Healthy Life Trajectories Initiative (HeLTI): overview

Background

Non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, respiratory diseases, and mental health challenges are currently responsible for over 60% of deaths globally. The impact is even greater in countries that have experienced rapid changes in population demographics, such as urbanisation, lifestyle changes, and changes in diet. These changes are associated with increased incidence of NCDs over a relatively short period of time (2-4 generations), with over 80% of deaths in impacted countries currently linked to at least one NCD.Footnote 1,Footnote 2 These numbers represent a global health crisis that is reducing the health and welfare of people worldwide and is imposing mounting social and financial burdens on society.

In order to strengthen national efforts and international cooperation in addressing the burden of NCDs, countries across the globe, including Canada, have made NCD-related commitments to implement the WHO Global Action Plan for the Prevention and Control of NCDs.Footnote 2 This includes commitments to global targets on NCDs as part of realizing the 2030 Agenda for Sustainable Development.Footnote 3

In particular, the WHO Global Action Plan for the Prevention and Control of NCDs highlights the growing body of evidence around long-term consequences of adverse environmental exposures early in the life-cycle. As many of the environmental factors that lead to negative outcomes are modifiable and because research has suggested that early and timely interventions can make a difference, a focus on interventions throughout the lifespan—starting from pre-pregnancy through pregnancy, infancy and childhood—is essential.

The HeLTI Approach

The Canadian Institutes of Health Research (CIHR) took note of the WHO strategy in designing its Healthy Life Trajectories Initiative (HeLTI) by using the premise of the Developmental Origins of Health and Disease (DOHaD) field in its design. This is based on the notion that environmental factors interact with genes during conception, fetal life, infancy and early childhood, when the possibility of modification of an individual’s development in response to environmental conditions is greatest, and that this programming affects the individual’s health later in life. These effects—including developmental delays, cognitive impairment, and chronic diseases—can be observed over several generations. Many environmental factors (such as nutrition, exposure to chemicals or toxins, stress hormones, maternal obesity, diabetes, and general lifestyle) are modifiable, which means that the right interventions can have lasting positive impacts on health.

HeLTI provides the opportunity for researchers to generate the evidence needed to shape public policies and programs that will have the potential to prevent and control NCDs. This initiative will generate evidence that will inform national policy and decision-making to improve health and prevent NCDs, It is anticipated that this focus on interventions throughout the lifespan will offer a major leap forward in global efforts to combat the rising tide of NCDs throughout the developing and developed world.

How it works

HeLTI is comprised of three distinct but complementary arms and is supported by a related enabling platform. These components coordinate and build upon both the diverse research capacity and wealth of existing data sets in Canada (interdisciplinary teams and the registry enabling platform), while using a unique set of coordinated linked international intervention cohorts to focus the powerful DOHaD approach specifically on NCDs both in Canada and in countries where the burden is greatest.

It is expected that this research initiative will yield greater value because of the collaborative nature than if studies were implemented as single country projects. In particular, the collaboration will allow for comparative analysis of harmonized interventions and data collection, the exchange and stimulation of scientific ideas and sharing of expertise, and the assessment of biological mechanisms in different populations.

Partnerships

The international component of HeLTI is supported through a partnership with the World Health Organization (WHO), as well as the partner funding agencies - the National Natural Science Foundation of China, Department of Biotechnology of India, and the Medical Research Council of South Africa. In addition to providing operational and/or financial support, these partners are providing oversight and support through a shared governance structure designed to enable coordination and harmonization across country cohorts. The governance structure will facilitate oversight of the initiative, technical support (including monitoring and quality assurance), data harmonization, data access and sharing, and best practices.

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