Registerbaserad forskning om barndomen för livslång hälsa och välfärd

Projektbeskrivning

The Umeå SIMSAM Lab was established to perform high quality, interdisciplinary microdata research on childhood and its relationship with lifelong health and welfare, focusing on areas of societal importance (Figure 1). The Lab has an exceptional microdata infrastructure combining social and medical data, innovative methodology, and awareness of the need to make research results available for policy development.

Recent medical, social and economic trends suggest that living conditions and welfare will not inevitably improve for the generations ahead. Different sorting processes lead to people entering upon various life paths early on in life, and as an echo from the past, life opportunities are shaped by previous and current family circumstances alongside people’s aspirations, wishes and abilities.

Young generations in Sweden are brought up in one of the richest countries, with a political landscape favouring active income redistribution policies, and that has historically built up a welfare society designed to offer equal chances to develop talents and progress. Despite increased economic wealth, there are a variety of social problems and inequities that raise concerns for the future. With increasing proportions of children living in low-income families, the relative gap in resources between children in well-off and poor families is widening (Salonen, 2012). In Malmö, life expectancy varies by five years between different parts of the city. The report from the “Malmö commission” clearly documents the nature and extent of social problems and inequities in a Swedish context (Kommissionen för ett hållbart Malmö, 2013). Some of these problems may be attributed to administrative inability to coordinate and reallocate available resources for more efficient use. However, the failure to make necessary investments in children and adolescents based on their overall needs is a path that is neither economically nor socially sustainable (Irwin et al., 2007; CSDH, 2008). The WHO European review of social determinants of health emphasizes the need for action on social determinants of health across the life course, and, in wider social and economic spheres, to achieve greater health equity as well as to protect future generations. Moreover, it recommends for all countries that the highest priority be given “to ensure a good start to life for every child” (Marmot 2012).
In advanced societies dominated by knowledge-driven economic activities, it has become increasingly important for people to have the knowledge, skills and social contacts necessary for work in this sector. As a consequence of economic restructuring towards knowledge-driven production, cognitive ability and education has moved to the forefront as one of the most influential factors for life-long wellbeing. People lacking education, formal training and skills tend to fall behind, which is reflected in unemployment, social exclusion and poverty. Paradoxically, scientists have argued that while reducing intergenerational transmission of social (dis)advantage, welfare systems increase the scope for social selection into higher social positions on the basis of personal characteristics, such as cognitive ability and personality profiles (Mackenbach 2012).
Statistics on ethnic groups show differences in labour force participation, which reinforces a social duality where some people benefit from work income and welfare systems, whereas others are more or less disconnected and excluded. Systematic variations of this kind also strengthen residential segregation, moving people with varying resources further apart, which in turn creates contrasting living conditions for young generations. This process of cumulative disadvantage is undesirable because it undermines democratic values, brings inefficient use of scarce resources, and creates intolerable health inequalities (CSDH, 2008).

Based on this line of thought, the proposed research programme is influenced by the notion of diorama, in which the life situation of people is best appreciated holistically on the basis of their everyday contexts (Hägerstrand 1982). The overarching research problem neither knows any academic borders, nor is it confined by sector-specific organizations and authorities. Intensified communication between the research community and decision-makers at different levels of society is necessary. Importantly, there is a potential for intervention research and policy making to be enhanced through the systematic use of research based on microdata. Results from interventions and register data can be combined in order to predict long term costs and consequences and in that way generate evidence for successful health and social policies. Of particular interest are analyses of drivers of health care costs and outcomes of preventive measures. The philosophy in medicine is to use the best available evidence. The adoption of the same principle in all societal decision-making will benefit the overall health of the current population and of future generations.

Achievements in previous work: As one of the major results of our efforts within the first round of the SIMSAM initiative, we have moved from words to deeds by acquiring the necessary permissions to combine longitudinal register data covering demographic, socioeconomic and health indicators for the entire Swedish population over several decades. By accessing (starting February 2013) this world-class and unique microdata infrastructure, we have the means to boost our efforts in investigating how different aspects of childhood interplay in determining life courses. To make an optimal use of this new infrastructure we have established a laboratory for interdisciplinary collaboration (the Umeå SIMSAM Lab, inaugurated in January 2013) that works as a nexus for more than 60 scholars representing a wide range of disciplines. The Lab hosts workshops and seminars as well as interdisciplinary research groups taking advantage of our unique data.

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