Human Development And Health Research Paper

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Both ‘health’ and ‘human development’ are broad terms, covering a lot of conceptual and empirical ground. Both will be defined quite broadly here. Health will encompass the broad range of indicators of physical and mental illness, as well as disability and mortality. Human development is associated with two relevant bodies of scholarship (see Lerner 1998 for extensive discussions). One view, seen most often in the early history of growth-oriented child development, defines human development as the unfolding of characteristics and capacities as one ages. A second view, used more often in current-day developmental psychology and by social scientists, defines human development as the patterns of skills, attitudes, and behaviors that emerge over the life course. These definitions are not discordant; what distinguishes them most are the assumptions and theoretical contexts on which the definitions rest.

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Except for the field of developmental psychopathology (Cicchetti and Cohen 1995), the dominant psychological view is a developmental one that focuses on the patterns typically observed across individuals who are not subjected to unusual traumas or disruptions. Generally it is assumed that developmental processes and outcomes are characteristic of the species; hence, variability is expected to be modest, although both personal experiences and the broader social and cultural contexts can affect the nature and timing of developmental phenomena to a limited extent. The strongest and most generalizable developmental patterns are observed in the early years of life when it is possible to predict with considerable accuracy developmental milestones such as walking, talking, and the capacity for abstract thinking. There has been less interest in and study of developmental changes during adulthood, which are fewer in number, less dramatic, and less consistent across individuals. In fact, it was the fields of lifespan psychology and psychological gerontology that made a major contribution to reorienting developmental psychology to a fully contextual view (Theory of, Schaie 1996).

In line with a contextual view of development, social scientists expect substantial variation in the ways in which skills, attitudes, and behaviors are patterned across individuals and the life course. Although they do not discount the possibility of universal or nearly universal laws of development, life course scholars assume that social and cultural forces are the primary determinants of human behavior—and that those forces will exert strong influences on the timing and nature of even those behaviors that are characteristic of the species. Because of dramatic differences in social systems and cultural traditions, wide individual and group variations in patterns of behavior over time are expected. Even when confronted with patterns of behavior that are strongly associated with age, social scientists will tend to view those patterns as the result of strong cultural proscriptions and/or the influence of powerful social forces (Elder 1992).

1. The Link Between Health And Human Development

Scholars studying developmental processes first became interested in illness as a threat to normal development. Serious illnesses and/or disabilities can constrain the individual’s ability to master developmental tasks and/or the timing of mastering them (e.g., Cicchetti and Cohen 1995, Newacheck and Taylor 1992). Moreover, failure to master early developmental tasks can disrupt the achievement of later ones, resulting in a snowballing pattern of developmental disadvantage. Although early research focused largely on disruptions to highly specific developmental tasks (e.g., cognitive development, motor skills), recent research casts a wider net, including, for example, studies of how severe childhood illness can delay or disrupt the development of social skills, self-esteem, and academic achievement (e.g., Gortmaker et al. 1990).

Another research tradition examines the relationships between health and human development from the opposite point of view: how patterns of development influence subsequent health. In this tradition, successful accomplishment of developmental tasks (be they biologically driven or socially culturally prescribed) is viewed as a form of resource accumulation (human and social capital) that affects health later in the life course. A broad body of research now documents the links between early achievements— including intelligence, educational achievement, self-esteem, feelings of self-efficacy, and the social skills required for successful social relationships—and health in middle and later life (e.g., Clausen 1993, Elder 1999).

Although these are distinct research traditions, both are part of a broader and deeper intellectual transformation of how health and illness are understood by both scientists and the larger public. From the middle of the nineteenth century until the middle of the twentieth century, the medical model dominated our understanding of the nature and causes of illness. The medical model views illness as biological dysfunction caused by the failure of the organism’s biological defenses to prevent damage or disturbance. It is a complex model, recognizing that threats to the body’s integrity can be generated from either external forces (injuries, viral and bacterial antagonists) or internal dysfunctions (congenital deficits, cellular dysregulation). But it is a purely biological model that ignores potentially health-relevant social, psychological, and cultural factors.

Since the 1950s a multidisciplinary model, sometimes called the biopsychosocial model of illness, has become the dominant perspective on illness among both scientists and the larger public. The major tenet of this model is that illness is a product of the complex and interacting effects of biological, psychological (including behavioral), social, and cultural factors. An important corollary of this model is that biological intervention alone typically cannot prevent, cure, or manage illness. Both the causes of and appropriate interventions for illness and premature mortality occur at multiple levels. Research on the reciprocal and complex links between human development and health has been one important illustration of the utility of the biopsychosocial model of illness.

2. Current State Of Knowledge

2.1 The Effects Of Health On Development

A broad body of research documents the fact that childhood illness, especially chronic illness, is associated with increased risk of developmental problems. This has been demonstrated for a variety of physical illnesses including epilepsy (Hermann et al. 1989), juvenile onset diabetes (Hoare 1984), and cystic fibrosis (Thompson et al. 1994), to name but a few. Problems and delays are observed most frequently for cognitive development and learning, emotional control and maturity, the ability to form successful attachments with peers, and behavioral problems at school and at home. Mental illness during childhood is associated with similar developmental problems (Rutter and Rutter 1993). Although the number of studies that examine the consequences of childhood chronic illness on long-term developmental outcomes is small, research to date suggests that developmental problems tend to multiply over time, supporting psychologists’ predictions that early developmental disruptions bode poorly for mastery of later developmental tasks.

There also is strong evidence that childhood mental illness is associated with poor adult outcomes. Turnbull et al. (1990), for example, report that the onset of major psychiatric illness before the age of 16 is associated with lower levels of educational attainment, lower occupational attainment and income, and higher rates of separation and divorce. Family formation is also affected by childhood mental illness. Forthofer et al. (1996) report that childhood and adolescent mental illness is associated with earlier, but less stable marriages.

The effects of chronic childhood physical illness on adult achievements are less clear and appear to vary across illnesses. Children suffering from illnesses that can be managed effectively typically attain levels of education, occupation, and income similar to those of their healthy peers (Newacheck and Taylor 1992). In contrast, illnesses that result in frequent incapacity and/or threats to survival (such as cystic fibrosis) and those that involve the brain (such as epilepsy) are associated with poorer adult socioeconomic outcomes.

Although childhood physical and mental illnesses are associated with developmental problems in a number of domains, cognitive problems, especially learning disabilities, have the most severe consequences for both short and long-term outcomes, as demonstrated in studies comparing children who did and did not experience learning disabilities as a result of epilepsy (Hermann et al. 1989). Children with epilepsy who did not have learning disabilities resembled healthy children with regard to social competence, depression, and behavior problems at school and at home. In contrast, children who experienced learning disabilities as a result of epilepsy exhibited developmental problems in a wide range of areas. Relative to other developmental problems, learning disabilities also are most strongly related to low levels of socioeconomic achievement during adulthood.

There is also an intergenerational component to the effects of health on development during childhood and adolescence. A broad body of research consistently reports that children who live with a parent who suffers from chronic physical illness, chronic or intermittent mental illness, and/or disability are at increased risk of developmental problems or delays (e.g., Hirsch et al. 1985). Indeed, the effect sizes for parental illness are as great as, and sometimes greater than, those for childhood illness. Again, a variety of developmental problems are observed, including cognitive and learning problems, behavior problems at school and at home, general social competence, and the ability to make successful attachments to peers.

Given the strong evidence that chronic illness (of self or parent) places children and adolescents at risk of developmental problems, recent research appropriately focuses on the processes and mechanisms that account for these relationships. This is a highly complex issue because there are multiple pathways by which illness affects development. For children who are chronically ill, characteristics of the illness, its sequellae, and the nature and efficacy of medical management all play a role in helping to protect against or, alternatively, increasing the risk of developmental problems. As noted above, some illnesses have direct effects on developmental outcomes (e.g., when diseases cause cognitive problems or constrict the child’s ability to form bonds with peers). Illness severity has an impact on development beyond the symptoms and impairments generated by the disease. For example, the greater the level of absence from school as a result of illness, the more severe the developmental problems (McCubbin 1988). Medical treatments also play a role in developmental outcomes. Some medications have side effects that place the child at risk of developmental obstacles (e.g., inability to concentrate); other treatments (e.g., chemotherapy) can impair functioning in multiple domains. Finally, the stigma associated with chronic illness (Hermann et al. 1989) can lead to rejection from peers and discomfort in public places (e.g., diabetic children require special diets and cannot participate in many ‘normal’ childhood activities).

Beyond the constraints of the illness and its treatment, the family plays a strong role in increasing or lessening the ill child’s risk of developmental problems. Quality of parenting and the parents’ methods of coping with a chronically ill child are especially important (McCubbin 1988). The entire dynamic of family life is changed by the presence of a chronically ill child. Parenting requires more time, special skills, and maintaining a delicate balance between ‘normalizing’ the child’s life as much as possible, while also providing high levels of supervision and medical management. Demands change over time as the illness waxes or wanes and as the child ages. Providing care to a chronically ill child over long periods of time is draining and affects all areas of parent’s lives (e.g., the marital relationship, relationships with other children, labor force participation, financial security) (Avison et al. 1991).

Family dynamics also appear to explain the conditions under which children experience developmental problems when a parent is chronically ill. Two processes seem to be especially important in this regard. First, if parental illness is accompanied by high levels of marital discord, the likelihood of developmental problems in the children is greatly increased (e.g., Mann and MacKenzie 1996). Second, the risk of developmental problems increases exponentially if the parent’s illness is associated with being ‘emotionally unavailable’ to the child (e.g., Wootton et al. 1997). Indeed, developmental delays can be observed by the age of 2 when the parent is emotionally estranged or distant from the child (Radke-Yarrow et al. 1985).

3. The Effects Of Development On Health

There also is impressive evidence that developmental outcomes during childhood and adolescence have strong effects on health in middle and late life. There are three primary pathways by which early developmental outcomes exert persisting effects on health: socioeconomic achievements, social integration, and social support.

Of all the social factors related to health, socioeconomic status (SES) is the most consistent and powerful (House et al. 1994, Link and Phelan 1995). SES typically is operationalized as a combination of income and education, and sometimes occupation as well. All three SES components are related to health and longevity, although they seem to operate in somewhat different ways. The relationship between income and health is multifaceted, for example, income is related to access to and quality of healthcare, and to goods and services that promote health (e.g., safe housing, adequate nutrition). Occupation is, of course, a primary determinant of income, but also affects health via prestige and greater autonomy and control in occupational settings (e.g., Link et al. 1993). Education typically exhibits the strongest relationships with health outcomes, in part via its effects on occupation and income, and more directly via better health habits and increased knowledge and use of information about health and healthcare (Ross and Wu 1995). SES during adulthood is strongly related to early development. As noted earlier, school performance and educational attainment are major developmental outcomes during early life.

Social integration refers to the attachments individuals sustain with the larger society and are typically measured in terms of occupational, organizational, and community roles. A broad body of research, beginning with Durkheim’s classic work on suicide, has documented strong links between social integration and health and longevity (House et al. 1988). Again, early developmental outcomes are linked directly to social integration during adulthood. Sustaining social integration requires social competence, reasonable intelligence, and the self-discipline required for adequate role performance—all of which are developmental outcomes that are established, in large part, during early life.

There is impressive evidence that health is related robustly to social relationships. The effects of social ties on health operate in a variety of ways. First, highquality relationships with family and friends are directly related to better health and longevity (e.g., House et al. 1988). Second, close relationships are the foundation from which social support emerges during times of stress. Social support takes a variety of forms ranging from consolation and reassurance to the provision of information and tangible assistance. High levels of social support help to protect against the onset or exacerbation of illness and facilitate recovery from illness (de Leon et al. 1999, George et al. 1989). The ability to form appropriate attachments and the social skills needed to sustain social bonds are established early in life.

Thus, early development sets the stage for subsequent health in a variety of ways. Moreover, the benefits of successful development tend to increase over time, whereas the disadvantages that result from unsuccessful development also spiral over time. This pattern, known as cumulative advantage disadvantage (Ross and Wu 1996), results in diverging levels of health across adulthood, until very late life when biological factors may act as ‘levelers,’ narrowing the differences between the advantaged and disadvantaged.

Health in middle and late life is affected by both proximal and distal factors. Unquestionably, proximal and contemporaneous factors are typically more powerful predictors of morbidity and mortality than are distal patterns. Nonetheless, life course research has added to the knowledge base in two ways. First, sometimes, early events and experiences have persisting demonstrable effects on health and longevity, even when more proximal factors are taken into account. Second, the indirect effects of early events and experiences often help to elucidate the selection processes that result in more proximal antecedents of morbidity and mortality.

4. Methodological Challenges

A variety of methodological issues complicate efforts to better understand the links between development and health; two especially important ones are considered here. First, adequate depiction of the complex and time-dependent relationships between development and health requires longitudinal data collected over a significant portion of the life span. Such studies are especially important for identifying the effects of development on health because it is not until middle age that a significant proportion of the population exhibits health problems. Few studies to date assess developmental and health outcomes over the appropriate age range (i.e., from childhood adolescence until at least late middle age). Such studies are very expensive in both time and money, making a substantial increase in the future unlikely.

Selective mortality also poses a serious threat to our understanding of the links between development and health, both of which are related strongly to mortality. Extant research is based on survivors, which has two important implications. First, it is likely that research findings underestimate the effects of developmental outcomes on subsequent health because the most unhealthy are likely to have died. Second, selective mortality may account for some of the observed patterns among survivors. For example, the narrowing of SES differences in health during late life may be due to earlier mortality among low SES persons rather than a ‘biological leveling’ at the end of life (Bartley and Plewis 1997). There is no way to overcome this problem. However, given longitudinal data covering large segments of the life course, the effects of selective survival can be estimated. The possible effects of selective survival should be considered in the interpretation of all empirical findings.

5. Future Directions

Future research on the links between health and human development is likely to focus on two major topics. First, efforts will continue to trace the specific pathways and mechanisms by which development and health affect each other. Although extant research has made important contributions to this issue, substantial components of these processes remain unknown and replication of findings to date is especially important because of reliance on cross-sectional and short-term longitudinal research designs. Second, future research will address the extent to which and ways in which developmental and health problems in early life can be compensated for or reversed. Some contributions to this issue will result from naturalistic research that identifies compensatory factors that permit early disadvantage, in either development or health, to be overcome or minimized. Other contributions will result from research in which interventions designed to prevent developmental or health problems or to compensate for them are evaluated in terms of feasibility, cost, and effectiveness. Given the complex web of factors associated with early developmental and health problems, the challenges of arresting or reversing trajectories of disadvantage will be great, but the benefits will be great as well.


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