Passionate concern for child and adolescent health

In her research, Anna Sarkadi examines, among other things, how existing activities within municipalities and regions can collaborate in new ways to help vulnerable families.

For most parents, their local child health centre (CHC) is the self-evident place to pose questions about child health and development or discuss breastfeeding, for example. To give more people the security of knowing that this support is available, Anna Sarkadi and her research team are currently evaluating a programme in which parents-to-be in socially disadvantaged areas can be visited at home by CHC staff.

“We’ve interviewed parents and seen that they really appreciate these early home visits. They can get in touch before the birth, and then find out who their ‘own’ CHC nurse will be. When we interview Swedish parents, they talk about the CHC being their most important lifeline. But this may not be true of parents who haven’t been aware of the CHC from the start, and who need proportionally more support to establish a contact with the CHC and feel that it’s there to help them," Sarkadi says.

“If you’re a newcomer in Swedish society, you may have a hard time trusting it and you may not know the difference between the social services and the CHC. They may have heard that ‘they take your children away, so beware.’ But both the families and society have a tremendous lot to gain from establishing contact early and building trust.”

Much of Sarkadi's research involves investigating the potential for new forms of collaboration among existing municipal and regional activities to help vulnerable families. One example is the ‘Healthier Wealthier Families’ model, funded by Forte (the Swedish Research Council for Health, Working Life and Welfare) and pilot-tested in the municipality of Sandviken. Aimed at families in financial difficulties, this model is now to be tested, through CHCs and linked to municipal budget and debt counselling, in a randomised study of families at risk of child poverty. Results to date have been highly encouraging.

“The people with problems are extremely grateful. They didn’t think they were able to talk about this at the CHC. Now, jointly with the budget and debt counselling services and a few families we work with, we’re studying how best to work preventively. It's a matter of how to draw up a budget, check whether you’re getting all the benefits you’re entitled to, and whether you have lots of complicated subscriptions or too many streaming services, for instance. Many people don’t prioritise home insurance, but that’s the worst thing you can do – and the same applies to opting out of unemployment insurance. We’re very hopeful about this study,” she says.

Sandviken is pleased, too, since providing budget and debt counselling in this way affords scope for preventive work to help the families before they lurch into financial crisis and children at risk of suffering.

“There’s a huge stigma around this. Reducing that stigma can bring a huge gain. We’re seeking to measure how people feel, in connection with not having enough money. Growing up in financial straits has, we know, an adverse impact on children's health when they don’t have access to the kinds of thing lots of people take for granted. They suffer from cramped accommodation and the parents are under stress and pressure, which makes it more difficult to have quality time with their children — to sit and read, or just play. Overcrowding also entails a risk of violence,” Sarkadi says.

The children themselves are often a key source of knowledge in her research. It is often they who, in questionnaire surveys or interviews, describe their experiences and feelings. Even very young children can give thoughtful answers on wide-ranging topics, from the pandemic to poverty — or what makes a good parent.

“They said that parents shouldn’t be too nice, that they should listen to their children and help them. That they should be capable of being strict, but not too strict; be able to say no; and teach their children to say thank you. That's exactly what all parenting is about. The children have such a sound grasp of this, and they don’t want someone who just lets them have their way.

“Children are very wise,” Sarkadi continues. We did another survey on whether it’s okay to share images of them on social media. The children said yes, if you ask first. It’s so self-evident, really, but I think far from all parents ask that question.”

Working close to the children and getting to know their needs, thoughts and wishes have influenced Sarkadi on the personal level as well, especially as a mother.

“A bit self-mockingly, I often say I’m superb at parenting in theory; but it can be pretty difficult in practice. Still, I’ve been able to use my knowledge all the way through the children's upbringing. At least, I’ve known what I ought to do ... I’ve genuinely tried to listen to them – put down what I was busy doing, looked them in the eye and listened. I’d read about that somewhere, and really took it to heart.

“Talking to children is a great thrill. They mustn’t be forgotten in society’s crises. Children see and hear a lot,” she adds.

Sarkadi trained as a doctor, just like her own mother. She began her medical training in Budapest, her home city, and arrived in Uppsala to complete it in 1995. She has love to thank for this turn of events. She and her husband Robert met during a medical conference in Prague. While finishing her medical studies, she learnt Swedish in a single semester.

Today, she is Professor of Social Medicine and head of the Child Health and Parenting (CHAP) research environment, where the researchers apply an interdisciplinary approach to evaluate society’s measures to promote children’s and parents’ mental health.