Scottish Government Prevention Unit: Areas of Shared Interest

Area of Shared Interest 4 – Prevention over the Life Course

Introduction

This area of shared interest focuses on prevention through the life course, recognising that experiences, opportunities and risks accumulate from pre-birth and early childhood through to later life.

A life-course approach recognises that outcomes are shaped by the accumulation of experiences, risk factors and protective factors across an individual's life. It acknowledges that certain developmental periods, particularly pregnancy and the first years of life, are characterised by heightened biological sensitivity during which experiences can become embedded within developing neurological, physiological and behavioural systems.

This helps explain why early childhood is a key focus of prevention policy, as early developmental advantages and disadvantages can influence later educational, health and social outcomes. The approach also highlights the importance of intervention at key transition points throughout life, including school entry, adolescence, parenthood, employment transitions, retirement and changes in health or care needs, where timely support may help prevent difficulties from emerging or escalating.

Prevention is often most effective when action is taken before negative outcomes become established, but the opportunities for intervention vary across different stages of life. Understanding these critical points, and how people navigate transitions between services and life stages, can help improve outcomes for individuals while supporting the sustainability of public services.

Why we are interested in the topic

Life-course analysis has been identified by the Prevention Unit as an important area for the further development of prevention policy and has been incorporated as a key lens within the Scottish Government's Prevention Toolkit.

A life-course perspective helps identify how experiences, risks and protective factors accumulate over time to influence outcomes. It highlights opportunities to intervene early, recognise critical and sensitive periods of development, and better understand how circumstances at different stages of life can shape future health, wellbeing and life chances. By taking a longer-term view, it supports more effective action to improve outcomes and prevent harms before they become entrenched.

Evidence from developmental science suggests that experiences during these periods can become biologically embedded, influencing subsequent health, learning, behaviour and wellbeing across the life course. This perspective is reinforced by Heckman's theory of skill formation, which highlights how early cognitive, social and emotional capabilities support the development of later skills and competencies. As skills develop cumulatively over time, early developmental advantages and disadvantages can have implications for later educational, health and socioeconomic outcomes.

Understanding how developmental pathways unfold over time can help identify where preventative action may be most effective. This includes both primary prevention, which seeks to reduce exposure to risk factors before problems arise, and prevention aimed at reducing the likelihood of adverse outcomes among individuals or groups experiencing greater levels of risk. Taking a preventative approach early in the life course also means ensuring that children and families can access the right support at the right time, recognising that timely and appropriate interventions, services and adjustments can help those in need of additional support.

Scotland faces a range of long-term social, economic and demographic challenges, including persistent inequalities, population ageing and increasing demand for public services. Many of the factors associated with these challenges, such as poor health, educational disadvantage, poverty and reduced employment opportunities, are influenced by experiences and environmental conditions that accumulate across the life course.

A life-course perspective also supports a more integrated understanding of how outcomes develop and interact over time. Health, child development, educational attainment, employment and wellbeing are interconnected, and are influenced by a common set of social, economic and environmental determinants. Examining these connections can help identify opportunities for preventative action across policy and organisational boundaries and contribute to a better understanding of the drivers of future demand for public services.

Existing work in this area

There is already a strong foundation of policy, research and analytical work in Scotland that reflects life-course approaches to prevention.

Within Scottish Government, a range of strategies and programmes focus on improving outcomes at key stages of life. These include early years and family support policies, efforts to reduce child poverty, programmes supporting children and young people’s health and wellbeing, employability initiatives, mental health strategies, healthy ageing policies, and approaches to social care reform. Many of these initiatives seek to intervene early and address the root causes of poor outcomes.

The wider research landscape includes substantial evidence on adverse childhood experiences, child development, educational attainment, healthy ageing, health inequalities and the social determinants of health. These include:

• The Heckman Curve is often cited as a fundamental concept in prevention and early years. It sets out that the return on investment of prevention is greatest for those in early years of life, given the cumulative benefits grow over their lifetime.
• The Scottish Government published an analysis paper on the primary to secondary school transition as an example of a key stage in life when a transition can lead to divergent outcomes for different individuals.
• The Marmot Review (2010) Fair Society, Healthy Lives report provides a major review of health inequalities which argued that health is shaped by the circumstances in which people are born, grow, live, work and age. The review placed a life-course approach at the centre of efforts to reduce inequalities, emphasising the importance of giving every child the best start in life and supporting wellbeing across the lifespan.
• The World Health Organisation’s Life Course Approach to Health and Sustainable Development material has increasingly promoted a life-course approach as a framework for improving population health, recognising that health trajectories are shaped by critical periods, transitions and cumulative exposures across life and across generations.

Areas for future exploration

Despite a substantial evidence base, several important questions remain about how best to apply a life-course perspective to prevention policy and practice.

Further work is needed to understand how risks and protective factors accumulate over time and how different experiences interact across the life course. This includes exploring how poverty, health, education, housing, family circumstances and community factors combine to influence outcomes for different groups. It also requires a greater understanding of the role of place, including how the social, economic and physical characteristics of neighbourhoods can shape opportunities, experiences and outcomes throughout life.

There is also an opportunity to strengthen the evidence on the effectiveness and cost-effectiveness of preventative interventions across the life course. Future research could help identify which approaches deliver the greatest long-term benefits, how impacts vary across different groups and communities, and how outcomes can be measured over extended periods.

Finally, there is a need to further develop data and analytical approaches that support a life-course perspective. This includes improving the linking of data across the life course and tracking outcomes over time, understand the cumulative effects of advantage and disadvantage, identify emerging risks, and evaluate the long-term impacts of preventative interventions and policies. Linking public sector administrative data can also enable more effective costing of services or interventions when data is based on the whole population.

Shared research and policy questions

To support the development of thinking in the area of prevention through the life course, we have established a set of shared research and policy questions set out in Figure 5.

Connecting on this area of shared interest

The Prevention Unit recognises that a life-course perspective is relevant across a wide range of policy areas and public services with significant activity across Scottish Government and beyond focussing on supporting positive outcomes at different life stages, from early years through to later life.

The Unit can facilitate connections between relevant policy areas, practitioners, researchers and other partners interested in advancing this agenda, helping to build a more joined-up understanding of prevention across the life course.

The Prevention Unit also aims to explore how life-course evidence and insights can support specific pieces of work, including the development of the Scottish Prevention Investment Framework, where such insight helping to identify where preventative action can have the greatest long-term impact on outcomes and demand for public services.

Contact

The Prevention Unit is supporting cross-sectoral work on prevention through the life course, working in conjunction with a number of teams across Scottish Government, in particular Directorate for Children and Families.

The Prevention Unit PreventionUnit@gov.scot can support coordination of contributions to ensure they reach the right teams.