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It’s Report Card Time: Round 1, Child Well-Being

April 23, 2013

Unicef coverIn keeping with the nation’s obsession with education testing, let’s take a peek at the just-released research report from UNICEF:  Innocenti Report Card 11, Child Well-Being in Rich Countries: A Comparative Overview.

The Report Card presents the latest available overview of child well-being in 29 of the world’s most advanced economies. Its purpose is to record the standards achieved by the most advanced nations and to contribute to debate in all countries about how such standards might be achieved.

As moral and pragmatic imperatives, the need to promote the well-being of children is widely accepted. Failure to protect and promote the well-being of children is associated with increased risk across a wide range of later-life outcomes such as impaired cognitive development, lower productivity and earnings, antisocial behavior, drug and alcohol abuse, higher levels of teenage births, and a higher incidence of mental illness.

The case for national commitment to child well-being is therefore compelling both in principle and in practice. And to fulfill that commitment, measuring progress in protecting and promoting the well-being of children is essential to policy-making, to advocacy, to the cost-effective allocation of limited resources, and to the processes of transparency and accountability. In that spirit, let’s take a look at the report card.

Five dimensions of children’s lives have been considered in the UNICEF report card: material well-being, health and safety, education, behaviors and risks, and housing and environment. In total, 26 internationally comparable indicators have been included in the overview.

How are we doing?

Sad to say, the U.S. ranks 26 out of 29 rich countries in the latest UNICEF comparative review of child well-being. We were dead last in 2001 and find ourselves there again in 2010. (The 10-year record is a limited overview, ranking only 20 countries because comparable data for the dimension of housing and environment was not available for all countries at the beginning of the decade.) Finland and the Netherlands led the child well-being rankings in both 2001–2002, and 2009–2010. Canada is ranked 17th and has not changed its position in the past decade.

The U.S. ranks in the bottom third in all dimensions of child well-being—material well- being (26th), health and safety (25th), education (27th), behavior and risks (23rd), and housing and environment (23rd).

We score well on a few indicators: lowest alcohol abuse by young people, 2nd in children reporting exercising for at least an hour a day; 4th in both smoking rate for young people and children eating fruit every day; and 5th in levels of air pollution.

We’re in the middle of the pack for the following indicators: family affluence, educational achievement, children involved in fighting, and young people reporting being bullied.

We score poorly on: relative child poverty rate; child poverty gap; infant mortality; birthrate; preschool enrollment; participation in further education; overweight; teenage births; cannabis use; and, homicide rates. The U.S. also ranks in the bottom third of rich countries on the children’s life satisfaction survey.

In the language of our sacred school report cards, “skills are below grade level in most areas; progress is inconsistent; [Uncle Sam] does not have positive attitude or eagerness to improve; not participating and sharing well in class activities; not demonstrating self-responsibility, social interaction and group dynamics (listening well, showing interest in learning).

A better understanding of the report card is obtained by the relative comparison. For example, while the Netherlands retains its position as the clear leader, and is the only country ranked among the top five countries in all dimensions of child well-being, the bottom four places in the table are occupied by three of the poorest countries in the survey, Latvia, Lithuania and Romania, and by one of the richest, the United States. Overall, there does not appear to be a strong relationship between per capita GDP and overall child well-being. The Czech Republic is ranked higher than Austria, Slovenia higher than Canada, and Portugal higher than the U.S.

Finland is the only country with a relative child poverty rate of less than 5% and heads the comparative rankings by a clear margin of more than 2%. The U.S. is in the bottom third of the 29 countries, with a child poverty rate of 23.1%.  In terms of the child poverty gap—the distance between the national poverty line and median incomes of households below the poverty line—we join the handful of countries that has allowed the gap to widen more than 30%. Here in the U.S. the child poverty gap is 37.5%.

The percentage of overweight children rose in 17 countries over the decade, with the sharpest rise in Poland, where it doubled. Childhood obesity levels are more than 10% in all countries except Denmark, the Netherlands, and Switzerland, but only Canada, Greece and the U.S. have childhood obesity levels higher than 20%. The U.S. had the highest proportion of children overweight at both the beginning and end of the decade, reaching almost 30% by 2009–10.

It is never pleasant to get a bad report card, but dismissing the news is unhelpful. As tempting as it might be to angrily dismiss a child’s poor report card as unfair, in error, or using the wrong measures, we know such evasions are counterproductive. And it’s certainly no use to allege that such report cards are irrelevant on the grounds that “my kid can beat up your kid any day of the week.”

Make no mistake, monitoring the level of children’s well-being is important: the exercise not only takes stock of how well off children are, but also reminds governments and societies around the globe of their obligations toward children and points them toward areas where improvements could and should be made.  We can do better.

Our next look at report cards will be U.S. Health in International Perspective, from the National Academies Press. Stay tuned.

— Michael Lytton, AJPM Blog Editor

For Further Reading:

Anda RF, Butchart A, Felitti VJ, Brown DW. Building a Framework for Global Surveillance of the Public Health: Implications of Adverse Childhood Experiences. Am J Prev Med 2010;39(1)93-8.

Butchart A. Epidemiology: The Major Missing Element in the Global Response to Child Maltreatment? Am J Prev Med 2008;34(4S):S103-5.

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