Person-Centered and Integrated Care across the Life-Cycle

Main Article Content

James Appleyard


The health and wellbeing of a person are complex adaptive processes related to the consequences of genetic, biological, social, cultural, behavioral, and economic determinants throughout the life course.  Circumstances change as the person develops with accumulative risk and protective factors especially during critical and sensitive periods. A life course perspective offers a more joined up approach with significant implications for long term health gain. There is an emphasis on an integrated continuum of early intervention and education rather than of disconnected and unrelated stages. Each stage in the life of a person exerts influence on the next.Disparities in health outcomes and in the psychosocial factors contributing to them are present early in life and are expressed and compounded during a person's lifetime. Risk factors are embedded in a person's biological makeup, manifested in the disparities in a population's health, and maintained by social, cultural, and economic forces. Research on health disparities has demonstrated the effect of many determinants interacting in various contexts at developmentally sensitive points. We need an integrated conceptual approach to translate this knowledge into effective health and social care

Article Details

Regular Articles
Author Biography

James Appleyard, British Medical Association International Association of Medical Colleges

Past President World Medical AssociationVice President of the British Medical AssociationHon Secretary to the Board of Trustees of the International Association of Medical Colleges 2007-President of the WMA Sept 2003-2004with special areas of interest in Human Rights, Child Health, and Health DatabasesProfessional Work Consultant Children’s Physician at the Kent and Canterbury Hospital from 1971-1998 Professor of Pediatrics, 1985-1995. Dean of Clinical Studies (UK) 1995-1997  St George’s University, Grenada W.I.Dean of Clinical Sciences, Kigezi International School of Medicine, Uganda 2000-2004 British Medical AssociationA Chief Officer for nine years as Chairman of Representative Body 1992-1995.and then as Treasurer 1996-2002 Ethics Chair of the WMA Ethics Committee 1995-1999 Member of the BMAs Ethics Committee 1992-2003Member of the East Kent Research Ethics Committee 2006- Treasurer and (Vice President)  of the British .Paediatric Association. 1983-1988PublicationsOn neonatal topics including coagulation disorders of the New Born,Children with disabilities, medical education, manpower and medical ethics in peer reviewed journals


Cloninger CR, Salloum IM, Mezzich JE (2012). The dynamic origins of positive health and wellbeing International Journal of Person Centered Medicine 2: 1-9.

Engle G (1977). The need for a new medical model: a challenge for biomedicine. Science. 197 (4286): 129–196.

Evans RG, Stoddart GL (1990). Producing health, consuming health care. Social Science and Medicine. 31: 1347–63.

Brunner E, Marmot M (1999). Social organization, stress, and health. In: Marmot M, Wilkinson RG, editors. Social Determinants of Health. New York: Oxford University Press, pp. 17–43.

, Marmot M, Wilkinson RG (1999). Life course, the social gradient, and health. In: Marmot M, Wilkinson RG, editors. Social Determinants of Health. New York: Oxford University Press; pp. 64–80.

(6) Hertzman C (1994). The lifelong impact of childhood experiences: a population health perspective. Daedalus. 123(4):167–80

(7)Cloninger C R and Zohar A H (2013). Personality and the perception of health and happiness. J Affect Disord 128 (1-2): 24-32.

(8) Zohar A H Cloninger C R and McGraty R (2013). Personality and heart rate variability. J Social Sciences 1 (6): 32-39.

Cloninger C R et al (2014). A time for action on health inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. International Journal of Person Centered Medicine, 4: 69-89.

(10) Felitti V & Anda RF (2008). The relationship of adverse childhood experiences to adult health,

wellbeing, social function and healthcare. In: R Lanius & E Vermetten (eds). The Hidden Epidemic: The Impact of Early Life Trauma on Health and Disease. Cambridge, UK: Cambridge University Press.

(11) Barker DJP (1998). Mothers, Babies, and Health in Later Life. Edinburgh: Churchill Livingstone.

(12) Martyn CN, Barker DJP, Osmond C. (1996). Mothers' Pelvic Size, Fetal Growth, and Coronary Heart Disease in Men in the UK. Lancet. 348:1264-8.

(13) McEwen BS (1998). Stress, Adaptation, and Disease: Allostasis and Allostatic Load. Annals of the New York Academy of Sciences. 840: 33–44.

(14) Gunnar M R (1998). Quality of Early Care and Buffering of Neuroendocrine Stress Reactions: Potential Effects on the Developing Human Brain. Preventive Medicine 27:208 -11.

(15) Hart J, Gunnar M , Cicchetti D (1996). Altered neuroendocrine activity in maltreated children related to symptoms of depression. Development and Psychopathology. 8:201-14

(16) D'Arcy C (1994). Education and Socioeconomic Status as Risk Factors for Dementia: Data from the Canadian Study of Health and Aging. Neurobiology of Aging. Amsterdam: Elsevier.

(17) Greenough WT, Black JE, Wallace CS. Experience and Brain Development (1987). Child Development. 50(3): 539–5

(18) Carlson M and Earls F (1997). Psychological and neuroendocrinological sequelae of early social deprivation in institutionalized children in Romania. Annals of the New York Academy of Science. 807:410–28.

(19 )Boyce SJ, Alkon A, Smider NA, Essex MJ, Kupfer DJ (2001). MacArthur Assessment Battery Working Group, and MacArthur Foundation Research Network on Psychopathology and Development. Autonomic Reactivity and Psychopathology in Middle Childhood. British Journal of Psychiatry.179:144–50

(19 ) Shore R (1997) Rethinking the Brain. New Insights into early development. Families and Work Institute, New York.

(20) Bremner JD, Randall P, Scott TM, Bronen RA, Seibyl JP, Southwick SM, Delaney RC,

McCarthy G, Charney DS & Innis RB (1995). MRI-based measurement of hippocampal

volume in patients with combat-related posttraumatic stress disorder. American Journal of

Psychiatry 152: 973-981

(21) Bremner JD, Vythilingham M, Vermetten E, Southwick SM,

McGlashen T & Nazeer A, (2003). MRI and PET study of deficits in hippocampal structure

and function in women with childhood sexual abuse and posttraumatic stress disorder,

American Journal of Psychiatry 160: 924-932.

(22) Department of Health, UK (2008). Children and young people in mind: the final report of the National CAMHS Review. London: UK Department of Health.

(23) Crittenden PM (2011) Raising parents: attachment, parenting and child safety. Abingdon: Taylor and Francis.

(24) Dawson G, Hessel D, Frey K (1994). Social influences on early developing biological and behavioral systems related to risk for affective disorder. Development and Psychopathology. 6:759–79.

(25) Powers C, Hertzman C (1997). Social and biological pathways linking early life and adult disease. British Medical Bulletin. 53(1):210–21.

(26) Sameroff AJ, Seifer R, Baldwin A, Baldwin C (1993). Stability of intelligence from preschool to adolescence: The influence of social and family risk factors. Child Development. 64:80–97.

(27) Leon DA (1998). Fetal growth and adult disease. European Journal of Clinical Medicine. 52(S1):S72-–S82.

(28) Lucas A (1998). Programming by early nutrition: An experimental approach. Journal of Nutrition.128:401S–406S.

(29) Ben-Shlomo Y, Kuh D (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology. 31:285–93

(30) Hubel DH, Wiesel TN, LeVay S (1977). Plasticity of ocular dominance columns in monkey striate cortex. Philosophical Transactions of the Royal Society London–Biological Science 278:377–409.

(31) Huttenlocher PR, Dabholkar AS (1997). Regional differences in synaptogenesis in human cerebral cortex. Journal of Comparative Neurology. 387:167–78

(32)Young TK (1998). Population Health: Concepts and Methods. New York: Oxford University Press.

(33) McKnight JL (1999). Two tools for well-being: Health systems and communities. Journal of Perinatology. 19:S12–S15,

(34) Patrick DL, Erickson P (1993). Health Status and Health Policy: Quality of Life in Health Care Evaluation and Resource Allocation. New York: Oxford University Press.

(35) Breslow L (1999) From disease prevention to health promotion. Journal of the American Medical Association. 281:1030–3.

(36) Holland, J.H. (2012). Signals and Boundaries: The building blocks of complex adaptive systems. Cambridge, MA: The MIT Press.

(37) International College of Person Centered Medicine (2014). The 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. International Journal of Person Centered Medicine 4: 66-68.

(38) Mezzich JE, Appleyard J , Botbol M , Ghebrehiwet T, Groves J, Salloum I, van Dulmen S (2013). Ethics in person centered medicine: Conceptual place and ongoing developments. International Journal of Person Centered Medicine 3: 225-227.