NordChild – The Nordic study on children´s health and wellbeing . Click for more
A branch of Child Public Health at the Nordic School of Public Health.
The Nordic School of Public Health (NHV) was founded in 1954, as a course center for further training, mainly of administrative medical doctors in the Nordic countries. In 1978 the School was reorganized and expanded, its tasks and target groups were widened. An important mission for the New School was to introduce and develop the modern concepts of Public Health, both in training and research, and to apply it in the Nordic countries.
Since the new professor of Social and Preventive Medicine (and also the Dean), Lennart Köhler, came from a position as Head of Child Health Services in a Swedish county and Associate Professor of Social Pediatrics at Lund University, an obvious focus for his interest was children’s health, now expressed as Child Public Health. This is an area based on the broad WHO health concept and on a Public Health approach, while concentrating on the special needs and characteristics of children. Both in training, research and service its ultimate goal isto consider the health of children in its social, economic and political context.
In teachingregularcourses in Child Health were introduced as part of the general programs in Public Health. In various shapes they came to run from 1979 until the closing down of the School in 2015.
In researchthe ideas of a joint Nordic study were first presented at the Nordic Pediatric Congress in Gothenburg in 1979. The original research questions came to deal with thehealth and living conditions of children with long term diseases, particularly Cystic fibrosisand Spina bifida. Research groups for these diagnoses were formed by researchers in major Nordic pediatric centers.
It was soon realized both that the assessment of the living conditions of these children required systematic knowledge about healthy children as well, and also that such information was not available. Therefore, a survey of a representative sample of children from each Nordic country, was launched to fill this gap and to act as a control group. In the process additional groups of long-term ill children were added, such as diabetes, Down’s syndromeand severe asthma.
This original control study became so interesting that it was decided to develop it into a major Child Health project, the NordChild study, designed as a cross-sectional postal study of children aged 2-17 years from the five Nordic countries: Denmark, Finland, Iceland, Norway and Sweden. It was organized by the Nordic School of Public Health in 1984 and then repeated in 1996 and 2011. The foundation for the studies is a basic welfare concept, “Having – Loving – Being”, as developed by the Finnish sociologist Erik Allardt.The level of living (having) is defined in material (objective) resources and the individual’s satisfaction of them (subjective). Quality of life (loving and being) is defined by the individuals as satisfaction of non-material needs in relation to other people, society and nature. It means that the well-being of the children is recorded through variables such as long-term illness, psychosomatic symptoms and quality of life and related to socio-economic factors (income, housing, education, employment), socio-relational factors (family, intimate and extended networks) and personal factors (activity, self-esteem, political resources, basic mood, satisfaction with life, sense of coherence).
A random sample stratified for age and gender was drawn in all the Nordic countries, aiming at about 15 000 children in each country. The response rate was 67% in 1984, 70% in1996and 48.2% in 2011, and the total population included was thus 10 213 individuals in 1984, 10 317 in 1996 and 7 715 in 2011, i.e. more than 28 000 children altogether. Data have been collected with a questionnaire, mainly with the same questions in all three studies and in all five countries. The questionnaires were translated from Swedish to Finnish, Danish, Norwegian, Icelandic and English. It includes questions about the child and its family, the health of the child, health care utilization, the child’s own activities and activities together with the parents. The questionnaire also includes questions about socioeconomic factors and the parents’ health and wellbeing. The parent, who is most familiar with the child’s situation, was instructed to fill in the answers together with his/her partner and with the child, if possible. The questionnaires have been validated in large population studies and studies of children with long term illness (1990 and 2000). Ethical approval was obtained in Finland, Iceland and Sweden. Denmark and Norway did not require approval at that time, but reported to their data inspections.
A list of involved researchersand their backgrounds in the 3 NordChild parts is enclosed (Aktiva forskare i de 3 NordChild delarna). Project leader from the beginning has been Lennart Köhler, NHV.
The project was economically supported by the NHV Research budget, the Nordic Science Research Council (NOS-S) and the Swedish National Institute of Public Health. Participating researchers were paid by their respective institutions.
So far, 10 doctoral theses and more than 130 other publicationsfrom the studies have been produced. After the closure of the Nordic School the data-bases and relevant documents, including all questionnaires, have been transferred to the Swedish National Data Service (SND) Department of Public Health and Community Medicine, University of Gothenburg. Contact person is Elisabeth Strandhagen, firstname.lastname@example.org; +4631-786 6494, +46709-906110.
All data are there available for anyone interested to use them, for further work and development or as background for other materials. Hopefully, a solid platform has thus also been created for new follow-up studies. Actually, there are not many projects which have the opportunity to compare new data of child health and development with 3 consecutive studies of the health and wellbeing of randomized child populations in all 5 Nordic countries, with a span of more than 25 years.