Reducing inequities in health and development through improving the compensatory capacity of universal child health and early education services

Research problemSweden makes major investments in universal child health and early education services. However, inequities in child health have increased.

We propose that the reason for this paradox is that welfare services have failed to provide services proportionate to need; i.e. proportionate universalism (PU), to reduce differential exposure and differential vulnerability to health risks.The purpose of this research program is to examine the compensatory capacity of universal child health and early education services in Sweden and propose models for service provision according to the principles of PU.RQsIs PU practiced in Swedish child health services and do such practices impact children´s health (WP1)?Are there inequalities in the provision and utilization of child health services (CHS) and what health economic impacts would providing services according to PU have (WP2)?Is mapping preschool performance using the Early Development Instrument (EDI) feasible in the Swedish context and is it a potential planning tool for compensatory resource allocation (WP3)?Can the preschool’s compensatory task be improved in a co-designed manner together with structurally vulnerable children (WP4)?Data and methodWP1 Registry data on sociodemographics and child perinatal health will create a composite score for structural vulnerability; regional data will be used to assess CHS practice of PU through multilevel structural equation modelling; registry data will be used on child health outcomes.WP2 CHS provision in relation to SES stratification (the Winkler Index) will be examined using Benefit Incidence Analysis.

Current versus ideal scenario of services with PU will be compared through a cost-utility framework to model health and economic outcomes at age 20, and a return-on-investment framework for returns at age 65.WP3 The EDI measures school readiness and is conceptualized as preschool performance in this proposal.

A model for the use and necessary adaptations of the EDI in Sweden will be followed by a feasibility test and trialing scale-up.

Co-design workshops will help develop the EDI for resource allocation.WP4 A toolkit to engage preschool-aged children in research will be developed and tested.

Children will participate in ‘forum play’ to generate ideas for preschool compensatory activities, which will undergo participatory evaluation.

The participatory process will be studied using behavioral observations.RelevanceThis proposal addresses four focus areas of the call aiming to generate equitable health and development for children in Sweden.

By proposing co-designed ways to improve universal child health and early education services according to the principles of PU, results from this program can be implemented in national and local policies and practices.This 6-year program is built on four interrelated, yet independent WPs.

Our multidisciplinary, applied research group Child Health And Parenting (CHAP) is complemented by experts in early education.