Conceptual framework with a life-course approach to support universal health coverage monitoring systems

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March 2019 - July 2020

Implementing partners:

Lead research institutions: Kobe University and Mahidol University
Other participating research institution: Kyushu University
Principal investigators: Dr Rei Ono, Graduate School of Health Sciences, Kobe University; Dr Chiyawat Pakaratee, Faculty of Physical Therapy, Mahidol University

Location of research:

Japan, Indonesia, and Thailand

Total Budget:
US$ 49,000



A life-course approach to Universal Health Coverage (UHC) has been proposed to better inform UHC implementation and monitoring. This approach envisions a sustained improvement in human health and well-being across the life span, from birth, the neonatal period and infancy, childhood and adolescence, young adulthood, to older adulthood. All of these stages are shaped by social, economic, and cultural contexts. However, existing indicators for monitoring UHC focus on easily accessible metrics measuring maternal, child and infectious diseases, while metrics for service coverage and related financial protection are needed for countries facing population ageing.    


To provide a narrative synthesis of existing concepts and frameworks related to the life course, population ageing and UHC to inform the development of a framework for monitoring progress toward UHC using a life-course approach.


  • The literature search was done in PubMed, Web of Science and Google Scholar, and included grey literature, using search terms related to the life course, ageing and UHC. The search was limited to English publications in the last ten years, between 2009 and 2019.
  • An initial search identified five existing frameworks on the life course approach to health. These were synthesized into one framework which served as the guiding framework for the second more comprehensive scoping review. This second review focused on evidence to support the various components of the synthesised framework. Additional search terms at this stage included those related to policy/interventions and function/disability to capture literature on the applications of a life course approach that consider not only health but also function as the outcome. This search identified 514 papers of which 84 were included in the final analysis.


While existing conceptual frameworks on the life course approach to health appropriately recognize all stages of the life course and the linkages between them, research on the life course approach to health tends to focus on the earlier life stages. Evidence from the epidemiological studies show that exposures to positive or negative events at an early age (for example, malnutrition or education) have long-lasting effects on health and disability outcomes at an older age. Despite the search for relevant applied research, only nine of the articles were related to policy, and the other 75 were epidemiological studies. The themes extracted from the policy papers emphasized the importance of integrated care that spans the life course, expansion of immunization services to include older people, and age-friendly services. Few studies discussed appropriate metrics for ageing inclusive monitoring or the evaluation of policies or described policies and programs relevance for low- and middle-income countries.

Global Implications

Evidence from epidemiological studies on the life course justify investing in early-life interventions as part of a strategy for improving the health outcomes of future ageing populations. However, there is no evidence to suggest that they should replace investments in later-life interventions that directly respond to the needs of older people. More research is needed to assess the relative impact of interventions at different stages of life to inform the appropriate allocation of resources along the life course. Further research on the practical applications of a life course approach to policies and programmes, especially in low- and middle-income countries, can help generate knowledge about the practical benefits and challenges to adopting this approach.

Implications for Kansai

The life-course concept may be useful as a common framework for local government initiatives to promote cross-sectoral/departmental collaboration for health systems development in the context of population ageing. It could be helpful in highlighting the interrelationships and possible collaborations between departments working on issues that are relevant to different age groups. It may also identify synergies or efficiencies that could be achieved through new inter-sectoral policies or health programmes. It may also help identify segments of the life course that are receiving inadequate attention or investment. In addition, understanding these types of local experiences could inform the development and standardization of key indicators to be monitored along the full span of the life course to assess progress towards UHC in light of population ageing.    


Developing a conceptual framework with a life-course approach to support universal health coverage monitoring systems. WHO Centre for Health Development (WHO Kobe Centre - WKC) Working Paper (#K18021).

Melinda G, Ono R, Tsuboi Y, Chaiyawat P, Kawaharada R, Perrein E, Rosenberg M, Agustina R, Fukuda H. Applying a life course approach to health service coverage monitoring in countries undergoing population aging: A scoping review. - PLOS ONE. Under review.

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