In my thesis, based on the Swedish All Children in Southeastern Sweden (ABIS) study, I studied socio-economic differences in children's health. I have also, within the framework of an international collaboration called Elucidating Pathways of Child Health Inequality (EPOCH), investigated the social inequality in overweight and obesity from birth cohorts in five other high-income countries; Netherlands, Canada, UK, Australia and USA.
My studies revealed that socioeconomic disparities in the likelihood of developing obesity could be observed as early as age 2, and these differences increased during childhood. During adolescence, low socioeconomic status increases the risk of overweight/obesity, as well as the risk of high blood pressure and low HDL cholesterol (components of metabolic syndrome).
The prevalence of obesity in Sweden's ABIS cohort showed less socioeconomic inequality compared to other cohorts in the EPOCH collaboration. This suggests that social policy measures in Sweden effectively reduce inequality in childhood obesity. Examples of such measures include subsidized preschool and free school meals, both of which have been proven to have an impact on socioeconomic differences in obesity.
We have examined how socio-economic factors relate to the risk of developing autoimmune diseases. We found that children whose mothers had only completed primary education were more likely to develop type 1 diabetes. This difference was partly explained by a higher average childhood BMI and an increased risk of serious life events in this group. We did not find any statistically significant socio-economic differences for the other autoimmune diseases we studied.
In the final study of the dissertation, the hypothesis was tested to examine whether social inequality, as measured by the mother's level of education and the risk of a child developing obesity, could be explained by differences in self-control. Maternal self-control was assessed using various behavioral variables such as smoking during pregnancy, smoking during the child's first year, duration of breastfeeding, and participation in the ABIS study data collection, including biological sampling. The child's self-control was evaluated by analyzing responses to the impulsivity subscale in the questionnaire's SDQ. The study's findings indicated that both maternal and child self-control accounted for a significant portion of the increased risk of obesity development at the age of 19 in children of mothers with lower levels of education.
One of the conclusions of the thesis is that the concept of self-control should play a central role in the theory of the causes of health inequality. This is because, in the modern environment, there is increasing access to stimuli that can affect the brain's reward system in a negative way, leading to addictive behaviors and long-term health problems. These negative stimuli, called Limbic traps, include social media, computer games, energy drinks, and highly processed food. As a result of the new environment, more and more people risk getting stuck in these negative behaviors. Due to the connection between socioeconomic status and self-control, children from low socioeconomic backgrounds are more prone to falling into these traps and experiencing the adverse health effects they bring. If no interventions are made, this will likely increase health inequality.
In the final section of the thesis, I discuss the potential impact of the research findings on healthcare and health policy, specifically in reducing social inequality in health. The suggested health policy measures aim to decrease the risk of harmful behaviors and limbic traps among children and young people. Examples of such measures include providing preschool for all children, offering free healthy meals in preschool and school, increasing opportunities for after-school activities, extending school days for older children with more physical education, music, and aesthetic subjects, implementing restrictions on mobile phone use to counter overuse, and developing policies to address housing and school segregation in society.
Clinical Research on Type 1 Diabetes
As a pediatrician, I primarily focus on treating children with diabetes, obesity, and lipid disorders. I am currently the responsible doctor at Crown Princess Victoria’s Children’s and Youth Hospital, Linköping, for the DIAGNOD-3 study, a phase III clinical trial investigating the drug Diamyd (GAD-alum). Senior Professor Johnny Ludvigsson at Linköping University is leading this international study. In DIAGNOD-3, patients who have recently developed Type 1 Diabetes will receive a treatment administered via injections into a lymph node on three occasions. Previous trials suggest that this treatment can modify the immune response in Type 1 Diabetes, potentially preventing the destruction of the insulin-producing cells in the pancreas. Preserving the body's insulin production could significantly benefit patients with Type 1 Diabetes, as previous research indicates that it helps protect against both acute and long-term complications.
