preterm

The dynamics of inequality: what have we learned?

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In the final episode of the DIAL podcast we’re looking at what’s been learned from DIAL projects about how and when inequality manifests in our lives and what its longer term consequences might be. We’re joined by Elina Kilpi-Jakonen from the University of Turku in Finland. Elina is the Scientific Coordinator for DIAL and, as the programme draws to a close she reflects on some of the programme’s highlights,  key findings and implications for the future.  

Transcript

Christine Garrington  0:00 

Welcome to DIAL a podcast where we tune in to evidence on inequality over the life course. In series four, we’re looking at what’s been learned from DIAL projects about how and when inequality manifests in our lives, and what its longer-term consequences might be. For this final episode of the series, we’re delighted to be joined by Elina Kilpi-Jakonen, from the University of Turku in Finland. Elina is the scientific co-ordinator for DIAL and today, as the programme draws to a close, she’s here to reflect on some of the program’s highlights, key findings and implications for the future. So welcome, Elina thank you very much indeed, for joining us. Now, first of all, I’m guessing it’s been no mean feat and indeed, I know, it’s been no mean feat, keeping an eye across 13 fantastic research projects with researchers based all over Europe. But just take a minute or two, if you would to remind us of what exactly the DIAL programme is and what it’s involved over the last few years.

Elina Kilpi-Jakonen  0:57 

So thanks a lot, Chris. The DIAL programme is, as you said, kind of transnational programme. And we’ve had 13 research projects involved. And all of those involve international collaboration. And it’s based in the social sciences and behavioural sciences, financed by NORFACE, which is a research organisation bringing together different funding institutes across Europe. And so the focus of DIAL has been on inequality and in particular inequality across the life course and trying to understand some of the structures of inequality cross nationally and some of the mechanisms kind of producing inequality and and what that means to people and societies as a whole.

Christine Garrington  1:41 

Wonder if I can ask you why it has been so important to look not just at inequality, per se, as you were saying there, but at how inequality manifests itself over the life course, because this is an important thing, isn’t it? And indeed how, when and where it sort of accumulates?

Elina Kilpi-Jakonen  1:57 

Inequality is a really complex and multifaceted issue. And so I think one one part of it is that inequality comes across in many different domains. So it’s important to take into account inequalities, for example, in education, labour market, health, and so on. And then I mean, to really understand where it comes from and what it means it’s important to look at the determinants across time, I mean, both across time for an individual and their parents, and so on, kind of that life course aspect, but also, for countries to see how it develops across time. Inequality isn’t something that just is, I mean, it develops. And so kind of building on that kind of developmental process to really kind of inform us about how we can do something about it, or how we can really kind of understand where it comes from, it’s important to take that into account.

Christine Garrington  2:58 

Now, you talked about the programme largely being based in the social sciences. But one of the key things about the project is that we’ve seen researchers from different disciplines as well as different countries coming together to try to tackle, as you say, as you rightly say, this incredibly complex area around inequality, what’s been the thinking there?

Elina Kilpi-Jakonen  3:20 

Well, I mean, inequality is something that interests a lot of academics working in different disciplines. And, and they come from it from from kind of different angles. And I think, because it is kind of a complex issue, and it’s an issue that kind of manifests itself in different ways. So really building on on the strengths of different disciplines, I think is a key key strength here. So we don’t only look at inequality in one domain, for example, say, say something like education, which would then be kind of a subset of disciplines that tend to be interested in inequality in education, but also how education is linked to inequalities in in other aspects and, and in addition to the kind of different domains that come from different disciplines, also, the ways in which we, we analyse it and building on the strengths and knowledge of different disciplines. I think is key here, key to, to just building a comprehensive picture and learning from each other, as well as as then taking that knowledge forward.

Christine Garrington  4:34 

It would be remiss of us not to talk about COVID. And in some ways, it was something of a setback for plans to to stage events and meetings around the the programme of research to get the word out there about it. But it also provided in some respects, a rather unexpected opportunity, didn’t it to use the programme to look at inequality in the context of COVID. So, so tell us a bit about that.

Elina Kilpi-Jakonen  4:58 

Yeah, so obviously the research programme began before COVID. And so the projects had their their kind of plans of what they wanted to do and the analysis that they were going to do. But given this massive impact that COVID had on on society and and on inequality as well. A lot of projects then decided that this would be a really important aspect to look at and an opportunity also to learn about inequality in a changing societal context. So different projects have taken this into account in different ways. But for example, there’s been kind of really important work on on just what happened to inequality for example, due to lock down and and the economic upheaval of COVID, not just the health implications, but then also using that upheaval, to think about how inequalities might be changed. And for example, so work by Alejandra Rodríguez Sánchez, Suzanne Harkness and Anette Fasang, looking at what happened to housework, during COVID. People were having to stay at home, both parents and children and seeing what happens to inequalities between men and women. And how the, the the number and age of children influences that and kind of what they saw was that obviously, this change in in family habits changed house work habits, but at the same time, when locked down ended a lot of couples returned to normal. So so even though there was a massive shift, and and people behaved differently for a short period of time, we can see that these kind of entrenched habits, then then go back to normal quite quickly.

Christine Garrington  6:43 

Yeah, really interesting piece of work that so. And also, despite COVID, you were able to, nevertheless, to involve a great number of stakeholders in in the research, what messages did you receive from them, I wonder about what was emerging?

Elina Kilpi-Jakonen  6:58 

So yeah, we’ve had some really interesting discussions with stakeholders, both policymakers and then kind of non-governmental organisations involved in both practical work and lobbying as well. And they’ve been really interested in in the work that we’re doing. So in particular, we’ve talked to stakeholders involved in kind of gender inequality work, and how participation in the labour market is unequal between men and women, and in particular, between mothers and fathers. And then we’ve also talked a lot to stakeholders involved in kind of childhood disadvantages, and how different types of children are put at a disadvantage. And what are some of the mechanisms kind of potentially either alleviating those disadvantages, or that are currently making those disadvantages larger, and that would kind of be important to look at. So we’ve kind of talked both about the the bigger picture of inequality, but also some of the mechanisms and obviously, stakeholders are, are often interested in what they can do. And then we’ve also had really good discussions about especially with policymakers also about the kinds of data that going forward, would be needed to, to kind of really analyse these things further. And I think there’s a lot of kind of shared interest in collecting data or making administrative data available for researchers to be able to address inequalities in the future.

Christine Garrington  8:28 

Yeah, now a major part of your role, Elina has been to pull together all of these different strands of work in some way to ensure that we get to a, what we hope is a coherent picture of what’s been learned from the programme as a whole. And I wonder whether it’s possible in the short period of time that we have to say what has been learned from the programme as a whole?

Elina Kilpi-Jakonen  8:48 

Well, that’s no mean feat. To then kind of say what’s been learned because I think there’s such richness in the research coming through and I mean, we’ve only kind of touched upon some of the aspects just now. And so we what we’ve been trying to do is, is bring together kind of thematically, things we’ve learnt in terms of, for example, gender inequalities, as I just mentioned. So So really looking at further at kind of motherhood, penalties and how, how those might be potentially for example, by by further training ameliorated although at the same time, we need to remember that women tend to nowadays have higher education levels than men. So education isn’t always the key here. So also looking at kind of gender and sexual minorities, even though we’ve been making progress in terms of legislation and policy. The discrimination can still be kind of an ongoing issue for people and and kind of the legacy of the past is still a major issue for for LGBT citizens across Europe and even though legislation has progressed a lot to still the practices in terms of, of workplaces or educational institutions aren’t aren’t really catching up necessarily, to such a large extent. And then moving on to kind of a different area, I think there’s been a lot of really interesting work in terms of, of the role of genetics, which is a big new area of research in terms of social sciences, and how that plays into the reproduction of inequalities across generations and over the life course, and how that changes depending on the environment that people live in. So, so we’re learning a lot about so called gene environment interplay, and which is obviously kind of something that social scientists are really keen to look at is the the environmental aspect of, of how genes play out. So so we’re learning a lot about the fact that genes aren’t our destiny as such, but but the the context or the environment matters a lot for that.

Christine Garrington  11:00 

Yeah, lots of really fascinating and very, very innovative work that’s going on in that area, for sure. Now, you’re talking about stakeholders a moment ago, you’ve been responsible also for helping to ensure the dissemination of this research to to those non-academics as well as other researchers. So I’m interested to know and I think others will be interested to know what sorts of resources there are available. For those interested to know more, aside from the obviously, the dozens, and I know, there are dozens of journal articles and working papers that have have been produced if you’d like for the scientific community. But what else is there.

Elina Kilpi-Jakonen  11:34 

Starting from those journal articles, I think we’ve tried to make a kind of effort to make those more accessible in terms of both bringing them all to our website, but also providing summaries that are not just the academic abstract. So even looking at the journal articles, starting from from summaries that are more accessible to everyone involved, and not just researchers in those fields, I mean, abstracts can sometimes be a bit difficult to disentangle. Then bringing together the research we’ve we’ve been producing policy briefs that, I mean, obviously are aimed at policy audiences but I think those bring together thematically some of the research as well in a really nice way. So those are available on the on the website, then obviously, this podcast series, I think is has been a great way of disseminating the research. In addition to that, so we had our final conference last autumn. And some of those videos from the presentations are available still through the website. I mean, there’s both recordings of presentations that bring together entire projects, but also kind of individual, more finely specified research topics. But But in particular, there’s there’s videos of researchers presenting their whole project at the final conference. So I think those are also a great resource.

Christine Garrington  12:57 

Yeah, indeed, a wonderful library of materials that people can dip into at their leisure and really catch up on and get to grips with the important things that have emerged from this, this work. So finally, Elina, the ultimate aim of a programme like this is obviously to improve our understanding and knowledge on the one hand and influence change for the good with the understanding on the other. And I wonder if you’re able to say how, I know it’s very difficult, but if you can say how all this important work might feed into the thinking and policies of those seeking to reduce inequalities today, and in the future?

Elina Kilpi-Jakonen  13:32 

At the same time as advancing academic knowledge, we definitely have wanted these research results to be relevant for policymakers and to reach policymakers and indeed, kind of other organisations interested in in these types of inequalities and processes. I mean, on the one hand, there has been really great comparative work on the kind of institutional influences that policies in different countries have and I think that’s a really important thing to draw from in terms of, for example, education policy, or family policies for work life balance and the gender inequality in pay so, so looking at the across national differences and comparing countries and then learning from that. But then also, I mean, there’s been really detailed work into kind of the mechanisms of inequality and more specific interventions for example, and how those influence inequality and and then really digging more deeply into how inequality is reproduced and what we might be able to do about that. So for example, work on on parenting and how that reproduces inequalities among children and and then thinking about well, how we might be able to to provide more equitable parenting for children and what we can do about that. So I think there’s, there’s been work on multiple levels that hopefully we’ll be able for policymakers to draw on in terms of developing these things in the future.

Christine Garrington  15:07 

Thanks to Elina Kilpi-Jakonen, DIAL’s scientific co-ordinator for joining us for the final episode of this fourth series of the DIAL podcast. You can find all the resources that Elina mentioned in this episode on the DIAL website at www.dynamicsofinequality.org. We hope you enjoyed this episode, which is produced and presented by Chris Garrington of Research Podcasts. And don’t forget to subscribe wherever you find your podcasts to access all our earliest series.

Pre-term children: how do they get an equal chance to thrive?

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In Episode 4 of Series 4 we’re talking to Professor Sakari Lemola from the University of Bielefeld and formerly from the University of Warwick. Sakari is one of the Principal Investigators of the DIAL project PremLife, which has been looking at what factors can provide protection and increase resilience for preterm children’s life course outcomes. 

Transcript

Christine Garrington  0:00 

Welcome to DIAL a podcast where we tune in to evidence on inequality over the life course. In series four, we’re looking at what’s been learned from DIAL projects about how and when inequality manifests in our lives, and what its longer-term consequences might be. For this episode, we’re delighted to be joined by Professor Sakari Lemola. He’s from the University of Bielefeld and formally from the University of Warwick, and one of the Principal Investigators of the DIAL project, PremLife, which has been looking at what factors can provide protection and increase resilience for preterm children’s life course outcomes. So Sakari, thank-you so much for joining us today. It’s great to have you on the DIAL podcast. I wonder if you can start by telling us a bit more specifically what this project has been investigating and why?

Sakari Lemola  0:45 

So the PremLife project has been particularly focused on the role of protective factors for social and educational transitions after preterm birth. Preterm birth is defined as birth before the 37th gestational week. Then there are two further categories one distinguishes between moderately to late preterm children at its birth between the 32nd and 36th gestational week – moderately and late preterm children. But they’re also very preterm children who are born before the 32nd gestational week. So in the PremLife project, we specifically look at both of these groups – the very preterm children and moderately and late preterm children compared to term born children and try to figure out what are their disadvantages they have in their lives? And also, what are protective factors that may improve their outcomes? In some domains they actually do really well when certain protective factors are present.

Christine Garrington  1:50 

Can you tell us something about how common preterm births are?

Sakari Lemola  1:54 

The incidence of preterm birth has been rising in the last few decades. So in the UK, around 7% of all babies are born preterm each year. This means that two children in an average sized primary school class are likely to have been born preterm and in spite of the advances in neonatal care of preterm birth in the last few decades, and also decreasing mortality rates, which is a very good thing. Negative long term, sequels and consequences of preterm birth have still remained, particularly for very preterm children, those born before the 32nd gestational week that means eight weeks too early or even earlier than that. That leads to medical complications, which often require distressing but life saving treatments frequent are, for instance, neonatal asphyxia, hypoxia due to immature lungs. Necessary treatment involves ventilation, continuous positive airway pressure, surfactant treatment, but also treatment with stress hormones, prenatal corticosteroids treatments to accelerate the long development.

Christine Garrington  3:10 

And so Sakari what does life look like for those children compared with their full-term born peers?

Sakari Lemola  3:16 

They often have an increased risk for poor cognitive development, they show poor educational outcomes, less favourable employment outcomes in adulthood and increased risk for developing mental health problems. And in the PremLife project, we try to specifically answer the question, first of all, of course, what are protective factors for those born preterm. But also we try to focus also to figure out out about what are the social and emotional development of the preterm birth, particularly related to social relationships, wellbeing and things like self-esteem and self-confidence.

Christine Garrington  3:58 

Now, there’s considerable policy interest across Europe and indeed elsewhere and ensuring that obviously, that children get the best possible start and in helping those children who for whatever rate, whatever reason may not get off to the best start. How has your work tied into that sort of policy context would you say?

Sakari Lemola  4:17 

In the PremLife project, we particularly aim to answer what can be done by policymakers, by practitioners, stakeholders to improve preterm children’s and adolescent development? So two focal points were, one was on preschool training in math and literacy. The second point was about how schooling should be organised in general. So we compared school systems in Germany, where so called school tracking takes place. That means children are sorted into higher or lower tracks after the first few school years and we compared Germany with the UK and Finland where no school tracking takes place. That means better and the lower performing children remain in their school classes in the UK and in Finland. But children with special needs they receive remedial teaching but they are not sorted into a different school or different school classes. A third focal point was related to physical activity in childhood and adolescence and what role physical activity actually plays for mental health and social emotional development.

Christine Garrington  5:32 

A key piece of work from the project involved the assessment of adults who had been born preterm. What was sort of the main thinking, the main driver for for this work?

Sakari Lemola  5:42 

Previous work has shown that preterm children have an increased risk for poor cognitive development and they also show poor educational outcomes. And particularly, most work has focused on childhood, but less work on later outcomes like adolescence and also in adulthood. In the PremLife project we have now also focused on adolescence and adulthood. And also particularly, we focused on differences in socio-emotional outcomes in adulthood, particularly regarding social relationships, a topic that has previously been neglected So, children who were born preterm in adolescence and in adulthood, they seem to be less satisfied with their social relationships, they are less likely to be partnered in adulthood, and they are also have decreased fertility so they are less likely to have children on their own later in life.

Christine Garrington  6:44 

Okay, and what were the key things then to emerge about how those people who were born preterm faired later on in life?

Sakari Lemola  6:52 

So we found out that children born preterm to still show differences compared to their term born peers, when they are grown up particularly. Yeah, they show more mental health problems, particularly anxiety disorders, they show lower wellbeing then full term born children in friendship relationships, they are less likely to experience intimate relationships in adulthood, they are less likely to become parents on their own. Somehow, it is likely that anxiety and shyness play a role which is increased in preterm children, they are more anxious about making a step for instance, in social relationships, and that may lead to lower rates of being partnered and becoming parents themselves.

Christine Garrington  7:47 

Okay, now, you made some key recommendations from this. Can you talk about those recommendations and just how practitioners, policymakers and those people born preterm might benefit from from those recommendations?

Sakari Lemola  8:00 

With regard to schooling and education outcomes a key recommendation is the importance of early training and early support in math and literacy. So what we found is that preterm children, they appear to disproportionately benefit from preschool training in math and literacy. So, preterm children who perform well in math, reading and writing when entering into school, so very early on age of five, six years, they were more likely to receive GCSE grades that qualify later to go to university than their term bond peers actually. However, it was exactly the other way around for preterm children who perform poorly in math, reading and writing at school entry, they were less likely to get sufficient GCSE grades compared to their term born peers with similar preschool skills. So their skills at school entry, the skills and math, reading and writing appear to be more important for preterm children than for term born children. And that highlights how important early support and rhythm medial teaching plays there. A second point is that school tracking as it happens currently, is it’s the current policy in in Germany, is a negative thing for preterm children probably also for for other children with early difficulties. Where people from a migration background who are not as fluent in German, for instance, as German children so children with more difficulties in school should rather receive remedial teaching but they should not be sorted out into lower performing school tracks as it is currently the case in Germany. We compared it with the outcome of preterm children who go to school in Finland and in the UK, and they seem not to have that. There is no such a negative effect of the school tracking because there is a different policy in the UK and in Finland.

Christine Garrington  10:11 

And what about the social and emotional side of their lives? What did you find there Sakari?

Sakari Lemola  10:15 

Here we had focused on two factors that appear to be relevant for preterm children. So this involves sensitive parenting on one hand and physical activity and playing sports in childhood and adolescence and preterm born children benefit from both from sensitive parenting and physical activities, such as playing sports. So both factors seem to increase self confidence and have to be considered as protective factors against the negative outcomes of preterm birth, particularly negative outcomes regarding social and emotional development.

Christine Garrington  10:53 

So much interesting research to emerge from this project Sakari. I wonder what the key things have been for you, things that have really caught your eye or have been of particular interest to you, things that maybe surprised you?

Sakari Lemola  11:05 

I think the key findings and surprising findings are that this early training in math and literacy, writing and reading are disproportionately important for preterm children compared to term born children. And this may generalise also to other children who may have a more difficult start in school for them. Most probably it is important to have early support. A second important finding was related to the school tracking that means the grouping of the children to higher and lower performance levels in school. So this has a particularly negative effect on preterm children, as we found out in Germany with an effect that, of course, isn’t present in the UK where there’s no such good tracking.

Christine Garrington  11:53 

Okay, that’s really helpful. Now, you’ve been really active in sharing your findings, not not just with academics, but health practitioners and policymakers. I know what has been the response from them, I’m interested to know.

Sakari Lemola  12:03 

So overall, we had very positive feedback from practitioners and policymakers and we are also confident that the messages will be heard, but of course, time will tell what will be applied and what not.

Christine Garrington  12:20 

Thanks to Sakari Lemola for discussing the findings and implications of DIAL’s PremLife project. You can find out more about this and other DIAL research on the website at dynamicsofinequality.org. We hope you enjoyed this episode, which is produced and presented by Chris Garrington of Research Podcasts. And don’t forget to subscribe wherever you find your podcasts to access earlier and forthcoming episodes.

  

Antenatal steroids: are there links with mental and behaviour problems later on?

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In Episode 8 of Series 3 of the DIAL Podcast, Katri Räikkönen from Helsinki University and a member of DIAL’s PremLife project, talks about her research investigating whether the babies of mothers who whilst pregnant are prescribed steroid drugs, because of concerns around premature births, are more likely to develop behavioural and mental disorders later on.

Associations Between Maternal Antenatal Corticosteroid Treatment and Mental and Behavioural Disorders in Children is research published in the Journal of the American Medical Association. 

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Born preterm or low weight? What could that mean for your relationships and wellbeing later on?

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In Episode 4 of Series 3 of the DIAL Podcast, Ayten Bilgin and Marina Mendonça from DIAL’s PremLife project discuss their research looking at the romantic and sexual relationships of adults who were born pre-term or with a low birth weight and the potential knock on effects of that on their physical and mental wellbeing.

Association of Preterm Birth and Low Birth Weight With Romantic Partnership, Sexual Intercourse, and Parenthood in Adulthood: A Systematic Review and Meta-analysis is research by Marina Mendonça, Ayten Bilgin and Dieter Wolke and is published in the Journal of the American Medical Association (JAMA Open)

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Rachel Robinson: Optimist or pessimist? Pre-term personalities and later life chances

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In Episode 7 of the DIAL Podcast, Rachel Robinson from the University of Helsinki discusses her research looking at whether pre-term babies are more likely to be pessimists or optimists and the implications for how they get on as young adults. The research is part of the NORFACE-funded PremLife Project  looking at adaptation and life outcomes of preterm and low birth weight children across the lifespan.

Further information:

Rachel Robinson was discussing research presented at the DIAL Mid-Term Conference in June 2019.

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