The overall aim of this EU Horizon2020 funded comparative project is to identify the opportunities offered by the urban environment for the promotion of mental wellbeing and cognitive function of older individuals in Europe. To achieve this, the project will advance understanding by bringing together longitudinal studies across cities in Europe, the US and Canada to unravel the causal pathways and multi-level interactions between the urban environment and the individual determinants of mental wellbeing in older age. The project will examine the causes of variation in mental wellbeing and disorders in old age both within as well as between cities and identify national and urban policies for the prevention and early diagnosis of mental conditions and disorders of older people. This knowledge will contribute to the establishment of preventive strategies in urban settings to promote the mental dimension of healthy ageing, reduce the negative impact of mental disorders on co-morbidities and preserve cognitive function in old age. The specific objectives of MINDMAP are:
To achieve these aims, we adopt an interdisciplinary approach that integrates insights and methodological approaches from mental health and psychiatry, biology, epidemiology, epigenetics, geriatrics, geography and social sciences. To achieve impact, we model the impact of concrete features of the urban environment, policies and interventions on common mental health disorders in European cities. We involve a wide number of stakeholders at the regional, national and European level to translate knowledge into practice. A major legacy of the project will be a research infrastructure of harmonized international urban cohort studies of ageing and mental health. This infrastructure will advance the study of the interactions between contextual exposures in the urban environment and individual determinants of mental health and cognitive ageing within and beyond the MINDMAP project.
Researchers: Lasse Tarkiainen, Kaarina Korhonen, Heta Moustgaard
Parental and childhood health may have significant consequences for educational and labour market outcomes. Acute health shocks and chronic conditions are known to affect employment careers among middle-aged adults, but less is known about the social consequences of illness for children and youth.
We use large, internationally exceptional register-based data on families with annual repeated measurements on parents and children over several decades to quantify the social consequences of parental and childhood health problems and to clarify the causal mechanisms through which they may affect educational and employment trajectories in youth.
Health-related marginalization in youth may have long-term consequences in terms of unemployment and labour market exclusion. These present a major strain on both the individual and the social protection system. By identifying key mechanisms of health related selection the results will inform policy interventions aiming at reducing such harm.
Key words: childhood health, parental health, educational outcomes, employment outcomes, intergenerational transmission
Researchers: Heta Moustgaard, Hanna Remes, Niina Metsä-Simola, Janne Mikkonen and Mikko Aaltonen
In the BIRTHFAM consortium (Population Research Unit & Institute for Molecular Medicine Finland) funded by the Academy of Finland we aim to gain a fuller understanding of the social and genetic determinants of poor health and social disadvantage. To achieve this we will build a cluster of family cohorts and develop novel, interdisciplinary study designs and methodology. Family data encompass a broader range of exposures within and across generations than data on individuals only, providing a more comprehensive view of life-course epidemiology. Furthermore, family data enable stronger causal inference by allowing for comparisons of family members with differing degrees of shared genetic and environmental exposures.
Building on existing data and expertise, we bring together two complementary types of data: 1) family-based register data with long follow-ups of large cohorts and 2) twin data with in-depth information of participants and their genetic makeup. We will develop and document family cohorts for three research initiatives that rely on the internationally unique linked Finnish data: 1) a multigenerational data set of up to five generations for examining intergenerational associations in health and social disadvantage; 2) a data set of participants with different degrees of relatedness (twins, siblings, cousins etc.) for estimating heritability and familial clustering of ill health; 3) harmonised data sets of family cohorts born over 50 years apart for assessing changes in the importance of early life circumstances on adult health.
We will also adapt and share new study designs and methods, organise training and build an international research network for sharing expertise and facilitate access to these exceptional data for top scientists around the world.
The consortium builds research infrastructure with diversity and flexibility for long-term research needs and innovative ideas yet to surface. Understanding how families transmit ill health and social disadvantage across generations highlight new opportunities for improving population health.
Researchers: Hanna Remes, Heta Moustgaard
Finnish criminal policy places a strong emphasis on the premise that preventing social exclusion reduces crime. Although existing register-based analyses demonstrate a strong association between measures of social disadvantage and crime, we don't currently know how these associations have changed during the recent past. The aim of this Academy of Finland -funded project (2018-2022) is to provide a comprehensive assessment of how criminal careers and sociodemographic backgrounds of persistent offenders have changed during 1987–2015. We analyze long-term conviction trajectories of different birth cohorts to see how lifetime conviction risks and criminal careers have changed. Next, we examine if sociodemographic factors associated with persistent offending and imprisonment have changed in this time frame, and whether offenders are becoming a more marginalized group. Finally, we provide new evidence on the effects of macroeconomic changes on the employment rates of offenders, and assess their vulnerability to such shocks.
Sociodemographic determinants of criminal careers in Finland 1987–2015 (CRIMCAR)
Key words: crime, violence, violent victimization, socioeconomic status
Researchers: Mikko Aaltonen, Joonas Pitkänen
This is a NordForsk-funded comparative research project on the social inequalities in health and well-being using unique register information on socioeconomic conditions, social security and health, available in Denmark, Finland, Norway and Sweden. It is a follow-up project implementing research made possible by the data infrastructure project C-LIFE. In the WELLIFE project we set to study three themes. First, we will study whether social policies, including labour market policies, modify the extent to which the onset of illness affects living conditions, in particular employment. For example, health data on cancer incidence and hospitalisation will be used to indicate types of ‘health shocks’. Second, we investigate the role of social policy in the extent to which ‘critical life events’, such as job loss, divorce or health shocks within the close family, translate into poor health and worse living conditions for parents and children. This part of the project will have a special interest in health and employment, but including other outcomes is important to understand the mechanisms at work. While these two objectives will provide new insights into the role of the welfare state in shaping the health-employment relationship, a key ambition is also to provide better understanding of the mechanisms at play in a life course and gender perspective on social inequality formation. The third objective is to analyse prevailing social trajectories experienced by people who fall ill, lose their job or experience divorce, etc. in different welfare settings.
Researchers: Kaarina Korhonen, Heta Moustgaard, Lasse Tarkiainen, Niina Metsä-Simola
Across societies, poor mental and physical health and excess mortality are consistently linked to union dissolution. External and alcohol-related excess mortality is most pronounced immediately after separation, particularly among men, suggesting that psychological support during the separation process is needed to avoid high-risk health behaviors, such as alcohol use as a coping mechanism. Poor mental health explains excess suicide mortality after separation, but particularly among men, separation is a risk factor for suicide even without pre-existing mental health problems. The findings of the project also suggest that mental health is more closely linked to union stability than to whether the union is marital or not. Poor mental health seems to put strain on unions and even hinder the formation of long-term unions. At the moment the main focus of the project is in examining the effects of physical health conditions on subsequent separation risk, and the role of socio-economic disadvantage in shaping these associations.
Key words: mental health, divorce, marriage, marital transitions, non-marital transitions, cohabitation, separation, psychotropic medication, mortality, physical health
Researchers: Niina Metsä-Simola, Elina Einiö
This NordForsk funded project facilitates the investigation of welfare, health and employment in the Nordic countries by aiming to establish a register-based comparative dataset that is to be made available to social scientists within public health and welfare research assessing health inequality in Denmark, Finland, Norway and Sweden.
The project title, Contingent Life Courses, reflects that people’s lives and life chances are structured by important features of the social context, and notably, the welfare state. The database will enable rigorous analyses of how life courses are shaped by social policy, and assessments of the importance of social policy and welfare reform for health, welfare and social.
An attractive feature of the proposed database is that it will make possible comparative research on the living conditions and life courses of marginal social groups and how these groups are affected by social policy. Marginal groups, such as school drop-outs, adolescents in poor health or who live in poor or socially disadvantaged households, long-term social assistance recipients, lone mothers, cancer survivors and immigrants, are all small groups that are often difficult to reach, identify and analyse in conventional comparative survey data. Using comparative national register data will hence bring the trajectories and conditions of such marginal groups to light.
Simultaneously, the data will allow studying important population trends such as the development of health inequality, labour market exclusion, use of welfare benefits and social mobility patterns, in a comparative perspective. Nordic register data are pivotal to such an aim, as survey data may be biased or have incomplete time-series, and national register-based studies may not be sufficiently comparable. The higher prevalence and variance in social policy reforms obtained by assembling data from four different national settings constitute a much richer set of data than could have been obtained for one single country.
In sum, the project represents a promising and ground-breaking initiative that – if successful – will foster novel research and scientific excellence, and significantly improve the position of Nordic social scientists and public health researchers internationally. Furthermore, the knowledge that can be produced from the C-LIFE project will be of significant value for policy makers, and may also serve as an instrument for evaluation of new policy interventions and welfare reforms in the years to come.
Researchers: Lasse Tarkiainen, Kaarina Korhonen, Heta Moustgaard
Social inequalities in health are a major challenge to public health in Europe and reducing them is a priority for the European Union. The objectives of DEMETRIQ are (i) to develop, evaluate and refine methodologies for assessing the effects of social, economic and health policies on the pattern and magnitude of health inequalities among socioeconomic groups, (ii) to assess the differential health effects by socioeconomic group of ‘natural policy experiments’ in the fields of unemployment and poverty reduction; tobacco and alcohol control; and access to education and preventive health care, and (iii) to synthesize the evidence from the findings of objectives 1-2, and to actively engage users in the research to promote effective exchange of knowledge for policy and practice. In our work package, we will examine population-wide behavioral change in terms of alcohol control. We will collect information on relevant aspects of alcohol control policies in EU countries, and carry out time series analyses of the impact of these variations on inequalities in alcohol consumption and related mortality and morbidity.
Key words: public health, social inequalities, Europe, alcohol control, policy, change, time series analysis
Researchers: Kimmo Herttua and Pekka Martikainen
Finland was the first country in Europe to achieve universal suffrage in 1906. In principle, men and women from all social classes had the right to vote in parliamentary elections. However, the poor who were continuously receiving poor relief from their local municipality were excluded from the national vote. The extent to which these voting restrictions affected the elderly and women is still unknown. Because the elderly were more at risk of earning less income because of a failing capacity to work, it is likely that they were more often politically excluded. This study will assess the proportion of those who were excluded from the vote because they had received poor relief at the beginning of the 1910s. The historic statistics needed in the study are held at the National Archives of Finland. The results of the study will enhance our understanding of the age discriminatory nature of Finland’s universal suffrage.
Key words: vote, universal suffrage, elderly, care, socioeconomic position
Researcher: Elina Einiö
Healthy life expectancy is a composite measure of length and quality of life and thus an important indicator of health in aging populations. In this study, we estimated educational differences in disability-free life expectancy (DFLE) for eight countries from all parts of Europe in the early 2000s. Long-standing severe disability was measured as a Global Activity Limitation Indicator (GALI) derived from the European Union Statistics on Income and Living Conditions (EU-SILC) survey. Census-linked mortality data were collected by a project comparing health inequalities between European countries (the EURO-GBD-SE project). The lowest DFLE was found among Lithuanians, the highest among Italians. Both life expectancy and DFLE were longer the higher the education, but educational differences were much larger in the latter in all countries. Highly educated Europeans cannot only expect to live longer, but they also spend more years in better health than those with lower education. However, the size of the educational difference in DFLE varies significantly between countries: the smallest differences appear to be in Southern Europe and the largest in Eastern and Northern Europe.
Key words: educational differences, Europe, disability-free life expectancy, long-standing activity limitation, Sullivan’s method, Census-linked mortality data, EU-SILC survey data
Researchers: Netta Mäki and Pekka Martikainen
Information on factors influencing the length of working lives and the distribution of life years between work and retirement is crucial for policy development in ageing societies. We found that both working life expectancy at age 50 and the share of remaining life spent in work have increased across periods following the recession of the early 1990s, and across successive cohorts. The trends were similar across the social classes, but there were large differences in the numbers of years spent in various states: compared with upper non-manual employees, male and female manual workers were expected to spend fewer years in both work and statutory retirement, but more years in other forms of non-employment. The likelihood of retirement through any route at age 63–64 was higher among people who became subject to the new flexible statutory pension age between 63 and 68 than among people who were subject to the old system with a fixed statutory pension age at 65. The reform led to increased retirement at age 63–64 regardless of health status, but the change was more pronounced among people with better health. In absolute terms, however, people with poorer health still retire a little bit earlier. After the reform, high levels of education, social class, and income were associated with a longer time spent in employment either in the form of later retirement or participation in post-retirement employment. Otherwise, economic constraints including high debt, low wealth, and renting one’s home were associated with continued employment both before and after retirement.
Keywords: socioeconomic factors, health, working life expectancy, labour market participation, timing of retirement, post-retirement employment, pension reform
Researcher: Taina Leinonen
Key Publications:
Leinonen T, Laaksonen M, Chandola T, Martikainen P. Health as a predictor of early retirement before and after introduction of a flexible statutory pension age in Finland. Soc Sci Med 2016;158:149–57.
Leinonen T, Martikainen P, Myrskylä M. Working Life and Retirement Expectancies at Age 50 by Social Class: Period and Cohort Trends and Projections for Finland. J Gerontol B Psychol Sci Soc Sci published online 11 November 2015.
With growing pressure from an ageing population on social and health-care expenditure, it is of major policy importance to analyze the reasons for admission to institutional care at older ages. This study focuses on how different chronic medical conditions, socio-economic factors, living with a spouse, and the death of a spouse are associated with admission among people aged 65 years or older. The findings in this study imply that the future need for institutional care will depend not only on the increasing numbers of older people but also on the development of the prevalence and severity of chronic medical conditions associated with admission, and on older people’s income, housing conditions and access to informal care from their spouse.
Key words: nursing home, institution, long-term care, elderly, socioeconomic position, widowhood, bereavement
Researcher: Elina Einiö