Innocenti Report Card 16

Worlds of Influence
Understanding What Shapes Child
Well-being in Rich Countries

Innocenti Report Card 16 was written by Anna Gromada, Gwyther Rees andYekaterina Chzhen with contributions from Dominic Richardson, Céline Little andDavid Anthony. The report was fact-checked by Alessandro Carraro, supervised
by Gunilla Olsson and Priscilla Idele and edited by Madelaine Drohan.
The United Nations Children’s Fund Office of Research – Innocenti (UNICEF
Innocenti) would like to acknowledge the generous support for Innocenti Report
Card 16 provided by the Government of Italy.
Any part of this Innocenti Report Card may be freely reproduced using thefollowing reference:
UNICEF Innocenti, ‘Worlds of Influence: Understanding what shapes childwell-being in rich countries’, Innocenti Report Card 16, UNICEF Office of
Research – Innocenti, Florence, 2020.
The Innocenti Report Card series is designed to monitor and compare theperformance of economically advanced countries in securing the rights of
their children.
In 1988, the United Nations Children’s Fund (UNICEF) established a research
centre to support its advocacy for children worldwide and to identify andresearch current and future areas of UNICEF work. The prime objectives of the
UNICEF Office of Research – Innocenti are to improve international
understanding of issues relating to children’s rights, to help facilitate full
implementation of the Convention on the Rights of the Child, and to support
advocacy worldwide. The Office aims to set out a comprehensive framework forresearch and knowledge within the organization, in support of its global policies
and programmes. Through strengthening research partnerships with leading
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views expressed are those of the authors.
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National Committees.

Cover photo © Dissolve/fStop©United Nations Children’s Fund (UNICEF), 2020
ISBN: 978-92-1-103307-6
eISBN: 978-92-1-005303-7
Print ISSN: 1605-7317
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Innocenti Report Card 16

Worlds of Influence
Understanding What Shapes Child
Well-being in Rich Countries

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EXECUTIVE SUMMARY

A new look at children from theworld’s richest countries offers amixed picture of their health, skills
and happiness. For far too many,
issues such as poverty, exclusionand pollution threaten their mental
well-being, physical health andopportunities to develop skills.
Even countries with good social,economic and environmental
conditions are a long way frommeeting the targets set in the2030 Agenda for Sustainable
Development. Focused andaccelerated action is needed if
these goals are to be met.
The evidence from 41
Organisation for Economic
Co-operation and Development(OECD) and European Union (EU)countries tells its own story: fromchildren’s chances of survival,
growth and protection, to whether
they are learning and feel listened
to, to whether their parents havethe support and resources to give
their children the best chance fora healthy, happy childhood. This
report reveals children’s
experiences against the backdropof their country’s policies andsocial, educational, economic andenvironmental contexts.

Skills for life

What makes a good
childhood?

Many also lack basic academic andsocial skills by the age of 15:

Good mental well-being
Feeling positive and being in goodmental health are key aspects ofquality of life. However, a striking
number of children in rich countries
do not have good mental well-being: Two in five children (on average) In 12 of 41 countries, less than For an equally important skill

75 per cent of children aged 15
have high life satisfaction.

 There are no reliable, comparable
data on children’s mental healthacross this set of rich countries.
But suicide is one of the mostcommon causes of death foradolescents aged 15 to 19.

Good physical health
Health indicators also highlightareas of concern: 1 in 15 infants in rich countries isborn with low weight – a key risk
to survival.

 In 10 countries, more than one inthree children is overweight orobese. The number of obese
children (aged 5–19) worldwide
is expected to grow from 158
million to 250 million by 2030.

do not acquire basic reading andmathematics skills by age 15. In
seven countries, the number
drops to less than one in two.
set – feeling confident indeveloping interpersonal
relationships – most children
agree that they make friends
easily. But in 18 countries morethan one in four children
disagree.

Why do all children in richcountries not have a good
childhood?
Poor-quality relationships

 Children view good relationships
as crucial. Those with more
supportive families have bettermental well-being.

 Many children feel that they lack

opportunities to participate indecisions at home and at school.

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 Bullying by peers remains aserious problem; it has a lastingnegative impact on relationships
and health. Children who are
frequently bullied have lower
mean life satisfaction.

 In some countries, at least 1 in

10 parents report no family or
friends they can count on for help
with looking after their children.

Lack of resources

 In almost half of rich countries,

more than one in five children
live in poverty. In many countries,
the poorest children are at
greater risk of depression,
obesity and low academic
achievement.

 Children without books at home
to help with school work suffer
academically.

 More time playing outside islinked to much higher levels ofhappiness. Yet many children saythat good play and leisurefacilities are not available in theirneighbourhoods.

 Adolescents disengaged from Consult children. They see

Gaps in family policy

 Connect policies. Carefully

education and the labour market
face a difficult start to adult life.
In five rich countries, more than
10 per cent of young people
aged 15 to 19 are not in
education, training or work.

 In five rich countries, parental

leave is less than 10 weeks (fullpay equivalent). Leave reserved
for fathers makes up only one
tenth of all parental leave.

 Expectations to prioritize work

can lead to long hours and stressthat reduce the time and energy
parents have for their children.
On average, two out of five
employees in Europe found it
difficult to fulfil family
responsibilities at least several
times per month.

The broader context

 Unemployment – which affects

family relationships and childwell-being – has still not dropped
below its pre-Great Recession
levels in some countries.

things from a different viewpointand express serious concern for
the future of the environment,
how much they value
relationships and participating
in decisions.
integrated policies thatcomplement and strengthen one
another are key to improving
child well-being.

 Create strong foundations. The
Sustainable Development Goals
provide a roadmap to ensuringchild well-being now and for the
future. Governments should
intensify and accelerate theirefforts to meet these goals,
including:

1. Reduce poverty, and ensurethat all children have access to
the resources they need.
2. Improve access to affordable
and high-quality early years
childcare for all children.

 Measles immunization rates have

 In 11 of 41 countries, at least

3. Improve mental healthservices for children andadolescents.

 Public provision of high-quality

 High levels of air pollution still

4. Implement and expand familyfriendly policies related to theworkplace.

Gaps in services
dropped in 14 out of 35 countries
with available time-series data.
childcare provides a stimulatingsocial and learning environment –and helps to reduce socioeconomic disadvantage. And yet,on average, across 29 European
countries, one in seven parents
with a child under 3 has unmetchildcare needs.

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5 per cent of households do nothave safely managed water.
threaten the physical and mental
health of children – who suffer
the greatest harms.

What needs to be done?
For every child to enjoy a good
childhood, UNICEF calls on
high-income countries to act
on three fronts:

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5. Reduce the stubbornly highlevels of air pollution.
6. Strengthen efforts toimmunize children against
preventable diseases.

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SECTION 1
INTRODUCTION

The COVID-19 crisis that has
engulfed the world during 2020
presents new threats to child wellbeing. Even before the crisis, in theworld’s richest countries, the daily
lives of millions of children fell far
short of what anyone would call agood childhood. They sufferedstress, anxiety and depression,
lagged behind their peers at school,
and were physically unwell. Living ina wealthy country did not bring themhappiness. Nor did it guarantee
them better health or education.
For the last 20 years, the Innocenti
Report Card series has led the way
in comparing children’s well-being
across rich countries. Report Card
16 develops this further through amulti-level approach to show thatchildren’s well-being is influenced
by children’s own actions andrelationships, by the networks andresources of their caregivers, andby public policies and the national
context. This approach is alignedwith the 1989 United Nations
Convention on the Rights of theChild, in that it recognizes the

responsibilities of governments,
families and communities to help
realize children’s rights andpromote their well-being.
This report finds that many of thewealthiest countries do not
manage to convert good economic
and social conditions into
consistently high child well-being
outcomes. It shows that no country
is a leader on all fronts, and that all
41 countries have significant room
for improvement. Such
improvement is urgently needed if
the world’s most affluent nations
are to meet the commitments they
made five years ago when they
endorsed the 2030 Sustainable
Development Goals. Yet there areworrying signs of back-sliding on
aspects such as immunization,
learning and mental health.
The COVID-19 crisis adds to thesechallenges. What started as ahealth crisis will spread to touch all
aspects of economies andsocieties. Children will not suffer
the worse direct health effects ofthe virus. But, as we know fromprevious crises, they will be agroup that experiences thelonger-term negative impacts mostacutely. In this report, we present
a baseline picture of children’swell-being in rich countries at thestart of the current crisis. In a
companion paper, we look ahead to
how the crisis may affect childwell-being over the coming years.
The time is right for countries tostep up efforts to realize the rights
of all children. A multi-levelapproach to child well-being can
support this goal because it
delivers a realistic picture. It
clarifies the links between theoutcomes of individual children, thepeople and communities aroundthem, and the nation in which theylive. Many countries have all therequisites – wealth, a clean
environment and generous social
policies – to support high levels ofchild well-being. Yet too many
children in these countries still do
not experience a good childhood.

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Our framework
We view a good childhood as one
in which children have a positive
experience of childhood and theprospect of a good future.1 We
develop a multi-level approach towell-being and adapt it forinternational comparisons. Ourmodel of concentric spheres ofinfluence is similar to the one
developed by American
psychologist Urie Bronfenbrenner
to explain how children interact
with their environment and how
this influences their development(see Figure 1).2

The world at large entails Policies
and Context (the two outer circles
in light blue). Policies refer tonational programmes of direct
relevance to the child, including
social policy, education and health.
Context includes broader

Figure 1: A multi-level framework of child well-being

The child stands at the heart of theframework. Child well-being
outcomes can be objective, suchas child mortality or educational
achievement. They can also be
subjective and expressed from thechild’s point of view, for example
whether they are satisfied with life
or feel they can make friends easily.

Context

Policies

Resources

Outcomes are influenced by theworld of the child, the world aroundthe child and the world at large.
The world of the child (in dark blue)
represents factors experienced
directly by a child: the child’s
Activities and Relationships, suchas those with family and peers. The
world around the child (in mediumblue) consists of Resources andNetworks. Resources include
children’s household economic
status and the quality of theneighbourhoods they live in.
Networks are the connections
between people around the child,
which the child may not directly
experience, but which can affecttheir well-being. An example iswork pressure on their parents.
These four inner circles of theframework can explain variations
between children within countries.

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economic, social and environmental
factors that influence child wellbeing either directly or indirectly.
Policies and Context are national
conditions for well-being that
potentially explain variations in childwell-being between countries.

Networks
ationships
Rel

Activities

Outcomes

The world of the child
The world around the child
The world at large

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Spotlight 1 About the data used in this report

This is our third study of multidimensional child wellbeing in rich countries and it builds on our previous
work. Report Card 7 broke new ground bycomparing child well-being across 21 countries.
It had a major impact on public discourse and on
policymakers. Report Card 11 extended the numberof countries to 29 and updated the rankings. Report
Cards 7 and 11 took a dashboard approach,assessing aspects of children’s physical, cognitiveand mental well-being side-by-side.
Report Card 16 introduces a multi-level frameworkand expands the coverage of child well-being bothconceptually and geographically. It covers 41 highincome countries (members of the OECD and/or theEU). The report also adopts a broader outlook on childwell-being. For example, we consider social skills to
be of equal value to academic skills so we included a
new indicator for making friends easily. We also pay
more attention to environmental factors given how
worried children are about the future of the planet.
These innovations, along with missing data, reduced
the potential for comparisons of Report Card 16 with
Report Cards 7 and 11. Yet, to help with tracking
well-being trends, we updated those elements of theprevious Report Cards for which we have new data.

Criteria for data selection
Report Card 16 employs an array of data from highquality administrative datasets and international
surveys. Indicators were chosen to represent key
concepts within our framework (see Figure 1). Our
selection of key indicators for the league tables was
guided by the following criteria:

 Coverage. Data should be available for the large
majority of the 41 Report Card countries.

 Recency. Data relating to 2016 or later should
be available.

 Relevance. The data should be relevant to crossnational comparisons.

 Variability. There should be enough variability inthe indicators between countries to be
informative.

 Comparability. The indicators should have thesame meaning across cultures.

The last criterion presents challenges for objective
and subjective indicators. For example, the numberof books that a child has at home is often used as an
objective measure of home educational resources, but
it may have different significance in different
countries.3 Subjective indicators may also vary inmeaning. For example, there may be culturaldifferences in self-evaluations of life satisfaction,4although it is possible to explain most of the variation
between countries in mean life satisfaction scoresbased on national social and economic conditions.5
Where a number of options met these criteria, weprioritized the continuity of indicators from previous
multidimensional Report Cards.

Data gaps
In many cases our choices were limited or there wasa lack of comprehensive data. Some of the mostimportant data shortages or gaps that we highlighted
in our search for indicators were: Mental well-being. There are limited data onchildren’s positive sense of well-being and flourishing.
The best indicator we could find – life satisfaction –was only available for 33 of the 41 countries. There isalso a shortage of comparable international data onchildren’s mental ill-health. We have used suicide
rates as a proxy but for many countries these data
were only available up until 2015.

 Violence and protection. We were not able to findany comparable indicators either on children’s
experience of violence or on child protection policies.

 Participation. Children’s experiences of being able

to participate, have their views heard or makechoices are hardly covered in most international
surveys. Only one such survey – Children’s Worlds –which currently covers a minority of OECD/ EU
countries, asks about these issues or aboutchildren’s knowledge of their rights.

These are three topic areas that urgently need to beaddressed by government statistical departments andthe international research community.
The application of the well-being framework to the
COVID-19 crisis can be found in Rees, Gwyther, Anna
Gromada, Dominic Richardson and Alessandro Carraro,Childhood in a Time of Crisis: Understanding how the
COVID-19 pandemic is shaping child well-being in richcountries, United Nations Children’s Fund Office of
Research – Innocenti, Florence, 2020.

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additional dimensions. For example,
child protection andimplementation of children’s rights
could be added to the Policies
sphere, and peace and security to
the Context sphere.

Figure 2 shows how we haveapplied the framework presented
in Figure 1 for this report. Our
selection of dimensions within eachsphere of the framework reflects
available data. Future work using
the framework could include

Figure 2: Overview of the application of the framework for this reportSocietyorld at large
The w
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Overweight/obesity,
mortality

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ork
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of
world the chiledTh

SkillsReading/mathematics,
making friends

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Box 1: Indicators used in the report
DimensionComponents

Indicators

Life satisfaction

Percentage of children with high life satisfaction at 15 PISA, 2018

Adolescent suicide

Suicide rate for 15- to 19-year-olds

WHO Mortality
Database, 2015

Child mortality

Child mortality rate (all causes), 5–14

UN IGME project, 2018

Overweight

Percentage of children overweight, 5–19

State of the World’sChildren, 2016

Academic proficiency

Percentage proficient in mathematics and reading
at 15

PISA, 2018

Social skills

Percentage who make friends easily at school at 15

PISA, 2018

Play

Playing outside

Frequency of playing outside at 10 years old(days per week)

Children’s Worlds, 2017–19

DigitalInternet use

Average duration of Internet use by children

EU Kids Online, 2018–19

Family support

Level of family support reported by children at
15 years old

HBSC, 2017/18

Family participation

Percentage of children aged 10 totally agreeing thatthey participate in decision-making at homeChildren’s Worlds, 2017–19

Outcomes

Mental well-being

Physical health

Relationships

Activities

SkillsFamilyBeing bullied

Frequency of children being bullied at 15 years old

PISA, 2018

School belonging

Sense of belonging at school at 15 years old

PISA, 2018

School participation

Percentage of children aged 10 totally agreeing thatthey participate in decision-making at schoolChildren’s Worlds, 2017–19

Parental support
networks

Main sources of support for parents in looking
after children

European Quality of Life
Survey, 2016

Work–family balance

Percentage of employees struggling to fulfil family
responsibilities

European Quality of Life
Survey, 2016

Hours worked

Average weekly hours worked on main job

OECD based on LabourMarket Statistics, 2017

Relationship with school

Parents’ rating of their relationship with school

European Quality of Life
Survey, 2016

Household resources School books at home

Percentage of children aged 15 having books athome to help with school work

PISA, 2018

Neighbourhood
resources

Local play facilities

Percentage of children aged 10 who agree that
there are enough places to play in their local area

Children’s Worlds, 2017–19

Parental leave

Weeks of full-rate equivalent parental leavein early childhood

OECD Family Database,
2018Child poverty

Percentage of children in households below 60% of
median income

Eurostat, HILDA, LIS andnational statistical agencies,
2018

Early childhood
education and care

Percentage of children attending early childhood
education and care one year before school

UNESCO, 2017, Report Card
15 and UNSTATSNEETPercentage of 15- to 19-year-olds out of school,
employment or training

OECD Family Database andEurostat, 2018

Immunization

Measles immunization

WHO/UNICEF, 2018

Low birthweight

Percentage of newborns weighing less than
2,500 grams

OECD Health Database andWHO, 2017

Peers
SchoolNetworks

Parent–community

Parent–work

Resources

Parent–school

Policies

Family policy

Education

HealthEconomyContext

SourceSociety

IncomeGross national income per capita in international dollars World Bank, 2018

Jobs

Unemployment rate (percentage of active population) World Bank, 2019Social support

Percentage of adults who have someone to count on Gallup World Poll, 2016–18

Violence

Homicide rate

World Bank, 2017

Air pollution

Mean levels of fine particulate matter PM2.5

Global Burden of Disease
Study, 2017

Water quality

Percentage of population using safe water

WHO/UNICEF Joint
Monitoring Programme, 2017

Environment

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SECTION 2
OUTCOMES

For this section, we consider twoquestions.
1. How do children experience theirlives in the present?
2. And what are their prospects forthe future?
These questions are related. For
example, having good health leads
to both current and future wellbeing. To address these questions,
we focus on indicators that directly
describe the well-being outcomesof the child.
Our league table of child well-being
outcomes corresponds to theinnermost circle of our model (seeFigure 3). It consists of three
dimensions (see Box 1):

 Mental well-being: This includes

both positive and negative aspectsof a child’s mental well-being – life
satisfaction and suicide rates.

 Physical health: This includes

rates of overweight and obesity,
which affect children now and in
future, and child mortality.

 Skills: This dimension focuses

both on academic skills –proficiency in reading andmathematics; and social skills –feeling able to make friends easily.

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The rationale for the inclusion ofthese components, indicators andtheir sources is explained later inthis section. We were unable toinclude 3 of the 41 countries –Israel, Mexico and Turkey – in theleague table of well-being
outcomes due to shortages of data
(see note to Figure 3). However,these three countries are included,
where possible, throughout therest of the report.
The Netherlands ranks highest in theleague table of outcomes, followed
by Denmark and Norway. These
three countries along with
Switzerland and Finland are in the
top third of rankings in all threeoutcomes. Chile, Bulgaria and theUnited States of America are at thebottom of the table. Only Chile, theUnited States and Malta are in thebottom third of rankings for each of
the three well-being outcomes.
National income is clearly no
guarantee of the best outcomes.
Each third of the league tablecontains a mixture of countries with
contrasting income levels. For
example, Slovenia ranks above
Sweden in the top third, while in thebottom third Lithuania fares better
than the United States.

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The rankings of some countries vary
widely from one well-being outcome
to another. For example, the Republicof Korea is in the top third forphysical health and skills, but in thebottom third for mental well-being.
In contrast, Romania is ranked fourthhighest for mental well-being but isin the bottom third for the physicalhealth and skills dimensions.
The physical health and skills
dimensions are moderately
correlated (r=0.58), meaning that if
a country reports good results in
one of these dimensions, it is likely
to report good results in the other.
But skills are less strongly correlatedwith mental well-being (r=0.30),
while physical health and mental
well-being are even more weakly
linked (r=0.10). This highlights themultidimensional nature of childwell-being outcomes.

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Figure 3: A league table of child well-being outcomes: mental well-being, physical health, and academic
and social skills
Overall ranking

Country

Mental well-being

Physical health

Skills1

Netherlands

1

9

3

2

Denmark

5

4

7

3

Norway

11

8

1

4

Switzerland

13

3

12

5

Finland

12

6

9

6

Spain

3

23

4

7

France

7

18

5

8

Belgium

17

7

8

9

Slovenia

23

11

2

10

Sweden

22

5

14

11

Croatia

10

25

10

12

Ireland

26

17

6

13

Luxembourg

19

2

28

14

Germany

16

10

21

15

Hungary

15

21

13

16

Austria

21

12

17

17

Portugal

6

26

20

18

Cyprus

2

29

24

19

Italy

9

31

15

20

Japan

37

1

27

21

Republic of Korea

34

13

11

22

Czech Republic

24

14

22

23

Estonia

33

15

16

24

Iceland

20

16

34

25

Romania

4

34

30

26

Slovakia

14

27

36

27

United Kingdom

29

19

26

28

Latvia

25

24

29

29

Greece

8

35

31

30

Canada

31

30

18

31

Poland

30

22

25

32

Australia

35

28

19
33

33

Lithuania

36

20

34

Malta

28

32

35

35

New Zealand

38

33

23

36

United States

32

38

32

37

Bulgaria

18

37

37

38

Chile

27

36

38

Note: A light blue background indicates a place in the top third of rankings, medium blue denotes the middle third, and dark blue the bottom third. The rankings in thetable were produced as follows: (1) We calculated a z-score for each indicator (reversed where necessary so that a higher score represents a more positive outcome); (2)we calculated the mean of the two z-scores within each dimension; (3) we calculated the z-score for each mean; and (4) for the overall ranking, we then calculated themean of the mean z-scores for each dimension. This table includes the 38 OECD/EU countries which had data of sufficient quality across at least five of the six Outcomesindicators listed in Box 1. We were unable to include Mexico and Turkey due to low coverage rates in the Programme for International Student Assessment (PISA) 2018
survey (which provides three of the six indicators that make up the league table). We were also unable to include Israel as data were missing on two of the six indicators.

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Mental well-being
Mental well-being means not only
the absence of mental ill-healthbut also a broader sense of positive
functioning.6 We represent bothof these aspects in the first
league table.

In some countries, less than two thirds of children have high life satisfaction
Figure 4: Percentage of children with high life satisfaction at 15 years of age

Positive functioning encompasses
various components including
emotions such as feeling happy,
satisfaction with life and a sense offlourishing. The league table
includes a question about life
satisfaction from the Programme
for International Student
Assessment (PISA) study, based on
the criteria for indicator selection(see Spotlight 1). Children aged 15
years were each asked to say how
satisfied they felt with their life as awhole using a scale from 0 (worst
possible life) to 10 (best possiblelife). In all countries, most children
were reasonably satisfied with theirlives (a score above the midpointon the scale), but there wasvariation between countries in thisregard – ranging from less than
55 per cent of children in Turkey
to 90 per cent of children in the
Netherlands (see Figure 4).
The fact that most children arereasonably satisfied with their lives
is encouraging. We still need toconsider what these percentages
mean in terms of the large
numbers of children who have low
life satisfaction. This is more thanmerely a question of momentary‘happiness’. For example, a study in
the United Kingdom showed that,compared with children withaverage to high life satisfaction,
those with low life satisfaction
were about eight times as likely toreport family conflict, six times as
likely to feel that they could not
express their opinions, five times as
likely to be bullied, and more than

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90Netherlands
Mexico86

Romania85

Finland84

Croatia82

Switzerland

82

Spain

82

Lithuania

82

Iceland

81

France80

Estonia

78

Portugal78

Latvia78

Austria

77

Slovakia

77

Hungary

77

Italy

76

Sweden76

Greece76

Luxembourg

76

Germany

75

Czechia73

Bulgaria

73

Slovenia

72

Ireland

72

Chile

72

Poland72

United States

71

Malta

70

Republic of Korea

67

United Kingdom

64

Japan

62

Turkey

53
0

20

40

60

80

Percentage of children with high life satisfaction (>5 out of 10)

Note: Percentage of children scoring more than 5 out of 10 on the Cantril Ladder for satisfaction
with life as a whole. No data available for Australia, Belgium, Canada, Cyprus, Denmark, Israel,
New Zealand and Norway.
Source: Programme for International Student Assessment (PISA) 2018.

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S E C T I O N

1.4

Greece2.1

Israel2.2

Cyprus2.4

Turkey

2.4

Italy

2.5

Spain

2.6

France3.4

Denmark

3.6

United Kingdom

3.7

Slovakia

4.2

Bulgaria

4.3

Germany

4.4

Hungary

4.5

Netherlands

4.8

Norway5.1

Romania

5.1

Slovenia

5.6

O U T C O M E S

twice as likely not to look forward
to going to school.7 Only 64 percent of children with low selfreported well-being felt they had
people who supported them,compared with 93 per cent of otherchildren. And 24 per cent ofchildren with low well-being said
that they did not feel safe at home,compared with only about 1 percent of other children.

More than 10 in 100,000 adolescents aged 15–19 years commit
suicide in some rich countries
Figure 5: Suicide rate per 100,000 adolescents aged 15–19 years

Portugal

2

There is a lack of reliable,comparable data on mental illhealth among children globally. As
in previous Report Cards, we used
the suicide rate among adolescents
aged 15–19 years as the best
available indicator. Unfortunately,
data were only generally available
up to 2015. Suicide rates in this age
group were above 10 per 100,000
in Lithuania, New Zealand andEstonia, and lowest in Greece,
Portugal and Israel.

Luxembourg

6.0

Belgium

6.1

Ireland

6.4

Croatia

6.6

Czechia

6.7

Malta

6.8

Physical health

Switzerland

7.0

Mexico

7.1

The full extent of the healthoutcomes associated withchildhood and adolescence only
becomes apparent later in life.
There are, however, some usefulindicators relating to children’s
physical health during childhood.
Here we look at two indicators thathave also been included in previous
Report Cards: child mortality andoverweight (including obesity).

Austria

7.2

Sweden7.3

Republic of Korea

7.3

Japan

7.5

Chile

8.0

Finland

8.2

United States

8.7

Poland8.8

Canada9.0

Latvia9.5

Australia

9.7

Iceland9.7
13.9

Estonia

14.9

New Zealand

18.2

Lithuania
0

2

4

6

8

10

12

14

16

18

20

For child mortality, we use themortality rate for children aged 5–14
years, provided by the United
Nations Inter-agency Group for Child
Mortality Estimation.8

Suicide rate per 100,000 people aged 15–19 years(three-year moving average)
Notes: Figures are three-year averages for 2013–2015, except that: (1) data were only available for two ofthese three years in Greece, New Zealand and Slovakia; and (2) five-year averages are used for the following
three countries that had fewer than 50,000 people in this age group – Cyprus, Iceland and Luxembourg.
Source: World Health Organization Mortality Database (numbers of suicides) and World Bank database(population estimates).

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2O U T C O M E S

Figure 6 shows a wide range ofrates, with child mortality aboutfour times higher in Mexico than it
is in each of the six countries withthe lowest rates. Among the 41
countries, the child mortality rate is
the outcome indicator most closely
associated with national income
and inequality (see Spotlight 6).
Among the richer countries in ourlist, the United States stands out.
It has a higher child mortality rate
than countries with similar levelsof per capita income.

In more than a quarter of countries, child mortality rates arestill over 1 per 1,000
Figure 6: Mortality rate per 1,000 children aged 5–14 years, 2018
Luxembourg

0.36

Denmark

0.50

Finland

0.60

Norway0.63

Ireland

0.64

Switzerland

0.66

Spain

0.71

Germany

0.72

Japan

0.73

Italy

0.73

Slovenia

0.74

Republic of Korea

0.75

Iceland

0.78

United Kingdom

0.78

Sweden0.79

Austria

0.80

France0.80

Belgium

0.80

Netherlands

0.81

Czechia

0.81

Malta

0.84

Australia

0.84

The second indicator of physicalhealth is overweight and obesity.
Being overweight is defined ashaving a body mass index (BMI) of
over 25, while obesity is indicatedby a BMI of over 30. Obesity is aserious problem for both medical
and psychological reasons. It
contributes to diabetes,
cardiovascular diseases,
hypertension, cancer, gallbladderdisease and a shorter life
expectancy.9 It takes a social andemotional toll by limiting
participation in social life andlowering self-esteem.

Portugal

0.87

New Zealand

0.87

Cyprus0.90

Israel0.94

Hungary

0.97

Canada0.98

Greece1.05

Croatia

1.13

Poland

1.16

Estonia1.22

United States

In recent years, rates of overweight
and obesity have increased
substantially in high-income
countries. For example, obesity
among children and adolescents
aged 2–19 years in the UnitedStates has risen by more than one
third in the last 15 years.10 The
global picture is bleak. The numberof obese children and adolescents
aged 5–19 years worldwide is
expected to grow from 158 million

1.34

Lithuania

1.41

Slovakia

1.42

Latvia

1.46

Chile

1.49
1.80

Romania
Bulgaria

1.93

Turkey1.96
2.47

Mexico
0

0.5

1.0

1.5

2.0

2.5

Mortality rate per 1,000 children aged 5–14 years
Source: United Nations Inter-agency Group for Child Mortality Estimation project.

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S E C T I O N

in 2020 to 254 million by 2030.11
The recent rise in obesity appears
to be linked with lifestyle changes
and insufficient regulation of foodproduction and advertising,including predatory commercial
practices, which could be
addressed by governments.12
Unlike the mortality indicator, there
is no clear link between overweight/
obesity rates and national income
among the rich countries includedin this report. There do appear to besome geographical patterns. Lower
rates tend to be found mostly incountries in the northern half ofEurope and East Asia. Higher rates
are found primarily in countries
around the Mediterranean and in
the Americas and Oceania.

SkillsLearning new skills can be a
rewarding experience for children in
the present, as well as a foundation
for adulthood. Child well-being
indices often include indicators ofskills development, but the focus
has usually been on academic skills.
Social and emotional skills are also
important both during childhood
and as a foundation for adulthood.
These types of skills are also
increasingly seen as important for
employability. With this in mind, we
aimed to include in our two
indicators for the skills dimension –a measure of educational
achievement near the end ofcompulsory secondary education
and a measure of social skills.

2

O U T C O M E S

In 10 countries, more than one in three children andadolescents is overweight (including obese)
Figure 7: Percentage of young people aged 5–19 years who
were overweight or obese in 2016
Japan

14

Estonia20

Lithuania

21

Latvia21

Switzerland

22

Slovakia

23

Sweden24

Belgium

24

Romania25

Netherlands

25

Denmark

25

Poland26

Luxembourg

26

Germany

27

Austria27

Finland27

Slovenia

27

Czechia

27

Norway27

Republic of Korea

28

Croatia28

Iceland28

Hungary

28

Bulgaria

28

Turkey30

France30

Ireland31

United Kingdom

31

Canada32

Portugal

33

Cyprus

33

Spain

34

Australia

34

Israel35

Mexico

36

Chile

36

Italy

37

Malta

37

Greece37

New Zealand

39

United States

42
0

5

10

15

20

25

30

35

40

45

Percentage of children aged 5–19 years
who are overweight or obese
Source: United Nations Children’s Fund, The State of the World’s Children 2019. Children, Food andNutrition: Growing well in a changing world, UNICEF, New York, 2019.

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Spotlight 2 Body image relates to life satisfaction
twice as strongly for girls than for boys

How adolescents feel about their bodies has an impact
on their well-being. A positive body image is linked togreater self-confidence. A negative body image canlead to shame, anxiety, depression, isolation and low
self-confidence.13 It is also the strongest contributor toanorexia and bulimia.14 For example, in the UnitedStates, most adolescent girls and one third ofadolescent boys report unhealthy attempts at weightcontrol, such as smoking, fasting, vomiting or taking
weight-regulating drugs.15

In those countries for which we have data, theproportion of children aged 11, 13 and 15 years who
were dissatisfied with their own body ranged from
more than 33 per cent in Iceland to 55 per cent in
Poland. More children overall thought they were too fat(29 per cent) than too thin (16 per cent). Based onweight and height measurements, 23 per cent of girls
and 27 per cent of boys aged 15 years were actually
overweight.16 Yet, girls of this age were more likely to
see themselves as fat (34 per cent) than boys (24 per

In most rich countries, more than two in five adolescents are dissatisfied with their bodies
Figure 8: Percentage of adolescents aged 11, 13 and 15 years who say they are too fat or too thin
60

50

16
21

15

17

17

15

16

16

14

27

23

23

18

20

18

18

13
16

16

12

12
16

13
15

14

11
17

17

13

20

16

13

14

30

12

16

40

14

Percentage

Average: 45%

1 6

36

33

38

Estonia

Poland33

Luxembourg

25

34

Austria

Greece33

Germany25

Latvia32

UK (Scotland)

Czechia

24

Slovakia

32

29

Lithuania

Belgium (French)

26

Romania32

31

Greenland

24

27

Bulgaria

Israel31

Netherlands

Hungary

29

31

27

SwedenUK (Wales)

33

30

Denmark

Switzerland

30

Finland

Belgium (Flemish)27

Ireland

1 6

28

25

FranceC A R D

28

24

Croatia

R E P O R T

Spain

27

UK (England)

I N N O C E N T I

Portugal

27

Italy

Source: Health Behaviour in School-aged Children (HBSC) 2018.

29

24

CanadaPercentage of adolescents who think they are too fat

Slovenia

21

20

Iceland

0

Malta

10

Percentage of adolescents who think they are too thinS E C T I O Ncent). This suggests that many children with a healthy
weight think they are fat, particularly girls. The numbers
are very similar at the ages of 11, 13 and 15 years,
indicating that these negative feelings may have started
even before adolescence.
Body image is much more closely linked to life
satisfaction for girls. On average, body image explains
10 per cent of the differences in life satisfaction of girls
and 5 per cent of the differences for boys. Yet the link
between body image and life satisfaction varies

2

O U T C O M E S

enormously (see Figure 9). It does not impact boys in
Bulgaria, where 1 in 10 boys is overweight. It isstrongest for girls in Scotland (United Kingdom),Finland, the Netherlands and Ireland.
Girls who are satisfied with their bodies typically comefrom families and peer groups who express fewer
weight-related concerns and emphasize positive body
behaviours (such as exercising and eating well) as
opposed to negative behaviours (such as dieting).17

The link between body image and life satisfaction is twice as strong for girls than boys
Figure 9: Percentage of differences in life satisfaction accounted for by body image
18

Percentage of differences in life
satisfaction related to body image

16
14
12
10
8
6
4
2

Bulgaria
IsraelLuxembourg
Slovakia
FranceBelgium (Flemish)
Belgium (French)
Estonia
Romania
Italy
Hungary
Czechia
Greenland
Malta
Switzerland
Lithuania
Portugal
Croatia
PolandGermany
Austria
Iceland
Slovenia
LatviaCanadaUK (England)
SwedenDenmark
GreeceSpain
UK (Wales)
IrelandNetherlands
Finland
UK (Scotland)

0

Girls

Boys

Notes: R-squared from regression model controlled for age with full weights. All regression coefficients significant at p=.01, apart fromfor boys in Bulgaria.
Source: Health Behaviour in School-aged Children (HBSC) 2018 (weighted and clustered).

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2O U T C O M E S

For educational achievement, we
focus on the proportion of children
who meet basic standards ofproficiency. We also take into
account the percentage of children
who are still in school in eachcountry at the age of 15. For thispurpose, we use Coverage Index 3
from the PISA study, which can beviewed as a measure of verified
enrolment.18 Our indicator is theestimated proportion of the total
child population who are still inschool and have reached a basic
level of proficiency in both reading
and mathematics (see Figure 10). It
can be interpreted as a minimum
estimate of the level of proficiency
in the child population at 15 yearsof age. Even in the best-performing
country, Estonia, more than one
in five children do not meet thebasic proficiency standard. In fivecountries, less than half of children
do so.

Many children still reach 15 years of age without having basic
reading and mathematics skills
Figure 10: Percentage of children aged 15 years with basic
proficiency in reading and mathematics
Estonia79

Ireland78

Finland78

Slovenia

75

Japan

73

Germany

73

Poland72

Republic of Korea

70

Denmark

69

Czechia

69

Belgium

69

Norway68

Canada

68

Spain

67

France67

Netherlands

66

New Zealand

65

Switzerland

65

Sweden64

Latvia64

Australia

64

United Kingdom

63

Austria

63

Portugal

63

Iceland62

Lithuania

61

Hungary

61

United States

60

Italy

58

Croatia

58

Malta

57

Luxembourg

56

Slovakia

54

Greece53

Israel48

Cyprus

45

Chile

40

Romania

34

Bulgaria

32
0

10
20
30
40
50
60
70
80
90
Estimated percentage of children aged 15 years who have basic
proficiency in both reading and mathematics

Note: The percentage of children meeting or exceeding basic proficiency in both reading andmathematics tests, multiplied by the Coverage Index 3 of the PISA survey.
Source: Programme for International Student Assessment (PISA) 2018, except for Spain (figures for Spainfrom PISA 2015, as 2018 data were unavailable).

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Our second indicator focuses onsocial skills. We use a question
asked in the PISA study about
whether children feel that they areable to make friends easily. We view
this indicator as tapping into theextent to which children feel
confident in developing
interpersonal relationships. This
type of skill is likely to be beneficial
to children both in the present andin adulthood in all aspect of theirlives. Figure 11 shows thepercentage of children who agreed
or strongly agreed that they makefriends easily. Romania ranks
highest on this indicator and is oneof seven countries where more thanfour in five children felt that they
make friends easily. In two countries– Chile and Japan – less than 70 per
cent of children felt this way.
Our analysis of this range ofimportant well-being outcomespresents a challenge topolicymakers. While all countries
can feel positive about theirposition in the rankings on one ormore of these key indicators, none
can feel satisfied with their positionon all six. And even in countries at
the top of the rankings, there arestill many children who are fallingbehind. In subsequent sections, wewill try to understand what factors
lie behind these variations in childwell-being outcomes and therefore
what improvements can be made.
We begin by looking at factors
close to the child – their daily lives
and their closest relationships –and then gradually move outwards,
towards the broader conditions
within societies that also have an
impact on children’s experiences
and well-being.

2

O U T C O M E S

Many 15-year-old children do not feel confident in their skills to make friends
Figure 11: Percentage of children aged 15 years who make friends easily
Romania

83

Norway82

Croatia

82

Netherlands

81

Spain

81

France81

Cyprus

81

Italy

79

Belgium

79

Hungary79

Denmark79

Slovenia

79

Switzerland

79

Republic of Korea

77

Sweden77

Austria77

Ireland76

Portugal

76

Australia

76

Luxembourg

75

Greece75

Finland75

Canada74

New Zealand

74

Bulgaria

74

Mexico74

United Kingdom

73

Czechia

73

Turkey72

United States

72

Germany72

Slovakia

72

Latvia71

Lithuania

71

Malta

71

Estonia

71

Poland70

Iceland

70

Japan

69

Chile

68

0

10

20

30

40

50

60

70

80

90

Percentage of children aged 15 years who make friends easily
Note: The percentage of children aged 15 years who agreed or strongly agreed that they make friends
easily at school.
Source: Programme for International Student Assessment (PISA) 2018, except for Cyprus (figures for
Cyprus from PISA 2015, as 2018 data were unavailable) and Israel (no data available).

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SECTION 3
THE WORLD OF THE CHILD
How direct experiences differentiate childwell-being within countries

In this section and the next, welook at the four levels of theframework closest to outcomes, as
they can help us to understandwhy, within the same country,
some children have higher wellbeing than others.19 We start with‘the world of the child’: theactivities in which children are
involved and their relationships withpeople close to them such as
parents, peers and teachers.

Context

Policies

Resources

Activities

Networks
ationships
Rel

Activities

Outcomes

The world of the child
The world around the child
The world at large

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Children’s activities inform us about
their daily lives. These activities
may not always be chosen bychildren and may reflect thepriorities of others, for example,
their parents. Indeed, children
spend substantial amounts of timein compulsory schooling. In 2018,
across OECD countries, theaverage compulsory instruction
time per pupil in lower secondary
school ranged from 766 hours per
year in Slovenia and Sweden to
1,200 hours per year in Denmark.20
International comparative studies ofchildren’s daily lives outside ofschool are rare. We use new dataon children’s activities in 15 richcountries from the latest wave of
the Children’s Worlds survey.
Children were asked how often
during the last week they had doneS E C T I O N

15 different activities – for example,
helping around the home, doing
homework, using a computer andspending time playing outside.
We were interested to see which ofthese activities were linked withchildren’s sense of well-being,based on how happy they had felt
in the past two weeks. Here wechoose happiness rather than life
satisfaction as an indicator because
it is likely to be more closely
associated with factors that mayvary over time, such as activities.
The strongest link found was
between happiness and time spent
with family.21 This is consistent withother research showing theimportance of family relationships
for children. There were also strong
links between happiness and thefrequency of playing outside.22 In
comparison, other factors such associal media use and doinghousework were weakly, and lessoften significantly, linked withhappiness. Figure 12 shows thedifferences in happiness between
children who played outside rarely
and those who did so daily. These
differences are large – more than
1 point on a happiness scale of
0 to 10 (from least to most happy) –in almost every country.
This example illustrates how
children’s activities can be linked totheir subjective experiences. Of
course, children do not necessarily
have a free choice about how they
spend their time. In line with ourframework, this will be affected by
the resources and relationships
around them. For example, howoften children play outside may
depend on parenting styles, culturaldifferences, family economic
circumstances, and safety andfacilities available in their local area.
Further analysis of the Children’s

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Children who play outside often are happier than children who do not
Figure 12: Mean happiness scores of children who played outside rarely
and those who did so daily
9.0

UK (Wales)

7.0
9.4

Poland

7.5
9.1

Finland7.6
9.0

Israel7.6
9.3

Estonia

7.8
9.5

Romania

8.1
9.7

Greece (Epirus)

8.3
9.7

Malta

8.5
9.3

Hungary

8.1
8.9

Norway7.8
9.5

Italy (Liguria)

8.5
9.0

Belgium (Flanders)

7.9
9.5

Spain (Catalonia)

8.5
9.6

Croatia

8.9
9.1

Switzerland

8.6
0

1

2

3

4

5

6

7

8

9

10

Mean happiness score (0 to 10)
Daily

Worlds data shows that all of thesefactors are indeed relevant. Children
were more likely to play outside if
their parents involved them inmaking decisions about their lives, if
they lived in more affluent families
and if they lived in neighbourhoods
with good play facilities.

RarelyNotes: Children were asked how often they
played outside. They were also asked to rate theirhappiness in the past two weeks on a scale from0 to 10 (least to most happy). The figurecompares the mean happiness scores for children
who said that they played outside less than oncea week and those who said they did so every day.
All differences significant (p<0.01), except
Switzerland (p<0.05).
Source: Children’s Worlds survey, Wave 3,
2017–2019, children aged about 10 years.

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Spotlight 3 Screen time has a small negative influence,and other activities matter more for well-being

The amount of time children spend online is increasing
rapidly. In the United States, the proportion ofadolescents who say they are connected “almost
constantly” has increased from 24 per cent to 45 percent in three years.23 An additional 44 per cent reportusing the Internet several times a day. In 11 European
countries, the amount of time children spend online
almost doubled in less than a decade: from an hour
and a half to almost three hours daily (see Figure 13). It
is understandable that parents and educators may beconcerned about the impact of new technologies onchildren’s well-being.

But does more screen time have a negative impact onchildren’s well-being? Despite public concern about
this issue, the link appears to be weak.25 Robust
studies suggest that moderate use is key.26 In thesestudies, the highest mental well-being was observed
not among those children who reported no screenuse, but among those who used screens for less than
2 hours per day.
Moderate use (between 30 minutes and 3 hours perday, depending on device and timing) was associatedwith the highest mental well-being. Children who did

Children are online almost twice as long than a decade ago
Figure 13: Average duration of Internet use in minutes per day among 9- to 16-year-olds
250

Minutes/day

200

150

100

50

2010

NorwaySpain

Romania

PortugalEstonia

Czechia

Lithuania

PolandFrance

Italy

Germany0

2018/19

Notes: Values have been calculated based on questions about how long children use the Internet a) on a normal weekday, and b) on a weekend
or holiday (approximately 1,000 cases per country). Only children who actively use the Internet were asked to estimate its duration so theincrease is not fuelled by increased access to the Internet. For full reports about the surveys see Livingstone et al. (2011), and Smahel et al. (2020).24
For details of the methodology see www.eukidsonline.net.
Source: EU Kids Online.

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Children’s relationships
When asked about what matters totheir well-being, children emphasize
good-quality relationships.28 Survey
findings back this up, showing that
positive relationships with family,
with peers and at school are linked
with higher well-being in one ormore dimensions.29

The impact of screen time is four times smaller than that ofbeing bullied
Figure 14: Links between eight different activities andadolescent mental well-being
Regularly eating breakfast

Family relationships
Comparative data on children’s
family relationships are scarce. The
Health Behaviour in School-agedChildren (HBSC) survey, covering
most European countries plus
Canada, asks children aged 11, 13
and 15 years four questions about
how much they feel helped andsupported by their family: whether
their family tries to help them;whether they get the emotional
help and support they need fromtheir family; whether they can talkabout problems with their family;
and whether their family is willingto help them make decisions.

Cycling
Getting enough sleep
Eating fruit
Technology use
Binge drinking
Wearing glasses
Being bullied
-0.25

-0.20

-0.15

-0.10

-0.05

0

0.05

0.10

0.15

0.20

0.25

Effect of a given activity on adolescent well-being
Notes: The chart shows median standardized coefficients from the specification curve
analysis based on the UK Millennium Cohort Study. The sample included 5,926 girls and5,946 boys aged 13–15 and 10,605 primary caregivers. Technology use was measured
through five questions concerning TV use, electronic games, social media use, owning
a computer and using the Internet at home.
Source: Orben, Amy and Andrew K. Przybylski, 'The association between adolescentwell-being and digital technology use', Nature Human Behaviour, vol. 3, no. 2, February
2019, pp. 173–182.

not use technology, as well as those who were very intensive users, had
lower well-being. The impact of technology has been shown to be timespecific – stronger on school days than on weekends. This may reflect
greater pressures on children during the days when they attend school.
However, the impact of screen time should be put into perspective andassessed against other real-world benchmarks. An analysis of data from theUnited States and the United Kingdom suggests that the overall link
between technology use and adolescent mental well-being is negative but
small, explaining only 0.4 per cent of the differences in mental well-being.27
Many common activities that do not draw as much media attention – suchas eating breakfast, cycling or getting enough sleep – have a larger
association with adolescent mental well-being (see Figure 14). Among
negative factors, screen time had an association with adolescent well-being
four times less strong than that of being bullied.

We averaged the responses tothese four questions to create anindicator of the quality of family
relationships, defining thosechildren who scored below the
midpoint (which means they weremore likely, on average, to disagree
than agree) as having poor-quality
relationships. Across 35 countries
and territories included in thisreport, the percentage of children
who had poor-quality family
relationships ranged from 6 percent in Hungary, the Netherlands
and Norway to over 30 per centin Bulgaria.

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In all countries, children who have less supportive families tend to havepoorer emotional well-being
Figure 15: Emotional well-being of 15-year-olds according to the quality of
their family relationships
Germany
Netherlands
Belgium (Flemish)
SpainAustria
Switzerland
NorwayCroatia
Luxembourg
Lithuania
CanadaSlovenia

Figure 15 shows the link between
the quality of family relationships
and children’s emotional well-being.
Emotional well-being is measured
by four questions about thefrequency of children feeling low;
feeling irritable or in a bad temper;
feeling nervous; and having difficulty
sleeping. In all countries, children
who reported having supportive
family relationships were also
more likely to have good emotional
well-being. The link between
supportive family relationships andemotional well-being was muchstronger in some countries, like
Luxembourg and Portugal, than inothers such as Iceland and Scotland(United Kingdom).

FinlandPeer relationships

IrelandPeer relationships become
increasingly important for children’swell-being as they grow up.30 Thereis no good indicator of the overall
quality of peer relationships for all
41 countries. This is another major
evidence gap. The PISA study does,
however, contain information on
children’s experiences of beingbullied at school. Being bullied isassociated with children’s
subjective well-being, particularly incertain European countries.31

Portugal
IcelandCzechia
Slovakia
UK (Wales)
Greenland
Estonia
LatviaHungary
FranceUK (England)
Belgium (French)
UK (Scotland)
SwedenMalta
Romania
PolandIsraelGreeceItaly
Bulgaria
0

10

20

30

40

50

60

70

80

90

100

Percentage with high emotional well-being
Children with low family support

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C A R DChildren with high family support

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Notes: Excludes Denmark (no data), and England(UK), Slovakia and Wales (UK) (over 10 per centmissing data). An index was created from themean response to four statement-based questions:(1) My family really tries to help me; (2) I get theemotional help and support I need from my family;(3) I can talk about my problems with my family;and (4) My family is willing to help me makedecisions. Children were asked to indicate to what
extent they agreed with each statement. The
percentages are of children who scored below the
midpoint on this index – i.e., were more likely, on
average, to disagree than agree. The indicator of
emotional well-being is constructed from fourquestions about how often children felt low, felt
nervous, had difficulty sleeping, and felt irritable orin a bad temper. Children are classified as having
low emotional well-being if they had more than oneof these experiences more than once a week. All
differences are significant (p<0.01) except England(UK), Scotland (UK) and Greenland (p<0.05).
Source: Health Behaviour in School-aged Children(HBSC) 2017/18.

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As we showed in Report Card 15, it
is also linked to lower educational
performance in most countries.32
Studies primarily from the UnitedStates and the United Kingdom haveshown that being bullied has alasting negative impact even up to
the age of 50, both on a person’ssocial relationships and on theirmental and physical health.33

Frequently bullied children are less satisfied with life
Figure 16: Bullying frequency and life satisfaction of 15-year-olds
Netherlands
MexicoRomania
Finland
Iceland
Switzerland

Figure 16 shows the relationship at
15 years of age between frequentbullying – defined as experiencing
at least one of six forms of bullying
at school at least a few times amonth34 – and life satisfaction. In all
countries, children who had beenbullied frequently had lower mean
life satisfaction scores than children
who had not. The gap in life
satisfaction between those who
had and had not been bullied often
was much bigger in somecountries, like the United States andthe United Kingdom, than in otherssuch as Bulgaria and Lithuania.

Croatia
Spain
Lithuania
FranceLatviaEstonia
Portugal
Austria
Luxembourg
Hungary
Slovakia
SwedenGreeceItaly
Czechia
Germany
Chile
United States
Ireland
Bulgaria
PolandSlovenia
Malta
United Kingdom
Republic of Korea
Japan
Turkey
0

10

20

30

40

50

60

70

80

Percentage with high life satisfaction
Frequently bullied

Not frequently bullied

90

100

Note: Frequently bullied means that a child had
experienced at least one of six forms of bullying
at least a few times a month, based on thequestion ‘During the past 12 months, how often
have you had the following experiences inschool?’, with the possible experiences listed as:‘Other students left me out of things on purpose’;‘Other students made fun of me’; ‘I was
threatened by other students’; ‘Other students
took away or destroyed things that belonged tome’; ‘I got hit or pushed around by otherstudents’; and ‘Other students spread nasty
rumours about me’. Excludes Cyprus (data notavailable) and Australia, Belgium, Canada,
Denmark, Israel, New Zealand and Norway(question on life satisfaction not asked). All
differences are significant (p<0.01).
Source: Programme for International Student
Assessment (PISA) 2018.

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Children with a stronger sense of school belonging do better at school and have higher life satisfaction
Figure 17: Differences in academic proficiency and in life satisfaction for 15-year-olds with a high and low senseof belonging to school
Estonia
IrelandRepublic of Korea
FinlandNetherlands
Japan
PolandGermany
SwedenSlovenia
United Kingdom
FranceSpain
Austria
Czechia
Switzerland
LatviaIceland
Portugal
United States
Lithuania
Italy
Hungary
Luxembourg
Slovakia
Malta
Croatia
GreeceBulgaria
Chile
Romania

Netherlands
FinlandRomania
Iceland
Croatia
Switzerland
FranceLatviaSpain
Estonia
Portugal
SwedenLithuania
Italy
Hungary
Austria
Luxembourg
Ireland
Slovakia
GreeceUnited States
Czechia
PolandGermany
Slovenia
Chile
Bulgaria
Malta
United Kingdom
Republic of Korea
Japan0

10 20 30 40 50 60 70 80 90 100

Percentage with proficiency in mathematics and reading
Low belonging

High belonging

0

10 20 30 40 50 60 70 80 90 100
Percentage with high life satisfaction
Low belonging

High belonging

Note: Excludes Cyprus (data not available) and Mexico and Turkey (more than 20 per cent of children aged 15 years not included in the survey). Data on readingscores not available for Spain. Question on sense of belonging not asked in Israel. Question on life satisfaction not asked in Australia, Belgium, Canada, Denmark,Israel, New Zealand and Norway. All proficiency differences are significant (p<0.01), except Bulgaria (ns). All life satisfaction differences are significant (p<0.01).
Source: Programme for International Student Assessment (PISA) 2018.

Connections with schoolChildren who have a strong sense of
belonging to school tend to havehigher academic achievement. As
school is such a major part of mostchildren’s lives, it is reasonable tosuppose that aspects such as
school belonging also contribute tolife satisfaction. Indeed, the PISA
study shows that, in most countries,
school belonging is positively
associated with academic
achievement and with life
satisfaction. Figure 17 shows the

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differences in proficiency in reading
and mathematics and thedifferences in life satisfaction
between 15-year-olds who agreed
and did not agree with thestatement ‘I feel like I belong at
school’ across 33 rich countries. In
all but one country, more of thosechildren with a greater sense of
belonging to school tended to havereached the basic level ofproficiency in reading andmathematics. This pattern wasparticularly strong in the Republic of

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Korea. The only exception to thegeneral pattern was Romania, wheremore children with a lower sense of
belonging had met the basic
proficiency standard. In all countries
for which data are available, morechildren with a higher sense ofschool belonging tended also toreport high life satisfaction, although
the difference was small in
Lithuania. In general, school
belonging appeared to be morestrongly linked with life satisfaction
than with academic proficiency.

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Spotlight 4 Protection and provision do not
suffice – children also need participation

It is important that children have the opportunity to
express their views and are involved in decisionmaking. This is enshrined in Article 12 of the United
Nations Convention on the Rights of the Child. Such
opportunities are vital for children’s well-being in thepresent and for their development towards adulthood.
As children grow up, parents and other adults need toadjust the balance between protecting children andenabling them to have appropriate levels of autonomy.
Children’s perceived satisfaction with their freedom
contributes independently to their subjective wellbeing, after taking account of their feelings of safety.35
Participation is one of the three Ps of the Convention
on the Rights of the Child, along with protection andprovision. Yet, international monitoring ofopportunities for participation is scarce comparedwith monitoring in relation to the other two themes.
Only some countries have data on this topic. In thesecountries, children’s sense that their voices are being
heard varies widely. The proportion of children who
totally agree that their parents involve them indecisions at home ranges from under half in regionsof Belgium and Italy, and in Switzerland, to two thirds
in Romania. In Italy (Liguria) and the Republic ofKorea, fewer than two in five children totally agree
that they are involved in decision-making at school,
compared with at least half of children in six othercountries or territories.

Many children do not feel consulted about decisions at home and at school
Figure 18: Percentage of children who participate in decisions at home and at school
Involved in decisions at home

Involved in decisions at school

Romania67

Spain (Catalonia)

58

Estonia66

UK (Wales)

57

Norway65

Romania

56

Poland65

Poland53

Israel64

Estonia

52

Malta

62

Malta

51

Croatia

59

Croatia49

UK (Wales)

58

Switzerland

47

Finland57

Finland45

Hungary53

Israel

44

Republic of Korea

51

Hungary42

Greece (Epirus)

50

Norway41

Spain (Catalonia)

50

Greece (Epirus)

41

Switzerland

48

Belgium (Flanders)

41

Italy (Liguria)

47

Republic of Korea

39

Belgium (Flanders)

46

Italy (Liguria)

38

0

20

40

60

80

Percentage of children who totally agreed

0

20

40

60

80

Percentage of children who totally agreed

Note: Responses of 10-year-olds to closed questions with five responses to choose from: ‘I do not agree’; ‘I agree a little bit’; ‘I agree
somewhat’; ‘I agree a lot’; and ‘I totally agree’. Chart shows proportion who responded to each question, ‘I totally agree’.
Source: Children’s Worlds, 2017–2019.

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SECTION 4
THE WORLD AROUND THE CHILD
How do immediate surroundings differentiate
child well-being within countries

In this section, we look at ‘theworld around the child’: a range
of factors within the child’s
environment that can trickle down
to influence their well-being. These
include the networks of the adults
closest to the child, household
resources and the quality of thelocal neighbourhood.

Context

Policies

Networks around the child

Resources

Networks
ationships
Rel

Activities

Outcomes

The world of the child
The world around the child
The world at large

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The networks of relations aroundchildren affect their well-being eventhough they do not always
experience them directly. In
contrast to the relationships
described in section 3, whichreferred only to relations involving
the child, networks refer toconnections established by theadults closest to the child –especially by the parents. They
include: the family support
network, and parents’ relationships
with work and with their child’s
school. Unfortunately, we areunable to link these connections
with data on child well-being
outcomes as information on
networks is not available within thesame international surveys.
Support for parents
Families that lack social support
networks may find it more difficult
to cope with adversity. This cannegatively affect children’s well-S E C T I O N

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90

100

Who can parents count on if they need help to look after their children?
Figure 19: Percentage of parents able to seek support from a family member, friend or service provider
Bulgaria
GreeceLithuania
PolandSlovenia
Austria
CyprusCzechia
Estonia
Finland
Hungary
Ireland
Slovakia
SwedenPortugal
Denmark
LatviaSpain
Germany
Italy
United Kingdom
Croatia
Malta
Netherlands
Romania
TurkeyFranceBelgium
Luxembourg
0

10

20

30
Family40

50
Friends

60
Service7080

NobodyNote: Data were only available for the 27 EU countries, plus Turkey and the United Kingdom. Original question: ‘From whom would you get support if you needed
help in looking after your children? Choose the most important source.’ Ranked by the proportion of parents who said they could count on help from either afamily member or a friend.
Source: European Quality of Life Survey (EQLS) 2016.

being. That is why the presence of
informal support for families throughsocial networks is often seen as aprotective factor for children’s
healthy development.36
Figure 19 shows the proportion ofparents who say that they would be
able to seek support from a family

member, friend or service provider
if they needed help to look after
their children. The chart is ranked
by the proportion of parents who
said that they would be able toseek support from either a family
member or a friend. Only a small
proportion of parents said theywould be unable to seek help fromeither of these sources. This ranges
from less than 1 in every 100
parents in Poland, Bulgaria, Greece,
Slovenia and Lithuania to more than
10 in every 100 parents in
Luxembourg and Belgium.

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Inability to fulfil family responsibilities relates to long working hours
Figure 20: Percentage of employees struggling to balance work and family, and average working
hours in European countries

TR

70

Percentage struggling to fulfil family responsibilities (2016)

R=0.8460

CZ
GR HUPL

50

LV

LT
EE SI

ES

BE

40

IT FR

UK
PT
LU

DE

30

AT

IE

NL

SK

SE

FI

DK

20
30

35

40

45

50

Average weekly hours worked in main job (2016)
Note: ‘Average weekly hours worked in main job’ includes any paid or unpaid overtime. ‘Percentage struggling to fulfil family responsibilities’ refers to thepercentage of employees who have chosen the option ‘At least several times a month’ under ‘It has been difficult to fulfil family responsibilities because of timespent on job’. Work–family balance data only available for the 27 EU countries, plus Turkey and the United Kingdom. Data on long working hours unavailable for
Bulgaria, Croatia, Cyprus, Malta and Romania.
Source: Data on work–family balance: European Quality of Life Survey (EQLS) 2016. Data on long working hours: OECD (2017) based on Labour Market Statistics,
2016 or latest available year.

Work pressure on parents
Although not working due to
involuntary unemployment is
economically and socially corrosive,
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individual and their relationships
with people around them. A cultureof regularly working overtime leads
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work-related stress can reduce thetime and energy parents have tointeract with their children. And,
indeed, it is in those countries withlong working hours that more
employees find it difficult to fulfil

S E C T I O N

family responsibilities because oftime spent at work (see Figure 20).
On average across the 24 countries
in this figure, 39 per cent of
employees found it difficult to fulfil
family responsibilities at least several
times per month. The proportion of
employees who struggle to balance
work and family varies acrosscountries, ranging from one quarterof respondents in Denmark to morethan two thirds of those in Turkey.
The relationship between parents
and schools
Parents’ relationships with theirchild’s school is another important
aspect of the Networks aroundthe child.
Figure 21 shows a rating on a scalefrom 1 to 10 (from least to mostsatisfied) that averaged the answers
to three questions about whether
parents feel that education
professionals consult them, areattentive and treat all people equally.
Satisfaction with these relationships
ranges from 6.8 in Turkey to 8.3 in
Bulgaria, Ireland and Malta.

Resources available to children
A good childhood requires
sufficient resources to support thechild both within the household andwithin the neighbourhood.
Household resources
The material resources available tochildren in their homes can affectvarious aspects of their well-being,
including their cognitive
development, physical health andsubjective well-being. Household
resources can mean resourcesindividual to the child. For example,
does the child have a computer?
Does the child have her/his own
bedroom? Or the term can refermore broadly to resources for theentire family. Does the family own

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a car? Can the family afford to takeholidays? A lack of resources canaffect children through various
routes. For example, research
indicates that low family affluence

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is linked to higher rates ofoverweight and obesity through avariety of mechanisms, including
access to different types of foodand patterns of physical activity.37

Parents’ rating of their relationships with their child’s school inEuropean countries
Figure 21: What do parents think about their relationship with the staff
at their child’s school?
Bulgaria

8.3

Malta

8.3

Ireland8.3

Finland8.2

Denmark

8.2

Estonia

8.1

Lithuania

8.1

Poland8.1

Hungary

7.9

Slovenia

7.8

Sweden7.8

United Kingdom

7.7

Latvia7.7

Germany

7.7

Croatia

7.6

Spain

7.6

Austria

7.6

Netherlands

7.6

Romania

7.6

Luxembourg

7.6

Slovakia

7.5

Czechia

7.5

France

7.4

Belgium

7.4

Portugal

7.3

Cyprus7.2

Greece

7.2

Italy

7.0

Turkey

6.8
1

2

3

4

5

6

7

8

9

10

Parents’ rating of relationship with school staff (1–10)
Note: Data only available for the 27 EU countries, plus Turkey and the United Kingdom. The chart presents
an average of parents’ answers to three questions about satisfaction with: (1) personal attention given by
education professionals; (2) being informed or consulted about their child’s education; and (3) all people
being treated equally by education services in the area.
Source: European Quality of Life Survey (EQLS) 2016.

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A lack of resources can also be abarrier to academic achievement.
As an example, Figure 22 shows the
proportion of children with basic
proficiency in reading andmathematics at age 15 for twogroups – those who had books athome to help with schoolwork andthose who did not. The proficiency
gap between the groups is quite
substantial in most countries.

Children living in households without educational books
have lower levels of academic proficiency
Figure 22: Percentage of 15-year-olds who have reached basic
proficiency in reading and mathematics, according to whether
or not there were books at home to help with schoolwork
Estonia
Finland
IrelandJapan
Netherlands
Republic of Korea
CanadaNeighbourhoods

PolandFrom a child’s viewpoint, theenvironment starts in the child’s
neighbourhood, particularly in thoseplaces in which they spend timeand play. There are scarcecomparative data on this topic
drawn from children themselves,
but the Children’s Worlds survey
gathers children’s views on theirneighbourhoods for a selection ofcountries. The proportion ofchildren who totally agreed thatthey have local places to playranged from one third in the
Republic of Korea to two thirds inEstonia and Switzerland.

Denmark
Slovenia
Germany
FranceBelgium
NorwayCzechia
Switzerland
SwedenUnited Kingdom
New ZealandAustralia
LatviaHungary
Portugal
Austria
United States
Lithuania
Italy
Iceland
Slovakia
Luxembourg
Croatia
Malta
IsraelGreeceBulgaria
Romania
Chile
0

10

20

30

40

50

60

70

80

90

100

Percentage proficient in reading and mathematics
No educational books at home

Educational books at home

Notes: Children were asked whether or not there were books at home to help with schoolwork. The
measure of academic proficiency is the one introduced in section 3 (see Figure 10). All differences
between the two groups were significant at p<0.01 except Israel, significant at p<0.05.
Source: Programme for International Student Assessment (PISA) 2018.

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Figure 23 shows that children wholive in neighbourhoods with places
to play tend to be happier thanthose who do not. In Estonia andSwitzerland, 7 in 10 children totallyagreed when asked whether theirneighbourhood had enough places
to play. In the Republic of Korea,
only one third of children did so.
Asked about their happiness, thesesame children expressed greater
happiness than those who had said
that their neighbourhood lacked
such amenities. The difference inmean happiness scores between
the two groups was more than one
point (on an 11-point scale) in the
Republic of Korea and Israel.

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Children who live in neighbourhoods with enough places to play are happierFigure 23: The extent to which children agreed that they have enough places to play in theirneighbourhood, and mean levels of happiness for children who totally agreed and for those who did not

Are there enough places to play?
Estonia70

Switzerland

70

Happiness
9.2
8.2
9.0
8.3
9.5
9.0

Croatia

65

Hungary

65

Poland63

Israel61

Greece (Epirus)

60

Spain (Catalonia)

58

Belgium (Flanders)57

Finland

57

9.2
8.5
9.1
8.6
9.0
7.9
9.6
9.0
9.4
8.9
9.0
8.3
9.0
8.0

Germany

53

Norway53

UK (Wales)

8.9
8.1
9.0
8.0
9.1

50

8.3
9.4

Italy (Liguria)

42

Malta

40

8.8
9.5
9.0

Romania36

Republic of Korea

34
100

90

80

70

60

50

40

9.6
9.1
9.4
8.2
30

20

10

Percentage of children who totally agreed
Totally agree

0 0

1

2

3

4

5

6

7

8

9

10

Mean happiness (0 to 10)
Did not totally agree

Notes: Data relate to children aged 10 years. The first chart shows responses to the statement ‘In my area, there are enough places to play or have a good time’.
The second chart compares mean scores for happiness in the last two weeks for children who totally agreed with the statement about having enough places toplay and those who did not. All differences significant at 99% level.
Source: Children’s Worlds survey, Wave 3, 2017–2019.

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SECTION 5
THE WORLD AT LARGE
Why do some countries have higher childwell-being than others?

The world of the child and theworld around the child allowed us
to see how well-being varies
between children within the same
country. Yet, children’s experienceof childhood does not exist in asocial vacuum – it is rooted in thesociety in which they live.
Therefore, we now broaden our
focus to the world at large,
understood as ‘national conditions
that support child well-being’ – theoutermost levels of our framework– to see why some countries havehigher child well-being than others.

Context

Policies

Resources

Networks
ationships
Rel

Activities

Outcomes

In the next circle outwards (Policies),
we look at the results of a country’ssocial, education and health policies
in providing services to children. In
the outermost circle (Context), we
focus on general quality of life issues
such as air quality and levels of social
support. Comparing policies andcontext between countries isfundamental to understanding why
their child well-being outcomes differ.

Policies
The world of the child
The world around the child
The world at large

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The penultimate circle (Policies),
refers to benefits and services
delivered to children and theirfamilies that can influence current
and future child well-being. We
focus on three policy areas – social,education and health policy – which
are interrelated and may influence

5

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Leave reserved for fathers makes up one tenth of parental leave in rich countries
Figure 24: Weeks of leave available to mothers and reserved for fathers in 2018, in full rate equivalent
90

80
70
60
50
40

Average: 36 weeks of full pay

30

Leave available to mothers

7.50

United States

8.2

8.4

8.6

11.7

12.1

13.0

15.0

15.0

15.7

16.4

18.0

20.3

21.7

23.4

26.0

26.6

26.6

27.6

31.0

32.9

40.6

43.6

44.6

45.3

45.4

46.0

47.5

48.3

52.3

52.4

52.8

53.1

55.9

66.0

66.1

69.2

0

71.7

10

86.4

20
97.1

Weeks of full pay equivalent

100

Romania
Estonia
Bulgaria
HungaryJapan
Lithuania
Austria
Slovakia
LatviaNorwaySlovenia
Germany
Czechia
FinlandSwedenLuxembourg
Croatia
PolandRepublic of Korea
Portugal
Chile
Denmark
Iceland
CanadaItaly
FranceGreeceSpain
Belgium
Netherlands
Malta
CyprusIsraelMexicoUnited Kingdom
TurkeyAustralia
New Zealand
Switzerland
IrelandUnited States

S E C T I O N

Leave reserved for fathers

Note: The medium blue bar (leave available to mothers) shows a combination of maternity leave and paid parental leave that can be used by the mother and is notreserved for the father. The dark blue bar shows the leave reserved for fathers on a ‘use-it-or-lose-it’ basis. Number of weeks of maternal and paternal leave each referto the full-rate equivalent. For example, if a mother is entitled to 20 weeks of maternity leave at 50 per cent of her usual salary, her full-rate equivalent leave is 10 weeks.
Source: Organisation for Economic Co-operation and Development (OECD) Family Database.

one another. For example, while
low birthweight is treated as anindicator of health policy, it is also
influenced by policies aimed attackling poverty.
Social policies
Governments can use social policy
to support children’s well-being.
One way that they can do this isthrough family policies that help
parents to raise their children. Here
we look at one such policy, parental
leave. We also look at the rate ofrelative child poverty, which reflectssocial policy in terms of the
distribution of income amongfamilies with children after taxes
and government transfers.

Parental leave
Family policies matter for ethical,
social, medical, educational,
economic and demographic
reasons. Maternity leave facilitatesbonding between the child andmother. It also allows women to
prepare for childbirth and to
recover from pregnancy and it
facilitates breastfeeding. A periodof well-paid, job-protected leavefrom work helps eligible employees
to maintain their income and their
attachment to the labour market.
Yet, leave entitlements that are
inflexible, underpaid or have agender imbalance can have anegative effect on the work
prospects of women and, to alesser extent, men.38
If taken, leave reserved for fathers
gives children access to bothparents, which is one of their rights
under the Convention on the Rightsof the Child, and supports child–father bonding. It also promotes
family stability, as men who takeparental leave are more likely toremain engaged fathers many years
after the leave is over.39
Early adopters of new paternity
leave entitlements can face
professional and cultural barriers
that prevent them from staying
with their child.40 To encourage
uptake, 35 out of the 41 countries
included in this report haveintroduced leave reserved forfathers on a ‘use-it-or-lose-it’ basis.
For example, Iceland has rewritten
its family law to reflect the child’s
right to access both parents –starting with each of them taking atleast three months of leave during
the period when the child is an
infant.41 Figure 24 shows statutory
parental leave entitlements in termsof the equivalent number of weeks
of pay at the full rate. There is wide
variation across the countries,

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3 5

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In almost half of rich countries, more than one in five children lives in poverty
Figure 25: Percentage of children living in households with income below 60 per
cent of the national median income in 2008, 2014 and 201840

35

Percentage of children in poverty

30

25

20

Average: 20%

15

10

33.0

32.0

32.0

30.0

27.6

27.2

26.8

26.6

26.2

24.4

24.1

23.9

22.7

22.7

21.4

21.0

20.6

20.5

19.9

19.7

19.3

19.2

19.0

19.0

18.8

17.5

17.5

17.3

15.8

15.2

14.5

13.8

13.2

13.1

13.0

11.7

11.5

11.1

11.0

11.0

IcelandCzechia
Denmark
FinlandRepublic of Korea
Slovenia
PolandNetherlands
NorwayHungary
Germany
Estonia
Ireland
CyprusAustralia
LatviaJapan
Portugal
Switzerland
Austria
SwedenCroatia
FranceSlovakia
Belgium
CanadaMalta
GreeceLuxembourg
Lithuania
United Kingdom
New Zealand
Italy
Bulgaria
Spain
Chile
MexicoUnited States
IsraelRomania
Turkey0

10.4

52018 (or latest available)

2014

2008

Notes: Percentage of children living in households with post-tax, post-transfer income – adjusted for family size and composition – below 60 per cent of thenational median income. Equivalence scale: first adult in a household counted as 1; each other household member aged 14 years or above counts as 0.5 person;
each household member aged 13 years or below counts as 0.3 person. Data for 2018 except for Canada, Chile, New Zealand, Turkey (2017); Australia, Iceland,Israel, United States (2016); and Japan (2015).
Source: EU Statistics on Income and Living Conditions, HILDA wave 17 (Australia), ENIGH, Household Economic Survey (New Zealand) estimates taken from
Perry, B (2017), Canadian Income Survey (estimates from L. Wollf and D. Fox), Survey of Living Conditions (Japan) estimates taken from A. Abe, Luxembourg
Income Study (Chile, Israel, Mexico, United States), combined data of Household Income and Expenditure Survey and Farm Household Economy Survey (Republicof Korea), courtesy of Statistics Korea and the Korean Committee for UNICEF.

ranging from no statutory leave in
the United States to more than one
year of leave in several countries.
On average, only 10 per cent of thetotal duration of leave is reserved
for fathers.
In many of the countries we coverin this report, family formations are
becoming increasingly diverse. This
diversity often includes increasing
proportions of lone-parent families,

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stepfamilies and two-householdfamilies, where children alternate
their time between the homes ofboth parents; a higher incidence of
one or both parents spending
lengthy periods of time working
abroad; and new rights for samesex partnerships. Thesedevelopments are gradually beingreflected in family policies. For
instance, in 2019, Canada andC A R D

1 6

Spain introduced parental leave forboth parents of same-sex couples.42
Child poverty
Children often pay a high price forgrowing up in poverty. Children inpoorer families tend to have worse
cognitive and socio-emotional
development, and worse health asadults.43 Relative child poverty isdefined here as children who live inhouseholds which, taking accountS E C T I O N

In 2018, the average relative childpoverty rate across the 41 countries
was 20 per cent. This rate ranged

T H E

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spending on families with children
in Nordic countries in comparison
with the post-communist countries(see Figure 26). However, it is not
only a matter of how much isspent, but also how it is spent.
Tax breaks run the risk of favouring
more middle-class and affluent
families. Conversely, high-quality
public services, if sufficiently
accessible and affordable, cansupport all children and theirfamilies.

by country from 10 per cent in
Iceland to 33 per cent in Turkey(see Figure 25). Yet, as we willshow in the economic context
subsection, the countries with thelowest relative child poverty(Iceland, Czechia and Denmark)only partially overlap with thecountries with the lowest income
inequality (Slovakia, Slovenia andCzechia) (see Figure 35). This ispartly due to different demographic
structures as well as higherof household size and composition,
fall below 60 per cent of thenational median per capita income.
This measure shows how effective
a national system of taxes andtransfers is in preventing families
with children from falling intopoverty. In this sense, we treat
national child poverty as an
outcome of multiple social policies.

5

On average, rich countries spend 2.4 per cent of gross domestic product (GDP) on families –services account for half of this sum
Figure 26: Public spending on cash transfers, services and tax breaks for families in 2015
4.0
3.5

Percentage of GDP

3.0
2.5

Average: 2.4% GDP

2.0
1.5
1.0
0.5

C A R D

1 6

TurkeyGreeceMexicoSpain

Republic of Korea

Japan

Portugal

Chile

CanadaLithuania

PolandSlovenia

Netherlands

IsraelLatviaIreland

Switzerland

Italy

Slovakia

Services

United States

Cash

Australia

Austria

Estonia

Czechia

FinlandGermany

Belgium

Luxembourg

New Zealand

Iceland

NorwayDenmark

SwedenHungary

FranceUnited Kingdom0

Tax breaks

Source: Organisation for Economic Co-operation and Development (OECD) Social Expenditure Database, 2015.

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S E C T I O N

5

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Spotlight 5 Poor children in the United Kingdom
are more likely to be obese and have low skills

Poverty is not just a monetary circumstance. It spills
over into other aspects of children’s lives. We looked
at its consequences for depression, obesity andvocabulary, corresponding to the mental well-being,physical health and skills dimensions at the heart of
the well-being framework (see Box 1). We used datafrom a UK study that followed thousands of children
born in the early 2000s for almost two decades.

To learn whether these patterns change with time, wegrouped 14-year-old children into categories according
to how often they had been in poverty at six points intime during their childhood (at the age of 9 months
and then at 3, 5, 7, 11 and 14 years of age). Children
who had lived in more persistent poverty had poorer
vocabulary skills (see Figure 27). The effect was
cumulative: the more often children had experienced
poverty, the more likely they were to have a poor
vocabulary. This probably reflects the fact that new
skills build on existing skills. Children who had
experienced poverty were also significantly more likely
to be obese and slightly more likely to be depressed
at 14 years of age. Yet, in the latter case, we foundless evidence of a cumulative effect of poverty.

We divided households with children into five income
groups. At 14 years of age, children in the poorestgroup were 2.6 times more likely to have a poor
vocabulary and 1.8 times more likely to be obese thanchildren in the richest group. The link between
income and depression was less clear.

30
25
20
15
10

19.2

20.4

14.4

13.0

23.5

23.2

19.6

15.7

22.2

15.2

0

14.4

5
10.0

Percentage of children aged 14 years

Persistent poverty impedes children’s development
Figure 27: History of household income poverty and three child outcomes at
14 years of age in the United Kingdom: vocabulary, obesity and depression

Low word score

Obese
Depressed
Number of points in time between infancy and age 14 years when a child lived in poverty

None

Once

2 to 4 times

5 or 6 times

Notes: Children aged 14 years in the United Kingdom. The word score is based on a 20-item test of word recognition. Obesity is defined asa BMI above 30. Depression is defined as a score of 12 or more using the 13-item Moods and Feelings Questionnaire. The analysis takes
account of survey design and weightings. The values shown in the charts are marginal effects after controlling for age (tenths of a year),gender and ethnic group. Poverty is defined as having an equivalized household income below 60 per cent of the national median income.
Source: Millennium Cohort Study, United Kingdom, 2000–2016.

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5

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What percentage of children have experienced organized learning before starting school?
Figure 28: Children with experience of organized learning one year before starting school

Average: 94.7%

90
80
70
60
50
40
30

67.6

82.3

83.4

86.4

87.1

89.4

91.1

91.2

92.7

93.2

93.2

93.6

93.7

93.9

94.1

94.2

94.6

95.4

95.4

95.9

96.2

96.2

97.0

98.1

98.2

98.4

98.8

99.0

99.1

99.1

99.1

99.3

99.3

99.4

99.7

99.8

99.9

99.9

Austria
United Kingdom
IrelandSwedenLithuania
FranceNetherlands
Switzerland
Portugal
Malta
PolandFinlandIsraelMexicoGermany
Belgium
Luxembourg
LatviaCanadaNorwayNew ZealandRepublic of Korea
Bulgaria
Croatia
Cyprus
Iceland
Slovenia
Italy
Denmark
Chile
Spain
Estonia
GreeceUnited StatesJapan
Czechia
Hungary
Australia
Romania
Slovakia
Turkey

0

99.9

10

99.9

20
100

Percentage of children one year before school1002017 (or latest available)

2010

Notes: Data for the blue bars are from 2017 or the latest year available (2016 for Bulgaria, Canada, Croatia, Malta, Romania, United States; 2015 for Cyprus; 2013
for Japan – figure from Report Card 15). Percentage of children with experience of organized learning one year before starting school is an official Sustainable
Development Goal indicator.
Source: United Nations Educational, Scientific and Cultural Organization (UNESCO). Data for New Zealand from United Nations Statistics Division.

Education policies
Preschool participation
Public provision of high-quality
childcare helps to reduce socioeconomic disadvantage before
children start formal schooling.44
It can also provide a stimulatingsocial and learning environment.
Ensuring that all children haveaccess to organized learning atleast one year before starting
school is one of the Sustainable
Development Goals. Figure 28
shows that in 17 countries morethan 5 per cent of children are notin preschool. In three countries, thefigure is more than 15 per cent:Romania (17 per cent), Slovakia (18per cent) and Turkey (32 per cent).
Enrolment rates are substantiallylower for younger children. AcrossEurope (the 27 EU countries, plus
Iceland, Norway, Switzerland andthe United Kingdom), 15 per centof parents with children under 3
years of age would like to use day
care but cannot do so. The main
obstacles include affordability andavailability of places. However,rates of participation and unmetchildcare needs do not necessarily
go together. In Denmark, where

70 per cent of children under3 years of age use organizedchildcare, 6 per cent of parents said
that they have unmet childcare
needs. This is almost the same
percentage as in Czechia, where
only 5 per cent of children attend
organized childcare. Across theEuropean countries, about one halfof parents of children under 4 yearsof age declared no need forchildcare. This reflects, in part,
cultural differences in childcare
styles and preferences.

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3 9

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In 22 European countries, more than 1 in 10 parents has an unmet childcare need
Figure 29: Unmet needs among parents of children under 3 years of age in European countries
35

25
20
15

Average: 14.5%

22.6

24.3

28.5

33.0

Netherlands

United Kingdom

Spain

21.9

Ireland

Slovakia

20.9

14.7

Austria

Greece13.1

Estonia

20.2

12.9

Slovenia

Norway11.3

Croatia

17.4

11.3

France10.9

Belgium

Romania

16.9

10.8

Switzerland

Cyprus10.7

Germany

16.8

10.7

Portugal

Poland9.1

Lithuania

15.9

8.8

Italy

Latvia8.2

Sweden15.3

6.5

Denmark

Luxembourg

5.9

Czechia

15.2

4.6

Bulgaria

0

Hungary

5

Finland10

2.0

Percentage of parents

30

Notes: An ‘unmet need’ for childcare is assessed based on the question ‘Would you like to make (more) use of childcare centres?’. No unmet needs data for Icelandand Malta.
Source: EU Statistics on Income and Living Conditions (EU-SILC) survey 2016 (for Switzerland, the latest available data were from 2014).

Countries with high childcare satisfaction have high enrolment and affordable prices
Figure 30: Satisfaction with childcare mapped against enrolment and affordability
9

9

7

PL
SK

DK

NL

SI

R=0.39

BE

BG HR

6

LU SE

DE
EE

HU
LT

CZ

8

MT
FI

AT

RO

ES

CY LV
GB
IE

FR
PT

IT

GR

5

4

Satisfaction with childcare

Satisfaction with childcare

8

MT
SE

FI

AT LU

DK
HU

7

DE

NL
EE
CZ

PL
ES
SK

6

RO

SI

LT
BE

LV
BG
IT

FR

CY
GB
PT HR

TR

IE

R=-0.56

GR

5

0

10

20

30

40

50

60

70

Percentage of children aged 0–3 years in preschool

80

4

0

10

20

30

40

50

60

70

80

Percentage of parents struggling with childcare costs

Notes: Satisfaction with childcare (scale from 0 to 10, from least to most satisfied) asked only to parents of a child below 12 years of age who had received formalchildcare in the past 12 months. Data on child enrolment are Eurostat estimates based on information from the EU Statistics on Income and Living Conditions(EU-SILC) survey. No data on child enrolment for Turkey. Data for Iceland are from 2015.
Source: European Quality of Life Survey (EQLS) 2016; Eurostat, ‘Children in Formal Childcare or Education by Age Group and Duration – % over the Population ofEach Age Group – EU-SILC Survey’, <https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_caindformal&lang=en>, accessed 24 February 2020.

4 0

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Health policies

Young people not in education,
employment or training
Young people who are disengaged
from both education and the labour
market may face a more difficult
start to adult life. One of theindicators used to monitor thisissue is the proportion of young
people aged 15–19 years who are
not in education, employment or
training (NEET). Between 2010 and2018, the NEET rate improved in
30 out of 37 countries – largely
reflecting the subsiding effects ofthe 2008 economic crisis. However,in Turkey, Mexico, Bulgaria, Chileand Italy, more than 1 in 10 young
people are still receiving neither an
education nor work experience.

At the country level, the preschoolparticipation rate is positively
correlated with service satisfaction(see Figure 30). This may reflect thefact that parents are more likely touse preschool if they have a good
opinion of the service. High cost
may be a deterrent. On average,
across the 29 European countries(the 27 EU countries, plus Turkey
and the United Kingdom), 40 per
cent of parents who had usedpreschool had found it difficult tocover its cost. Between countries,
the proportion of parents who had
struggled to pay childcare costs
ranges from 3 per cent in Sweden
to 78 per cent in Turkey.

5

Vaccines
Some achievements in child healthcan lead to complacency. One
example is the herd immunity tomeasles established by highimmunization coverage. In someregions where measles epidemics
had been consigned to the past,
immunization rates have dropped,
putting children once again at risk.
In recent years, some of theworld’s richest countries, including
Czechia, Greece and the United
Kingdom, have lost their measles
elimination status.45
Immunization rates are typicallyused as measures of the availability

In five rich countries, more than 1 in 10 young people are out of school and work
Figure 31: Percentage of all young people aged 15–19 years not in education, employment or training (NEET)
30

Percentage of 15- to 19-year-olds

25

20

15

10
Average: 6%

3.9

4.0

4.1

4.6

5.1

5.3

5.3

5.6

5.9

6.0

6.3

6.8

6.8

6.8

7.1

7.1

8.1

8.5

8.7

8.9

8.9

9.0

Iceland

Portugal

Switzerland

Finland

New ZealandAustralia

Austria

Slovakia

CanadaIreland

Malta

FranceHungary

SwedenCyprusUnited States

GreeceCroatia

Spain

IsraelUnited Kingdom

15.3

3.9

Belgium

13.7

3.5

PolandTurkey3.5

Denmark

11.8

3.4

Germany

2010

Mexico3.3

Netherlands

11.4

2.9

LatviaChile

2.6

Lithuania

2018

Bulgaria

2.5

Norway9.2

2.4

Czechia

11.0

1.9

Slovenia

Italy

1.5

Luxembourg

0

Estonia
Romania5Note: Data for the blue bars are from 2018 or the latest year available (2015 for Chile).
Source: Data for Bulgaria, Croatia, Cyprus, Malta and Romania: Eurostat 2018. Data for remaining countries: Organisation for Economic Co-operation andDevelopment (OECD) Family Database Table PF2.1.B (updated 26 October 2017).

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rate has dropped between 2010
and 2018 in 14 out of the 35 richcountries for which comparable
data are available (see Figure 32).

importance of cross-country
collaboration to keep children freeof this preventable disease.

and affordability of preventive
health services for children. Yet,with the rise of anti-vaccination
movements, some immunization
rates have also become measuresof the efficacy of public healthcommunication. They indicate
whether the general public is wellinformed about immunization orwhether false information is putting
children at risk. Additionally, 1 in 10
cases of measles is contracted
while travelling abroad or while incontact, in one’s own country, withsomeone from another country.46
This shows that high immunization
coverage at the country level isinsufficient and emphasizes the

Therefore, of all of the importantchild vaccines, including polio andDPT (diphtheria-pertussis-tetanus),
we focus on the measles vaccine.47
Across 40 countries (all except
Ireland), the measles immunization
rate averages 91 per cent, ranging
from 80 per cent in France to99 per cent in Hungary, Mexico andthe Republic of Korea. This range ofvalues is larger than for DPT
vaccines and therefore the measles
immunization rate meets ourvariability criterion for data usage(see Spotlight 1). Moreover, thisLow birthweightThe second health policy indicatoris the proportion of babies whoweigh less than 2,500 grams atbirth. Birthweight is considered themost important predictor of an
infant’s chances of survival andgrowth.48 At the policy level,birthweight is treated as anindicator of the quality of careavailable during pregnancy. It is also
related to the health, age andnutrition of the mother, and whether
there was substance abuse during

Measles immunization dropped in 14 rich countries from 2010 to 2018
Figure 32: Percentage of children who received the second dose of the measles vaccine
100

Percentage of children

90

Average: 91.1%

80
70
60
50
40
30
20
80

81

83

84

84

85

87

87

87

88

88

88

89

89

89

90

90

90

92

92

93

93

93

93

93

93

94

94

94

94

95

95

95

95

96

96

97

99

99

MexicoRepublic of Korea
Hungary
Slovakia
Portugal
IsraelSwedenMalta
Iceland
Croatia
United States
Spain
Slovenia
LatviaNorwayJapan
Germany
FinlandChile
Australia
PolandLithuania
New Zealand
Luxembourg
Denmark
Switzerland
Netherlands
Italy
United Kingdom
Estonia
CyprusTurkeyCanadaBulgaria
Belgium
Czechia
Austria
GreeceRomania
France

0

99

10

2018

2010

Note: Percentage of children who received the measles vaccine second dose (MCV2) administered as per the national schedule. Ireland is omitted as no 2018 data
were available for MCV2.
Source: WHO/UNICEF estimates for 2018. See: World Health Organization, ‘Immunization, Vaccines and Biologicals: Data, statistics and graphics’,<www.who.int/immunization/monitoring_surveillance/data/en>, accessed 24 February 2020.

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One in 15 infants born in rich countries is underweight at birthFigure 33: Number of live births weighing less than 2,500 grams as a percentage of total live births
12

Percentage of live births

10

8
Average: 6.7%

6

4

9.9

9.4

9.3

9.3

8.9

8.3

8.3

8.1

8.1

7.8

7.7

7.6

7.5

7.5

7.4

7.4

6.9

6.7

6.6

6.6

6.5

6.5

6.4

6.4

6.3

6.3

6.2

6.0

6.0

5.9

5.7

5.7

5.2

4.9

4.9

4.6

4.5

4.4

4.2

4.2

Iceland
Estonia
Finland
LatviaSwedenNorwayDenmark
Lithuania
Croatia
Ireland
PolandNetherlands
MexicoNew ZealandRepublic of Korea
Chile
Luxembourg
Austria
Switzerland
Australia
CanadaGermany
Slovenia
Belgium
United Kingdom
Czechia
Italy
Malta
Slovakia
FranceIsraelSpain
TurkeyRomania
Hungary
United States
Portugal
GreeceBulgaria
Japan
Cyprus0

3.8

22017 (or latest available)

2010

Note: Data for the blue bars are from 2017 or the latest year available (2016 for Australia, Belgium, Chile, France, Sweden; 2015 for Romania; 2013 for Germany).
Starting year data are from 2010, except for Turkey (2012) and Cyprus (2007).
Source: Data for Bulgaria, Croatia, Cyprus and Romania are from: World Health Organization Regional Office for Europe, European Health Information Gateway,‘% of Live Births Weighting 2500 g or More’, <https://gateway.euro.who.int/en/indicators/hfa_600-7100-of-live-births-weighing-2500-g-or-more>, accessed
7 January 2020. Data for remaining countries are from: Organisation for Economic Co-operation and Development, OECD.Stat, ‘Health Status: Key indicators’,<https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT>, accessed 7 January 2020.

the pregnancy. Based on the above
threshold, the average percentage
of live births that are underweightacross the 41 countries is close to
7 per cent. This proportion has
remained stable over the last
decade (see Figure 33). There aresubstantial differences between
countries in the proportion ofunderweight live births, ranging
from 4 per cent in Iceland to almost
10 per cent in Cyprus.

Context
The national context that supports
child well-being includes economic,
social and environmental
components. These components

may affect children directly. For
example, air pollution can damage
their health. Or the components
may affect them indirectly. For
example, parental unemployment
can put a strain on household
resources and relationships, whichcan, in turn, affect child well-being.
In this section, we deliberately
choose broad indicators that apply
to the whole population for two
reasons. First, they minimize thenumber of people missing from thedata, including marginalized
children, who are often invisible insurveys. Second, a clean
environment, healthy economy andstrong social fabric contribute to agood life for all and constitute afoundation for the well-being ofcurrent and future generations.
Economic context
Jobs
As we’ve seen in the earlier section
about work pressure on parents,
employment does not always
translate into well-being. However,there are good reasons to include it
as a key factor. Work can provide
the resources, networks, skills andsense of meaning that facilitate
well-being. Unemployment has
been found to be one of the mostimportant and persistent factors

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4 3

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Unemployment still has not dropped below its pre-crisis level in all countries
Figure 34: Unemployment rates from 2007 to 2019

18
16
14
12
10
8
6

Average: 6%

4

18.1

14.7

9.2

11.9

9.1

8.2

7.9

7.8

7.4

7.3

6.8

6.6

6.4

6.4

6.1

6.1

5.9

5.5

5.4

5.3

5.3

4.9

4.8

4.8

4.8

4.6

4.6

4.2

4.0

3.9

3.9

3.8

3.8

3.7

3.5

3.4

3.3

3.2

3.0

Japan
Czechia
IcelandGermany
PolandMexicoHungary
Republic of Korea
Netherlands
United Kingdom
United States
Israel
NorwayRomania
Malta
Austria
New Zealand
Bulgaria
Denmark
Switzerland
Ireland
Australia
Luxembourg
Slovenia
Estonia
CanadaPortugal
Slovakia
Belgium
Lithuania
SwedenFinlandChile
Croatia
Cyprus
LatviaFranceItaly
TurkeySpain
Greece

0

2.5

2
2.4

Unemployed as a percentage of active population

20

2019

2007

Note: Unemployment as a percentage of the total labour force, modelled on International Labour Organization estimates. Unemployment refers to the share of thelabour force (aged 15–64 years) who would like to work and have taken active steps to find employment – that is, those who are without work but available for andseeking employment.
Source: World Development Indicators 2019.

affecting adult well-being.49 As aconsequence, it is likely to affectfamily relationships and child wellbeing. This issue has been a theme
in previous Report Cards. For
example, in Report Card 12, weargued that: “Children feel anxious
and stressed when parents endure
unemployment or income loss, andthey suffer family downturns in
subtle and painfully evident ways”.50
Not all adults can or want to work.
To reflect this, we look at the
unemployment rate for people
between the ages of 15 and 64
years who would like to work andhave taken active steps to findemployment. In this way, we avoid

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I N N O C E N T I

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making a judgement on choices
such as parents who have decided
to stay at home to look after theirchildren. In 2019, the average
unemployment rate across the 41
countries included in this reportwas 6 per cent, ranging from justover 2 per cent in Japan to about
18 per cent in Greece. In many
countries, the unemployment rate
has returned to its pre-crisis level,
meaning before 2008, or dropped
further. But this is not universallythe case and, in some countries,
most notably Greece and Spain, theunemployment rate remains well
above the pre-crisis level (seeFigure 34).

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1 6

IncomeWe use the gross national income(GNI) per capita as a proxy for acountry’s economic context.
Although GNI is an imperfectmeasure because it does notevaluate what is produced orconsider the long-term costs andbenefits of economic growth,51 it isstill one of the most widely usedmeasures of goods and services
produced in an economy.
Historically, raising GNI resulted in asurplus of goods that satisfied basic
physiological needs, enabled thedivision of labour and, finally, gave
rise to the modern phenomenon ofleisure. Today, a high GNI can help

S E C T I O N

in building high-quality health care,education and social protection. It
also tends to coexist with labourarrangements that are conducive tohaving more free time.52

T H E

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A T

L A R G E

Putting equality at the heart of thedebate raises the concern that
ignoring levels of economic
prosperity could lead to equality inmisery. Figure 35 shows that there
is no obvious trade-off between
inequality and income, however.
Some of the less affluent countries
have high inequality, while most of
the richer countries are more equal.
Only the United States has very
high income and very highinequality. Its position should beseen as the exception rather than
the rule.

inequality correlates with a lack oftrust. It erodes social cohesion andempathy among citizens, both ofwhich are preconditions formeaningful political participationand democracy.54

The relationship between national
income and inequality
More equal societies tend to reporthigher life expectancy and fewersocial problems such as violence,
mental illness, bullying amongchildren and teenage pregnancy.53
In unequal societies, it is moredifficult for disadvantaged groups torealize their full potential. Income

5

In the policies section, we focusedon households with children. In thissection, the Gini coefficient is used
to show the distribution of income
across the whole of society. The
higher the Gini coefficient (on ascale from 0 to 1), the higher thelevel of inequality.

There is no trade-off between inequality and income
Figure 35: National income and income inequality
0.5

CL

MX

0.45

TR

0.4
Income inequality

US
LT

BG
RO

0.35

LV
GR
Average: 0.32

GB

KR
NZ IL
ES

CY
PT

JP

AU

IT
EE

HR

CA

0.3

MT

PL
HU

IE

FR
FI

0.25
SK

0.2
10,000DE
SE AT NL

CH

DK

NO

BE
IS

CZ
SI

LU

Average: $42,925

20,00030,00040,00050,000National income per person (int. $)60,00070,00080,000Notes: Gross national income (GNI) based on purchasing power parity in international dollars (int. $) per capita in 2018 (2017 for Cyprus). Income inequality ismeasured as income Gini coefficient from 2017 or the latest year available (2016 for Australia, Austria, Belgium, Czechia, Denmark, Estonia, France, Germany, Greece,
Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Mexico, the Netherlands, Poland, Portugal, Slovakia, Slovenia, Spain; 2015 for Croatia, Cyprus, Iceland, Japan,
Malta, Switzerland, Turkey; 2014 for Bulgaria, New Zealand). Orange lines represent cross-country averages.
Source: Data on GNI for all countries and on the Gini coefficient for Bulgaria, Croatia, Cyprus, Malta and Romania from: World Bank. Data on the Gini coefficient
for all remaining countries from: Organisation for Economic Co-operation and Development.

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Spotlight 6 Infant mortality relates morestrongly to inequality than to income

During the first year of life, survival is measured using theinfant mortality rate. During the remaining years ofchildhood, the child mortality rate is used. The two
indicators are driven by different factors and hence aredifferently influenced by public policies. Infant mortality
reflects the quality of the health system, especiallyprenatal and neonatal care. In contrast, the child mortality
rate in rich countries tells us more about safety and mental
health, as it is driven largely by accidents and suicide.

All countries covered in this report have made impressive
progress in systematically reducing infant mortality. Fifty
years ago, the average rate was 25 deaths per 1,000 live
births. This went down to 16 deaths per 1,000 live births
in 1978; 13 deaths per 1,000 live births in 1988; 8 deaths
per 1,000 live births in 1998; 5 deaths per 1,000 live births
in 2008; and 3.8 deaths per 1,000 live births in 2018.55
Today, the relatively small differences between wealthy
countries reflect less the basic standards of public health

Income inequality matters more than national income for infant mortality
Figure 36: Infant deaths per 1,000 live births against national income and income inequality
12

12

MX

10

10

TR

TR

8

BGCL

6

Infant mortality

Infant mortality

8

RO
MT
US
SK

4

HR PL
GR HU LT
LV
PT

NZ
CA

IL
KR
CZ ES IT

EE
CY

2

0

MX

10

20

30

SI

40

GB
FR

FI

50

NO LU

IS

2

R=-0.49

60

National income (int. $1,000)

70

80

0
0.20

CL

BG
US

SK

IE

SE

JP

RO
MT

6

4

CH

DK
AU DE NL
BE AT

R=0.66

NZ
CA
HR

PL
GR LV GBDK HU CHNLFR IE AU
DE
BE AT
PT IL
IT ES KRCZCYNO SE LU EE
JP
SI
IS FI

0.25

0.30

LT

0.35

0.40

0.45

Income inequality

Notes: Infant deaths reported per 1,000 live births in 2018. For information on income and inequality, see note beneath Figure 35. The results holdalso when using log GNI (R=-0.57).
Source: Infant mortality rates: World Development Indicators 2018. Data on income and inequality: see Figure 35.

4 6

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C A R D

1 6

0.50

S E C T I O N

5

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country grows richer and, finally, more progress can be madethrough reducing inequalities than through further growth.

and more the efforts to reach out to every infant in theearliest days and weeks of life, including those from themost marginalized families.

Patterns are slightly different for child mortality. Herenational income is as important as inequality (see Figure37). The best results are obtained by countries that areboth rich and more equal, such as Denmark, Finland andNorway. Luxembourg is an outlier because it is rich andhas low child mortality but is less equal than the threeleading countries.

In rich countries, infant mortality is more strongly linked toincome inequality than to national income (see Figure 36).
Possibly, infant mortality follows the curve known fromstudies of life expectancy: additional economic growthbrings an enormous premium at the early stages of
economic development, then the effect tapers off as the

Income inequality and national income relate equally strongly to child mortality
Figure 37: Child mortality, gross national income and income inequality
3.0

3.0

2.5

RO

1.5

CL

LV

SK LT

US

EE
HR PL
GR
CA
HU
IL
AU AT
PT CY MTNZ
NL
GB
CZ KR
FR BE SE IS
SI IT JP
DE
ES
FI
DK

1.0

0.5

MX

2.0

TR

BG

Child mortality

Child mortality

2.0

2.5

MX

1.5

LV

SK
PL

1.0
IE CH
NO

TR

BG

R=0.66

RO

0.5

LT

CL
US

EE
HR

GR
CA
HU
CY IL
PT NZ
NLMT
CZ BE ATAUJP GBFRSI IS SE DE
IT ES KR
NO
CH IE
FI
DK
LU

LU
R=-0.70

0
10

20

30

40

50

60

National income (int. $1,000)

70

80

0
0.20

0.25

0.30

0.35

0.40

0.45

0.50

Income inequality

Notes: Child mortality covers all causes of death in the age range 5–14 years, reported per 1,000 children in 2018. For information on income andinequality, see note beneath Figure 35. The results hold also when using log GNI (R=-0.77).
Source: Child mortality rates: United Nations Inter-agency Group for Child Mortality Estimation 2018. Data on income and inequality: see Figure 35.

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4 7

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In almost all countries, more than 1 in 20 adults has nobody to count on
Figure 38: Percentage of people who have someone they can count on in times of trouble

Average: 90.7%

90
80
70
60
50
40
30
20

78.3

80.5

81.0

81.3

82.6

85.0

86.8

87.0

88.8

88.9

89.7

90.0

90.5

90.6

90.7

90.8

91.3

91.5

91.6

91.8

91.9

92.0

92.0

92.7

92.7

92.7

93.1

93.1

93.3

93.4

93.5

93.5

93.6

94.0

94.4

94.6

94.8

95.5

95.9

IcelandFinland
NorwayDenmark
New ZealandIreland
Australia
United Kingdom
Switzerland
Estonia
Slovenia
Netherlands
Malta
Lithuania
Bulgaria
Slovakia
CanadaBelgium
Czechia
Italy
SwedenSpain
Luxembourg
Austria
FranceLatviaUnited States
Germany
IsraelPolandPortugalJapan
Hungary
Chile
TurkeyMexicoCroatia
Romania
CyprusRepublic of Korea
Greece

0

96.0

10
97.6

Percentage of people who have someone to count on

100

2016–18

2010–12

Note: Three-year averages are calculated to minimize survey bias for 2016–2018 and 2010–2012.
Source: World Happiness Report based on the Gallup World Poll.

Social context
We measure the social context
within each country as a wholeusing two indicators relating tosocial support and violence. Social
support reflects a positive aspect of
a community: the possibility tocount on others in times of need.
Violence reveals rips in the social
fabric. A small proportion of people
in high-income countries fall victim
to crime, but many more areaffected by its prospect, includingchildren. In the United Kingdom, forexample, 41 per cent of adolescentsworry about crime. The environment

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and crime are the two public issues
that adolescents worry about most(see Spotlight 7).56
Social support
We use the percentage of people
who feel that they have someone
to count on if they are in trouble asa proxy for social support. On
average, across the 41 countries,
91 per cent of adults reported thatthey have someone to count on if
they are in trouble. The proportionof people who feel this way varies
by country, from 78 per cent in
Greece to 98 per cent in Iceland(see Figure 38).

C A R D

1 6

Violence
The country-level homicide rate
reflects exposure to violence in its
most extreme form. Using it as aproxy for social cohesion reduces
bias in international comparisonslinked to definitions, legislation anddata availability. The average annual
homicide rate across the countries
in this study was 2 homicide victims
per 100,000 people in 2017, ranging
from a low of 0.2 homicides per
100,000 people in Japan to 5.3
homicides per 100,000 people in
the United States and 24.8
homicides per 100,000 people in
Mexico. The average rate improved

5

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The homicide rate dropped in 24 countries but remains high and rising in Mexico and the United States
Figure 39: Intentional homicides per 100,000 inhabitants in 2010 and 2017
25
20
7

5

4

3
Average: 2.0%

2

0.3

0.5

0.6

0.5

0.6

0.6

0.7

0.7

0.7

0.7

0.7

0.7

0.8

0.8

0.8

0.9

0.9

0.9

0.9

1.0

1.1

1.1

1.2

1.2

1.2

1.3

1.4

1.5

1.5

1.5

1.7

2.2

1.8

2.5

4.2

4.3

4.3

4.5

5.3

0

24.8

1

0.2

Homicide (per 100,000)

6

MexicoUnited States
Lithuania
TurkeyChile
LatviaHungary
Estonia
CanadaBelgium
Slovakia
Romania
Bulgaria
IsraelFranceUnited Kingdom
FinlandDenmark
SwedenCroatia
Germany
Slovenia
Malta
Ireland
Iceland
PolandNetherlands
Australia
Spain
Portugal
New Zealand
Italy
GreeceAustria
Republic of Korea
Czechia
Cyprus
Switzerland
NorwayLuxembourgJapan

mbourgS E C T I O N

2017 or latest available

2010

Note: Data for the blue bars are from 2017 or the latest year available (2016 for Austria, Italy; 2015 for Israel, Malta; 2012 for Turkey).
Source: World Bank, 2017.

from around 2.2 homicide victims
per 100,000 people in 2010, despite
the reverse trend in some countries.
Environmental context
The natural environment is theprimary support system for human
life. It has an impact on people’s
health, leisure pursuits and social
relationships. Unsustainable
environmental practices erodechildren’s current and future
well-being. The World HealthOrganization estimates that
4.2 million people die globally eachyear as a result of exposure to air
pollution.57 Toxic air contributes tomore deaths than tobacco.58

Additionally, an estimated
1.5 million premature deaths –that is, deaths that occur before theaverage age of death in a certain
population – are caused each year
by drinking unsafe water.59
Air quality
Air pollution harms everyone but
takes the highest toll on children –and it starts to harm them before
they are born. Toxic air inhaled by apregnant woman can lead to faster
cell ageing of the foetus. Children
are more vulnerable to air pollution
than adults because they have asmaller lung capacity and a lesswell-developed immune system.

They are also shorter and, hence,closer to the ground level, where
pollution typically accumulates.60
High exposure can lead to longterm health problems such asasthma. Studies have shown thatsome of this damage can bereversed if action is taken before
the child reaches the age of 18
years, by which time the lungs arenearly mature.61
The smaller the pollution particles,
the more likely they are to movefrom the lungs into thebloodstream and cause further
damage. For this reason, we use
the average annual concentration of

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C A R D

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4 9

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Children’s health is threatened by high levels of air pollution
Figure 40: Annual mean PM2.5 concentrations (μ/m3) in all areas in 2010 and 201745
40

PM2.5 concentrations

35
30
25
20
15

Average: 13.7

10

44.3

25.0

21.4

21.0

20.9

20.9

19.1

17.9

17.6

17.3

16.8

16.2

16.1

16.0

15.9

14.6

13.9

13.4

12.9

12.5

12.0

12.0

11.9

11.8

11.7

10.5

10.4

10.3

9.7

10.0

8.6

8.2

8.2

7.4

7.0

6.7

6.5

6.4

6.2

6.0

Finland
New ZealandSwedenCanadaIceland
Estonia
NorwayUnited States
Portugal
Ireland
Australia
Spain
Denmark
Switzerland
Luxembourg
United Kingdom
Japan
FranceLithuania
Germany
Netherlands
Austria
Belgium
LatviaMalta
Romania
Hungary
Slovenia
Czechia
Greece
Italy
CyprusSlovakia
Croatia
Bulgaria
PolandMexicoChile
IsraelRepublic of Korea
Turkey

0

5.9

5

2017

2010

Note: Population-weighted exposure to ambient PM2.5 pollution.
Source: World Development Indicators 2017; Brauer, Michael, et al., 2017, for the Global Burden of Disease Study 2017, ‘PM2.5 Air Pollution, Mean Annual Exposure(Micrograms Per Cubic Meter)’, World Bank Data, <https://data.worldbank.org/indicator/EN.ATM.PM25.MC.M3>, accessed 25 February 2020; Brauer, Michael, etal., ‘Ambient Air Pollution Exposure Estimation for the Global Burden of Disease 2013’, Environmental Science and Technology, vol. 50, no. 1, 2016, pp. 79–88.

fine particulate matter (PM2.5) as
an indicator of environmental
context. Ambient PM2.5 pollution
averaged 13.7 micrograms (μg) per
cubic metre (m3) across the 41 richcountries, ranging from 5.9 µg/m3
in Finland to 44.3 µg/m3 in Turkey.
Water quality
Poor water quality hampers foodhygiene and health. It can alsopresent a burden on finances andtime and increase plastic waste, ifbottled water is used. We provide
two perspectives on water quality:
the proportion of households withsafely managed water and the

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proportion of people satisfied withwater quality in the place they live.
Safely managed water comes froma protected water source that is
located on the premises, available
when needed and free fromcontamination.62 This is a minimum
standard that the countries wefeature in this report should be able
to meet given their historicallyunparalleled wealth. In six countries –Greece, Iceland, Malta, New Zealand,
the Netherlands and the United
Kingdom – over 99.9 per cent of the
population had access to safely
managed water (see Figure 41).

C A R D

1 6

At the other end of the spectrum,
the majority of people living in
Mexico do not have water thatmeets this basic standard. In 11 of
the 41 countries, at least 5 per centof households do not have safely
managed water. When asked
whether they were satisfied with
the quality of water in the place
where they live, 84 per cent ofpeople across the countries said
yes. The proportion of satisfied
people ranges from 65 per cent inTurkey to 99 per cent in Iceland.

S E C T I O N

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L A R G E

In most rich countries, more than 1 in 10 adults is not satisfied with the quality of water in the place where they live
Figure 41: Percentage of the population with safely managed water in 2017 and percentage of the population satisfied
with water quality in the place they liveMalta
New Zealand
GreeceIcelandUnited Kingdom
Netherlands
SwedenGermany
Slovakia
Luxembourg
Finland
CyprusBelgium
IsraelPolandUnited States
Austria
CanadaAustralia
Chile
Japan
Spain
NorwayRepublic of Korea
Slovenia
Czechia
FranceIreland
Bulgaria
Denmark
Switzerland
Portugal
LatviaItaly
Estonia
Lithuania
Croatia
Hungary
Romania
MexicoTurkey
100

80

60

40

20

Percentage of population satisfied with water in 2016
Percentage of population satisfied with water in 2010

0

20

40

60

80

100

Percentage of population with safely managed water in 2017
Percentage of population with safely managed water in 2010

Notes: Countries ranked by safely managed water in 2017 (2016 in Australia). No water safety data for Turkey. Water satisfaction data refer to the proportion of
population aged 15 years and above who answered ‘Satisfied’ to the question ‘In the city or area where you live, are you satisfied or dissatisfied with the quality ofwater?’. No water satisfaction data available for Bulgaria, Croatia, Cyprus, Malta and Romania.
Source: Data on safely managed water: WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), 2017 data, <https://
washdata.org>, accessed 25 February 2020. Data on water satisfaction: Organisation for Economic Co-operation and Development (OECD) Better Life Index
based on three-year average from the Gallup World Poll 2014–2016.

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C A R D

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5 1

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Spotlight 7 Environment andyoung people’s well-being

Two in five young people in the United Kingdom worry about the environment
Figure 42: Attitudes of girls and boys in the United Kingdom towards environmental issues
0%

Girls

18%

Boys

13%

10%

20%

30%

40%

27%

60%

70%

80%

34%

23%
Very worried

50%

100%

15%

36%
Quite worried

90%

6%

21%
A little worried

7%

Not at all worried

Not sure

Note: Responses of children aged 10–17 years from the United Kingdom. Equally weighted by age and gender.
Source: The Children’s Society, The Good Childhood Report 2019, The Children’s Society, London, 2019.

It is hardly surprising that children are increasingly
speaking out about the environment. They are
growing up in the midst of the climate emergency
and will have to deal with it for the rest of their lives.
Yet, until recently, children have been largely ignored
in debates about the environment. Young people are
now forcing the world to pay attention to their views,
either as individuals such as Swedish climate activist
Greta Thunberg, or collectively through initiatives
such as Youth for Climate. This international
movement of students organized climate strikes in
125 countries in March 2019, involving more than
1 million young people.63 “We are the voicelessfuture of humanity”, said the strike’s organizers.64

satisfaction.65 Research on children’s feelings aboutclimate change is a new field, and representative data
are available only for a limited number of countries.
In the United Kingdom, young people worry more
about the environment than about the economy,
Brexit, digital security or homelessness. Only
crime merited the same degree of concern. Girls
were more likely than boys to worry about theenvironment (see Figure 42).
In Australia, 59 per cent of young people consider
climate change to be a threat to their safety (only
14 per cent disagree). Climate change and plastic
pollution top their list of environmental concerns(see Figure 43). Almost 90 per cent want to move torenewable energy, while only 3 per cent want to ‘staywith fossil fuels’. Three out of four adolescents inAustralia want their government to act.66

What children think about the future relates to theircurrent well-being. For example, children who worry
about the environment tend to have lower life

In Australia, climate change is the biggest environmental concern for adolescents
Figure 43: Environmental concerns of adolescents in Australia
Climate change
Plastic pollution
Extinction of animals
Air pollution
Ocean pollution
Deforestation
Damage of the reef
Littering
Recycling crisis
Over-fishing
Extinction of plants

71

59
59

64
63
63
63

56
53
45
42
0

10

20

30

40

50

60

70

Percentage of adolescents who report being worried about a given issue
Note: Responses of 1,007 children aged 14–17 years; sample representative of Australia.
Source: United Nations Children’s Fund Australia, 2019.

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Figure 44: A league table of conditions (policies and context) for child well-being
Ranking

Country

1

NorwayPolicies

Context

Social

Education

HealthEconomySociety

Environment

6

9

8

1

2

7

2

Iceland

10

19

1

6

1

4

3

Finland

5

12

5

22

3

2
16

4

Germany

9

6

19

7

25

5

Denmark

12

16

12

9

4

17

6

Sweden

18

17

2

15

22

3

7

Luxembourg

23

1

24

2

15

11

8

Ireland

26

14

10

5

6

9

9

Netherlands

21

3

23

8

10

15

10

Slovenia

3

11

15

25

11

26

11

Switzerland

30

8

26

3

8

22

12

Estonia

1

33

11

27

18

14

13

Poland

8

5

13

23

26

33

14

Austria

13

13

33

10

21

20

15

Lithuania

15

2

9

30

30

30
25

16

Latvia

11

4

4

36

31

17

Japan

7

23

34

11

29

18

18

Australia

28

32

18

13

7

8

19

Czechia

4

22

36

14

13

28

20

New Zealand

37

20

22

21

5

1

21

Malta

32

15

21

20

12

23

22

Portugal

22

7

27

29

27

13

23

Canada

27

25

29

19

23

5

24

Belgium

29

10

32

17

20

19

25

Republic of Korea

17

21

6

16

38

38

26

Hungary

2

34

17

24

32

36

27

United Kingdom

35

24

30

12

9

10

28

Slovakia

16

38

14

31

19

29

29

United States

41

30

28

4

33

6

30

Croatia

20

27

7

37

36

37

31

Israel

39

26

20

18

28

34

32

France

25

18

39

28

24

21

33

Spain

36

31

25

40

17

12

34

Italy

34

35

31

33

16

31

35

Bulgaria

19

39

37

34

14

32

36

Chile

33

37

16

38

34

35

37

Cyprus

24

28

38

35

37

27

38

Romania

14

40

40

26

39

39

39

Greece

31

29

41

41

40

24

40

Mexico

38

36

3

32

41

40

41

Turkey

40

41

35

39

35

41

Note: A light blue background indicates a place in the top third of rankings, medium blue denotes the middle third, and dark blue the bottom third. The rankings in
the table were produced as follows: (1) We calculated a z-score for each indicator (reversed where necessary so that a higher score represents a more positive
condition); (2) we calculated the mean of the two z-scores within each dimension; (3) we calculated the z-score for each mean; and (4) for the overall ranking, wethen calculated the mean of the mean z-scores for each dimension.

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A league table of conditions
for well-being
We conclude this section with asummary league table of national
conditions that support child wellbeing (see Figure 44). These
conditions consist of the twooutermost levels of our model(see Box 1):
1. Policies. The social, educationand health services andprogrammes that have a bearing
on children’s lives.
2. Context. The overall economic,
social and environmental
context in the country.
We rank all 41 countries on thevarious components of Policies andContext and give each country an
overall ranking.
Norway is ranked highest for theconditions that support child wellbeing, followed by Iceland andFinland. Turkey is ranked lowest,
followed by Mexico and Greece.
There is a lot of variation in country
rankings across the six dimensions.
Only Norway ranks in the top third forall six dimensions, and only Turkey isin the bottom third for all six. There isplenty of room for improvement in
the conditions for child well-being
across all 41 countries.
Some countries have large
variations in rankings across the six
dimensions. For example, Australia
is ranked in the top third for each of

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the Context dimensions – economy,society and environment – but inthe middle third for health policy
and the bottom third for social andeducation policies to support childwell-being. In contrast, Lithuania isin the top or middle third for eachof the Policy dimensions, while
being in the bottom third for eachContext dimension. New Zealand isranked first for environment
because of its clean air and safe
water. Yet its overall ranking also
takes high child poverty and shortparental leave into account.

The link between conditions
and outcomesA test of our framework is theextent to which the national
policies and Context – together
called ‘conditions for child wellbeing’ – are associated with childwell-being outcomes. We would
not expect an exact match, as avariety of unmeasured factors also
influence well-being outcomes,
including time lags between
improvements in conditions andoutcomes, but we should expect areasonably strong association.
Figure 45 shows that this is thecase. In general, countries that rank
highly for the broad conditions
listed in the second league tablealso have a high ranking for thewell-being outcomes identified in
the first league table.67
The quadrants on the chart showwhether countries have relatively

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good or poor conditions andoutcomes. There is a cluster ofcountries in the top right quadrant,
indicating good conditions and highoutcomes. These include Denmark,Finland, the Netherlands andNorway. All are in the top 10
countries on both conditions andoutcomes. Six countries are in thebottom left quadrant, indicating
relatively poor national conditions
for child well-being and low childwell-being outcomes. Most ofthese are countries with a lower
national income, but they also
include the United States. There arealso countries with a weaker match
between conditions and outcomes.
France and Spain, in the top left
quadrant, rank much higher foroutcomes than they do for
conditions. On the other hand,
Lithuania, Malta and New Zealandstand out in the bottom rightquadrant as having above-average
conditions but relatively pooroutcomes. The mismatch between
conditions and outcomes should
prompt reflection, particularly incountries which rank much lower
for outcomes than they do for
conditions. The reasons for thesepatterns are likely to be complex
and to require more detailed
analysis according to eachcountry’s context.

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Child well-being outcomes reflect but do not match national conditions for child well-being
Figure 45: Z-scores of country rankings of national conditions plotted against rankings of well-being outcomes

Good conditions, good outcomes
Denmark, Finland, Netherlands,
Norway, Slovenia, Switzerland

Poor conditions, good outcomesFrance, Spain

1.5
NL
DK

1.0

NO
CH

ES

FR

FI

BE
SI

0.5
LU
IE SE
DE

HR
HU PT

CY

IT
KR

-1.2

Outcomes

-1.5

-0.9

AT

-0.6

-0.3

CZ

0.0

JP

0.3

0.6

0.9

1.2

EE
IS

RO
SK

GR

-0.5

GB

LV

CA

PL

AU

LT

R=0.42

BG

US

-1.0

MT

-1.5

NZ

CL

-2.0

Conditions
Poor conditions, poor outcomes
Bulgaria, Chile, United States

Good conditions, poor outcomes
Lithuania, Malta, New ZealandNote: The chart is based on the mean of z-scores for each dimension, for indicators of conditions and outcomes respectively, and so the relative positions ofcountries do not exactly match those shown in Figure 3 and Figure 44.
Source: See Figure 3 and Figure 44.

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SECTION 6
WHAT CAN COUNTRIES DO TO
IMPROVE CHILD WELL-BEING?

Figure 46: The cascading impacts of the COVID-19 crisis on child well-being

Falling GDP, job loss
Increased social tensions
Environmental change

Context

Policies

Strain on health services
School closures
Rising poverty

Resources

Networks
ationships
Rel

The world aroundthe child acts as a
prism throughwhich the impact ofsocietal changes islessened orintensified

Activities
Unequal impacts on children:
Poorer physical health
Poorer mental well-being
Losses in skills

Outcomes

The world of the child
The world around the child
The world at large

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6W H A TThe richest countries in the world
are failing to ensure that all theirchildren have a good childhood.
The extent of the shortcomings
varies between countries, but poor
mental and physical health, and alack of satisfactory academic andsocial skills are features of many
childhoods in all countries.
Report Card 16 provides a baselineof how countries were faring interms of child well-being at the startof the COVID-19 crisis. It introduces
a new conceptual framework ofchild well-being which can now be
used to understand how effects of
COVID-19 will cascade down fromthe national context through theimmediate world around the childto affect well-being (see Figure 46).

The effects of the COVID-19
crisis on national conditions

 Economy. GDP will probably fall,even in the best-protected
countries. Its shock effects willreverberate throughout economies
and strain funding for policies tosupport child well-being.

 Society. The impacts of the crisis
are likely to be felt unequally,
putting a pressure on the fabricof societies, decreasing trust andengendering tensions.

 Environment. The initial drop in

human-caused pollution during
lockdowns was a temporary
respite for the naturalenvironment. But it is unlikely tolast. As economies try to makeup lost ground, environmental
damage may increase.

 Health. The huge demands on

health services during the COVID19 crisis are likely to havecrowded out other health needs
and weakened systems, especiallyC A N

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in countries with already underresourced health care.

 Education. School closures wereapplied to contain COVID-19 inalmost all countries covered inthis report. Online schooling hasbrought mixed results.

 Social protection. Rising

unemployment and job insecurity
will strain many families financiallyand psychologically. During an
economic recession, increasingsocial protection can be moredifficult but also more needed.

The impacts on children

 Physical health. Children’s

physical health will be affected in
the short and long term. In the
short term, strained healthsystems can deprioritize routine
immunizations or treatment ofchronic health conditions. In thelong term, rising levels of poverty
can affect children’s healththrough nutrition, housing andliving conditions.

 Mental well-being. The existingchildren’s mental health crisis willprobably intensify. The
experiences of lockdown,
bereavement and ongoing strains
on family relationships of
economic uncertainty can damage
many children’s mental well-being.
Children may feel anxious,
insecure and fearful for the future.

 Skills. In most countries, children

have missed months of educationand peer contact. Previous crises
have shown that many children
will never make up for this loss oflearning. This will have longerterm impacts on their lives and on
the societies in which they live.

Rising inequalities

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lockdown has already seen an
increase in gender-based violence.
The new burdens of caring forchildren and home schooling havefallen disproportionately on women.
The initial impacts have also been
unevenly spread across sectors.
Many better-paid workers in officeprofessions continued to earn
through a switch to working fromhome. This has not happened formany lower-paid manual workers
reliant on government aid schemes.
Informal sector workers have been
hardest hit and some have faced
barriers accessing any financial
support.
The impacts on children willprobably follow the scenario of
rising inequalities. A child living ina well-off family, with a room of
their own, a good Internet
connection, and parents who havethe time, skills and confidence tosupport home learning will suffer
the educational impact of school
closures less than a child in a
family with poorer material andhuman resources. The world
around the child can cushion or
intensify the effects of events inthe world at large.
The COVID-19 crisis therefore
presents three challenges fornations and governments in termsof maintaining and promoting thewell-being of their children:
1. To minimize the impact of the
COVID-19 crisis on children.
2. To provide effective support for
those children who do suffer
negative impacts.
3. To ensure that these actions
acknowledge and minimize
inequalities.

The impacts of the COVID-19 crisis
will be distributed unevenly. The

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Policies
Based on the evidence presented
in this report, UNICEF calls for all
high-income countries to act onthree fronts:
Consult children: Improvechildren’s well-being through ashift in thinking
Ensuring that all children have agood childhood requires a shift inthinking about what ‘well-being’means and who should decide
about it. Children’s and young
people’s ideas about well-being do
not always match those of adults.
This is evident in findings presented
in this report about their serious
concerns for the future of theenvironment, how much they value
good-quality relationships and theirviews on personal autonomy. Adult
decision-makers at all levels, fromparents to politicians, need to bewilling to listen to theseperspectives and take them into
account when designing policies
and allocating resources.
Governments should strengthen theopportunities for children’s voices
to be systematically heard. This canbe achieved through child-friendly,
public policy consultations;ensuring all children know theirrights; and creating new ways totake account of children’s views inschools, communities and nations.
Children’s participation in society ispart of consensus- building
between generations on whatmatters most.

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Connect policies: Improvechildren’s well-being through an
integrated approach
An integrated approach to childwell-being means acknowledging
the links and trade-offs between
child well-being outcomes andnational conditions and coordinating
public policies appropriately. The
report has shown how conditions at
different levels of a child’s worldinteract to influence their well-being.
Employment regulation is a good
example. Children’s personalhappiness is linked to family
relationships. Yet parents who work
long hours struggle to find abalance between work and family.
Employment policy connects withchild well-being, a fact that millions
of families in high-income countries
can attest to. To be effective andefficient, child well-being
interventions need an integrated
approach that recognizes how
policy actions at one level will
influence another. Governments
typically assess the economic
impact of legislation and policy.
They should also consider routinely
incorporating an equivalentassessment of their impact onchildren’s well-being.68
Create strong foundations: Sustain
improvements for child well-being
through future-proofing
Governments must plan andprepare for the future to ensure that
improvements in child well-being
are sustained. This means choosing

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policies that set a strong
foundation for children and forsociety as a whole. The Sustainable
Development Goals provide an
excellent basis for intensifying andaccelerating improvements in childwell-being globally. The evidence inthis report suggests a range ofactions that are essential toachieving these goals, including:
1. Taking new and decisive action
to reduce income inequality andpoverty, and ensuring that all
children have access to theresources they need.
2. Improving access to affordable
and high-quality early years
childcare for all children.
3. Improving mental health services
for children and adolescents.
4. Implementing and expanding
family-friendly policies related to
the workplace.
5. Reducing the stubbornly highlevels of air pollution, among a
range of measures to protect thenatural environment.
6. Strengthening efforts to protect
children from preventablediseases, including reversing
recent falls in many countries inmeasles immunization.
These are steps that every
government can take to improve
the lives of children in the present
and the future. Every child deservesa good childhood.

ABBREVIATIONSInternational Standards Organizationinternational abbreviations for countries
included in Report Card 16

Abbreviations and acronyms used inReport Card 16

Italy

BMI

JP

Japan

DPT

Diphtheria-pertussis-tetanus

KR

Republic of Korea

EQLS

European Quality of Life Survey

Bulgaria

LT

Lithuania

CA

CanadaLU

Luxembourg

CH

Switzerland

LV

Latvia

CL

Chile

MT

Malta

CY

CyprusMX

MexicoCZ

Czechia

NL

Netherlands

DE

GermanyNO

NorwayDK

DenmarkNZ

New Zealand

EE

Estonia

PL

Poland

ES

Spain

PT

PortugalFI

FinlandRO

Romania

FR

FranceSE

SwedenGB

United Kingdom of Great Britain
and Northern Ireland

SI

SloveniaSK

Slovakia

AT

AustriaIT

AU

Australia

BE

Belgium

BG

GR

GreeceHR

Croatia

HU

Hungary

IE

IrelandIL

IsraelIS

IcelandTR

TurkeyUS

United States of America

Body mass index

EU

European Union

EurostatEurostat Statistical Officeof the European Union

EU-SILCEU Statistics on Incomeand Living Conditions

GNI

Gross national income

HBSC

Health Behaviour in
School-aged Children

HILDA

Household, Income and Labour
Dynamics in Australia Survey

NEET

Not in education,
employment or training

OECD

Organisation for Economic
Co-operation and Development

PISA

Programme for International
Student Assessment

PM2.5

Fine particulate matter

SDG

Sustainable Development Goal

UNESCO

United Nations Educational,
Scientific and Cultural
Organization

UNICEF

United Nations Children’s FundWHO

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World Health Organization

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34. We selected this threshold to exclude
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35. Steckermeier, Leonie C., ‘Better Safe
than Sorry. Does agency moderate therelevance of safety perceptions for the
subjective well-being of young children?’,Child Indicators Research, vol. 12, no. 1,
2019, pp. 29–48.
36. Luthar, Suniya S., and Nancy
Eisenberg, ‘Resilient Adaptation Among
At-Risk Children: Harnessing science
toward maximizing salutary environments’,Child Development, vol. 88, no. 2, 2017, pp.
337–349.
37. Wang, Youfa, and Hyunjung Lim, ‘The
Global Childhood Obesity Epidemic and the
Association between Socio-economic
Status and Childhood Obesity’,
International Review of Psychiatry, vol. 24,
no. 3, 2012, pp. 176–188.
38. Thévenon, Olivier, and Anne Solaz,‘Labour Market Effects of Parental Leave
Policies in OECD Countries’. OECD Social,
Employment and Migration Working Papers
141, 2013. Richardson, Dominic, andUNICEF Office of Research – Innocenti, ‘Key
Findings on Families, Family Policy and theSustainable Development Goals: Synthesis
Report, ‘Innocenti Research Report, United
Nations Children’s Fund Office of Research– Innocenti, Florence, 201839. Petts, Richard J., and Chris Knoester,‘Paternity Leave-Taking and Father
Engagement,’ Journal of Marriage andFamily, vol. 80, no. 5, 2018, pp. 1144–1162.
40. See, for example, the case studies ofJapan and the Republic Korea in Chzhen,
Yekaterina, Anna Gromada and Gwyther
Rees, ‘Are the world’s richest countries
family friendly?’, United Nations Children's
Fund Office of Research – Innocenti,
Florence, 2019.

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41. See: Act on Maternity/Paternity Leaveand Parental Leave, No. 95/2000 and its
subsequent amendments up to 2016
(Ministry of Welfare of Iceland, 2016).
42. In Canada, the leave lasts five or eightweeks, depending on which type ofparental leave the couple chose initially<https://www.canada.ca/en/employmentsocial-development/news/2018/09/
new-five-week-parental-sharing-to-start-inmarch-2019.html> (last visited on 19
November 2019). In Spain, paternity leave
was extended to eight weeks and to thesecond parent (starting from April 2019).
The plans are to extend it further to 12
weeks in 2020 and to 16 weeks in 2021.
43. National Academies of Sciences,
Engineering, and Medicine; Greg Duncan
and Suzanne Le Menestrel (eds), A
Roadmap to Reducing Child Poverty.
National Academies Press, Washington DC,
2019. Available at: <https://doi.
org/10.17226/25246>, accessed 15 June
2020. Adamson, Peter, Measuring Child
Poverty: New league tables of child poverty
in the world's rich countries, United Nations
Children's Fund Office of Research –Innocenti, Florence, 2012.
44. Blossfeld, Hans-Peter, et al., eds.,
Childcare, Early Education and Social
Inequality: An international perspective,
Edward Elgar Publishing, Cheltenham,
2017; Heckman, James J., and Lakshmi K.
Raut, ‘Intergenerational Long-term Effectsof Preschool-structural Estimates from a
Discrete Dynamic Programming Model’,
Journal of Econometrics, vol. 191, no. 1,
2016, pp. 164–175.
45. United Nations Children’s Fund, For
Every Child, Every Right: The Convention
on the Rights of the Child at a crossroads,
United Nations Children's Fund, New York,2019.
46. Organisation for Economic Cooperation and Development, and European
Union, Health at a Glance: Europe 2018
– State of health in the EU cycle, OECD
Publishing/European Union, Paris/Brussels,2018. Available at: <https://doi.
org/10.1787/health_glance_eur-2018-en>,
accessed 23 February 2020.

47. An additional reason for not focusing
on polio and DPT (diphtheria-pertussistetanus) is that there is very little variance incoverage among the rich countries. Acrossthe 41 countries included in this report,
coverage is 95 per cent on average for
either vaccine.
48. Centers for Disease Control andPrevention, Morbidity and Mortality Weekly
Report (MMWR), vol. 33, no. 32, UnitedStates Department of Health and Human
Services, Atlanta, 17 August 1984, pp.
459–460, 465–467.
49. Clark, Andrew E., et al., ‘Lags andLeads in Life Satisfaction: A test of thebaseline hypothesis’, Economic Journal,
vol. 118, no. 529, 2008, F222–F243; Boarini,
Romina, et al., ‘Can Governments Boost
People’s Sense of Well-being? The impactof selected labour market and healthpolicies on life satisfaction’, Social
Indicators Research, vol. 114, no. 1, 2013,
pp. 105–120.
50. Fanjul, Gonzalo, ‘Children of theRecession: The impact of the economiccrisis on child well-being in rich countries’,
Innocenti Report Card 12, United Nations
Children’s Fund Office of Research –Innocenti, Florence, 2014.
51. This refers to what economists call‘externalities’, which are costs of benefits
that affect external actors. For example, GNI
can increase due to production thatpollutes the environment, effectively
decreasing long-term conditions forwell-being. These issues with national
income have long been recognized – see,for example, a speech made by Robert
Kennedy, delivered on 18 March, 1968 at
the University of Kansas, about grossnational product that “measures everythingin short, except that which makes life
worthwhile”, <https://www.jfklibrary.org/
learn/about-jfk/the-kennedy-family/
robert-f-kennedy/robert-f-kennedyspeeches/remarks-at-the-university-ofkansas-march-18-1968>. But they remain
largely unresolved and are becoming more
pertinent as evidence of environmental
problems mounts.

52. R=0.66. Authors’ calculations based on
average annual hours worked in 2018 and
GNI per capita in international dollars in
2018. See: Organisation for Economic
Co-operation and Development, OECD
Data, ‘Hours Worked’, <https://data.oecd.
org/emp/hours-worked.htm>, accessed 25
February 2020; World Bank.
53. Wilkinson, Richard, and Kate Pickett,
The Spirit Level: Why equality is better for
everyone, Penguin, London, 2010.
54. Packer, George, ‘The Broken Contract:
Inequality and American decline, Foreign
Affairs, vol. 90, no. 6, 2011, pp. 20–31
55. Authors’ calculations based on WorldBank data for 41 countries that, as at
December 2019, are Organisation for
Economic Co-operation and Development
and/or European Union members.
56. The Children’s Society’s household
survey, Wave 18, June–July 2019, 10- to
17-year-olds, Great Britain. Equallyweighted by age and gender.
57. World Health Organization, ‘Air
Pollution: Overview’, <https://www.who.
int/health-topics/air-pollution#tab=tab_1>,
accessed 23 February 2020.
58. United Nations Environment
Programme, Global Resources Outlook
2019: Natural Resources for the Future We
Want. Report of the International Resource
Panel, UNEP, Nairobi, 2019.

61. Peters, John M., et al., Epidemiologic
Investigation to Identify Chronic Effects ofAmbient Air Pollutants in Southern
California, The Children’s Health Study Final
Report, California Air Resources Board,
2004.
62. <https://www.who.int/water_
sanitation_health/monitoring/coverage/
indicator-6-1-1-safely-managed-drinkingwater.pdf>
63. Estimates of the organizers.
64. <https://www.theguardian.com/
environment/2019/mar/01/youth-climatechange-strikers-open-letter-to-worldleaders, accessed 19 June 2020.>
65. The Children’s Society, The GoodChildhood Report 2019, The Children’sSociety, London, 2019.
66. UNICEF Australia, A Climate for
Change – 2019 Young Ambassador Report,
UNICEF Australia, Pyrmont, 2019.
67. The Pearson correlation between thez-scores for conditions and outcomes was
0.41.
68. This approach has already been taken
in some of the countries covered in thisReport Card through Child Rights Impact
Assessments.

59. Ibid.
60. When children are born, they tend tohave only one fifth of the adult lung mass.
Before they reach the teenage years, theybreathe faster, inhale more air and tend to
spend more time outdoors. Then, when the
toxic air is inhaled, the ability to fight its
effects is compromised by an undeveloped
immune system. This means that the sameamount of pollution is more likely to cause
health problems among children thanamong healthy adults. Furthermore, in
those places where air pollution stems
primarily from vehicles, it tends toaccumulate close to the ground, meaningthat the lower the human height, the higher
the exposure.

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ACKNOWLEDGEMENTS

Innocenti Report Card 16 was written by
Anna Gromada, Gwyther Rees andYekaterina Chzhen with contributions from
Dominic Richardson, Celine Little and David
Anthony. The report was fact-checked by
Alessandro Carraro, supervised by Gunilla
Olsson and Priscilla Idele and edited byMadelaine Drohan.
A panel of advisers and UNICEF reviewers
provided quality assurance. Support andadvice were provided by Laurence Chandy,
Alessandra Guedes, Daniel Kardefelt
Winther, Amenawon Njilan Esangbedo,
Nikita White and all UNICEF National
Committees. Administrative support at the
UNICEF Office of Research – Innocenti wasprovided by Cinzia Iusco Bruschi, Lisa
Gastaldin and Flora Zecchi. Production was
led by Sarah Marchant, and communicationand outreach by Dale Rutstein, Patrizia
Faustini and Kathleen Sullivan.
All related materials can be downloaded
from the UNICEF Office of Research –Innocenti website: www.unicef-irc.org

Authors

Advisory boardÁrsæll Már Arnarsson (Health Behaviour in
School-aged Children, Iceland)
Asher Ben-Arieh (Haruv Institute, Hebrew
University of Jerusalem)
Mario Biggeri (Università degli Studi diFirenze)
Jonathan Bradshaw (University of York)
Dorothy Currie (Health Behaviour in
School-aged Children, University of St
Andrews)
Enrique Delamonica (UNICEF New York
Headquarters)
David Gordon (University of Bristol)

Anna Gromada is a Social and Economic
Policy Consultant at the UNICEF Office of
Research – Innocenti, a researcher at thePolish Academy of Sciences and a
co-founder of the Kalecki Foundation. Prior
to this, she collaborated with the
Chancellery of the President of the
Republic of Poland, the Organisation for
Economic Co-operation and Development
and the Government of France. She holds
degrees in Economics, Development,
Sociology and Politics.
Gwyther Rees is a Social and Economic
Policy Manager at the UNICEF Office of
Research – Innocenti. In addition, he is an
Associate Research Fellow at the
University of York, where he is also
Research Director of Children’s Worlds – aglobal survey of children’s views on theirlives and well-being. He has a PhD from
Cardiff University and a researchbackground in child protection andchildren’s subjective well-being.

6 4

Yekaterina Chzhen is an Assistant Professorof Sociology at Trinity College Dublin. She
moved to Trinity in August 2019 from the
UNICEF Office of Research – Innocenti,
where she had been a Social Policy
Manager since 2013. She holds a PhD fromthe University of York and publishes onpoverty and inequality across the life
course. She tweets from @kat_chzhen.

I N N O C E N T I

R E P O R T

Jo Inchley (Health Behaviour in Schoolaged Children, University of Glasgow)
Bergsteinn Jónsson (UNICEF Iceland
National Committee)
Dagmar Kutsar (University of Tartu)
Gill Main (University of Leeds)
Luisa Natali (UNICEF Office of Research –Innocenti)
Mario Piacentini (Organisation for
Economic Co-operation and Development)
Laura Speer (KIDS COUNT, Annie E. Casey
Foundation)
Ramya Subrahmanian (UNICEF Office of
Research – Innocenti)

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Previous issues in this series:
Innocenti Report Card 1
A League Table of Child Poverty in Rich Nations
Innocenti Report Card 2
A League Table of Child Deaths by Injury in Rich Nations
Innocenti Report Card 3
A League Table of Teenage Births in Rich Nations
Innocenti Report Card 4
A League Table to Educational Disadvantage in Rich Nations
Innocenti Report Card 5
A League Table of Child Maltreatment Deaths in Rich National
Innocenti Report Card 6
Child Poverty in Rich Countries 2005
Innocenti Report Card 7
Child Poverty in Perspective: An overview of childwell-being in rich countries
Innocenti Report Card 8
The Child Care Transition: A league table of early childhood
education and care in economically advanced countries
Innocenti Report Card 9
The Children Left Behind: A league table of inequality in childwell-being in the world’s rich countries
Innocenti Report Card 10
Measuring Child Poverty: New league tables of child poverty inthe world’s rich countries
Innocenti Report Card 11
Child Well-being in Rich Countries: A comparative overview
Innocenti Report Card 12Children of the Recession: The impact of the economic crisis on
child well-being in rich countries
Innocenti Report Card 13
Fairness for Children: A league table of inequality in childwell-being in rich countries
Innocenti Report Card 14
Building the Future: Children and the Sustainable Development
Goals in rich countries
Innocenti Report Card 15
An Unfair Start: Inequality in children's education inrich countries

for every child, answers

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Print ISSN: 1605-7317
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September 2020
ISBN: 978-92-1-103307-6
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Sales no.:E.20.XX.1