Proposal preview

Public Health Interventions and the Life Course Approach: Metrics for the Long-Run Success of Interventions, 19th-20th Centuries

This session explores estimating the long-run returns of public health interventions on different socioeconomic and health outcomes. The voluminous literature on sanitary reforms and health interventions in the 19th and 20th century has originally focussed on short-term effects on morbidity and mortality. Recently, more attempts have been made to assess long-run effects on earnings and educational attainment (e.g., Beach et al. 2016; Bleakley 2010). This is logical as the evidence of long-run effects of adverse early life conditions on educational achievement, earnings, morbidity and mortality later in life has cumulated quickly over the recent years (e.g. Almond and Currie 2011; cf. Parman 2015). As the effects unfold over decades and generations, analysis of historical data is essential for working towards more comprehensive estimation of the social returns of various types of interventions. The purpose of this session is to capture emerging research in this vein utilizing new long-run, intra- and intergenerational data and metrics.

One policy implication typically drawn from literature is that the optimum time to intervene is before the children are born or in the very first years of life. This, however, does not mean that second-best interventions regarding timing have no or just little effects. There are many examples that show that school-based public health interventions can be very successful and can increase school enrolment, attendance, and literacy (e.g., Beakley 2007). Schooling itself has also been suggested to have disseminated health-seeking behaviour (Riley 2008). The so-called life course approach therefore incorporates, but is broader than, the foetal origins hypothesis. It is based on the evidence that there are several critical periods of growth and different sensitive developmental stages in childhood and adolescence, and postulates coherent policies that address the totality of human life across ages and generation (e. g. WHO Europe The Minsk Declaration 2015). This approach is based on the plasticity of the human morphology, behaviour and physiology, id est the ability of an organism to modify its biology or behaviour to respond to changes in the environment (Bogin 1999). The life course approach can be enriched by so-called life history theory. It assumes an idea that in its very basic form should be familiar to economists: allocating scarce energy and time resources over the life span to competing functions of the human body – maintenance, growth, reproduction and defence – in view of maximizing chances of survival and reproduction (Stearns 1992). In this perspective, energetic trade-offs might be resolved in favour of reproductive success, rather than health or longevity (Gibson and Mace 2006). The combination of both approaches best reflect the adaptive options that an organism has during its life course to changing environments, and might therefore contribute to explain human health reactions towards changing socioeconomic conditions and new public health interventions.

Against this backdrop, this session will analyse different cases of public health interventions and their respective short and long-term effects in the 19th and 20th century. A particular attention shall be given to sanitary reforms as well as the impact of changes in health care. New metrics are sought to quantify and estimate returns to such changes and interventions on various dimensions (e.g., income, height, schooling, morbidity). The aim is to compare and contrast interventions and to think on the broader and unexpected consequences specific public interventions might have had.

If slots remain in the final line-up, a further open CFP will be organized after acceptance.


  • Sakari Saaritsa, University of Helsinki,, Finland
  • Jöel Floris, University of Zürich and the Institute of Evolutionary Medicine,, Switzerland

Session members

  • Gregori Galofré-Vilà, University of Oxford,
  • David Stuckler, University of Oxford,
  • Jonathan Wells, University College London,
  • Rebecca Sear, London School of Hygiene and Tropical Medicine,
  • Vellore Arthi, University of Essex,
  • Myra Mohnen, University of Essex,
  • Volha Lazuka, Lund University,
  • Maarit Olkkola, Aalto University,
  • Philipp Barteska, Universitat Pompeu Fabra,
  • Sonja Dobkowitz, University of Bonn,
  • Michael Rieser, University of Basel,
  • Sakari Saaritsa, University of Helsinki,
  • Jarmo Peltola, University of Tampere,
  • Joël Floris, University of Zürich and the Institute of Evolutionary Medicine,
  • Kaspar Staub, University of Zürich and the Institute of Evolutionary Medicine,

Proposed discussant(s)

  • Bernard Harris, University of Strathclyde,