obstetric and pediatric support, with significantly greater health care costs.199, 200

Smoking during pregnancy is linked with a range of adverse outcomes, including miscarriage, which increase with the number of cigarettes smoked.201 Mothers who smoke during pregnancy are more likely to deliver babies with low birth weight which is associated with short and long-term health problems. These babies are also more likely to be stillborn, and there is greater risk of sudden infant death syndrome in children whose mother smoked during and after pregnancy.202

Menopause is associated with shifts in weight distribution to the abdomen, which is associated with a greater risk of heart disease and diabetes.203

More research on, and greater awareness of, these lifecourse risks for women is needed.