UNICEF
Office of Research
Innocenti Report Card 11

Child well-being
in rich countries
A comparative overview

Innocenti Report Card 11 was written by Peter Adamson.
The UNICEF Office of Research – Innocenti would like to acknowledge
the generous support for Innocenti Report Card 11 provided by the
Andorran and Swiss National Committees for UNICEF, and theGovernment of Norway.
Any part of this Innocenti Report Card may be freely reproduced using
the following reference:
UNICEF Office of Research (2013). ‘Child Well-being in Rich Countries:
A comparative overview’, Innocenti Report Card 11, UNICEF Office of
Research, Florence.
The Report Card series is designed to monitor and compare theperformance of economically advanced countries in securing therights of their children.
In 1988 the United Nations Children’s Fund (UNICEF) established aresearch centre to support its advocacy for children worldwide and to
identify and research current and future areas of UNICEF’s work. The
prime objectives of the Office of Research 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 Childsupporting advocacy worldwide. The Office aims to set out acomprehensive framework for research and knowledge within theorganization in support of its global programmes and policies. Throughstrengthening research partnerships with leading academic institutions
and development networks in both the North and South, the Officeseeks to leverage additional resources and influence in support ofefforts towards policy reform in favour of children.
Publications produced by the Office are contributions to a global debate
on children and child rights issues and include a wide range of
opinions. For that reason, some publications may not necessarily reflect
UNICEF policies or approaches on some topics. The views expressed
are those of the authors and/or editors and are published in order tostimulate further dialogue on child rights.

Cover photo © luxorphoto/Shutterstock©United Nations Children’s Fund (UNICEF), April 2013
ISBN: 978-88-6522-016-0
ISSN: 1605-7317

UNICEF Office of Research – Innocenti
Piazza SS. Annunziata, 1250122 Florence, Italy
Tel: +39 055 2033 0
Fax: +39 055 2033 220
florence@unicef.org
www.unicef-irc.org

UNICEF
Office of Research
Innocenti Report Card 11

Child well-being
in rich countries
A comparative overview

PART ONE presents a league table of child well-being
in 29 of the world’s advanced economies.
PART TWO looks at what children say about theirown well-being (including a league table ofchildren’s life satisfaction).
PART THREE examines changes in child well-being
in advanced economies over the first decade of the
2000s, looking at each country’s progress ineducational achievement, teenage birth rates,
childhood obesity levels, the prevalence of bullying,
and the use of tobacco, alcohol and drugs.

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A league table of child well-being

The table below ranks 29 developed countries according to the overall well-being of their children. Each country’s overall rank isbased on its average ranking for the five dimensions of child well-being considered in this review.
A light blue background indicates a place in the top third of the table, mid blue denotes the middle third, and dark blue the bottom third.
Overall well-being

Dimension 1

Dimension 2

Dimension 3

Dimension 4

Dimension 5

Average rank(all 5 dimensions)

Material
well-being

Health andsafetyEducation

Behaviours
and risks

Housing andenvironment(rank)(rank)(rank)(rank)(rank)

1

Netherlands

2.4

1

5

1

1

4

2

Norway

4.6

3

7

6

4

3

3

Iceland

5

4

1

10

3

7

4

Finland

5.4

2

3

4

12

6

5

Sweden

6.2

5

2

11

5

8

6

Germany

9

11

12

3

6

13

7

Luxembourg

9.2

6

4

22

9

5

8

Switzerland

9.6

9

11

16

11

1

9

Belgium

11.2

13

13

2

14

14

10

Ireland

11.6

17

15

17

7

2

11

Denmark

11.8

12

23

7

2

15

12

Slovenia

12

8

6

5

21

20

13

France

12.8

10

10

15

13

16

14

Czech Republic

15.2

16

8

12

22

18

15

Portugal

15.6

21

14

18

8

17

16

United Kingdom

15.8

14

16

24

15

10

17

Canada

16.6

15

27

14

16

11

18

Austria

17

7

26

23

17

12

19

Spain

17.6

24

9

26

20

9

20

Hungary

18.4

18

20

8

24

22

21

Poland

18.8

22

18

9

19

26

22

Italy

19.2

23

17

25

10

21

23

Estonia

20.8

19

22

13

26

24

23

Slovakia

20.8

25

21

21

18

19

25

Greece

23.4

20

19

28

25

25

26

United States

24.8

26

25

27

23

23

27

Lithuania

25.2

27

24

19

29

27

28

Latvia

26.4

28

28

20

28

28

29

Romania

28.6

29

29

29

27

29

Lack of data on a number of indicators means that the following countries, although OECD and/or EU members, could not be included in the league tableof child well-being: Australia, Bulgaria, Chile, Cyprus, Israel, Japan, Malta, Mexico, New Zealand, the Republic of Korea, and Turkey.

1 1

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3Introduction

The league table opposite presents
the latest available overview of childwell-being in 29 of the world’s mostadvanced economies.
Five dimensions of children’s lives
have been considered: material
well-being, health and safety,
education, behaviours and risks, andhousing and environment. In total,
26 internationally comparable
indicators have been included in theoverview (see Box 1).
The table updates and refines thefirst UNICEF overview of child wellbeing published in 2007 (Report
Card 7) .i Changes in child well-being
over the first decade of the 2000s
are examined in Part 3.

Key findings» The Netherlands retains its
position as the clear leader andis the only country ranked among
the top five countries in all
dimensions of child well-being.

» The bottom four places in thetable are occupied by three ofthe poorest countries in thesurvey, Latvia, Lithuania andRomania, and by one of therichest, the United States.

» Overall, there does not appear
to be a strong relationshipbetween per capita GDP andoverall child well-being. The
Czech Republic is ranked higher
than Austria, Slovenia higher
than Canada, and Portugal
higher than the United States.

» There are signs that thecountries of Central and Eastern
Europe are beginning to close
the gap with the moreestablished industrial economies(see Part 3).

Change over a decade
Although changes in methods andstructure make it difficult to makecomparisons between the first two
issues of the UNICEF overview ofchild well-being (see Part 3) it isnonetheless clear that there havebeen some significant changes overthe first decade of the 2000s.

» Overall, the story of the first
decade of the 2000s is one ofwidespread improvement in
most, but not all, indicators ofchildren’s well-being. The ‘lowfamily affluence’ rate, the infantmortality rate, and the percentageof young people who smoke
cigarettes, for example, havefallen in every single country forwhich data are available.

Data sources and background papers» The Netherlands is also theclear leader when well-being isevaluated by children themselves– with 95% of its children rating
their own lives above the midpoint of the Life Satisfaction Scale(see Part 2).

» Four Nordic countries – Finland,
Iceland, Norway and Sweden – sit
just below the Netherlands at the
top of the child well-being table.

» Four southern European countries– Greece, Italy, Portugal and Spain– are placed in the bottom half ofthe table.

The data sources used for this report are set out in the three background
papers detailed below and available at http://www.unicef-irc.org
Martorano, B., L. Natali, C. de Neubourg and J. Bradshaw (2013). ‘Child Wellbeing in Advanced Economies in the Late 2000s’, Working Paper 2013-01.
UNICEF Office of Research, Florence.
http://www.unicef-irc.org/publications/pdf/iwp_2013_1.pdf
Martorano, B., L. Natali, C. de Neubourg and J. Bradshaw (2013). ‘Child Wellbeing in Economically Rich Countries: Changes in the first decade of the 21st
century’, Working Paper 2013-02. UNICEF Office of Research, Florence.
http://www.unicef-irc.org/publications/pdf/iwp_2013_2.pdf
Bradshaw, J., B. Martorano, L. Natali and C. de Neubourg (2013). ‘Children’s
Subjective Well-being in Rich Countries’, Working Paper 2013-03. UNICEF
Office of Research, Florence.
http://www.unicef-irc.org/publications/pdf/iwp_2013_3.pdf

4

I n n o c e n t i» Spain has slipped down the
rankings – from 5th out of 21
countries in the early years ofthe decade to 19th out of 29
countries in 2009/2010.

» The United Kingdom has risen
up the rankings from bottom
place (21st out of 21 countries)
in 2000/2001 to a mid-table
position today.
Part 3 of this report examineschanges over the first decade of
the 2000s in more detail.

Measuring progress for children
The league table of child well-being
is designed to measure andcompare progress for children
across the developed world. Its
purpose is to record the standards
achieved by the most advanced
nations and to contribute to debate
in all countries about how suchstandards might be achieved.
As a moral imperative, the need topromote the well-being of children
is widely accepted. As a pragmatic
imperative, it is equally deservingof priority; failure to protect andpromote the well-being of children
is associated with increased risk
across a wide range of later-life
outcomes. Those outcomes range
from impaired cognitive
development to lower levels ofschool achievement, from reduced
skills and expectations to lower
productivity and earnings, fromhigher rates of unemployment toincreased dependence on welfare,from the prevalence of antisocial
behaviour to involvement in crime,from the greater likelihood of drug
and alcohol abuse to higher levels of
teenage births, and from increased
health care costs to a higher
incidence of mental illness.ii, iii

The case for national commitment
to child well-being is therefore
compelling both in principle and inpractice. And to fulfil thatcommitment, measuring progressin protecting and promoting thewell-being of children is essential topolicy-making, to advocacy, to the
cost-effective allocation of limited
resources, and to the processes oftransparency and accountability.

International comparability
The measurement of child wellbeing, however, is a relatively new
area of study and the overview
presented here remains a work inprogress. Chief among its
limitations is the fact thatinternationally comparable data onchildren’s lives are not sufficiently
timely. Between the collection ofdata in a wide variety of different
settings and their publication inquality-controlled, internationallycomparable form the time-lag istypically two to three years. Thismeans that most of the statistics onchild well-being used in this report,though based on the latest available
data, apply to the period 2009–2010. Such a delay would be
frustrating at the best of times. But
the last three years have been far
from the best of times. Beginningin late 2008, economic downturnin many developed nations has
seen rising unemployment and falls
in government expenditures whichcannot but affect the lives of many
millions of children. Data from2009 and 2010 capture only the
beginning of this turbulence.
Nonetheless, for the most part,the data used in this overview track
long-term trends and reflect theresults of long-term investments inchildren’s lives. Average levels of

R e p o r t

C a r d1 1school achievement, or
immunization rates, or theprevalence of risk behaviours,for example, are not likely to besignificantly changed in the shortterm by the recessions of the last
three years.
For the time being, it must be
accepted that data-lag is part ofthe entry price for international
comparisons of child well-being.
And although national-levelmonitoring of children’s lives is themore important task, UNICEF
believes that international
comparison can also play a part.
It is international comparison thatcan show what is achievable in thereal world, highlight strengths andweaknesses in individual countries,
and demonstrate that child wellbeing is policy-susceptible. And it
is international comparison thatcan say to politicians, press andpublic everywhere – ‘This is how
your performance in protecting
children compares with the recordof other nations at a similar levelof development.’
Finally, any single overview of acomplex and multidimensional
issue carries a risk of hiding morethan it reveals. The following pages
therefore set out to make thisoverview of child well-being astransparent as possible byexamining each of its dimensions
in turn.

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5

Box 1 How child well-being is measured

The table below shows how the overview of child well-being has been constructed and sets out the full list of
indicators used. The score for each dimension has been calculated by averaging the scores for each component.
Similarly, component scores are arrived at by averaging the scores for each indicator.
Dimensions

Components

Dimension 1
Material well-being
Figure 1.0

Monetary deprivation

Dimension 2
Health and safety
Figure 2.0

Health at birth

Dimension 3
Education
Figure 3.0

Relative child poverty rate

1.1a
1.1b

Child deprivation rate

1.2a

Low family affluence rate

1.2b

Infant mortality rate

2.1a

Low birthweight rate

2.1b

Preventive health services

Overall immunization rate

2.2Childhood mortality

Child death rate, age 1 to 19

2.3

Participation rate: early childhood
education

3.1aParticipation rate: further education,age 15–19

3.1b

NEET rate (% age 15–19 not in
education, employment or training)

3.1c

Average PISA scores in reading,maths and science

3.2

Being overweight

4.1aEating breakfast

4.1b

Eating fruit

4.1c

Material deprivation

Participation

Health behaviours

Risk behaviours

Exposure to violence

Dimension 5
Housing and environment
Figure 5.0

Figure no.

Relative child poverty gap

Achievement

Dimension 4
Behaviours and risks
Figure 4.0

Indicators

Housing
Environmental safety

Taking exercise

4.1d

Teenage fertility rate

4.2a

Smoking

4.2bAlcohol

4.2cCannabis

4.2dFighting

4.3aBeing bullied

4.3b

Rooms per person

5.1aMultiple housing problems

5.1b

Homicide rate

5.2a

Air pollution

5.2b

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Dimension 1 Material well-being
Figure 1.0 An overview ofchildren’s material well-being

Netherlands
Finland

The league table of children’s material
well-being shows each country’s
performance in relation to the averagefor the 29 developed countries underreview. The table is scaled to showeach country’s distance above or
below that average.

NorwayIcelandSwedenLuxembourg
Austria
Slovenia

The length of each bar shows eachcountry’s distance above or below theaverage for the group as a whole. The
unit of measurement is the ‘standard
deviation’ – a measure of the spreadof scores in relation to the average.

Switzerland
FranceGermany
Denmark
Belgium
United Kingdom
CanadaCzech Republic
Ireland
Hungary
Estonia
GreecePortugal
PolandItaly
Spain
Slovakia
United States
Lithuania
LatviaRomania
-3.5

-3.0

-2.5

-2.0

-1.5

-1.0

-0.5

0.0

0.5

1.0

1.5

Assessing material well-being
COMPONENTS

Monetary
deprivation

Material
deprivation

IND I C ATOR S

Relative child poverty rate (% of children living
in households with equivalent incomes below
50% of national median)Child poverty gap (distance between national
poverty line and median incomes of households
below poverty line)
Index of child deprivation (% of children lacking
specific items)
Family affluence scale (% of children reporting
low family affluence)I n n o c e n t i

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7Children’s material well-being
The table opposite (Figure 1.0)
presents an overview of children’smaterial well-being in developed
countries. Overall, it suggests thatmaterial well-being is highest in
the Netherlands and in the four
Nordic countries and lowest in
Latvia, Lithuania, Romania and theUnited States.
Two components of material wellbeing have been considered inarriving at this overview – relative
income poverty and material
deprivation. The strengths andweaknesses of both measures werediscussed in detail in the previous
report in this series (Report Card 10)iv
which argued that both measures arenecessary to achieve a rounded viewof children’s material well-being.

Relative poverty:
child poverty rates
Two separate indicators havebeen used to measure monetarydeprivation. They are the relative
child poverty rate (Figure 1.1a) andthe ‘child poverty gap’ (Figure 1.1b).
The relative child poverty rate shows
the proportion of each nation’sCountries with grey bars have not been
included in the ranking tables, or in theoverall league table of child well-being,as they have data for fewer than 75% of
the total number of indicators used.

Figure 1.1a Relative child poverty rates% of children aged 0–17 living in households with equivalent incomes
below 50% of national medianFinlandNetherlands
Denmark
Iceland
NorwaySlovenia
SwedenAustria
Ireland
Switzerland
Germany
FranceCzech Republic
United Kingdom
Hungary
Belgium
Luxembourg
Estonia
Slovakia
PolandCanadaPortugal
GreeceItaly
Lithuania
Spain
LatviaUnited States
Romania
CyprusMalta
Australia
New ZealandJapan
Bulgaria
0children living in households where
disposable income is less than 50%of the national median (after taking
taxes and benefits into accountand adjusting for family size andcomposition). This is the definitionof child poverty used by the
majority of the world’s developed
economies. Broadly speaking, itshows the proportion of children
who are to some significant extent

5

10

15

20

Findings» Finland is the only country with a relative child poverty rate of lessthan 5% and heads the league table by a clear margin of more than
two percentage points.

» The countries in the top half of the league table all have relative childpoverty rates of less than 10%.

» Four southern European countries – Greece, Italy, Portugal and Spain –have child poverty rates higher than 15% (along with Latvia, Lithuania,
Romania and the United States).

25

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excluded from the advantages andopportunities which most children
in that particular society would
consider normal.

Figure 1.1b Child poverty gaps
Gap between the poverty line and the median income of thosebelow the poverty line – as % of the poverty line
Luxembourg
Hungary
Netherlands
Austria
FinlandFranceNorwaySwedenGermany
Slovenia
Iceland
Switzerland
CanadaUnited Kingdom
Czech Republic
Belgium
PolandGreecePortugal
LatviaDenmark
Estonia
Slovakia
Romania
Italy
IrelandLithuania
United States
Spain

Relative poverty:
the poverty gap
The relative child poverty rates in
Figure 1.1a show what percentage
of children live below each nation’s
relative poverty line. But they reveal
nothing about how far below thatline those children are being
allowed to fall. To gauge the depthof relative child poverty, it is also
necessary to look at the ‘childpoverty gap’ – the distance between
the poverty line and the medianincomes of those below the line.
Figure 1.1b shows this ‘childpoverty gap’ for each country.
Considering ‘rate’ and ‘gap’ together
shows six countries in the bottom
third of both tables. They are Italy,
Latvia, Lithuania, Romania, Spainand the United States. By contrast,
there are also six countries thatfeature in the top third of bothtables – Austria, Finland,
Netherlands, Norway, Slovenia
and Sweden.

CyprusMalta
Australia
New ZealandJapan
Bulgaria
0

5

10

15

20

25

30

35

40

Findings» Hungary and Luxembourg have the smallest child poverty gaps.
» Denmark is an exception among Nordic countries in having a high childpoverty gap (almost 30%). Only a small proportion of Danish children(6.3%) fall below the country’s relative poverty line; but those who do,fall further below than in most other countries.

» Several countries have allowed the child poverty gap to widen to morethan 30%. They are Bulgaria, Ireland, Italy, Japan, Lithuania, Romania,
Slovakia, Spain and the United States.

What this means for the childrenof Spain or the United States, forexample, is that 20% or more fall
below the relative poverty line andthat, on average, they fall almost
40% below that line. In the
Netherlands or Austria, on the other
hand, 6% to 8% of children fall
below the relative poverty line and,on average, they fall approximately
16% below.
Taken together, these two childpoverty indicators – the rate and thegap – make up the relative income
component of children’s material
well-being.

I n n o c e n t i

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C a r d1 1Material deprivation:
the Child Deprivation Index

9

example, does not mean thatchildren’s actual living standards arelower in Canada (only that a greater
proportion of Canadian children live
in households where disposable
income is 50% of the median). In
order to arrive at a more complete
picture of child poverty, a measureof actual material deprivation has
therefore also been included.

Relative income measures, however,
have little to say about the actual
living conditions of children indifferent countries. The fact that ahigher percentage of children live in
relative income poverty in Canada
than in the Czech Republic, for
Figure 1.2a Child deprivation rates% of children lacking two or more specific items – see text

Again, two indicators have beenused. The first is the UNICEF Child
Deprivation Rate (introduced inReport Card 10) v which shows whatpercentage of children in eachnation lack two or more of thefollowing 14 items:
1. Three meals a day
2. At least one meal a daywith meat, chicken or fish
(or vegetarian equivalent)
3. Fresh fruit and vegetables
every dayIcelandSwedenNorwayFinlandDenmark
Netherlands
Luxembourg
IrelandUnited Kingdom
Spain
Slovenia
Austria
Czech Republic
Germany
Belgium
FranceEstonia
Italy
GreeceSlovakia
Lithuania
PolandPortugal
LatviaHungary
Romania

4. Books suitable for the child’s
age and knowledge level (notincluding schoolbooks)
5. Outdoor leisure equipment(bicycle, roller-skates, etc.)
6. Regular leisure activities(swimming, playing an
instrument, participating inyouth organizations, etc.)
7. Indoor games (at least one per
child, including educational baby
toys, building blocks, board
games, computer games, etc.)
8. Money to participate in school
trips and events
9. A quiet place with enough roomand light to do homework
10. An Internet connection
11. Some new clothes (i.e. not all
second-hand)
12. Two pairs of properly fitting
shoes

CyprusMalta
Bulgaria
0

10

20

30

40

50

60

70

80

Findings» The five Nordic countries and the Netherlands claim the top six places.
» Luxembourg and Ireland are the only other countries with child deprivation
rates below 5% (although the United Kingdom comes close at 5.5%).

» France and Italy have child deprivation rates higher than 10%.
» Four countries have child deprivation rates of more than 25% – Hungary,
Latvia, Portugal and Romania.

13. The opportunity, from time
to time, to invite friends home
to play and eat
14. The opportunity to celebrate
special occasions such as
birthdays, name days, religious
events, etc.
Figure 1.2a presents the childdeprivation rate for 26 countries(no comparable data are available
for Canada, Switzerland or theUnited States).

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1 1

The results are computed into the
Family Affluence Scale used in
Figure 1.2b to show the percentage
of children in each country living in‘low affluence’ families.

Figure 1.2b Percentage of children reporting low family affluence
Iceland
NorwayNetherlands
Denmark
Switzerland
SwedenLuxembourg
Finland
Slovenia
FranceBelgium
CanadaGermany
Spain
Austria
IrelandUnited Kingdom
United States
Portugal
Italy
GreeceEstonia
Czech Republic
PolandLithuania
LatviaHungary
Slovakia
Romania

As might be expected, the childdeprivation rate and the low family
affluence rate produce broadly
similar league table rankings. They
are, however, different in that one
focuses on the child and the otheron the family. Taken together, they
provide a more secure overview ofchildren’s material deprivation.

Real and relative

0

5

10

15

20

25

30

35

40

Findings» The Netherlands and the Nordic countries, along with Luxembourg
and Switzerland, have the smallest percentage of children reporting
low family affluence.

» Low family affluence rates are highest in eight Central and Eastern
European countries – the Czech Republic, Estonia, Hungary, Latvia,
Lithuania, Poland, Romania and Slovakia.

Material deprivation:
low family affluence» Does your family own a car, vanThe second indicator used tomeasure material deprivation isbased on written questionnaires
completed by representative
samples of children aged 11,
13, and 15 in each country.vi
The relevant part of thequestionnaire asks:» During the past 12 months, howor truck?
many times did you travel away
on holiday with your family?

» How many computers does yourfamily own?

» Do you have your own bedroom
for yourself?

The differences between the twocomponents of children’s material
well-being – relative poverty andmaterial deprivation – are often
misunderstood. It is not the casethat one is a relative measure andthe other absolute. Both are relative
measures. Deprivation rates may
appear to measure absolute poverty
because they are based on a
specific list of possessions rather
than the median income of eachnation. But those possessions arechosen to represent what mostpeople consider normal for a childgrowing up in any wealthy country
in the early 21st century. They are
therefore relative to both time andplace. The true difference between
the two approaches is that one
measures poverty in relation to an
income norm that varies fromcountry to country (the national
median income) whereas the othermeasures poverty by a common
standard for all of the countries
under review.

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1 1

Dimension 2 Health and safety
Figure 2.0 An overview of childhealth and safety

IcelandSwedenThe league table of children’s healthand safety shows each country’s
performance in relation to the averagefor the 29 developed countries underreview. The table is scaled to showeach country’s distance above or
below that average.

Finland
Luxembourg
Netherlands
Slovenia
NorwayCzech Republic
Spain

The length of each bar shows eachcountry’s distance above or below
the average for the group as a whole.
The unit of measurement is the‘standard deviation’ – a measure of
the spread of scores in relation to
the average.

FranceSwitzerland
Germany
Belgium
Portugal
IrelandUnited Kingdom
Italy
PolandFindings

Greece» Nordic countries again

Hungaryhead the table, with Iceland,
Sweden and Finland claiming
the top three places.

Slovakia
Estonia
Denmark» Austria, Canada and Denmark

Lithuania
United States
Austria
CanadaLatviaRomania
-3.0

-2.5

-2.0

-1.5

-1.0

-0.5

0.0

0.5

1.0

1.5

2.0

Assessing health and safety
COMPONENT S

Health at birth

IND I C ATOR S

Infant mortality rate (deaths under 12 months old
per 1,000 live births)
Low birthweight rate (% babies born below
2,500 grammes

Preventive healthservices

National immunization rate (average coveragefor measles, polio and DPT3 for children age
12 to 23 months)

Child and youth
mortality

Overall child and youth mortality rate
(deaths per 100,000 aged 1 to 19)

are to be found towards thefoot of the league table alongwith the United States. (In allof these cases the low ranking
is partly attributable to low
immunization rates.)

1 2

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1 1

12

14

Health and safety
The health dimension of children’swell-being is based on threecomponents for whichinternationally comparable data are
available. The components are:a) health at birth – as measured
by the infant mortality rate andthe percentage of babies bornwith low birthweight (below
2,500 grammes).
b) the availability of children’s
preventive health services –as measured by national
immunization levels for measles,
polio and DPT3.
c) child health and safety – asmeasured by the death rate ofchildren and young people(aged 1 to 19) from all causes.
The chart on the previous page
(Figure 2.0) combines these threecomponents into a league table ofchild health for the 29 developed
countries under review.

Health at birth:
infant mortality
In all developed countries, infantmortality rates (IMRs) have been
reduced to fewer than 10 infant
deaths per thousand live births.
The relatively small differences
between countries therefore reflect
not variations in the fundamentals
of public health such as safe waterand sanitation but variations in thecommitment and the capacity todeliver whatever services arenecessary to protect every motherto-be, every birth, and every infant
in the earliest days and weeks oflife. The IMRs set out in Figure 2.1a
may therefore be read as a measureof commitment to maternal andchild health for all – including themothers and children of the poorestand most marginalized families.

Figure 2.1a Infant mortality rates
Deaths under 12 months old per 1,000 live births
Iceland
Slovenia
SwedenLuxembourg
Finland
NorwayPortugalEstonia
Italy
Denmark
Czech Republic
Germany
Ireland
Austria
FranceNetherlands
Belgium
Spain
GreeceSwitzerland
United Kingdom
CanadaLithuania
PolandHungary
United States
Slovakia
LatviaRomania
Japan
CyprusAustralia
New Zealand
Malta
Bulgaria
0

2

4

6

8

10

Findings» Three Nordic countries – Finland, Iceland and Sweden – plus
Luxembourg and Slovenia – head the table with infant mortality rates
of fewer than 2.5 deaths per 1,000 births.

» 26 of the 35 countries have reduced infant mortality to 5 or fewer
per 1,000 births.

» The only countries with infant mortality rates higher than 6 per
1,000 births are Latvia, Romania, Slovakia and the United States.

» Three of the richest nations in the developed world – Canada, theUnited Kingdom and the United States – are placed in the bottom
third of the infant mortality league table.

I n n o c e n t i

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C a r dIt is possible that the low rankingof the United States in the league
table of infant mortality is notjustified: there is an as yet
unresolved debate about whether
infant mortality rates in the UnitedStates might include the deaths ofextremely premature and/or low
birthweight babies who are kept
alive for a time by advanced neonatal care but who, in othercountries, might not be classified
as ‘live births’.

Health at birth:
low birthweight

1 1

1 3

Figure 2.1b Low birthweight% babies born below 2,500 grammes
IcelandSwedenFinland
Estonia
Ireland
NorwayNetherlands
Slovenia
PolandCanadaDenmark
Luxembourg

The second indicator used tomeasure health at the beginningof life is the proportion of babies
who are born with low birthweights(below 2,500 grammes).

Switzerland

According to the United States
Centers for Disease Control andPrevention, “The birthweight of an
infant is the single most important
determinant of its chances ofsurvival and healthy growth.” vii
It is also a guide to the general
health, and health behaviours, ofpregnant women and mothers, bothof which are important to every
other dimension of child well-being.
Low birthweight is also known to
be associated with increased risk
across a range of health problems
in childhood and on into adult life.

United Kingdom

Figure 2.1b shows the percentage
of babies born with low birthweightin each of the 29 countries forwhich data are available.

FranceBelgium
Germany
Italy
Austria
Slovakia
Czech Republic
Spain
United States
Portugal
Hungary
GreeceNew ZealandAustralia
Japan
0

2

4

6

8

10

12

Findings» Five European countries – Estonia, Finland, Iceland, Ireland and Sweden –have succeeded in reducing the incidence of low birthweight below 5%.

» Only in Greece, Hungary, Portugal and the United States does the lowbirthweight rate exceed 8%.

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Preventive health services:
immunization

Figure 2.2 Immunization rates
Average coverage for measles, polio and DPT3 for children aged 12 to 23 months

The second component chosen
to evaluate child health is theavailability and effectiveness ofeach country’s preventive childhealth services. This has beenmeasured by each country’s
immunization rate (average
vaccination coverage for measles,
polio and DPT3).

Hungary
GreeceSlovakia
FinlandCzech Republic
Luxembourg
PolandSwedenBelgium
Portugal
Netherlands
Spain
Romania
FranceSlovenia
United Kingdom
Lithuania
IcelandGermany
Estonia
Italy
Switzerland
United States
NorwayIreland
LatviaDenmark
CanadaAustria

Routine immunization rates in thedeveloped nations are generally
maintained at high levels, averaging
close to 95%. As with infantmortality rates, the relatively
small differences between countries
can therefore be said to mirror
commitment to the ideal ofreaching out to every single child,including the most marginalized,with an essential preventive healthservice to which all children havea right.
Figure 2.2 presents an immunization
league table for 29 countries.

Japan
Bulgaria
CyprusAustralia
New Zealand
Malta
70

75

80

85

90

95

Findings» Greece and Hungary head the table with 99% immunization coverage.
» Three of the richest countries in the OECD – Austria, Canada andDenmark – are the only countries in which the immunization rate falls
below 90%.

100

It might be suspected that low
immunization rates in countries
such as Austria, Canada andDenmark have been affected byrumours, based on discredited
research, linking the triple MMR
vaccine (measles, mumps andrubella) with autism. This would
not really be an ‘excuse’ for low
coverage rates, as running a firstclass immunization programmemeans making sure that the public
is well informed and that false
information is not allowed to put
children at risk. But in fact the MMR
scare would not appear to be themajor cause of low immunization
rates in Austria, Canada andDenmark – all of which have low
rates even when measles
vaccination is excluded from thecalculations (in Canada, the measles

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C a r dimmunization rate is higher thanfor DPT3 or polio).

Child health:the 1 to 19 death rate
The third component used to build
an overall picture of child health isthe death rate among children andyoung people between the agesof 1 and 19.
Deaths in this age group are rarein advanced economies and thecauses go beyond disease andthe efficacy of health services
to include deaths from suicide,murder, traffic injuries, drownings,
falls and fires. Differences between
countries in the death rate forchildren and young people in thisage group may therefore be said
to reflect overall levels of healthand safety throughout childhood
and adolescence.
Figure 2.3 presents the 1- to
19-year-old death rate for eachcountry. In absolute numbers,
the differences between countries
are clearly small. But it is worth
noting that if all European countries
had the same child death rate as
Iceland or Luxembourg then over
8,000 child deaths a year could
be prevented – each one
representing unimaginable anguishfor the family concerned.
Taken together, the threecomponents set out above provide
an approximate guide to the healthdimension of children’s well-being.
Ideally, such an overview would also
have included some indicator ofchildren’s mental and emotional
health, and of the prevalence ofchild abuse and neglect. But such
issues are difficult to define andmeasure even within an individual
country; internationally, no
comparable data are available.

1 1

1 5

Figure 2.3 Child and youth mortality rates
Deaths per 100,000 aged 1 to 19
Iceland
Luxembourg
Switzerland
Netherlands
SwedenSpain
Germany
NorwaySlovenia
Italy
United Kingdom
FinlandDenmark
FrancePortugal
Ireland
Austria
Czech Republic
Belgium
GreeceHungary
PolandSlovakia
Estonia
Lithuania
LatviaRomania
CyprusMalta
Bulgaria
0

5

10

15

20

25

30

35

40

Findings» Iceland, Luxembourg, the Netherlands, Spain, Sweden and Switzerland
head the table with child death rates below 15 per 100,000.

» Central and Eastern European countries occupy the bottom third of thetable – along with Belgium and Greece.

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Dimension 3 Educational well-being
Figure 3.0 An overview ofchildren's educational wellbeing

Netherlands
Belgium
Germany

The league table of children’s
educational well-being shows eachcountry’s performance in relation to
the average for the 29 developed
countries under review. The tableis scaled to show each country’s
distance above or below that average.

Finland
Slovenia
NorwayDenmark
Hungary
PolandIceland

The length of each bar shows eachcountry’s distance above or below theaverage for the group as a whole. The
unit of measurement is the ‘standard
deviation’ – a measure of the spreadof scores in relation to the average.

SwedenCzech Republic
Estonia
CanadaFranceSwitzerland
Ireland
Portugal

Findings

Lithuania» Educational well-being is

Latviaseen to be highest in Belgium,
Finland, Germany and theNetherlands – each of which
achieves an overall scoresignificantly above averagefor the 29 countries.

Slovakia
Luxembourg
Austria
United Kingdom
Italy
Spain

» Greece, Romania, Spain andUnited States
GreeceRomania
-4.0

-3.0

-2.0

-1.0

0.0

1.0

2.0

Assessing educational well-being
COMPONENTSIND I C ATOR S

Preschool participation rate (% of those aged
between 4 years and the start of compulsory
education who are enrolled in preschool)

Participation

Further education participation rate (% of those
aged 15 to 19 enrolled in further education)
NEET rate (% aged 15 to 19 not in education,
employment or training)

Achievement

Average score in PISA tests of reading, maths
and science literacy

the United States show thelowest levels of educational
well-being.

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Educational well-being
In gauging educational well-being,
two main components have been
considered – participation rates andachievement levels. Taken together
they provide an approximate
guide to both quantity and qualityof education. Figure 3.0 (opposite)
combines the two into a single
overview of children’s educational
well-being for 29 developed countries.

Figure 3.1a Preschool enrolment rates

Participation:
early childhood education

United Kingdom

The first component – participation –has been assessed by three
indicators:a) participation in early childhood
educationb) participation in further educationc) the proportion of young people,
aged 15 to 19, who are notparticipating in education,
training or employment.
In recent times it has been widely
acknowledged that the foundationsof educational success are laid down
before formal education begins.viii
In response to this and otherpressures, all governments indeveloped countries have invested
to a greater or lesser degree in freeor subsidized preschool education.
The quality and quantity of that earlyyears education is difficult to measure
on an internationally comparable
basis – a difficulty highlighted inReport Card 7 (2007) which notedthat the lack of any indicator ofparticipation in early childhood
education is a “glaring omission”
from the attempt to build an overall
picture of children’s well-being.ix
The present report begins to makegood that omission by including thepreschool participation rate for 32
developed countries (Figure 3.1a).

% of children aged between 4 years and the start of compulsory education who areenrolled in preschool
FranceNetherlands
Spain
Belgium
Denmark
Italy
NorwayGermany
IcelandSwedenLuxembourg
Hungary
Austria
Slovenia
Estonia
Portugal
Czech Republic
LatviaIrelandRomania
Switzerland
Lithuania
Slovakia
PolandUnited States
GreeceFinlandJapan
Malta
CyprusBulgaria
60

65

70

75

80

85

90

95

100

Findings» Early childhood education is virtually universal in Belgium, France,
the Netherlands and Spain.

» Preschool enrolment rates exceed 90% in half of the 32 countries listed.
» In only eight countries do participation rates in early childhood education
fall below 80% – Bulgaria, Finland (but see Box 2), Greece, Lithuania,
Poland, Slovakia, Switzerland and the United States.

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Figure 3.1b Participation in further education

Findings% of children aged 15 to 19 in education» Five countries enrol 90% or moreof their young people in further
education – Belgium, Ireland,
Lithuania, Poland and Slovenia.

Belgium
PolandIreland» Seven of the wealthiest OECD

Lithuania
Slovenia

countries fall into the bottom
third of the further education
league table – Austria, Canada,
Italy, Luxembourg, Spain,
the United Kingdom and theUnited States.

Hungary
Netherlands
Czech Republic
LatviaGermany
Sweden» The further education enrolment

Finland
Norwayrate exceeds 80% in all of themore populous developed
countries except the United
Kingdom. The United Kingdom
is the only developed country
in which the further education
participation rate falls below
75%; this may be the resultof an emphasis on academic
qualifications combined with adiverse system of vocational
qualifications which have notyet succeeded in achieving
either ‘parity of esteem’ oran established value inemployment markets.

Slovakia
Iceland
Switzerland
Estonia
Portugal
FranceDenmark
GreeceItaly
Spain
CanadaUnited States
Austria
Romania
Luxembourg
United Kingdom
New ZealandAustralia
Bulgaria
Cyprus
Malta
60

65

70

75

80

85

90

95

Note: It is possible that some countries with very small populations, for example Luxembourg andMalta, may show low rates of participation in further education because a proportion of the relevant
age group are continuing their studies outside their own countries.

The age at which compulsory
education begins varies between
4 and 7. The preschool participation
rate is here defined as thepercentage of children between
the age of 4 and the beginning ofcompulsory education who areenrolled in preschools.

Further education
At the other end of the educationalladder is the further education
participation rate (Figure 3.1b)which shows the percentage ofyoung people aged 15 to 19 whoare enrolled in schools andcolleges. Participation in further
education reflects ‘educational wellbeing’ in as much as it indicates
successful passage through theyears of compulsory schooling. It isalso, of course, associated with awider range of opportunities at the
beginning of adult life.

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Figure 3.1c NEET rate

Findings% of children aged 15 to 19 not in education, employment or training» At the top of the table, Denmark,Norway and Slovenia have NEET
rates below 3%.

NorwaySlovenia» At the foot of the table, Ireland,

Denmark

Italy and Spain have NEET rates
of more than 10%.

Luxembourg
Czech RepublicNetherlands
PolandGermany
Lithuania
Slovakia
FinlandResearch in different countries
has also shown associations
between NEET status and mental
health problems, drug abuse,
involvement in crime, and long-term
unemployment and welfare
dependence.x

SwedenHungary
Belgium
Austria
FrancePortugal
Switzerland

Figure 3.1c records the NEET rate
for 33 advanced economies.

GreeceEstonia
LatviaCanadaUnited States
United Kingdom
Romania
IrelandItaly
Spain
CyprusAustralia
Malta
New Zealand
Bulgaria
0

2

4

6

NEET rate
The third indicator of educational
well-being looks at participationfrom a different perspective – thepercentage of young people (aged
15 to 19) who are not participatingin either education, employment or
training (the so-called ‘NEET’ rate).
In all countries, NEET rates areaffected by economic conditions

8

10

12

14

16

18

and employment opportunities aswell as by the effectiveness ofeducation systems in preparing
young people for the transition towork. Equally obviously, a high
NEET rate represents a threat to thepresent and future well-being ofyoung adults, a disincentive tothose still in the education system,
and a waste of educational
investment and human resources.

To make international comparisonsfair, the data must refer to a similar
period of time. Unfortunately, thelatest available common year for
NEET rates is 2009–2010. Figure
3.1c may therefore not reflect thecurrent situation. It does howeverreflect the major impact of thecurrent economic downturn on
youth unemployment rates (whichreached a peak of 18.3% in
November 2009 and were slightly
below that level in 2012). In total,
more than 23 million young people
in OECD countries now fall into the
NEET category and more than halfof this total are reported to havegiven up looking for work.xi
Commenting on the impact of
economic crisis on the transition
from school to work, the OECD
noted in 2011 that “High generalunemployment rates make thistransition substantially more difficult,as those with more work experience
are favoured over new entrants into
the labour force.” xii

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Figure 3.2 Educational achievement by age 15

Findings

Average score in PISA tests of reading, maths and science literacy» Finland is a remarkable outlier –registering a score almost 20
points clear of the second placedcountry (see Box 2).

Finland
CanadaNetherlands» Canada and the Netherlands take

Switzerland
Estoniasecond and third places.

Germany» Three of Europe’s wealthiest

Belgium

countries, Austria, Luxembourg
and Sweden, find themselves inthe bottom half of the educational
achievement table, as do all four
countries of southern Europe.

PolandIceland
NorwayUnited Kingdom
Denmark» Romania is also an outlier,Slovenia
Irelandregistering a score more than
40 points below the next lowest
country in the table.

FranceUnited States
Hungary» Australia, Japan and New ZealandSwedenwould all have been placed in the
top five places had it been possible
to include them in the main league
table (see note page 7).

Czech Republic
Portugal
Slovakia
Austria
LatviaItaly
Spain
Luxembourg
Lithuania
GreeceRomaniaJapan
New ZealandAustralia
Bulgaria
400

420

440

460

Educational achievement
The second component ofeducational well-being is the qualityof the education received.
This key element of child well-being
is of course difficult to define andmeasure on an internationallycomparable basis. Ideally, theconcept of ‘quality’ in education
would embrace a broad range of

480

500

520

540

560

factors such as the developmentof social understanding and value
formation (including education for
citizenship) as well as theopportunity to develop the diverse
abilities and potentials of young
people. But this lies in the future.
At present, the only practicalmeasure of quality in education isprovided by the OECD’s Programmeof International Student Assessment(PISA) which measures pupils’
abilities in three basic competences– reading, maths and science.
Repeated every three years, thetests are administered torepresentative samples of 15-yearolds and are intended to measureknowledge and skills in relation to
the demands of managing lives
and careers in the modern world.
In total, 34 member countries of
the OECD, plus non-member
partner countries, participate inthis evaluation of educational
achievement.
Figure 3.2 presents an overview of
the results of the latest PISA survey
for the countries under review. In
each case, the scores shown are an
average of results in reading, maths
and science. All scores have been
re-presented on a common scale
based on an unweighted averageI n n o c e n t i

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C a r dscore for all participating countries(re-set to 500 to make interpretationeasier).

1 1

2 1

Box 2 The Finland paradox

Disadvantage
The indicators used here tomeasure children’s overall
educational well-being broadly
reflect each nation’s commitment
to fulfilling every child’s right to beadequately prepared for thedemands of the world in which heor she will live. Managing andnegotiating that world – making
decisions about jobs and careers,families and homes, finances andpensions, citizenship andcommunity participation – demands
a highly developed ability to acquireand analyse new information and toadapt to changing circumstances.
In such a society, the educationallydisadvantaged are likely to be verymuch more disadvantaged than in
the past. They are also likely to findit ever more difficult to benefit from,and contribute to, the complex
societies in which they live.1
As with the other dimensions ofchild well-being considered in thisreport, educational well-being istherefore a critical measure bothfor children today and for theirsocieties tomorrow.

The fact that Finland has the lowest rate of preschool enrolment (Figure3.1a) and the highest level of educational achievement (Figure 3.2)
might seem to contradict the idea that preschool education is importantto success at school. But it is perhaps better interpreted as a warningof the care needed in making cross-national comparisons.
First, compulsory schooling in Finland does not begin until a child isseven years old, which means that the age group on which thepreschool enrolment rate is based is the child population between theages of four and seven (in many other countries it is the childpopulation between the ages of four and five). If the preschool
enrolment rate were to be re-defined as ‘the percentage of children
enrolled in preschool education in the year before compulsory schooling
begins’ then Finland would rank near the top of the table with anenrolment rate approaching 100%.
Second, preschool enrolment rates say nothing about the quality of theeducation received. If it were possible to measure quality, then it islikely that Finland would again be found towards the top of the table.
This prediction is based on the fact that Finland spends considerably
more than the OECD average on early years care and education, has
exceptionally high minimum qualification requirements for preschool
teaching staff, and the highest standards of staff-to-child ratios of any
advanced economy (1:4 for children under three years old, and 1:7 forchildren between 4 and 6).
Most commentators on Finland’s outstanding record of educational
achievement cite the quality of the country’s early years education.

1 Report Card 9 in this series focused on thisissue, showing that different countries do much
more than others for their lowest-achieving
pupils (i.e. have a much smaller ‘educational
achievement gap’ between the lowest-achieving
10% and the national average).

Sources:
Miho Taguma, Ineke Litjens, Kelly Makowiecki, Quality Matters in Early Childhood
Education and Care: Finland, OECD, 2012.
Starting Strong II, Early Childhood Education and Care, OECD, 2006.

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Dimension 4 Behaviours and risks
Figure 4.0 An overview of
behaviours and risks

Netherlands
Denmark

The league table of children’s
behaviours and risks shows eachcountry’s record in relation to theaverage for the countries underreview. The table is scaled to showeach country’s distance above or
below that average.

Iceland
NorwaySwedenGermany
Ireland
Portugal
Luxembourg

The length of each bar shows eachcountry’s distance above or below theaverage for the group as a whole. The
unit of measurement is the ‘standard
deviation’ – a measure of the spread ofscores in relation to the average.

Italy
Switzerland
FinlandFranceBelgium
United Kingdom
CanadaAustria
Slovakia
PolandSpain
Slovenia
Czech Republic
United States
Hungary
GreeceEstonia
Romania
LatviaLithuania
-2.5

-2.0

-1.5

-1.0

-0.5

0.0

Assessing behaviours and risks
COMPONENTSIND I C ATOR S% overweight

Eating and exercise% eating breakfast daily% eating fruit daily% exercising
Teenage fertility rate

Risk behaviours

Smoking
Alcohol
Cannabis

Exposure to violenceFighting
Being bullied

0.5

1.0

1.5

2.0

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Behaviours and risks
The fourth dimension of child wellbeing incorporated into the overall
league table of child well-being ismore difficult to pin down thanmaterial well-being or health oreducation. Yet the dimension here
labelled ‘behaviours and risks’includes a range of habits andbehaviours critical to the present
and future well-being of children.
Three separate components areincluded. The first is the extent towhich children in each country are
forming healthy, well-informed
habits of eating and exercise.
This has been measured by fourindividual indicators:a) the percentage who are
overweight (as measured by bodymass index computed from selfreported height and weight)b) the percentage of children ineach country who report eating
breakfast every dayc) the percentage who report eating
fruit every dayd) the percentage who report
engaging in physical exercise
for at least an hour every day.
All of these indicators, though ofvarying significance, are associatedwith long-term health and wellbeing. Regular exercise, forexample, is linked not only tophysical and mental health but tothe prevention and/or treatment ofsuch specific problems as asthma,obesity, anxiety and depression.
Unhealthy eating patterns in theearly years have also been shownto increase the risk of later-life
health problems including diabetes,
heart disease and cancer.xiii
Figures 4.1a to 4.1d show country
rankings for each of the chosen
indicators. In all cases, data are

drawn from questionnaires
completed by young people
themselves.

Risk behaviours
The second component considered
under ‘behaviours and risks’ is theprevalence of a second set of
behaviours that represent
immediate dangers to children as
well as serious threats to longerterm well-being. Within thelimitations of the available data,
four such risk indicators havebeen chosen:a) the teenage fertility rate (annual
number of births per 1,000 girls
aged 15 to 19)b) the cigarette smoking rate
(percentage of children aged 11,
13 and 15 who smoke cigarettes
at least once a week)c) the alcohol abuse rate
(percentage of children aged
11, 13 and 15 who report having
been drunk at least twice)d) the cannabis use rate
(percentage of children aged
11, 13 and 15 who reporthaving used cannabis in the last
12 months).
Giving birth at too young an age
puts at risk the well-being of bothmother and child. The mother is atgreater risk of dropping out ofschool, of unemployment, ofpoverty, and welfare dependence –so helping to perpetuate
disadvantage from one generation
to the next. The child is also atgreater risk – of poverty, of poor
health, and of underachievement
at school. The direction of causality
in these relationships is notnecessarily clear cut. Teenage
mothers tend to come from poorer
backgrounds, to be doing less wellat school, and to have narrower

career prospects; having a baby
may make all these problems
worse, but not having a baby will
not make them go away.
Nonetheless, having a baby at too
young an age is an indicator ofmuch that may have gone wrong in
the life of a teenager before she
became pregnant. And it is for thisreason that teenage birth rates arewidely regarded as a particularly
revealing indicator of many aspectsof child well-being that areotherwise difficult to capture.
The threats posed to physical andmental health by tobacco, alcoholand cannabis are well established.
Figures 4.2a to 4.2d record theperformance of each country undereach indicator.

Violence
The final component of the‘behaviours and risks’ dimension ofchild well-being is the degree towhich children and young people
experience violence in their lives.
Given the known dangers of
growing up in a violent environment– from immediate suffering andinjury to longer-term problems ofanxiety, depression, behaviouralproblems, and propensity to use
violencexiv – it is unfortunate thatfew data are available to compare
children’s exposure to violence
either as victims or as witnesses.
However, the Health Behaviour in
School-aged Children surveyxv
does provide data on children’s
experiences of both fighting(Figure 4.3a) and being bullied(Figure 4.3b).

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Figure 4.1a Overweight

Figure 4.1b Eating breakfast% of children aged 11, 13 and 15 who are overweight by BMI% of children aged 11, 13 and 15 who eat breakfast every day

Netherlands
Switzerland
Denmark
FranceLatviaLithuania
Belgium
SwedenNorwayUnited Kingdom
Slovakia
Germany
Luxembourg
Iceland
Austria
Estonia
Romania
Czech RepublicHungary
IrelandFinland
PolandSpain
Italy
Slovenia
Portugal
CanadaGreeceUnited States

Netherlands
Portugal
Denmark
SwedenIceland
Ireland
Belgium
NorwayFinlandFranceGermany
Spain
Estonia
LatviaItaly
CanadaUnited Kingdom
PolandLuxembourg
Lithuania
Switzerland
Slovakia
Austria
Czech RepublicHungary
GreeceUnited States
Romania
Slovenia
0

5

10

15

20

25

30

0

35

10

20

30

40

50

60

70

80

Figure 4.1d Exercise

Figure 4.1c Eating fruit% of children aged 11, 13 and 15 who eat fruit daily% of children aged 11, 13, 15 who report at least one hour ofmoderate-to-vigorous physical activity daily

Denmark
CanadaPortugal
United States
Switzerland
NorwayItaly
Czech Republic
Romania
Austria
Slovenia
FranceLuxembourg
Spain
United Kingdom
Belgium
IrelandGermany
Slovakia
Hungary
Iceland
GreeceNetherlands
PolandSwedenLatviaEstonia
Lithuania
Finland

IrelandUnited States
Austria
Spain
Czech Republic
Finland
CanadaSlovakia
Luxembourg
United Kingdom
PolandSlovenia
LatviaRomania
Hungary
Netherlands
Germany
Belgium
Lithuania
Iceland
NorwayGreeceEstonia
Portugal
SwedenSwitzerland
FranceDenmark
Italy
0

10

90

20

30

40

50

60

0

5

10

15

20

25

30

35

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Figure 4.2b Smoking

Fig 4.2a Teenage fertility rate

% of children aged 11, 13 and 15 who smoke cigarettes atleast once a week

Births per 1,000 girls aged 15 to 19

Iceland
NorwayCanadaUnited States
Portugal
IrelandUnited Kingdom
Denmark
Germany
GreeceSwedenNetherlands
Belgium
Slovenia
Switzerland
PolandSpain
FranceLuxembourg
Finland
Estonia
Italy
Slovakia
Romania
Austria
Hungary
Lithuania
Czech Republic
LatviaSwitzerland
Netherlands
Slovenia
Italy
Denmark
SwedenFranceGermany
NorwayFinland
Luxembourg
Czech Republic
GreeceAustria
Spain
CanadaBelgium
Iceland
PolandIreland
Portugal
Hungary
LatviaLithuania
Slovakia
Estonia
United Kingdom
Romania
United States
Japan
CyprusAustralia
Malta
New Zealand
Bulgaria
0

5

10

15

20

25

30

35

40

45

0

2

4

6

8

10

12

14

Figure 4.2c Alcohol

Figure 4.2d Cannabis% of children aged 11, 13 and 15 who report having been
drunk at least twice% of children aged 11, 13 and 15 who report having usedcannabis in the last 12 months

United States
IcelandNetherlands
Italy
Luxembourg
FrancePortugal
GreeceSwedenNorwaySwitzerland
Belgium
Germany
Ireland
Spain
Austria
PolandCanadaSlovakia
Romania
Slovenia
Hungary
United Kingdom
Estonia
Czech Republic
Denmark
LatviaFinlandLithuania

NorwaySwedenRomania
GreeceIcelandFinlandGermany
Austria
Portugal
Hungary
Denmark
Slovakia
IrelandLithuania
PolandEstonia
Luxembourg
Belgium
Italy
Netherlands
United Kingdom
Slovenia
LatviaCzech Republic
United States
FranceSpain
Switzerland
Canada
0

5

10

15

20

25

30

0

5

10

15

20

25

16

30

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Findings
Obesity» Childhood obesity levels are running at morethan 10% in all countries except Denmark, theNetherlands and Switzerland.

» Only Canada, Greece and the United States havechildhood obesity levels higher than 20%.
Eating fruit» The only countries in which fewer than 30% ofchildren eat fruit every day are Finland and Sweden –plus the three Baltic countries, Estonia, Latvia
and Lithuania.
Eating breakfast» More than 50% of children eat breakfast every day inall 29 countries except Romania and Slovenia. Only in
the Netherlands and Portugal does the percentage ofchildren who eat breakfast every day exceed 80%.
Exercise» Ireland and the United States are the only countries
in which more than 25% of children report exercising
for at least an hour a day.2» Italy is the only country in which fewer than 10%
of children report exercising for an hour a day.
Teenage births

Alcohol» Alcohol abuse by young people is lowest in the
United States.

» Alcohol abuse by young people is 10% or less inonly eight countries – France, Greece, Iceland, Italy,
Luxembourg, the Netherlands, Portugal and theUnited States.

» In the Czech Republic, Denmark, Estonia, Finland,
Latvia and Lithuania, more than 20% of young people
report having been drunk on at least two occasions.
Cannabis» Only in Norway does the rate of cannabis use byyoung people fall below 5%.

» Canada’s children and young people have the highest
rate of cannabis use (28%).

» The young people of six countries record cannabis
use rates of 20% or more. They are Canada, theCzech Republic, France, Spain, Switzerland and theUnited States.
Fighting and being bullied» Germany is a clear leader in having the lowest
percentage of children who report being involved
in fighting.

» The Netherlands, Slovenia and Switzerland have the» Three Nordic countries – Denmark, Iceland andlowest rates of teenage births (below 5 per 1,000).

Sweden – have low levels of both bullying andfighting.

» Romania, the United Kingdom and the United States
have the highest rates of teenage births (above 29
per 1,000).
Smoking» Canada, Iceland, Norway, Portugal and the UnitedStates are the only countries in which the smoking
rate for young people is below 5%.

» The highest smoking rates (more than 10% of young
people report smoking cigarettes at least once aweek) are found in Austria, the Czech Republic,
Hungary, Latvia, Lithuania, Romania and Slovakia.
2 The ‘one hour a day’ criterion used here follows the recommendationsof the World Health Organization.

» Only in Spain does the proportion of young people
involved in fighting exceed 50% (with Greece closebehind at 49%).

» Only in Lithuania does the proportion of young
people who report being bullied exceed 50%.

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Figure 4.3a shows what percentageof 11-, 13 - and 15-year-olds reportbeing “involved in a physical fight atleast once in the past 12 months.”
Figure 4.3b shows the percentage
who report being “bullied at schoolat least once in the past coupleof months.”

Figure 4.3a Fighting

Being bullied can make a misery ofa child’s life for weeks, months oreven years. It can also contribute toemotional and behavioural problems,
including anxiety and depression,
impaired school performance, andincreased absenteeism and truancy.xvi
But the monitoring of bullying inchildren’s lives is made more difficult
by the fact that bullying is difficult todefine. In order to make measurement
and comparison as meaningful as
possible, the children who took partin the survey were also given thefollowing definition of bullying.

Estonia“We say a student is being bullied
when another student, or a groupof students, say or do nasty andunpleasant things to him or her. It isalso bullying when a student is teased
repeatedly in a way he or she does
not like or when he or she isdeliberately left out of things. But it
is not bullying when two students ofabout the same strength or powerargue or fight. It is also not bullying
when a student is teased in a friendly
and playful way.”% of children aged 11, 13 and 15 who report “being involved in a physical fight atleast once in the past 12 months”
Germany
Finland
Portugal
Switzerland

Denmark
SwedenIceland
Luxembourg
Netherlands
United States
IrelandFrancePolandCanada
Italy
United Kingdom
Austria
Lithuania
Slovakia
Belgium
Slovenia
Romania
LatviaHungary
Czech Republic
Greece
Spain
0

10

20

30

40

50

60

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Good news

Figure 4.3b Being bullied

Reporting the ‘behaviours andrisks’ dimension of child well-being
inevitably focuses attention on thenegative behaviours of young
people. But in almost all cases such
behaviours involve only a small
minority. The same data may also
be used to report that, amongchildren and young people in the
countries under review:% of children aged 11, 13 and 15 who report “being bullied at school at least once inthe past couple of months”» 99% of girls do not get pregnant
while still a teenager» 92% do not smoke cigarettes» 85% are not overweight» 86% do not use cannabis» 85% do not get drunk» about two thirds are neither
bullied nor involved in fighting.

Italy
SwedenSpain
Czech Republic
IcelandDenmark
Slovenia
Netherlands
NorwayPolandSlovakia
United States
Hungary
GreeceUnited Kingdom
Ireland
Luxembourg
Germany
FinlandFranceCanadaSwitzerland
Belgium
Portugal
Austria
Estonia
Romania
LatviaLithuania
0

10

20

30

40

50

60

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Dimension 5 Housing and environment
Figure 5.0 An overview of
housing and environment

Switzerland
Ireland

The league table of children’s housing
and environment shows eachcountry’s performance in relation to
the average for the 29 developed
countries under review. The table isscaled to show each country’s
distance above or below that average.

NorwayNetherlands
Luxembourg
Finland
IcelandSwedenSpain

The length of each bar shows eachcountry’s distance above or below theaverage for the group as a whole. The
unit of measurement is the ‘standard
deviation’ – a measure of the spread ofscores in relation to the average.

United Kingdom
CanadaAustria
Germany
Belgium
Denmark
FrancePortugal
Czech Republic
Slovakia
Slovenia
Italy
Hungary
United States
Estonia
GreecePolandLithuania
LatviaRomania
-3.0

-2.5

-2.0

-1.5

-1.0

-0.5

0.0

0.5

1.0

Assessing housing and environment
C O M PONENT S

IN D I C ATO R S
Rooms per person

Housing

Environmental safety% of households with children reporting morethan one housing problem
Homicide rate (annual number of homicides
per 100,000)
Air pollution (annual PM10 [µg/m3])

1.5

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1.4

1.6

Housing and environment
An acknowledged weakness of thefirst UNICEF overview of child wellbeing (Report Card 7) was the lackof any measure of children‘senvironmental well-being. This
has now begun to be remediedby drawing on recent data fromthe European Unionxvii and theWorld Health Organization. Two
components have been considered:a) housing – as measured byovercrowding and reported
housing problemsb) environmental safety – asmeasured by children’s exposure
to crime and pollution.

Overcrowding
In many families, the modern era
has seen an emptying of children’s
lives and homes. Instead of having
four or five siblings, today’s child
more commonly has one or none.
At the same time, rising divorce
and separation rates, changes infamily structure, and the rise of outof-home child care mean that many
children live in homes that are
significantly less crowded thanin the past. Nonetheless, where
overcrowding remains it is asignificant factor in children’s wellbeing. Apart from the loss ofopportunity for privacy, and for
quiet time and study, overcrowding
has also been linked to adverse
effects on parenting behaviours andon children’s cognitive andemotional development, including
increased risk of stress andbehavioural difficulties.xviii
Given the available data,xix the mostsignificant variable appears to berooms-per-person and this is themeasure used in Figure 5.1a.

Figure 5.1a Rooms per person
Belgium
IrelandNetherlands
Spain
Finland
NorwayUnited Kingdom
Luxembourg
SwedenDenmark
Germany
FranceAustria
Iceland
Portugal
Italy
Czech Republic
GreeceEstonia
Slovenia
Slovakia
Lithuania
PolandRomania
LatviaHungary
Malta
CyprusBulgaria
0

0.2

0.4

0.6

0.8

1

1.2

Findings» In 17 of 26 countries, the average home has more rooms than people.
» Of the nine countries with fewer rooms than people, eight are inCentral and Eastern Europe.

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Multiple housing problems

Figure 5.1b Multiple housing problems

Figure 5.1b complements theovercrowding indicator byattempting an assessment of thephysical quality of children’s homes.
Specifically, it shows whatpercentage of households withchildren report more than two of
the following problems:% of households with children reporting more than one housing problem

1. leaking roof, damp floors/walls/
foundations/rot in windows
2. dwelling too dark
3. no bath or shower
4. no indoor flushing toilet for thesole use of the household.
As with overcrowding, the tableagain shows the expected divide
between the poorer countries
of Eastern Europe and thewealthier North.

Crime and pollution
The second component ofchildren’s environmental well-beingis the safety of the environment asmeasured by two quite different
indicators: the level of crime andthe level of pollution.

Crime
Suffering violence, witnessing
violence, or fearing violence should
not be part of growing up. And
although it seems that early
exposure to violence affects somechildren more severely than others,
the risk for all children is that anenvironment of violence may
disrupt normal development andaffect well-being in both short andlong term. Consequences may
include behavioural disorders suchas aggression and an inability torelate to others, emotional disorders
such as depression and anxiety, andIceland
NorwayDenmark
Netherlands
SwedenSlovakia
IrelandSpain
Czech Republic
FinlandGermany
Austria
FranceGreeceUnited Kingdom
Italy
Portugal
Luxembourg
Slovenia
Belgium
Hungary
PolandEstonia
Lithuania
LatviaRomania
Malta
CyprusBulgaria
0

5

10

15

20

25

30

35

40

Findings» Denmark, Iceland and Norway head the table with fewer than 1%of households reporting multiple housing problems.

» The rate of multiple housing problems rises to more than 20% in
Latvia and to almost 40% in Romania.

» Belgium and Luxembourg are the only two countries in western
Europe in which more than 5% of households with children reportmultiple housing problems.

45

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health-related disorders such as
sleep disruption and nightmares.xx
Exposure to violence, says the Safe
Start initiative in the United States,“can interfere with a child’s ability tothink and learn and can disrupt thecourse of healthy physical,
emotional, and intellectual
development.” xxi
Measuring and comparing violencein the child’s environment isobviously problematical. Crime andvictimization rates would be apossible measure, but variations inmethods of defining and recording
crimes in different legal systems
make it impossible to make reliablecross-national comparisons. The
one available indicator thateliminates most of the potential forbias is the homicide rate for eachcountry. Rather than omit altogether
the important issue of violence inthe environment of the child, it was
decided to accept the homicide rate
as an approximate guide to theoverall level of violence in thesociety (Figure 5.2a).

Pollution
The second component ofchildren’s environmental well-being– the extent of environmental
pollution – is also difficult tocompare internationally. One
common standard for which data
are available is the level of outdoor
air pollution and this has beenused to construct the league table
presented in Figure 5.2b.

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8

Figure 5.2a Homicide rates
Annual number of homicides per 100,000
Iceland
Austria
NorwaySlovenia
Switzerland
Germany
Spain
SwedenCzech Republic
Luxembourg
Italy
FranceNetherlands
United Kingdom
Portugal
GreecePolandHungary
Denmark
Slovakia
Belgium
CanadaRomania
IrelandFinland
LatviaUnited States
Estonia
Lithuania
Malta
Australia
CyprusNew Zealand
Bulgaria
0

1

2

3

4

5

6

Findings» Estonia, Latvia, Lithuania and the United States are the only countries
in which the homicide rate rises above 4 per 100,000. Almost all othercountries fall into the range of 0 to 2.5 per 100,000.

» Homicide rates are more than fifteen times higher in the worst performing
country, Lithuania, than in the best performer, Iceland.

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Figure 5.2b Air pollution
Average annual concentration of fine particulate matter in the atmosphere(annual PM10 [µg/m3])
Estonia
IrelandUnited States
Luxembourg
FinlandLithuania
CanadaSwitzerland
NorwayUnited Kingdom
IcelandSwedenGermany
Austria
Netherlands
Belgium
Slovakia
Hungary
FranceDenmark
Portugal
Spain
Czech Republic
Slovenia
PolandItaly
LatviaRomania
GreeceAustralia
New Zealand
Japan
Malta
CyprusBulgaria
0

10

20

30

40

50

60

70

Findings» The lowest levels of air pollution are found in Estonia, Finland, Ireland,
Luxembourg and the United States (all below 20 parts per million).
The good result for the United States is influenced by legislation on air
pollution (1997, revised in 2006) which enforced stricter limits than inmost European countries.

» The highest levels are found in Greece, Italy, Latvia, Poland and Romania(all higher than 30 parts per million).

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C a r d1 1Conclusion
The five dimensions of child wellbeing considered here – material
well-being, health, education,
behaviours and risks, and housing
and environment – contributeequally to the league table of overall
child well-being on page 2. But as
will be obvious from the comments
on each of the indicators used, themeasurement and comparison ofchild well-being levels acrossdifferent countries is an imperfectexercise with significant gaps andlimitations. Ideally, it would also
require better and more childoriented data on such criticalimportant indicators as:» the quality of parenting» the quality as opposed toquantity of early childhood
education» children’s mental and emotional
health» children’s exposure to violencein the home (both as victims
and as witnesses)» the prevalence of child abuse
and neglect» the quality and safety ofchildren’s specific environments
including the opportunity for safe,
unsupervised play

» the well-being of children
being brought up in the careof the state» the commercialization andsexualization of childhood» the exposure to, and effectof, media of all kinds inchildren’s lives.

The earliest years
In addition to these gaps, there is
one other weakness in almost all
current attempts to monitor thewell-being of children, whether
internationally or within individual
countries. That weakness is the lackof data about children’sdevelopmental well-being in theearliest months and years of life.
It is perhaps no longer necessary
to argue the case for theimportance of the early years.
Advances in both neuro-scienceand social science have repeatedly
confirmed that it is at this time thatgenetic potential interacts in
infinitely complex ways with earlyexperience to construct the neuralpathways and connections thatquickly become both thefoundations and the scaffolding for
all later development. It is therefore
at this time that the child’s wellbeing, health and development are
most in need of society’s concern
and protection.
Yet in practice most of the available
data on children’s lives relate toolder children and young teenagers.
The two major international surveys
on which this report draws, forexample, are the Health Behaviourin School-aged Children survey(focusing on children aged 11 to 15)
and the Programme of International

Student Assessment (examining
the educational progress of pupils
at age 15).
The almost total absence ofnationwide data on thedevelopmental progress of very
young children may reflect the factthat the importance of earlychildhood development has only
relatively recently been brought topublic and political prominence.
In part, also, it may reflect thetraditional view that the collectionof data on the lives of the very
young is impractical, potentiallyintrusive, and of limited relevanceto public policy. But in part, also,
the problem has been the lack of
any widely applicable means ofmeasuring and monitoring children’sdevelopmental progress in theearliest years of life. Without sucha measure, policy is blind,
expenditure difficult to justify, goals
impossible to set, and progressincapable of being monitored.
This may now be beginning tochange as two countries – Canada
and Australia – become the first in
the world to begin the regularmonitoring of early years
development for all children.
Box 3 tells the story of themeasures now being used.
In essence, the method deployed
in both countries is a teachercompleted checklist for every childat about the age of five years (a few
months after entry into formal
schooling). The checklist includesI n n o c e n t i

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C a r dapproximately 100 items covering
five domains of early childdevelopment – physical healthand well-being, social competence,emotional maturity, language andcognitive skills, and communication
skills. “We now have communitylevel information about earlychildhood development for all ofAustralia,” says the foreword to thefirst issue of the Australian Early
Development Index (AEDI). “In thesame way that the GDP is ameasure of our economic status,
the AEDI is a national measure of
how well we are supporting ourchildren’s development.”
There is a long way to go before
any nation can say that it has
adequate information about theearly years development of all its
children. But a start has been madein Australia and Canada towards
making known the proportion of thenation’s young children who aredevelopmentally ‘on track’, ‘at risk’or ‘vulnerable’. Capable of being
aggregated and mapped for a
specific geographic community, for
an electoral ward or administrative
district, for a State or Province orfor the nation as a whole –such data are beginning to assist
parents, communities, children’sorganizations, the academic
community, and government at alllevels to become involved in
knowing more and doing more insupport of ensuring the best
possible start in life for every child.

1 1

No one should claim that
supporting child development in
the early years is a simple
proposition, or that all the answers
are available if only the resources
could be found. But it has become
equally clear that properly directed
investment in these years can havevery substantial and sustained
effects on the well-being of children
today, on their lives tomorrow, andon the long-term well-being of theirsocieties as a whole.xxii
In the future, therefore, it is hopedthat the UNICEF overview of childwell-being will be able to also take
into account data on childdevelopment in the critical earlymonths and years of children’s lives.

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Box 3 Canada and Australia: Measuring the early years

Canada and Australia have become the first countries
to put in place systems for the regular monitoring ofchildren’s developmental progress in the years before
schooling begins.
Most provinces in Canada are now using the country’s
Early Development Instrument (EDI) to monitor thedevelopmental progress of all young children. In
Australia an adapted version of the EDI, known as theAustralian Early Development Index (AEDI), has beenin use nationwide since 2009.
The EDI is essentially a checklist completed byteachers for every child at or around the mid-point of
the first year of full-time schooling. Each assessment
takes approximately 10 to 20 minutes to complete andcovers five domains of early development – physicalhealth and well-being, social competence, emotional
maturity, cognitive development, and linguistic ability.
The list includes approximately 100 questions such as:» How often has the child arrived at school too
tired to do schoolwork?

» How would you rate this child’s ability to get

Population measure
The EDI is not a ‘pass or fail’ development test for any
individual child, nor is it used for screening purposes.
It is a population measure intended to inform
communities, politicians, children’s organizations,
local and national governments about the early years
development of their children. And it is an approximate
guide to whether the cumulative effects of children’s
early years experiences are enabling them to fulfil theirpotential and take full advantage of the years ofeducation that are about to begin.
The results of the EDI are aggregated and madeavailable in different ways to provide an overview ofdevelopmental progress for different populationgroups – by gender, by neighbourhood or city, bysocio-economic quintile, by ethnic group, or byparticipation in particular kinds of early childhood
education programmes. Eventually, the EDI may also
make possible the setting of targets and themonitoring of progress towards reducing the
proportion of children who are developmentally‘vulnerable’ or ‘at risk’.xxiii

along with peers?

» Would you say that this child can sit still or isrestless?

» Would you say that this child is generallyinterested in books?

» How would you rate this child’s ability tocommunicate needs in an understandable way?
The end result is a measure showing what percentage
of children in any given population group can beconsidered to be:» ‘On track’ (above the 25th percentile for thenation as a whole)» ‘At risk’ (between the 10th and 25th percentile)» ‘Vulnerable’ (below the 10th percentile).

Origins in Canada
The EDI was developed in the 1990s at the Canadian
Institute for Advanced Research and the CanadianCentre for the Study of Children at Risk (now the
Offord Centre for Child Studies at McMaster University,
Ontario).xxiv Towards the end of the decade theGovernment of Canada made a major commitment toassessing “the readiness to learn of Canadian children
so that we can assess our progress in providing
children with the best possible start.“ xxv Following apilot implementation in North York, Toronto, the EDI
was finalized in 2000. Ten years later, nationwide
coverage has almost been achieved and ‘early
development maps’ are now available on-line and in
published form.

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International beginnings
The EDI has been used to evaluate early years development in regional populations of Brazil, Chile, Estonia,
Ireland, Jordan, Mexico, Peru, Scotland, Sweden and the United States. Pilot studies and evaluations havebeen conducted in Hong Kong, Indonesia, Jamaica, Kosovo, Moldova, Mozambique, the Netherlands,
Pakistan, the Philippines and Vietnam.
In addition, Canadian and Australian experts have worked with the UNICEF Early Child Development Unit
to create an Early Child Development Index for inclusion in the fourth round of the Multiple Indicator Cluster
Surveys conducted by UNICEF in close to 50 low- and middle-income countries.

Overall, analysis of the nationwide results haveshown that:» Approximately 25% of children experience somedifficulties that prevent them from taking fulladvantage of the education offered by school.xxvi» 30% of children in poor families are developmentallyvulnerable – as opposed to 15% of children frombetter-off families.xxvii» There is a pronounced tendency for boys to be moredevelopmentally vulnerable than girls.xxviii» Follow-up studies from earlier evaluations in specificcommunities have confirmed the relationshipbetween ‘school readiness to learn’, as identified by
the EDI, and school performance at Grade 3.xxix
Adaptation by Australia
The EDI was used as a basis for an Australian Early
Development Index (AEDI) which has been adopted
by the Council of Australian Governmentsxxx as anational progress measure for early childhood
development. In 2009, the Federal Government
made available Aus$24.5 million to fund nationwide
implementation,xxxi including AEDI training for allteachers of school entry classes. Between May andJuly 2009, 15,522 teachers in 7,422 Australian schools
conducted AEDI evaluations for 261,147 children(97.5% of all children in their first year of full-timeschool). The Government has now committed tonational implementation of the AEDI every three years.
As in Canada, the results have been made available
on-line to all communitiesxxxii and in published form
as a Snapshot of Early Childhood Development inAustralia.xxxiii
So far, the AEDI has been able to report that:» Approximately one quarter of Australian children
are developmentally vulnerable on one or moredimensions at the time of entry into school(approximately the same proportion as in Canada).

» Approximately 12% of children are vulnerable on
two or more dimensions.

» Between 20% and 30% of children are not regularly
read to and/or encouraged to read.

» Boys are almost twice as likely to be
developmentally vulnerable on one or more domains
as girls (30% as opposed to 17%).xxxiv» Children living in economically disadvantaged areas
are twice as likely to be developmentally vulnerable
on one or more domains as children living in areasof higher socio-economic status (32% as opposed
to 16%).

» The proportion of Australia’s indigenous children
who are developmentally vulnerable is twice as highas the proportion of non-indigenous children (47%as opposed to 22%).
The years immediately ahead will tell whether the EDI
in Canada and the AEDI in Australia will have asustained impact. For the moment, they represent an
important beginning in making available nationwide
data on early years development. For local and national
government, the results are a guide to policy andresource allocation. For the academic and researchcommunity, they provide data that can be linked toother social and economic variables in order to gain
more understanding of the circumstances anddeterminants of early years development. Perhaps
most important of all, they are a means of raisingcommunity awareness and mobilizing community
resources in support of the early years developmentof all children.

Further information
Early Development Instrument (Canada):
Offord Centre for Child Studies, McMaster University,
Ontario, Canada, www.offord centre.ca
Australian Early Development Index
www.rch.org.au/australianedi

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C a r d1 1Part 2
WHAT CHILDREN SAY

Despite data limitations, theoverview of child well-being set
out in Part 1 represents the best
currently available statistical
snapshot of children’s lives acrossthe developed world.
But it is not the only overview
available. In recent years it has
also become possible to monitor
some aspects of what children
themselves have to say about theirown lives. Part 2 of this report
therefore looks at the issue ofchildren’s subjective well-being
and at some of the argumentsthat surround it.

Omission
Subjective well-being was included
as one of six dimensions
considered in the first UNICEF
league table of child well-being
published in 2007 (Report Card 7).
Why then has it been omitted fromthe current overview?
Apart from the concerns about suchmeasures touched on below, it isargued that subjective well-being
overlaps with and transcends allother dimensions of child well-being
and is therefore best considered asa separate measure in its own rightrather than as one component of anindex. The measures presented
here should therefore be considered
in conjunction with the overview ofchild well-being presented in Part 1.

Life satisfaction
Figure 6.0 provides an overview ofchildren’s subjective well-being in
29 developed countries. Based on
the Children’s Life Satisfaction
League Table,3 the chart shows the
proportion of children aged 11, 13
and 15 in each country who reporta high level of life satisfaction.
Specifically, it shows the proportion
who answered ‘6 or more’ when
asked to rate their overall life
satisfaction on a scale of 0 to 10(where ‘0’ represents ‘the worst
possible life for me’ and ‘10’
represents ‘the best possible life
for me’).

Comparing subjective andobjective
How does the league table ofchildren’s life satisfaction comparewith the overview of child well-being
set out in Part 1 of this report?
First of all, it should be noted thatthe ‘objective’ and ‘subjective’
measures of child well-being
deployed in Parts 1 and 2 aremeasuring slightly different
concepts. The overview presented
in Part 1 measures many dimensionsof well-being that might be better
described as ‘well-becoming’ – i.e.
dimensions that reflect the concernsof families and communities as theyseek to promote both the present
and future well-being of theirchildren. The Children’s Life

3 Sometimes known as the ‘Cantril Ladder’ after Hadley Cantril (1906–1969)
who first developed the scale in The Pattern of Human Concerns (1965).

Satisfaction League Table shown
opposite, on the other hand, is ameasure of how children feel about
their own lives according to theirown priorities in the here and now.
Nonetheless, one might expect areasonably close correlation
between the results of the two
measures, and this is in fact thecase (Figure 6.1).
But there are also some striking
contrasts:
Three southern European countries
rise sharply in the rankings whenwell-being is assessed by children’s
self-reported life satisfaction:» Greece jumps from 25th placein the league table of child wellbeing to 5th place in the league
table of children’s life
satisfaction.

» Spain rises from 19th to 3rd.
» Italy climbs from 22nd to 15th.
Several countries see almost as
sharp a drop in ranking position
when child well-being is assessedby children themselves:» Germany drops 16 ranking places(from 6th place to 22nd).

» Luxembourg drops 10 ranking
positions (from 7th to 17th).

» Canada and Poland each drop
7 places.

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3 9

Figure 6.0 The children’s life satisfaction league table (2009/2010)

Findings% of children aged 11, 13 and 15 who rate their life satisfaction with a score of
6 or more on the 11-step ‘Cantril Ladder’ scale» Over 85% of children in thedeveloped nations have a highlevel of overall life satisfaction;even in the countries at thebottom of the league, morethan 75% of children placed
themselves above the mid-pointof the life satisfaction ladder.

Netherlands
IcelandSpain
Finland
GreeceBelgium» The Netherlands heads the

Norwayleague table of children’s
subjective well-being with 95%
of its children reporting a highlevel of life satisfaction.

Switzerland
Estonia
Slovenia» In the top five countries – Finland,

SwedenIreland

Italy

Greece, Iceland, the Netherlands
and Spain – approximately 90%
of children reported a high levelof life satisfaction in 2009/2010.

Austria» Only in Poland and Romania does

Denmark
United Kingdom

the ‘high life satisfaction’ rate fall
below 80%.

Luxembourg
France» Children in Canada, Germany,

Czech Republic

Portugal and the United Statesfind themselves in the bottom
third of the Life Satisfaction
League Table – along with
Hungary, Lithuania, Poland,
Romania and Slovakia.

LatviaPortugal
Germany
United States
CanadaSlovakia
Hungary
Lithuania
PolandRomania
70

75

80

85

90

95

100

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Relationships

Figure 6.1 Comparison of the UNICEF overview of child well-being withthe children’s life satisfaction league table
Rank

UNICEF league table ofchild well-being

Rank

Children’s life satisfaction
league table

Difference
in rank

1

Netherlands

1

Netherlands

no change

2

Norway2

Iceland+1

3

Iceland

3

Spain

+16

4

Finland4

Finlandno change

5

Sweden5Greece+20

6Germany6

Belgium+37Luxembourg

7

Norway–5

8

Switzerland

8

Switzerland

9

Belgium

9

Estonia+14

10

Ireland10

Slovenia+2

11

Denmark

11

Sweden–6

12

Slovenia

12

Ireland–2

13

France13

Denmark–2

14

Czech Republic

14

United Kingdom+2

15

Portugal

15

Italy

+7

16

United Kingdom

16

Austria+2

17

Canada17

Luxembourg

–10

18

Austria18

France

–5

19

Spain

19

Czech Republic–5

20

Hungary20

Latvia+8

21

Poland21

Portugal

–6

22

Italy

22

Germany–16

23=

Estonia23

United States

+3

23=

Slovakia

24

Canada–7

25

Greece25

Slovakia–2

26

United States

26

Hungary–6

27

Lithuania

27

Lithuania

no change

28

Latvia28

Poland29

Romania29

Romaniano change–7
no change

Findings» Overall there is a strong correlation between the two tables. Over halfof the 29 countries featured have a similar ranking position whichever
method of assessment is used (i.e. a difference in ranking position offive places or fewer).

» The Netherlands and the Nordic countries perform strongly on bothsubjective and objective measures (though Norway and Sweden drop
five and six places respectively when the measure used is children’s
own self-reported life satisfaction).

» Most Central and Eastern European countries are found in the bottom
half of both tables, with the notable exception of Estonia which rises by
14 places when measured by children’s self-reported life satisfaction.

Children’s own subjective
assessments can also provide a
guide to one of the most critical of
all factors in assessing well-being –the quality of the close relationships
in the child’s life.
From the earliest years, the child’ssense of subjective well-being is
intimately bound up withrelationships, and particularly withparents and peers. A recent survey
by the UK Children’s Society, forexample, finds that family
relationships are the single mostimportant contributor to children’s
subjective well-being.xxxv Other
studies have shown that
relationships with peers can play
an important role in both day-to-day
well-being and long-term
developmental progress. It isthrough relationships with peersthat children experiment with social
roles and learn and practise thecontrol of aggression, themanagement of conflict, the earningof respect and friendship,discussion of feelings, appreciationof diversity, and awareness of theneeds and feelings of others. No
child grows up without experiencing
some difficulty and tension in
relationships with parents andpeers, but for many children
prolonged or more severe
difficulties in these relationships
can be a cause of stress, anxiety
and depression.xxxvi, xxxvii
The quality and contribution of
the child’s closest relationships is
obviously difficult to define andmeasure; any indicator simple
enough to be used for thecompilation of national statistics
cannot hope to provide any morethan an approximate guide.
Nonetheless, some insight may begained from Figure 6.2, which sets

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4 1

out the percentage of children ineach country who:

Figure 6.2 Children’s relationships with parents and peers
Average ofthe threerelationships
scores% of children
who findclassmateskind and helpful% of children
who find it
easy to talkto mothers% of children
who find it
easy to talkto fathers

Netherlands

84.5

80.4

91.7

81.4

Iceland

83.2

80.3

89.3

79.8

Sweden

79.9

82.0

85.5

72.4

Denmark

77.0

77.2

84.2

69.5

Romania

76.7

64.8

90.4

74.8

Finland

75.1

66.1

86.6

72.5

Ireland

74.8

73.4

82.9

68.1

Hungary

74.8

58.1

89.9

76.4

Spain

74.8

67.1

86.5

70.8

Germany

74.7

77.9

81.5

64.5

Norway

74.0

78.2

78.7

65.1

Portugal

73.9

79.4

81.3

61.2

Switzerland

73.5

78.9

79.7

62.0

Estonia

73.4

65.1

86.1

69.1

Austria

72.0

69.0

82.2

64.9

Findings

Luxembourg

71.9

73.5

79.5

62.7

» Measured by the average

United Kingdom

71.7

63.3

83.0

68.6

Poland

70.1

51.0

86.6

72.6

rating for the three relationships,
the Netherlands again heads
the rankings.

Belgium

69.9

75.0

77.5

57.3

» Denmark, Iceland, the Netherlands

Italy

69.3

68.5

79.7

59.9

Latvia

67.4

54.5

82.0

65.8

Slovakia

67.2

61.7

78.7

61.3

Lithuania

66.8

58.0

80.4

62.1

Czech Republic

66.8

56.0

81.4

62.8

Canada

66.7

58.2

79.3

62.6

Greece

63.8

44.3

83.1

64.1

United States

63.3

56.2

73.9

59.7

France

59.4

56.6

71.2

50.3

Note: Data for the indicators ‘easy to talk to mothers’ and ‘easy to talk to fathers’ are missing forSlovenia. It was therefore not possible to calculate an average score for relationships.

» find it easy to talk to their mothers» find it easy to talk to their fathers» find their classmates kind andhelpful.
Overall, the countries where children
find it easy to talk to their mothers
are also those where children findit easy to talk to their fathers. But
there does not appear to be asignificant association between ‘easein talking to parents’ and ‘findingclassmates kind and helpful’. In
Hungary and Poland, for example, ahigh percentage of young people
find it easy to talk to their parents
but a low percentage find theirclassmates kind and helpful.
In Belgium, the reverse is thecase: a high percentage considerclassmates kind and helpful but amuch smaller percentage find it easy
to talk to their fathers.

and Sweden are the only countries
ranked in the top group for all
three relationships.

» Canada, France and the UnitedStates are the only countries
ranked in the bottom group for
all three relationships.

» In every country, children foundit more difficult to talk to theirfathers than to their mothers –and the gap between the two
measures is, on average, 16
percentage points. Only in Iceland
does the difference narrow to lessthan 10 percentage points.

4 2

Nonetheless the table as a wholepresents a positive picture ofchildren’s relationships in thedeveloped nations. On average
across the 28 countries, two thirdsof children report that theirclassmates are kind and helpful,
more than 83% find it easy to talkto their mothers, and 67% findit easy to talk to their fathers.

Controversy
Self-reported well-being measures
are the subject of much academic
debate.4 Proponents argue that
if the aim is to measure children’swell-being then there can be no
more direct or reliable method thanasking children themselves to say
what they think about their own
lives. In particular, self-reported
measures such as the children’s life
satisfaction league table (Figure 6.0)
have the advantage of allowing
children themselves to decide what
aspects of their lives are of mostimportance to them. The overview
of child well-being presented inPart 1 is an index constructed byadults, circumscribed by thelimitations of the available data,
and based on a weighting system
for which there is no agreed
scientific basis. The Children’s Life
Satisfaction Table, on the other
hand, allows young people todecide, in a less structured but
arguably less arbitrary and more
subtle way, what elements matterto their own well-being and what
weight or importance to attach to

I n n o c e n t ieach. Adding momentum to thesearguments is the desire to respectchildren’s rights, to listen to their
voices, and to include them as far
as possible in the process ofmeasuring and promoting theirown well-being.
Critics might agree with all of theabove points, but this would not
deter them from expressing
concerns about the validity of selfreported well-being measures –especially when used for purposesof international comparison. Chiefamong those concerns is that
responses to survey questions may
be culturally conditioned. A scoreof 6 on a Life Satisfaction Scale, forexample, may mean one thing in a
culture which emphasises
accepting one’s lot in life anddiscourages complaint – and quite
another in a culture where children
are encouraged to strive for better,to compare themselves to others,
and to be aware of their rights.
A related concern is that aseemingly simple process like rating
one’s own life satisfaction on ascale of 0 to 10 can in practice
involve complex psychologicalprocesses, of which perhaps themost applicable are cognitive
dissonance and adaptive
preference. Many studies haveshown that people seek to maintainpeace of mind, reconcile innerconflicts, or maintain a positive selfimage, by adjusting their opinions,aspirations, and levels of

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expectation according to theirperception of what is possible orrealistic. In this way, for example, it
is conceivable that fatalism orresignation may come to be
expressed as ‘life satisfaction’.
Finally, it may be argued that
subjective judgements of well-being
are made in relation to the lives ofothers and that this makes crossnational comparison questionable.
When asked to imagine ‘the best
possible life for me’ and ‘the worst
possible life for me’, for example,
some children may take as theirframe of reference the lives offamily and friends, classroom andcommunity; others may think lessof the world around them and moreof the virtual world as portrayed bymedia of all kinds. Might this notalso be a distorting influence onlevels of self-reported life
satisfaction in different countries?
In sum, children – like adults – arelikely to adapt their sense of life
satisfaction both to their own
realities and to the examples andnorms set by the societies in which
they live. Does this mean that somedeprived and disadvantaged
children report that they are‘satisfied’ with their lives because
they cannot realistically expect
anything better? Or because they
have been taught not to complain?
Or because they feel defensive
about their homes and protective
towards their parents? xxxviii
Conversely, do some privileged

4 Subjective well-being measures first came to prominence with the work of Richard Easterlin’s 1974 paper ’Does Economic Growth Improve the Human
Lot? Some Empirical Evidence‘. Since that time, the trickle of survey data on self-reported well-being has become a flood. Questions about happiness or
subjective well-being are now included, for example, in the United States General Social Surveys, the Pew Survey of Attitudes, the Virginia Slims Poll, the
DDB Needham Lifestyles Survey and the Gallup-Healthways Well-Being Index. France has brought together a Commission on the Measurement of
Economic Development and Social Progress with a mandate to examine ‘the adequacy of current measures of economic performance and how measuresof development could take better account of societal well-being’.

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C a r dchildren report ‘dissatisfaction’because they are constantly being
invited to compare theirpossessions and opportunities, theirlooks and bodies and lifestyles, withthe rich and famous in the virtual
community of a globalized andcommercialized media?

Well-being and well-becoming
Such arguments caution against
too glib a reading of subjective
measures of well-being, especiallywhen used as the basis forinternational comparison. But they
do not add up to a dismissal. Thereis considerable evidence that
subjective well-being measuresreflect more than cultural
conditioning, psychological
adaptation, or genetic make-up.
Life satisfaction measures, as wehave seen, tend to correlate wellwith more objective measures ofwell-being and with other measuresof coping ability and social
competence.xxxix
Subjective well-being measures
record something real andimportant about children’s lives.
Caution is needed in interpreting
the results, especially when making
international comparisons, but itwould be absurd to dismiss findingsthat show subjective well-being in
one country to be markedly lower
than in comparable countries, orthat show a deteriorating trend overtime, or that provide insights into
differences by age or gender. For its
part, the league table of overall

1 1child well-being need not beashamed of reflecting adult value
judgements; it is part of the
responsibility of adults to makesuch judgements on behalf ofchildren (if a child were to consider
that school achievement or taking
exercise are not important to his
or her well-being, this would not
be a reason for adults to ignore
such considerations).
This last point again reminds usthat the ‘objective’ and ‘subjective’
measures of child well-being
deployed in Parts 1 and 2 of thisreport are not measuring the samething. For all these reasons, UNICEF
takes the view that both the selfreported life satisfaction levels
presented in Part 2 and theoverview of child well-being
presented in Part 1 provide valuable
information about children’s lives:
while there is reason for care ininterpreting the results of both,there is no reason to dispense withthe services of either.

4 3

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PART 3
Child well-being – the 10 year record

The first UNICEF overview of childwell-being was published in 2007,
drawing on internationallycomparable data from the years
2001 to 2003. The current overview
draws on data from 2009 and 2010.
Is it therefore possible to say
whether child well-being has risen
or fallen in economically advanced
nations over the first decade of
the 2000s?

Figure 7.0 Limited overview of child well-being

Changes in measures and methods
make it impossible to draw simple
comparisons between the two
overviews. However, overall
progress in child well-being may
be tracked over the decade byconstructing a ‘limited overview’using only those measures common
to both 2001/2002 and 2009/2010.
xxxx

The background paper
to thisreport sets out this ‘limited
overview’ in more detail. Figure 7.0
summarizes the results by showing
each country’s league table ranking
at the beginning and end of thedecade (average rank for four
available dimensions of child wellbeing – material well-being, health,education and behaviours and risks).
Overall, the results show that therank order of countries has remained
reasonably stable over the decade,but with some significant changes.

Changes in material well-being
It is also possible to compare theprogress of countries over timeby focusing not on composite
measures but on individualCountry rankings at beginning and end of the decade
Rank

Early 2000s

Rank

Late 2000s

Changein rank1

Sweden1

Netherlands+22

Finland2

Norway+2

3Netherlands

3

Finland–1

4=

Denmark

4

Sweden–3

4=

Norway5Germany+2

6France6Denmark–2

7

Germany

7

Belgium+18Belgium

8=

France–2

9=Czech Republic

8=

Ireland+4

9=

Poland8=

Switzerland+3

11

Switzerland

11

Portugal+5

12

Ireland

12

Poland

–3

13

Spain

13

Czech Republic

14=

Canada14=

Canadano change

14=

Italy

14=

Italy

no change

16=

Greece16

United Kingdom

+4

16=

Portugal

17

Austria+1

18

Austria

18=

Greece–2

19

Hungary18=

Hungary+1

20=

United Kingdom

18=

Spain

–5

20=

United States

21

United States–1–4

The tables are ranked by each country’s average rank in four dimensions of child well-being – material
well-being, health, education, and behaviours and risks – for which comparable data are available
towards the beginning and end of the first decade of the 2000s.

Findings» Finland and the Netherlands lead the child well-being tables in both
2001/2002 and 2009/2010.

» Austria, Greece, Hungary the United Kingdom and the United States
are ranked in the bottom third of the table for both 2001/2002 and2009/2010 (though the United Kingdom rose four places).

» Over the decade, Portugal climbed from the bottom third to a
mid-table position.

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indicators of child well-being forwhich data are available at both the
beginning and end of the decade.

4 5

The Czech Republic, Hungary and
Poland still report the highest rates
of ‘low family affluence’, but (alongwith Portugal) they also record the
sharpest falls. Over the decade, the‘low family affluence’ rate declinedby more than 20% in the Czech
Republic and Poland, and by about
15% in Hungary.

In each case, countries are ranked
by the levels recorded in 2009/2010.
Figure 7.1a, for example, showsthat all 21 countries for which
comparable data are available haveseen a significant decline in material
deprivation – as measured by the‘low family affluence’ rate (see page10). By the end of the decade, ‘lowfamily affluence’ had fallen below
20% in all countries except Hungary.

The ‘low family affluence’ rate mayof course continue to fall even if
those on low incomes fall further
and further behind the income
norms of their societies (as it isbased not on changing medianincomes but on the possessionof a fixed list of material goods andopportunities). Unfortunately, it is
not possible to track and comparechanges in relative child poverty overFigure 7.1a also shows that thecountries of Central and Eastern
Europe are beginning to close thegap with the more establishedindustrial economies of the West.

the course of the decade becauseof technical changes in theequivalence rate by which theOECD adjusts household incomesto allow for differences in family
size and composition.

Changes in child health
It is also possible to measureprogress by tracking changes insome key indicators of child health.
Figure 7.1b, for example, showsthat infant mortality rates (IMRs)
have declined in all 21 countries
for which data are available.
Here, also, there are signs thatCentral and Eastern Europe iscatching up, with Hungary and
Poland recording the biggest falls(along with Ireland).

Figure 7.1a Changes in the percentage of children reporting low family affluence between 2001/2002 and 2009/2010(lacking specific items – see above and page 9)
50
40
30
20
10

2001/2002 ■2009/2010 ■Hungary

PolandCzech Republic

Greece

Italy

United States

Portugal

United Kingdom

Ireland

Austria

Spain

CanadaGermany

Belgium

FranceFinlandSwedenSwitzerland

Denmark

Netherlands

Norway0

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Figure 7.1b Changes in infant mortality rate between the early 2000s and late 2000s
Deaths under 12 months old per 1,000 live births
8

6

4

2

early 2000s ■United States

Hungary

PolandCanadaUnited Kingdom

Switzerland

GreeceSpain

Belgium

FranceAustria

Netherlands

Czech Republic

Germany

IrelandItaly

Denmark

Portugal

NorwayFinlandSweden0late 2000s ■Figure 7.1c Changes between 2003 and 2009 in the percentage of young people aged 15–19 remaining in education
100

90

80

70

2003 ■

United Kingdom

Austria

United States

Canada

Spain

Italy

GreeceDenmark

FrancePortugal

Switzerland

NorwayFinlandSwedenGermany

Czech RepublicNetherlands

Hungary

Ireland

PolandBelgium

60

2009 ■

Findings» Overall, the table shows a rise in further education enrolment rates in 14 out of 21 countries, with particularly
significant increases in Canada, Hungary, Ireland, Portugal and the United States.

» Although starting from a high level at the beginning of the decade, France registered the biggest fall in further
education enrolment – dropping more than three percentage points.

» The United Kingdom also saw a decline of more than two percentage points despite starting from a low positionat the beginning of the decade.

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4 7

Figure 7.1d Changes in educational achievement between 2003 and 2009
Average score in PISA tests of reading, maths and science literacy
560
540
520
500
480

2003 ■

Greece

Spain

Italy

Austria

Portugal

Czech Republic

SwedenHungary

United States

FranceIrelandDenmark

NorwayPolandBelgium

Germany

Switzerland

Netherlands

CanadaFinland460

2009 ■

Note: Data for the United Kingdom are not included, though reported in Report Card 7, due to technical reasons.

Findings» Overall, the table shows a relatively stable picture of educational achievement.
» Finland is the outstanding performer in both 2003 and 2009.
» Canada and the Netherlands take second and third places in both periods.
» The biggest gains in average PISA scores over the period were made by Germany and Italy but above allby Portugal which, between 2003 and 2009, has gone a long way towards closing the ‘educational achievementgap’ with other European countries.

» Significant declines were recorded by Austria, the Czech Republic, France, Ireland and Sweden.
The Czech Republic, with an IMR ofunder 5 per 1,000 at the beginningof the decade, had no need ofcatching up.
As noted in Part 1, the official
comparison of infant mortality rates
may do an injustice to the bottom
ranked country – the United States –as it is possible that the comparison
is not ‘like-for-like’ (it is possible that
infant mortality rates in the UnitedStates might be affected by thedeaths of extremely premature
and/or low birthweight babies who
survive for a short period because
of intensive neonatal care but who

would not, in other countries, beclassified as ‘live births’).

Changes in education
Two indicators are also available tomeasure progress in children’s andyoung people’s educational wellbeing (in this case between 2003
and 2009).
Figure 7.1c, for example, records
changes in further education
enrolment rates.

Educational achievement
Secondly, the Programme ofInternational Student Assessment(PISA) makes it possible to track
nation-by-nation changes in
educational achievement.
Figure 7.1d shows the changes in
PISA scores of 15-year-olds in 20
countries between 2003 and 2009(average of scores in reading,maths and science literacy).

Changes in behaviours
Changes in some key aspects ofchildren’s behaviours and lifestyles
can also be measured over a period
corresponding to approximately the
first decade of the 2000s. Figure
7.2a, for example, shows changes

4 8

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Figure 7.2a Changes between 2001/2002 and 2009/2010 in the percentage of young people aged 11, 13 and 15
who are overweight
30
25
20
15
10
5

PolandFinland

Spain

Italy

Portugal

CanadaGreeceUnited States

Belgium

PolandIreland

Portugal

Hungary

United Kingdom

United States

Hungary

Austria

Czech Republic

Canada2001/2002

Germany

NorwayIrelandUnited Kingdom

SwedenBelgium

FranceSwitzerland

Denmark

Netherlands02009/2010

Figure 7.2b Changes between 2003 and 2009 in the teenage fertility rate(annual number of births per 1,000 girls aged 15 to 19)
50
40
30
20
10

2003

in the percentage of children
whose self-reported height andweight places them in the‘overweight’ category (computedby body mass index).

Births to teenagers
Certain risk behaviours in children
and young people can also be

Spain

Austria

GreeceCzech Republic

Finland

NorwayGermany

FranceSwedenDenmark

Italy

Netherlands

Switzerland

0

2009

measured and compared acrosscountries over the six years 2003
to 2009.
Figure 7.2b, for example, looks
at changes in the proportion ofgirls who give birth while still in
their teens.

Risk behaviours
The first decade of the 2000s
saw very significant progress in
reducing the proportion of children
and young people who expose
themselves to health problems
and other dangers by smoking
cigarettes, drinking alcohol andI n n o c e n t i

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4 9

Findings
Obesity

Teenage births» The percentage of overweight children rose in 17» Births to teenagers declined in 18 out of 21 countriesof the 21 countries over the decade.

between 2003 and 2009.

» The sharpest rise was seen in Poland, where the» Austria, the Czech Republic, Hungary and United

percentage of overweight children doubled.

» Only Belgium, France, Spain and the United Kingdom
saw a fall in the percentage of overweight children.

States all recorded falls in teenage fertility rates of
10 points or more.

» The exceptions to the falling trend were Belgium,
Spain and the United Kingdom. This finding isparticularly significant for the United Kingdom
because its teenage fertility rate at the beginning of
the decade was already the highest in Europe.

» The United States had the highest proportion ofchildren overweight at both the beginning and end of
the decade, reaching almost 30% by 2009/2010.

» Despite a 10 point fall over the decade, the UnitedStates continues to have the highest teenage fertility
rate in the developed world.
Figure 7.3a Changes between 2001/2002 and 2009/2010 in the percentage of young people aged 11, 13 and 15
who reported smoking at least once a week
18
15
12
9
6
3

2001/2002

using cannabis. Figures 7.3a, 7.3b
and 7.3c summarize trends in eachof these high-risk behaviours overthe decade.
The three charts, tracking recent
trends in three of the risk
behaviours most likely to damage
the short- and long-term well-being

Czech RepublicHungary

Austria

Italy

FinlandFranceSpain

PolandSwitzerland

Belgium

Netherlands

SwedenGreeceGermany

Denmark

United Kingdom

Ireland

Portugal

United States

CanadaNorway0

2009/2010of children, tell a story of significant
progress over the decade.

bullied. Figures 7.4a and 7.4b tell thestory of this progress.

Violence

Children’s subjective well-being

Continuing the good news, the great
majority of developed countries also
saw a decline in the percentage ofchildren who report being involved infighting and who report having been

Finally, the children’s life satisfaction
scale also makes it possible to lookat how children’s overall subjective
well-being has changed over the first
decade of the 2000s (Figure 7.5).

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Figure 7.3b Changes between 2001/2002 and 2009/2010 in the percentage of young people aged 11, 13 and 15
who reported having been drunk on more than two occasions
35
30
25
20
15
10
5

2001/2002

FinlandDenmark

Czech Republic

United Kingdom

Hungary

CanadaPolandAustria

Spain

IrelandGermany

Belgium

Switzerland

NorwaySwedenGreecePortugal

France

Italy

Netherlands

United States0

2009/2010

Figure 7.3c Changes between 2001/2002 and 2009/2010 in the percentage of young people aged 11, 13 and 15
who reported having used cannabis in the last 12 months
45
40
35
30
25
20
15
10
5

Note: No data available for Norway In 2001/2002.

First call
While there have clearly been
setbacks for children in particularcountries on particular indicators,
the overall story of the first decadeof the 2000s is one of steady
improvement in most measures ofchildren’s well-being. Indicators

2001/2002

CanadaSwitzerland

Spain

FranceUnited States

Czech Republic

United Kingdom

Netherlands

Italy

Belgium

PolandIrelandDenmark

Hungary

Portugal

Austria

Germany

Finland

GreeceSweden0

2009/2010

such as the ‘low family affluence
rate’, the infant mortality rate, andthe cigarette smoking rate havefallen in every single country forwhich data are available. Further
education enrolment rates haveincreased in most nations, and thegreat majority of countries havealso seen declines in teenage birthrates, cannabis use, fighting andbullying.
Mitigating the good news is the fact
that, in some countries and for someindicators, this progress may havebeen halted or even thrown into
reverse by the widespread economic

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Findings» Despite the declining overall trend, the children

Cigarettes» The percentage of children and young people who

and young people of three countries – the Czech
Republic, Denmark and Finland – still have alcoholabuse rates of over 20%.

smoke cigarettes has fallen in all 21 countries forwhich comparable data are available (with the
exception of Greece and Sweden where rates were
low at the beginning of the decade and haveremained stable).

» The biggest rise in alcohol abuse by young people
was seen in the Czech Republic (rising from 15%
to 22%).

» The biggest falls over the decade were recorded in

Cannabis

Germany, Norway, Portugal and the United Kingdom– all of which more than halved the proportion ofyoung people who report smoking cigarettes.

» 17 out of 20 countries reported a fall in cannabis use.
» The biggest percentage point falls were achievedin Canada, Germany, Switzerland and the United
Kingdom.

Alcohol» More than three-quarters of the 21 countries also

» Canada still has the highest level of cannabis use

saw declines in alcohol use by young people – asmeasured by the proportion of 11-, 13- and 15-yearolds who report having been drunk on at least
two occasions.

among young people, despite reducing its usage
rate from 40% in 2001/2002 to 28% in 2009/2010.

» Germany has more than halved cannabis use among» The biggest falls were again recorded in Germany

young people over the decade (from 19% to 9%).

(where the alcohol abuse rate fell from 18% to under
12%) and in the United Kingdom (which saw adecline from 30% to just under 20%).

» Starting from a higher level, the United Kingdom has
also halved cannabis use among young people (from
34% to 17%).

» Switzerland has cut cannabis use among young
people by more than a third (from 38% to 24%).

Figure 7.4a Changes between 2001/2002 and 2009/2010 in the percentage of young people aged 11, 13 and 15
who reported having having been involved in fighting at least once in the previous twelve months
60
55
50
45
40
35
30
25

2001/2002
Note: No data available for Norway in 2001/2002.

2009/2010

Spain

GreeceCzech RepublicHungary

Belgium

Austria

United Kingdom

Italy

CanadaPolandFranceIrelandUnited States

Netherlands

SwedenDenmark

Switzerland

Portugal

FinlandGermany20

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Figure 7.4b Changes between 2001/2002 and 2009/2010 in the percentage of young people aged 11, 13 and 15
who reported having being bullied at least once in the past couple of months
50
40
30
20
10

2001/2002

Austria

Portugal

Belgium

Switzerland

CanadaFranceFinlandGermany

IrelandUnited Kingdom

GreeceHungary

United States

PolandNorwayNetherlands

Denmark

Czech Republic

Spain

SwedenItaly02009/2010

Note: See page 27 for the HBSC definition of bullying provided to students.

Findings
Fighting» The proportion of children and young people whoreport being involved in fighting fell in 17 of the 20
countries for which data are available.

» Denmark saw the biggest fall in the percentage whoreport being involved in fighting (down from 40%
to 30%).

» Spain saw the biggest rise (from 40% to 55%).
» Germany is a clear leader in having the lowest
percentage of children who report being involved
in fighting (23%).

Being bullied» The percentage of children who report being bullied
also fell in 16 out of 21 countries.

» Italy saw the biggest fall in bullying over the decadeand now has the lowest ‘bullying rate’ of any developed
country.

» Denmark, Italy and Spain all recorded a fall in thebullying rate of more than 10 percentage points.

» The Czech Republic and Sweden achieved further small
declines despite having the lowest bullying rates at the
beginning of the decade.

» Five countries – Belgium, Finland, Greece, Hungary and
Ireland – saw a rise in the bullying rate over the decade.

recession beginning in late 2008.
The statistics used in this reportreflect the beginning of thedownturn but by no means its fullconsequences. Over the last three
years, many developed nations
have witnessed further rises inunemployment, falling real incomes(especially for the already low paid),
and cuts in the government services

on which disadvantaged families
depend most heavily.
Unfortunately, few countries haveup-to-date information on what has
been happening to children’s lives
during this period. But even without
detailed data, it is possible toanticipate some of the likely
consequences. UNICEF and otherorganizations working with children
know from long experience what is
likely to happen when economies
enter periods of turbulence andrecession. In the second half ofthe 1980s and the early 1990s,
for example, many nations began tosuffer the consequences of a debt
crisis and an economic adjustment
process which saw unemployment

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and underemployment rise andgovernment expenditures andservices fall. Throughout that period
UNICEF argued, not always
successfully, for ‘adjustment with ahuman face’ – urging the WorldBank and the IMF, as well as national
governments and aid agencies, todo all within their power to preventthe heaviest burden of economic
recession from falling on thoseleast able to sustain it. Today, thatsame argument needs to bebrought to bear on the governmentsof the world’s richest nations.

5 3

At the heart of the case to be madeis the fact that childhood is a periodof special susceptibility; a time of
rapid and miraculously delicate
development of mind and body; atime when skill should be building
on skill, but a time when
disadvantage can also build on
disadvantage; a time in which
future patterns and pathways ofhealth and well-being are being laid
down and in which disruption canhave lifelong consequences.
Protecting the years of childhood istherefore essential both for thewell-being of those who arechildren today and for the wellbeing of the societies of tomorrow.
It is therefore a commitment thatshould not be set aside, eventemporarily, because otherproblems appear more pressing,a commitment that should have afirst call on societies’ capacities,
a commitment to be maintained ingood times and bad. There will
always be something more
immediate than protecting the wellbeing of children. There will neverbe anything more important.

Figure 7.5 Changes in children’s self-reported life satisfaction
Changes between 2001/2002 and 2009/2010 in the percentage of children aged 11, 13 and 15 who rate their life satisfaction
with a score of 6 or more on the 11-step ‘Cantril Ladder’ scale
95
90
85
80
75

2001/2002

Netherlands

Spain

Finland

GreeceBelgium

NorwaySwitzerland

SwedenIrelandDenmark

United Kingdom

Italy

Austria

FranceCzech Republic

Portugal

Germany

United States

CanadaHungary

Poland70

2009/2010

Findings» The subjective well-being story is mixed – with approximately half of the 21 countries showing a rise in children’s
overall life satisfaction and half showing a fall. In almost all cases the recorded changes were small.

» The children of the Netherlands reported the highest level of life satisfaction at both the beginning and end of
the decade.

» The children of Norway, Portugal and the United Kingdom saw the biggest percentage point rises in life satisfaction.
» Austria, Canada and Greece showed the biggest falls (though in each case the fall was less than three points).
» Two Nordic countries, Denmark and Finland, also saw a small decline in children’s overall life satisfaction.

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REFERENCES

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ii Duncan, G., K. Telle, K. Ziol-Guest and
A. Kalil (2009). ‘Long-run Impacts of Early
Childhood Poverty: Comparative evidence
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conference ‘The Long-run Impact of Early
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iii Johnson, R. and R. Schoeni (2007).
‘The Influence of Early-Life Events on
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viii Institute of Health Equity (2012).
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ix UNICEF, op. cit. (2007).
x Godfrey, C., S. Hutton, J. Bradshaw,
R. Coles, G. Craig, J. Johnson (2002).
‘Estimating the Cost of Being “Not in
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at Age 16-18’, Research Report RR346.
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xi Quintini G., J. P. Martin and S. Martin(2007). ‘The Changing Nature of the
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ftp://ftp.iza.org/SSRN/pdf/dp2582.pdf
xii OECD (2011). Education at a Glance:
OECD indicators. Paris: OECD, pp.
340-341. Available at:
http://www.oecd.org/education/preschoolandschool/
educationataglance2011oecdindicators.htm
xiii Currie et al., op. cit. (2012).

v Ibid.

xiv Ibid.

vi Currie, C., C. Zanotti, A. Morgan, et al.
(2012). ‘Social Determinants of Healthand Well-being among Young People’.
Health Behaviour in School-aged Children(HBSC) Study: International report fromthe 2009/2010 survey. Copenhagen:World Health Organization.

xv Ibid.

vii Centers for Disease Control andPrevention (1984). ‘Morbidity andMortality Weekly Report’ (MMWR),
US Department of Health and Human
Services, Atlanta, August 17, 1984,
Vol. 33(32):459-60,465-67.

xvi Moore, K., N. Jones and E. Broadbent(2008). ‘School Violence in OECDCountries’, Woking: Plan Limited.
xvii Cornell University (2007).
‘Child Development and the PhysicalEnvironment’, Cornell University,
College of Human Ecology. See also:
http://www.who.int/ceh/indicators/en/ andhttp://ec.europa.eu/health/healthy_
environments/partnerships/index_en.htm

xviii Evans, G. W. (2006). ‘Child
Development and the PhysicalEnvironment’, Annual Review of
Psychology, Vol. 57: 423-451.
xix European Union Statistics on Incomeand Living Conditions (EU-SILC) (2009).,
xx Margolin G. and E. B. Gordis (2004).
‘Children’s Exposure to Violence in the
Family and Community’, Current
Directions in Psychological Science, Vol.
13, No. 4: 152-155. Available at:
http://www.psy.miami.edu/faculty/
dmessinger/c_c/rsrcs/rdgs/peers_social_
general/margolin.exposure2violence.
curdir.04.pdf
xxi Cohen, E., B. McAlister Groves and
K. Kracke (2009). ‘UnderstandingChildren’s Exposure to Violence. Moving
From Evidence to Action’, Children
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North Bethesda, MD: Safe Start Center.
xxii Institute of Health Equity, op. cit.
(2012).
xxiii Kershaw, P. (2010). ‘Smart Family
Policy: Measuring and monitoring its
development across Canada’, Presentation
given at Offord Centre for Child Studies,
17 June 2010. Available at:
http://www.offordcentre.com/conference/
presentations/Paul%20Kershaw%20
June%202010.pdf
xxiv Janus, M. and D. R. Offord (2007).
‘Development and Psychometric
Properties of the Early Development
Instrument (EDI): A measure of children’s
school readiness’, Canadian Journal of
Behavioural Science, Vol. 39, No. 1: 1-22.
xxv Ibid., p. 5.
xxvi Ibid., p. 14.

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C a r dxxvii Hertzman, C. and J. Bertrand (2007).
‘Children in Poverty and the Use of Early
Development Instrument Mapping to
Improve Their Worlds’, Paediatrics andChild Health. Vol. 12(8): 687–692.
Available at:
http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC2528797/
xxviii Janus and Offord, op. cit. (2007),
p. 13.
xxix Janus, M. (2010). The Natural Historyof the Early Development Instrument.
Presentation given at Offord Centre forChild Studies, 16 June 2010. Available at:
http://www.offordcentre.com/conference/
presentations/Magdalena%20EDI%20
conf%20June%202010%20.pdf
xxx Council of Australian Governments,
COAG, Human Capital Reform: Report by
the COAG National Reform Initiative
Working Group, February, 2006.
xxxi Goldfeld, S., M. Sayers, S. Brinkman,
S. Silburn and F. Oberklaid (2009). ‘The
Process and Policy Challenges of
Adapting and Implementing the Early
Development Instrument in Australia’,
Early Education and Development.
Vol. 20 No.6: 979.
xxxii Australian Early Development Index.
Available at: http://maps.aedi.org.au/
xxxiii Centre for Community Child Healthand Telethon Institute for Child HealthResearch (2009). A Snapshot of Early
Childhood Development in Australia –AEDI National Report 2009.
Canberra: Australian Government.
xxxiv Australian Institute of Health andWelfare (2011). ‘Headline Indicators forChildren’s Health, Development andWellbeing’. Cat. no. PHE 144. Canberra:
AIHW, p. 64.

1 1xxxv Children’s Society Quarterly
Surveys. Available at:
http://www.childrenssociety.org.uk/
what-we-do/research/well-being/background-programme/quarterly-surveys
xxxvi Ladd, G. W. (2005). ‘Children’s’Peer Relations and Social Competence:
A century of ‘progress’’, Current
Perspectives in Psychology, Yale
University Press.
xxxvii Morrison Gutman, L., J. Brown,
R. Akerman and P. Obolenskaya (2010).
‘Change In Wellbeing from Childhood toAdolescence: Risk and resilience’, Centre
for Research on the Wider Benefits ofLearning. London: Institute of Education.
xxxviii The Children’s Society (2012). The
Good Childhood Report 2012: A review ofour children’s well-being. Available at:
http://www.childrenssociety.org.uk/sites/
default/files/tcs/good_childhood_report_2012_final.pdf
xxxix Currie et al., op. cit. (2012).
xxxx Martorano, B., L. Natali, C. de
Neubourg and J. Bradshaw (2013).
‘Child Well-being in Economically RichCountries: Changes in the first decade of
the 21st century’, Working Paper 2013-02.
Florence: UNICEF Office of Research.

5 5

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Acknowledgements

The Innocenti Report Card 11 project wascoordinated by the UNICEF Office of
Research, and assisted bya panel of advisors and reviewers.
Research was completed at the endof December 2012.

External advisors and peer reviewers

The full text and the background papers
to this report can be downloaded fromthe UNICEF Office of Research website
at www.unicef-irc.org.

Magdalena Janus (Offord Centre for Child
Studies, McMaster University, Hamilton,
Canada)Research and data analysis
Peter Adamson (independent consultant
to UNICEF Office of Research)
Jonathan Bradshaw (University of York)
Bruno Martorano (UNICEF Officeof Research)
Luisa Natali (UNICEF Office of Research)
UNICEF advisors
Gordon Alexander (Director, UNICEF
Office of Research)
James Elder (Chief, Communication Unit,
UNICEF Office of Research)
Goran Holmqvist (Associate Director,
Strategic Research, UNICEF Office of
Research)
Chris de Neubourg (Chief, Social andEconomic Policy Unit, UNICEF Officeof Research)

Sharon Goldfeld (Associate Professor, theRoyal Children’s Hospital Centre forCommunity Child Health and the
Murdoch Children’s Research Institute,
Melbourne, Australia)

Leonardo Menchini (Chief, Social Policy,
Monitoring and Evaluation, UNICEF
Egypt)
Dominic Richardson (Organisation for
Economic Co-operation andDevelopment)
Administrative support at the UNICEF
Office of Research was provided by
Cinzia Iusco Bruschi and Laura Meucci.

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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 of educational disadvantage in rich nations
Innocenti Report Card 5
A league table of child maltreatment deaths in rich nations
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 inchild well-being in the world’s rich countries
Innocenti Report Card 10
Measuring child poverty: New league tables of childpoverty in the world’s rich countries

Graphics: MCC Design, UK (mccdesign.com)
Printed by: ABC Tipografia, Sesto Fiorentino, Florence, Italy

Innocenti Report Card 11, 2013Child Well-being in Rich Countries:
A comparative overview

UNICEF Office of Research – Innocenti
Piazza SS. Annunziata, 1250122 Florence, Italy
Tel: +39 055 20 330
Fax: +39 055 2033 220
florence@unicef.org
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ISSN 1605-7317© The United Nations Children’s Fund (UNICEF)
April 2013

ISBN: 978-88-6522-016-0

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