Vipin Gupta Associate Professor, Department of Anthropology,
University of Delhi
The idea of the life course approach is based on the hypothesis of developmental origins of health and disease (DOHaD). According to this approach, the exposures acting during a critical window of biological development can alter the structure or function of organs, tissues, or body systems and which, in turn, predispose people to disease at a later age. The human life course encompasses a long period from the day of conception to death and this journey of life has several biologically sensitive stages like foetal life, birth, neonatal stage, and childhood up to five years of age, puberty, adolescence, and senescence. There are specific vulnerable windows of life pertaining to women, like menarche, monthly periods, gestation(s) and menopause, that has the potential for causing life-long unwanted biological impressions.
Human life is most sensitive to adverse exposures, at these critical junctures, that may cause permanent damages for the remaining life. Undoubtedly, all these biological aspects are attached with loads of sociocultural norms, responsibilities, values, and phase-specific appropriate behaviour that may vary with gender. Further, human life has several occasions of sociocultural vulnerability which may have short- or long-term implications, for instance, education or lack of education, relationships, marriage, poverty, employment, unequal entitlements, violence, and many more. The subject matter of anthropology certainly includes every possible aspect of human life ranging from biological, molecular, social, cultural to philosophical, which gives anthropological explorations a holistic outlook. Therefore, the multidisciplinary nature of anthropological research fits very well in the interdisciplinary framework of the life course approach for guiding research on human health, wellbeing, and welfare.
The omic technologies like next-generation DNA sequencing, methylome sequencing, proteomics, transcriptomics, and metabolomics are offering novel ways of biosocial assessment of critical phases of human life. For example, epigenetic studies are exploring DNA methylation due to social behaviours like smoking habits, alcohol intake, poverty, exposures to intense and risk-prone occupations, psychosocial stress, etc. The use of omic technologies in assessing long/short term risks operates with precision and opens a number of opportunities for improving the health of the population. The development of tools for gathering more objective and precise data pertaining to the timely measurement of exposures, diseases, and behaviours, will improve predictive algorithms for non-communicable chronic diseases. It thus helps in designing precision medicine or personalized prevention strategies.
The incorporation of the phenomics approach, i.e., intensive phenotyping of participants, and inclusion of environment-wide data collection, while planning a longitudinal study can pave the way for simultaneous assessment of physical, mental, and social well-being of the communities. Anthropologists can use the biopsychosocial model that has evolved into a more complex, relational, flexible, dynamic, and developmental model to study life course health and wellbeing. The use of technological advancements in measuring the phenotypes in longitudinal studies can be used for exploiting the classical concept of nature versus nurture.
There are varieties of ways one can approach a problem and set up a long-term study, for instance, pregnancy and birth cohorts, household demographic surveillance study, adolescent cohorts, elderly cohorts, disease-specific cohorts, exposure driven cohorts, etc. Moreover, socio-cultural exposures, like, the persistence of socio-economic gradients or financial distress during the life course, the experience of self-employment, delayed gratification in life, loneliness during different stages of life and marital problems and relationships, can certainly raise the scope of identifying the micro-level risks. This facilitates wider interpretation and application of the research findings. There is also a possibility that the researcher may come across exciting or intriguing findings if the study participants are entering older age and getting disease or unwarranted health conditions like the decline in cognition, cancer etc. One must not forget the additional value of parental and grandparental data for assessing inter-generational effects, for example, adding father’s data in pregnancy or birth cohorts is of great scientific value for evaluating risks associated with offspring.
I strongly believe that the future of any discipline is decided by what an individual scientist would like to achieve in the next 20-30 years of his academic career. Setting a longitudinal study requires a scientific vision, an enormous thought process in designing the study, consistent and multiple sources of funding, and institutional support. I have experience in establishing large and intensively phenotype cohorts like Andhra Pradesh and Children and Parents Study [APCAPS], and Gestational Route to Healthy Birth [GaRBH cohort] on clustering of cardiometabolic risk and metabolomic assessment of maternal and child health, respectively. Such studies require setting high standards in the quality of data collection. These necessitate intensive fieldwork which is expensive, requires regular funding and demands additional effort and time.
Sound methodology and rigorous and tested data collection strategies for a longitudinal study give reliable results. Training in conducting long-duration fieldwork is the strength of anthropologists that can be optimally utilized in managing longitudinal studies. One can start with a life-course study on social issues and factors that may have a direct/indirect impact on health. Understanding the long term consequences of inequalities in gender, employment, caste on the overall wellbeing and welfare of the communities is one example. A Group of anthropologists can also start a longitudinal study on tribal health with respect to non-communicable diseases by collecting data on biomarkers, body fat distribution, bone density, health expenditure, harmony, conflicts, and welfare resilience, etc.
The engagement in such studies will not only improve the anthropological landscape of research but will also ensure direct implications on policy decisions. The anthropological attempts for establishing a life-course study may involve stakeholders at community and government levels which will be useful in managing ethical issues. Although the field of life course epidemiology is dominated by clinicians/medical doctors, anthropologists can make an impact through their biopsychosocial models integrated with ethnographic ways of data collection.
There is considerable scope for bio-banking in India given its huge ethnic diversity. To make it significantly representative, we can easily collect a sample of at least one million people, where participants can voluntarily donate their samples. These would help generate exhaustive biological measurements at baseline for clinical, epidemiological, and anthropological studies. Researchers from different regions may follow the participants for the long term and enrich the data bank.
Future researchers can utilize the information as per their research interests for analysis. Several such biobanks are already in place. Some of these are UK biobank, Kadoorie bank of China, Biobank Graz in Austria, Shanghai Zhangjiang Biobank, and IARC biobank, etc. Anthropologists from various regional institutions are aware of local demographic information and ecological conditions and can form a consortium for developing a biobank. Ethics and a vision for strong health objectives must guide and guard the creation of these reservoirs of data. It requires committed researchers to ensure the continuous exercise of data collection from regional populations for at least 10 years or more.
Life-course studies are institutions in themselves. These are the instruments for accomplishing long-term objectives for health research by establishing large, multipurpose, and futuristic scientific resources. These can be purposefully utilized to answer research questions relating to present and future problems. I believe anthropology has a strong future by identifying biosocial interactions that can explain cause and effect relationships between modifiable exposures and disease. This provides enormous inputs into wellbeing related outcomes. It is time for anthropologists to address global health issues and to connect their voices, weighted by empirical research. We should connect with the international community and synergise all resources to help people by providing them with feasible and affordable solutions.