Planning for state and local public health services in a genomic era: Health equity across the life course

Over the past decade, the concept of the life course has gained ascendancy in public health science. The term “life course,” carries different meanings, however, among scientists from different disciplines, and among practitioners and policymakers who must translate science into public health policies and programs. While critics have examined conceptual inflation (erroneous assumptions about shared meanings of the life course concept among scientists who use it differently), far less attention has been paid to the conceptual inflation embedded in the research translation process and in the models that guide public health planning. To the extent that conceptual inflation in research about health and the life course results in a depoliticized and ahistorical knowledge base, it may also give rise to interventions that focus exclusively on the individual and ignore the importance of social context and cumulative disadvantage in health access and health outcomes. Drawing on interviews and archival research of public health genetics programs, we trace how inequities in access to health services arise from (a) planning models that describe core public health functions and essential public health services without consideration of history or social context; and (b) a two-dimensional research translation process that focuses on individual health outcomes and ignores community level effects. Remedying inequities in access to public health services will require redesigning planning models so that they relate more effectively with a more holistic conceptualization of the life course, and a more robust research translation enterprise that engages health services research, social scientists, and policymakers.