Inequality says more than wealth about children's well-being

Any national government going into 2008 with a resolution to propel their children toward good health, secure development and happiness, may do better to follow the example of their counterparts in Japan or Sweden than in the US or the UK.

Last year’s well publicized UNICEF report on well-being in rich countries [1] dealt a severe shaking to the UK’s complacency – and led to much close interrogation of the data behind it.

UK Government subsequently issued a more optimistic take on the health and development of its children; but now new research published in the British Medical Journal online as Child well-being and income inequality in rich societies: ecological cross sectional study [2] adds more fuel to the original causes for concern.

Kate Pickett and Richard Wilkinson isolated one of the 40 indicators used in the UNICEF survey – relative poverty – and examined how far it explained the variation between the other 39. They also analyzed additional data on income inequalities and well-being from 50 US states and the District of Columbia.

They found that child well-being – defined as a composite of the UNICEF indicators – was highly associated with income inequality and the proportion of children in relative poverty in 21 rich nations. It was not associated with average income.

Hence the emergence of Japan and Sweden as role models – two states where income is reasonably well distributed – as opposed to the US or UK – where, relatively speaking, it is not. The findings confirm a review (by the same authors) of over 168 studies dealing with the relationship between income inequality and wealth.

Pickett (senior lecturer in epidemiology at the University of York) and Wilkinson (Professor of social epidemiology at Nottingham’s Queen’s Medical Centre) are also interested in explaining the association. They consider three hypotheses. The first – that children's lack of access to material resources accounts for those in unequal societies doing less well – they discount on the grounds that the statistical relationship between average income and child well-being is weak.

They also rule out a second hypothesis: that inequalities are mediated by early childhood experience and the quality of family relationships. They find that inequality data does not correlate with family structure or family relationship variables collected for the UNICEF study.

The explanation they prefer relates to children's awareness of differences in status. There is good evidence, some of it reported in Prevention Action [see, for example, Does peace always mean burying differences? [3] that even very young children categorize others socially. In that vein, they report on the evidence linking status differentiation to children's performance, for example in school.

Pickett and Wilkinson say the uneven quality of data makes it necessary to apply a strong health warning to all three propositions. But evidence on the characteristics and implications of children's ability to discern social difference is persuasive and will be explored further in these pages in the coming months.

Meanwhile, more bad news for the UK. Even accounting for the negative impact of high inequalities in wealth and levels of child poverty, the country still has higher than expected proportions of children who do not find their peers kind and helpful, who are frequently drunk and who have sexual intercourse before they are 15.

References

Kate Pickett and Richard G Wilkinson, "Child well-being and income inequality in rich societies: ecological cross sectional study", BMJ Online, 16th November 2007

Richard Wilkinson and Kate Pickett, "Income inequality and population health: a
review and explanation of the evidence", Social Science Medicine, 2006; 62: pp1768-84.