Olle Lundberg

The impact of childhood living conditions on illness and mortality in adulthood

The aim was to explore the relationships between indicators of economic and social problems in childhood on the one hand and illness and mortality in adulthood on the other. In 1968 a representative sample of the Swedish population born 1906-1951 were interviewed about their childhood living conditions, among other things. Four indicators of adverse childhood living conditions were included. Two of these reflect economic circumstances (economic hardship; a large family, defined as four or more siblings), and two reflect social conditions (broken family; conflicts in the family). In 1981, 13 years later, this sample was re-interviewed. This allows for illness in 1981 to be related to reports of childhood conditions given in 1968. A follow-up of mortality for the period 1981-1984 was also conducted. When one controls for age, sex and fathers social class, those exposed to economic as well as social problems during childhood are found to have a considerably higher risk of being ill as adults. Of the four factors analysed, conflicts in the family during upbringing is that most strongly related to illness later in life, as well as with mortality. Having a broken family, and, to some extent, economic hardship during childhood, are also clearly associated with illness later in life. These results also hold true when all four factors are included simultaneously in the model, and remain relatively unchanged when controlling for mental illness in 1968.(ABSTRACT TRUNCATED AT 250 WORDS)

Health in Sweden : the National Public Health Report 2005.

Health in Sweden – The National Public Health Report 2005 : Scandinavian Journal of Public Health

Childhood conditions, sense of coherence, social class and adult ill health: Exploring their theoretical and empirical relations

In order to expand our knowledge of how health inequalities are generated, a broader range of possible mechanisms has to be studied. Two mechanisms of potential importance here are childhood conditions and sense of coherence. Drawing on theoretical arguments and empirical findings in these two research fields, a conceptual model of the relationships between childhood conditions, sense of coherence, adult social class and adult health is presented. On the basis of this model, this paper sets out to analyse (1) the degree to which a low sense of coherence is based in childhood experiences, (2) the degree to which the impact of childhood conditions on adult health is mediated through sense of coherence, and (3) the importance of sense of coherence for class differences in ill health. The analyses are carried out on both cross-sectional data (n = 4390) and panel data (n = 3773) from the Swedish Level of Living Surveys in 1981 and 1991. The analyses indicate that childhood family size and the experience of a broken home are unrelated to sense of coherence later in life, while economic hardship has a small and indirect effect, mediated via class position in adulthood. Only dissension in the childhood family was found to have a direct, although fairly modest, effect on sense of coherence. Furthermore, it is demonstrated that sense of coherence does not mediate the effect of childhood factors on adult health. Rather, childhood conditions and adult sense of coherence appear to be complementary and additive risk factors for illness in adulthood. The results presented here also suggest that sense of coherence may be a factor involved in the shaping of class inequalities in health.

Causal explanations for class inequality in health--An empirical analysis

One of the most important issues for research on social class inequalities in health are the causes behind such differences. So far, the debate on class inequalities in health has mainly been centred around hypotheses on artefactual and selectional processes. Although most contributors to this branch of research have argued in favour of causal explanations, these have gained very little systematic scrutiny. In this article, several possible causal factors are singled out for empirical testing. The effect of these factors on class differences in physical and mental illness is studied by means of logit regressions. On the basis of these analyses, it is shown that physical working conditions are the prime source of class inequality in physical illness, although economic hardship during upbringing and health related behaviours also contribute. For class inequality in mental illness these three factors plus weak social network are important. In sum, a large part of the class differences in physical as well as mental illness can be understood as a result of systematic differences between classes in living conditions, primarily differences in working conditions.

Short stature as an effect of economic and social conditions in childhood

Only a few studies on the effect of environmental factors on height are based on adults and none, that we could find, relates adult height to both economic and psycho-social conditions in childhood. The aim of this study is to investigate whether four indicators of economic and psycho-social conditions during childhood are related to a variation in adult height and whether these factors can explain the variation in height between men and women from different childhood classes. The study is based on data derived from a study of living conditions in Sweden conducted in 1991. Beside childhood socio-economic group, indicated by fathers occupation, we employ four indicators of economic and psycho-social conditions during the childhood period, previously employed elsewhere. These are economic hardship, large family, dissension in the family and disunited family during childhood. The prevalence of short stature differs significantly by three of the four indicators on economic and psycho-social childhood conditions. It is also more common if the person has grown up in a disunited family, but this effect is not significant. The proportion of short persons also varied significantly by childhood socio-economic group. On the whole, short stature in adulthood seems to be a reflection of a number of adverse conditions in childhood, both economic, status related and psycho-social, and can, consequently, be seen as summing up the whole childhood period rather than merely reflecting differences in nutrition or any other specific condition.

Health and inequalities among the oldest old.

The elderly, and especially the oldest old, have generally been overlooked in research on social class inequalities in health. On the basis of nationally representative data from Sweden for the age group 77 to 98 (N= 537), we have been able to demonstrate clear differences in health between social classes. These inequalities were found both for men and women. It should be noticed, however, that the patterns of class differences varied depending on the health indicator used. The often employed global measure of self-rated health showed the smallest class gradient when controlling for age and sex, whereas larger differences were found with more concrete and descriptive measures such as peak flow rate.

Class and health: Comparing Britain and Sweden

The questions addressed in this article are two, namely are class differences in health apparent in Sweden in the same manner as was shown for Britain in the Black Report? and is it possible to learn anything new about inequality patterns in different stages of life from analyses of self-reported morbidity data? By analysing data on long-standing illness by the means of logistic regression, it is shown that the risk of falling ill is distributed in very similar ways in the two countries, although the dispersion of these risk factors seems to be greater in Britain. In an analysis of acute sickness this result is not obtained, which is assumed to be an effect of differences in answering patterns. For Sweden, it is shown that social classes do not differ much in terms of health among the young. Instead, inequalities in health seem to be established at first in middle age.

Fieldwork and measurement considerations in surveys of the oldest old

This paper starts with a discussion of the need for general level of living surveys targeted towards the very old, both for research and the production of statistics. We argue in favour of level of living surveys among the oldest, including questions on living conditions in a number of areas such as health, economy, housing, social relation, activities, political resources, etc. Data of this kind are likely to be of utmost importance, both for the production of reliable descriptive statistics on the living conditions among the elderly, and for the purpose of research on ageing.The main part of the paper, then, is directed towards two key issues in the planning and undertaking of such studies, namely the need for a low non-response rate and for medically valid information on health and functional capacity. These discussions are based on our recent experiences from the level of living survey on the survivors in a large national panel survey, aged 77–98 in 1992.In order to achieve a low non-response rate, studies of this kind on the oldest old require additional efforts in survey planning and operation. Similarly, relevant and medically valid data on health and functional ability requires that special attention is paid to questionnaire construction and interviewer training.

Educational differences in cancer mortality among women and men: a gender pattern that differs across Europe

We used longitudinal mortality data sets for the 1990s to compare socioeconomic inequalities in total cancer mortality between women and men aged 30–74 in 12 different European populations (Madrid, Basque region, Barcelona, Slovenia, Turin, Switzerland, France, Belgium, Denmark, Norway, Sweden, Finland) and to investigate which cancer sites explain the differences found. We measured socioeconomic status using educational level and computed relative indices of inequality (RII). We observed large variations within Europe for educational differences in total cancer mortality among men and women. Three patterns were observed: Denmark, Norway and Sweden (significant RII around 1.3–1.4 among both men and women); France, Switzerland, Belgium and Finland (significant RII around 1.7–1.8 among men and around 1.2 among women); Spanish populations, Slovenia and Turin (significant RII from 1.29 to 1.88 among men; no differences among women except in the Basque region, where RII is significantly lower than 1). Lung, upper aerodigestive tract and breast cancers explained most of the variations between gender and populations in the magnitude of inequalities in total cancer mortality. Given time trends in cancer mortality, the gap in the magnitude of socioeconomic inequalities in cancer mortality between gender and between European populations will probably decrease in the future.

Welfare trends in Sweden: balancing the books for the 1990s

Welfare trends in Sweden: balancing the books for the 1990s : Journal of European Social Policy