Academic dissertation for the Degree of Doctor of Philosophy at Stockholm University to be publicly defended on Thursday, November 10, 2022, 10:00. The public defence will be held in English and will take place in Hörsal 4, Albano, Albanovägen 18 and online via Zoom.

Josephine Jackisch, Department of Public Health Sciences

Download the thesis from DiVA (Academic Archive On-line)

Zoom link to the Webinar:
https://stockholmuniversity.zoom.us/j/61897664435

Opponent

Professor Naja Hulvej Rod, Department of Public Health, University of Copenhagen, Denmark.

Supervisors

Associate Professor Ylva B. Almquist, Department of Public Health Sciences at Stockholm University.
Dr. Alyson van Raalte, Max Planck Institute for Demogarphic Research, Rostock, Germany.
Professor Olle Lundberg, Department of Public Health Sciences at Stockholm University.

Abstract

Taking a life course approach can help us to understand health inequalities. This thesis illustrates that socially-patterned childhood experiences might play a critical role for inequalities in mortality. The association between childhood adversity and premature mortality is investigated in the context of a 1953 Stockholm birth cohort. Over a series of four empirical studies, it is shown that childhood adversity is a major risk factor for premature mortality, and is a significant contributor to socioeconomic inequalities in mortality.

More specifically, Study I found that indicators of early life socioeconomic disadvantage and childhood adversity were individually associated with adult mortality. When all of these co-occurring indicators were studied simultaneously, involvement with child welfare services – specifically involvement resulting in placement in out-of-home care – was the indicator most robustly associated with premature mortality in adulthood. Based on the results Study I, involvement with child welfare services was used as a proxy for childhood adversity the following three studies.

Study II showed that involvement with child welfare services could explain almost half of the education and income gradients in life-expectancy between ages 29–67.

Study III demonstrated that the increased mortality risk among adults who were placed in out-of-home care as children persisted to midlife. Moreover, increased mortality risks after out-of-home care were not unique to the Swedish welfare context but could be verified in a cohort from Great Britain.

Finally, Study IV found that adults who experienced involvement with child welfare services not only had increased risks of major diseases in adulthood, but also had worse survival prospects after a first hospitalisation.

Involvement with child welfare services, specifically placement in out-of-home care, can have consequences for socioeconomic attainment, and physical and mental health. Even in this cohort that entered adulthood during some of the most generous years of the Swedish welfare state, the unequal distribution of life chances following experiences of childhood adversity was not eliminated. These empirical studies extend our understanding of how childhood adversity contributes to the complex processes that generate inequalities in mortality. The results further indicate that it is never too early nor too late to prevent inequalities in health.

Illustration: Banksy "Girl with Balloon" on Waterloo Bridge, London, adapted photography from Dominic Robinson,CC BY-SA 2.0 WikimediaCommons