Child well-being in rich countries - A comparative overview - UNICEF Office of Research Innocenti Report Card 11 - UNICEF Innocenti
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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 the Government 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 the performance of economically advanced countries in securing the rights of their children. In 1988 the United Nations Children’s Fund (UNICEF) established a research centre to support its advocacy for children worldwide and to identify 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 Child supporting advocacy worldwide. The Office aims to set out a comprehensive framework for research and knowledge within the organization in support of its global programmes and policies. Through strengthening research partnerships with leading academic institutions and development networks in both the North and South, the Office seeks to leverage additional resources and influence in support of efforts 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 to stimulate 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, 12 50122 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 their own well-being (including a league table of children’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 in educational achievement, teenage birth rates, childhood obesity levels, the prevalence of bullying, and the use of tobacco, alcohol and drugs.
2 I n n o c e n t i R e p o r t C a r d 1 1 PART 1 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 is based 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 Material Health and Education Behaviours Housing and (all 5 dimensions) well-being safety and risks environment (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 table of child well-being: Australia, Bulgaria, Chile, Cyprus, Israel, Japan, Malta, Mexico, New Zealand, the Republic of Korea, and Turkey.
I n n o c e n t i R e p o r t C a r d 1 1 3 Introduction The league table opposite presents » The bottom four places in the Change over a decade the latest available overview of child table are occupied by three of Although changes in methods and well-being in 29 of the world’s most the poorest countries in the structure make it difficult to make advanced economies. survey, Latvia, Lithuania and comparisons between the first two Romania, and by one of the issues of the UNICEF overview of Five dimensions of children’s lives richest, the United States. child well-being (see Part 3) it is have been considered: material well-being, health and safety, » Overall, there does not appear nonetheless clear that there have education, behaviours and risks, and to be a strong relationship been some significant changes over housing and environment. In total, between per capita GDP and the first decade of the 2000s. 26 internationally comparable overall child well-being. The » Overall, the story of the first indicators have been included in the Czech Republic is ranked higher decade of the 2000s is one of overview (see Box 1). than Austria, Slovenia higher widespread improvement in than Canada, and Portugal most, but not all, indicators of The table updates and refines the higher than the United States. children’s well-being. The ‘low first UNICEF overview of child well- being published in 2007 (Report » There are signs that the family affluence’ rate, the infant Card 7) .i Changes in child well-being countries of Central and Eastern mortality rate, and the percentage over the first decade of the 2000s Europe are beginning to close of young people who smoke are examined in Part 3. the gap with the more cigarettes, for example, have established industrial economies fallen in every single country for Key findings (see Part 3). which data are available. » The Netherlands retains its position as the clear leader and is the only country ranked among Data sources and background papers the top five countries in all dimensions of child well-being. » The Netherlands is also the clear leader when well-being is The data sources used for this report are set out in the three background evaluated by children themselves papers detailed below and available at http://www.unicef-irc.org – with 95% of its children rating their own lives above the mid- Martorano, B., L. Natali, C. de Neubourg and J. Bradshaw (2013). ‘Child Well- being in Advanced Economies in the Late 2000s’, Working Paper 2013-01. point of the Life Satisfaction Scale UNICEF Office of Research, Florence. (see Part 2). http://www.unicef-irc.org/publications/pdf/iwp_2013_1.pdf » Four Nordic countries – Finland, Martorano, B., L. Natali, C. de Neubourg and J. Bradshaw (2013). ‘Child Well- Iceland, Norway and Sweden – sit being in Economically Rich Countries: Changes in the first decade of the 21st just below the Netherlands at the century’, Working Paper 2013-02. UNICEF Office of Research, Florence. top of the child well-being table. http://www.unicef-irc.org/publications/pdf/iwp_2013_2.pdf » Four southern European countries Bradshaw, J., B. Martorano, L. Natali and C. de Neubourg (2013). ‘Children’s – Greece, Italy, Portugal and Spain Subjective Well-being in Rich Countries’, Working Paper 2013-03. UNICEF Office of Research, Florence. – are placed in the bottom half of http://www.unicef-irc.org/publications/pdf/iwp_2013_3.pdf the table.
4 I n n o c e n t i R e p o r t C a r d 1 1 » Spain has slipped down the The case for national commitment school achievement, or rankings – from 5th out of 21 to child well-being is therefore immunization rates, or the countries in the early years of compelling both in principle and in prevalence of risk behaviours, the decade to 19th out of 29 practice. And to fulfil that for example, are not likely to be countries in 2009/2010. commitment, measuring progress significantly changed in the short in protecting and promoting the term by the recessions of the last » The United Kingdom has risen well-being of children is essential to three years. up the rankings from bottom policy-making, to advocacy, to the place (21st out of 21 countries) For the time being, it must be cost-effective allocation of limited in 2000/2001 to a mid-table accepted that data-lag is part of resources, and to the processes of position today. the entry price for international transparency and accountability. comparisons of child well-being. Part 3 of this report examines And although national-level International comparability changes over the first decade of monitoring of children’s lives is the the 2000s in more detail. The measurement of child well- more important task, UNICEF being, however, is a relatively new Measuring progress for children believes that international area of study and the overview comparison can also play a part. The league table of child well-being presented here remains a work in It is international comparison that is designed to measure and progress. Chief among its can show what is achievable in the compare progress for children limitations is the fact that real world, highlight strengths and across the developed world. Its internationally comparable data on weaknesses in individual countries, purpose is to record the standards children’s lives are not sufficiently and demonstrate that child well- achieved by the most advanced timely. Between the collection of being is policy-susceptible. And it nations and to contribute to debate data in a wide variety of different is international comparison that in all countries about how such settings and their publication in can say to politicians, press and standards might be achieved. quality-controlled, internationally public everywhere – ‘This is how As a moral imperative, the need to comparable form the time-lag is your performance in protecting promote the well-being of children typically two to three years. This children compares with the record is widely accepted. As a pragmatic means that most of the statistics on of other nations at a similar level imperative, it is equally deserving child well-being used in this report, of development.’ of priority; failure to protect and though based on the latest available data, apply to the period 2009– Finally, any single overview of a promote the well-being of children 2010. Such a delay would be complex and multidimensional is associated with increased risk frustrating at the best of times. But issue carries a risk of hiding more across a wide range of later-life the last three years have been far than it reveals. The following pages outcomes. Those outcomes range from the best of times. Beginning therefore set out to make this from impaired cognitive in late 2008, economic downturn overview of child well-being as development to lower levels of in many developed nations has transparent as possible by school achievement, from reduced seen rising unemployment and falls examining each of its dimensions skills and expectations to lower in government expenditures which in turn. productivity and earnings, from higher rates of unemployment to cannot but affect the lives of many increased dependence on welfare, millions of children. Data from from the prevalence of antisocial 2009 and 2010 capture only the behaviour to involvement in crime, beginning of this turbulence. from the greater likelihood of drug Nonetheless, for the most part, and alcohol abuse to higher levels of the data used in this overview track teenage births, and from increased long-term trends and reflect the health care costs to a higher results of long-term investments in incidence of mental illness.ii, iii children’s lives. Average levels of
I n n o c e n t i R e p o r t C a r d 1 1 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 Indicators Figure no. Relative child poverty rate 1.1a Dimension 1 Monetary deprivation Relative child poverty gap 1.1b Material well-being Child deprivation rate 1.2a Figure 1.0 Material deprivation Low family affluence rate 1.2b Infant mortality rate 2.1a Dimension 2 Health at birth Low birthweight rate 2.1b Health and safety Preventive health services Overall immunization rate 2.2 Figure 2.0 Childhood mortality Child death rate, age 1 to 19 2.3 Participation rate: early childhood 3.1a education Participation rate: further education, Dimension 3 Participation 3.1b age 15–19 Education NEET rate (% age 15–19 not in Figure 3.0 3.1c education, employment or training) Average PISA scores in reading, Achievement 3.2 maths and science Being overweight 4.1a Eating breakfast 4.1b Health behaviours Eating fruit 4.1c Taking exercise 4.1d Dimension 4 Teenage fertility rate 4.2a Behaviours and risks Smoking 4.2b Figure 4.0 Risk behaviours Alcohol 4.2c Cannabis 4.2d Fighting 4.3a Exposure to violence Being bullied 4.3b Rooms per person 5.1a Dimension 5 Housing Multiple housing problems 5.1b Housing and environment Homicide rate 5.2a Figure 5.0 Environmental safety Air pollution 5.2b
6 I n n o c e n t i R e p o r t C a r d 1 1 Dimension 1 Material well-being Figure 1.0 An overview of Netherlands children’s material well-being Finland The league table of children’s material Norway well-being shows each country’s Iceland performance in relation to the average Sweden for the 29 developed countries under review. The table is scaled to show Luxembourg each country’s distance above or Austria below that average. Slovenia Switzerland The length of each bar shows each France country’s distance above or below the average for the group as a whole. The Germany unit of measurement is the ‘standard Denmark deviation’ – a measure of the spread Belgium of scores in relation to the average. United Kingdom Canada Czech Republic Ireland Hungary Estonia Greece Portugal Poland Italy Spain Slovakia United States Lithuania Latvia Romania -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 IND I C ATOR S Relative child poverty rate (% of children living in households with equivalent incomes below Monetary 50% of national median) deprivation Child poverty gap (distance between national poverty line and median incomes of households below poverty line) Index of child deprivation (% of children lacking Material specific items) deprivation Family affluence scale (% of children reporting low family affluence)
I n n o c e n t i R e p o r t C a r d 1 1 7 Children’s material well-being The table opposite (Figure 1.0) Figure 1.1a Relative child poverty rates presents an overview of children’s % of children aged 0–17 living in households with equivalent incomes material well-being in developed below 50% of national median countries. Overall, it suggests that Finland material well-being is highest in Netherlands the Netherlands and in the four Denmark Nordic countries and lowest in Iceland Latvia, Lithuania, Romania and the Norway United States. Slovenia Two components of material well- Sweden Austria being have been considered in Ireland arriving at this overview – relative Switzerland income poverty and material Germany deprivation. The strengths and France weaknesses of both measures were Czech Republic discussed in detail in the previous United Kingdom report in this series (Report Card 10)iv Hungary which argued that both measures are Belgium necessary to achieve a rounded view Luxembourg of children’s material well-being. Estonia Slovakia Relative poverty: Poland child poverty rates Canada Two separate indicators have Portugal been used to measure monetary Greece deprivation. They are the relative Italy child poverty rate (Figure 1.1a) and Lithuania Spain the ‘child poverty gap’ (Figure 1.1b). Latvia The relative child poverty rate shows United States the proportion of each nation’s Romania Cyprus Countries with grey bars have not been Malta included in the ranking tables, or in the Australia overall league table of child well-being, New Zealand as they have data for fewer than 75% of Japan the total number of indicators used. Bulgaria 0 5 10 15 20 25 children living in households where disposable income is less than 50% Findings of the national median (after taking » Finland is the only country with a relative child poverty rate of less taxes and benefits into account than 5% and heads the league table by a clear margin of more than and adjusting for family size and two percentage points. composition). This is the definition of child poverty used by the » The countries in the top half of the league table all have relative child poverty rates of less than 10%. majority of the world’s developed economies. Broadly speaking, it » Four southern European countries – Greece, Italy, Portugal and Spain – shows the proportion of children have child poverty rates higher than 15% (along with Latvia, Lithuania, who are to some significant extent Romania and the United States).
8 I n n o c e n t i R e p o r t C a r d 1 1 Figure 1.1b Child poverty gaps excluded from the advantages and Gap between the poverty line and the median income of those opportunities which most children below the poverty line – as % of the poverty line in that particular society would consider normal. Luxembourg Hungary Relative poverty: Netherlands the poverty gap Austria The relative child poverty rates in Finland Figure 1.1a show what percentage France Norway of children live below each nation’s Sweden relative poverty line. But they reveal Germany nothing about how far below that Slovenia line those children are being Iceland allowed to fall. To gauge the depth Switzerland of relative child poverty, it is also Canada necessary to look at the ‘child United Kingdom poverty gap’ – the distance between Czech Republic the poverty line and the median Belgium incomes of those below the line. Poland Greece Figure 1.1b shows this ‘child Portugal poverty gap’ for each country. Latvia Denmark Considering ‘rate’ and ‘gap’ together Estonia shows six countries in the bottom Slovakia third of both tables. They are Italy, Romania Latvia, Lithuania, Romania, Spain Italy and the United States. By contrast, Ireland there are also six countries that Lithuania feature in the top third of both United States tables – Austria, Finland, Spain Netherlands, Norway, Slovenia Cyprus and Sweden. Malta What this means for the children Australia of Spain or the United States, for New Zealand Japan example, is that 20% or more fall Bulgaria below the relative poverty line and that, on average, they fall almost 0 5 10 15 20 25 30 35 40 40% below that line. In the Findings Netherlands or Austria, on the other hand, 6% to 8% of children fall » Hungary and Luxembourg have the smallest child poverty gaps. below the relative poverty line and, » Denmark is an exception among Nordic countries in having a high child on average, they fall approximately poverty gap (almost 30%). Only a small proportion of Danish children 16% below. (6.3%) fall below the country’s relative poverty line; but those who do, Taken together, these two child fall further below than in most other countries. poverty indicators – the rate and the » Several countries have allowed the child poverty gap to widen to more gap – make up the relative income than 30%. They are Bulgaria, Ireland, Italy, Japan, Lithuania, Romania, component of children’s material Slovakia, Spain and the United States. well-being.
I n n o c e n t i R e p o r t C a r d 1 1 9 Material deprivation: example, does not mean that Again, two indicators have been the Child Deprivation Index children’s actual living standards are used. The first is the UNICEF Child Relative income measures, however, lower in Canada (only that a greater Deprivation Rate (introduced in have little to say about the actual proportion of Canadian children live Report Card 10) v which shows what living conditions of children in in households where disposable percentage of children in each different countries. The fact that a income is 50% of the median). In nation lack two or more of the higher percentage of children live in order to arrive at a more complete following 14 items: relative income poverty in Canada picture of child poverty, a measure 1. Three meals a day than in the Czech Republic, for of actual material deprivation has 2. At least one meal a day therefore also been included. with meat, chicken or fish Figure 1.2a Child deprivation rates (or vegetarian equivalent) % of children lacking two or more specific items – see text 3. Fresh fruit and vegetables Iceland every day Sweden 4. Books suitable for the child’s Norway age and knowledge level (not Finland including schoolbooks) Denmark Netherlands 5. Outdoor leisure equipment Luxembourg (bicycle, roller-skates, etc.) Ireland 6. Regular leisure activities United Kingdom (swimming, playing an Spain instrument, participating in Slovenia youth organizations, etc.) Austria Czech Republic 7. Indoor games (at least one per Germany child, including educational baby Belgium toys, building blocks, board France games, computer games, etc.) Estonia 8. Money to participate in school Italy trips and events Greece Slovakia 9. A quiet place with enough room Lithuania and light to do homework Poland 10. An Internet connection Portugal Latvia 11. Some new clothes (i.e. not all Hungary second-hand) Romania 12. Two pairs of properly fitting shoes Cyprus Malta 13. The opportunity, from time Bulgaria to time, to invite friends home to play and eat 0 10 20 30 40 50 60 70 80 14. The opportunity to celebrate Findings special occasions such as » The five Nordic countries and the Netherlands claim the top six places. birthdays, name days, religious events, etc. » Luxembourg and Ireland are the only other countries with child deprivation rates below 5% (although the United Kingdom comes close at 5.5%). Figure 1.2a presents the child deprivation rate for 26 countries » France and Italy have child deprivation rates higher than 10%. (no comparable data are available » Four countries have child deprivation rates of more than 25% – Hungary, for Canada, Switzerland or the Latvia, Portugal and Romania. United States).
1 0 I n n o c e n t i R e p o r t C a r d 1 1 Figure 1.2b Percentage of children reporting low family affluence The results are computed into the Family Affluence Scale used in Iceland Figure 1.2b to show the percentage Norway of children in each country living in Netherlands ‘low affluence’ families. Denmark Switzerland As might be expected, the child Sweden deprivation rate and the low family Luxembourg affluence rate produce broadly Finland similar league table rankings. They Slovenia are, however, different in that one France focuses on the child and the other Belgium on the family. Taken together, they Canada provide a more secure overview of Germany Spain children’s material deprivation. Austria Ireland Real and relative United Kingdom The differences between the two United States components of children’s material Portugal well-being – relative poverty and Italy material deprivation – are often Greece misunderstood. It is not the case Estonia that one is a relative measure and Czech Republic the other absolute. Both are relative Poland measures. Deprivation rates may Lithuania Latvia appear to measure absolute poverty Hungary because they are based on a Slovakia specific list of possessions rather Romania than the median income of each 0 5 10 15 20 25 30 35 40 nation. But those possessions are chosen to represent what most Findings people consider normal for a child » The Netherlands and the Nordic countries, along with Luxembourg growing up in any wealthy country and Switzerland, have the smallest percentage of children reporting in the early 21st century. They are low family affluence. therefore relative to both time and place. The true difference between » Low family affluence rates are highest in eight Central and Eastern the two approaches is that one European countries – the Czech Republic, Estonia, Hungary, Latvia, measures poverty in relation to an Lithuania, Poland, Romania and Slovakia. income norm that varies from country to country (the national median income) whereas the other Material deprivation: » Does your family own a car, van measures poverty by a common low family affluence or truck? standard for all of the countries The second indicator used to » During the past 12 months, how under review. measure material deprivation is many times did you travel away based on written questionnaires on holiday with your family? completed by representative samples of children aged 11, » How many computers does your 13, and 15 in each country.vi family own? The relevant part of the » Do you have your own bedroom questionnaire asks: for yourself?
I n n o c e n t i R e p o r t C a r d 1 1 1 1 Dimension 2 Health and safety Figure 2.0 An overview of child Iceland health and safety Sweden The league table of children’s health Finland and safety shows each country’s Luxembourg performance in relation to the average Netherlands for the 29 developed countries under Slovenia review. The table is scaled to show Norway each country’s distance above or Czech Republic below that average. Spain The length of each bar shows each France country’s distance above or below Switzerland the average for the group as a whole. Germany The unit of measurement is the Belgium ‘standard deviation’ – a measure of Portugal the spread of scores in relation to Ireland the average. United Kingdom Italy Poland Greece Findings Hungary » Nordic countries again Slovakia head the table, with Iceland, Estonia Sweden and Finland claiming Denmark the top three places. Lithuania » Austria, Canada and Denmark United States are to be found towards the Austria foot of the league table along Canada with the United States. (In all Latvia of these cases the low ranking Romania is partly attributable to low -3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0 immunization rates.) Assessing health and safety COMPONENT S IND I C ATOR S Infant mortality rate (deaths under 12 months old per 1,000 live births) Health at birth Low birthweight rate (% babies born below 2,500 grammes National immunization rate (average coverage Preventive health for measles, polio and DPT3 for children age services 12 to 23 months) Child and youth Overall child and youth mortality rate mortality (deaths per 100,000 aged 1 to 19)
1 2 I n n o c e n t i R e p o r t C a r d 1 1 Health and safety The health dimension of children’s Figure 2.1a Infant mortality rates well-being is based on three Deaths under 12 months old per 1,000 live births components for which internationally comparable data are Iceland Slovenia available. The components are: Sweden a) health at birth – as measured Luxembourg by the infant mortality rate and Finland the percentage of babies born Norway with low birthweight (below Portugal 2,500 grammes). Estonia Italy b) the availability of children’s Denmark preventive health services – Czech Republic as measured by national Germany immunization levels for measles, Ireland polio and DPT3. Austria c) child health and safety – as France measured by the death rate of Netherlands children and young people Belgium (aged 1 to 19) from all causes. Spain Greece The chart on the previous page Switzerland (Figure 2.0) combines these three United Kingdom components into a league table of Canada child health for the 29 developed Lithuania countries under review. Poland Hungary Health at birth: United States infant mortality Slovakia Latvia In all developed countries, infant Romania mortality rates (IMRs) have been reduced to fewer than 10 infant Japan deaths per thousand live births. Cyprus The relatively small differences Australia between countries therefore reflect New Zealand not variations in the fundamentals Malta of public health such as safe water Bulgaria and sanitation but variations in the 0 2 4 6 8 10 12 14 commitment and the capacity to deliver whatever services are Findings necessary to protect every mother- » Three Nordic countries – Finland, Iceland and Sweden – plus to-be, every birth, and every infant Luxembourg and Slovenia – head the table with infant mortality rates in the earliest days and weeks of of fewer than 2.5 deaths per 1,000 births. life. The IMRs set out in Figure 2.1a » 26 of the 35 countries have reduced infant mortality to 5 or fewer may therefore be read as a measure per 1,000 births. of commitment to maternal and child health for all – including the » The only countries with infant mortality rates higher than 6 per mothers and children of the poorest 1,000 births are Latvia, Romania, Slovakia and the United States. and most marginalized families. » Three of the richest nations in the developed world – Canada, the United 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 R e p o r t C a r d 1 1 1 3 It is possible that the low ranking Figure 2.1b Low birthweight of the United States in the league % babies born below 2,500 grammes table of infant mortality is not justified: there is an as yet Iceland unresolved debate about whether Sweden infant mortality rates in the United Finland States might include the deaths of Estonia extremely premature and/or low Ireland birthweight babies who are kept Norway alive for a time by advanced neo- Netherlands natal care but who, in other Slovenia countries, might not be classified Poland as ‘live births’. Canada Health at birth: Denmark low birthweight Luxembourg The second indicator used to Switzerland measure health at the beginning France of life is the proportion of babies Belgium who are born with low birthweights Germany (below 2,500 grammes). Italy According to the United States United Kingdom Centers for Disease Control and Austria Prevention, “The birthweight of an Slovakia infant is the single most important Czech Republic determinant of its chances of Spain survival and healthy growth.” vii United States It is also a guide to the general Portugal health, and health behaviours, of pregnant women and mothers, both Hungary of which are important to every Greece other dimension of child well-being. Low birthweight is also known to New Zealand be associated with increased risk Australia across a range of health problems Japan in childhood and on into adult life. 0 2 4 6 8 10 12 Figure 2.1b shows the percentage of babies born with low birthweight Findings in each of the 29 countries for » Five European countries – Estonia, Finland, Iceland, Ireland and Sweden – which data are available. have succeeded in reducing the incidence of low birthweight below 5%. » Only in Greece, Hungary, Portugal and the United States does the low birthweight rate exceed 8%.
1 4 I n n o c e n t i R e p o r t C a r d 1 1 Figure 2.2 Immunization rates Preventive health services: Average coverage for measles, polio and DPT3 for children aged 12 to 23 months immunization Hungary The second component chosen Greece to evaluate child health is the Slovakia availability and effectiveness of Finland each country’s preventive child Czech Republic health services. This has been Luxembourg measured by each country’s Poland immunization rate (average Sweden vaccination coverage for measles, Belgium polio and DPT3). Portugal Netherlands Routine immunization rates in the Spain developed nations are generally Romania maintained at high levels, averaging France close to 95%. As with infant Slovenia mortality rates, the relatively United Kingdom Lithuania small differences between countries Iceland can therefore be said to mirror Germany commitment to the ideal of Estonia reaching out to every single child, Italy including the most marginalized, Switzerland with an essential preventive health United States service to which all children have Norway a right. Ireland Latvia Figure 2.2 presents an immunization Denmark league table for 29 countries. Canada Austria It might be suspected that low immunization rates in countries Japan such as Austria, Canada and Bulgaria Denmark have been affected by Cyprus rumours, based on discredited Australia research, linking the triple MMR New Zealand vaccine (measles, mumps and Malta rubella) with autism. This would 70 75 80 85 90 95 100 not really be an ‘excuse’ for low coverage rates, as running a first- Findings class immunization programme » Greece and Hungary head the table with 99% immunization coverage. means making sure that the public is well informed and that false » Three of the richest countries in the OECD – Austria, Canada and information is not allowed to put Denmark – are the only countries in which the immunization rate falls children at risk. But in fact the MMR below 90%. scare would not appear to be the major cause of low immunization rates in Austria, Canada and Denmark – all of which have low rates even when measles vaccination is excluded from the calculations (in Canada, the measles
I n n o c e n t i R e p o r t C a r d 1 1 1 5 immunization rate is higher than Figure 2.3 Child and youth mortality rates for DPT3 or polio). Deaths per 100,000 aged 1 to 19 Child health: Iceland the 1 to 19 death rate Luxembourg The third component used to build Switzerland an overall picture of child health is Netherlands the death rate among children and Sweden young people between the ages Spain of 1 and 19. Germany Deaths in this age group are rare Norway in advanced economies and the Slovenia causes go beyond disease and Italy the efficacy of health services United Kingdom to include deaths from suicide, Finland murder, traffic injuries, drownings, Denmark falls and fires. Differences between France countries in the death rate for Portugal children and young people in this Ireland age group may therefore be said Austria to reflect overall levels of health Czech Republic and safety throughout childhood Belgium and adolescence. Greece Figure 2.3 presents the 1- to Hungary 19-year-old death rate for each Poland country. In absolute numbers, Slovakia the differences between countries Estonia are clearly small. But it is worth Lithuania noting that if all European countries Latvia had the same child death rate as Romania Iceland or Luxembourg then over 8,000 child deaths a year could Cyprus be prevented – each one Malta representing unimaginable anguish Bulgaria for the family concerned. 0 5 10 15 20 25 30 35 40 Taken together, the three components set out above provide Findings an approximate guide to the health » Iceland, Luxembourg, the Netherlands, Spain, Sweden and Switzerland dimension of children’s well-being. head the table with child death rates below 15 per 100,000. Ideally, such an overview would also have included some indicator of » Central and Eastern European countries occupy the bottom third of the children’s mental and emotional table – along with Belgium and Greece. health, and of the prevalence of child abuse and neglect. But such issues are difficult to define and measure even within an individual country; internationally, no comparable data are available.
1 6 I n n o c e n t i R e p o r t C a r d 1 1 Dimension 3 Educational well-being Figure 3.0 An overview of Netherlands children's educational well- Belgium being Germany The league table of children’s Finland educational well-being shows each Slovenia country’s performance in relation to Norway the average for the 29 developed Denmark countries under review. The table Hungary is scaled to show each country’s Poland distance above or below that average. Iceland The length of each bar shows each Sweden country’s distance above or below the Czech Republic average for the group as a whole. The Estonia unit of measurement is the ‘standard Canada deviation’ – a measure of the spread of scores in relation to the average. France Switzerland Ireland Portugal Lithuania Findings Latvia » Educational well-being is Slovakia seen to be highest in Belgium, Luxembourg Finland, Germany and the Austria Netherlands – each of which United Kingdom achieves an overall score Italy significantly above average Spain for the 29 countries. United States » Greece, Romania, Spain and Greece the United States show the Romania lowest levels of educational -4.0 -3.0 -2.0 -1.0 0.0 1.0 2.0 well-being. Assessing educational well-being COMPONENTS IND 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) Average score in PISA tests of reading, maths Achievement and science literacy
I n n o c e n t i R e p o r t C a r d 1 1 1 7 Educational well-being In gauging educational well-being, Figure 3.1a Preschool enrolment rates two main components have been % of children aged between 4 years and the start of compulsory education who are considered – participation rates and enrolled in preschool achievement levels. Taken together France they provide an approximate Netherlands guide to both quantity and quality Spain of education. Figure 3.0 (opposite) Belgium combines the two into a single Denmark overview of children’s educational Italy well-being for 29 developed countries. Norway Participation: United Kingdom early childhood education Germany Iceland The first component – participation – Sweden has been assessed by three Luxembourg indicators: Hungary a) participation in early childhood Austria education Slovenia Estonia b) participation in further education Portugal c) the proportion of young people, Czech Republic aged 15 to 19, who are not Latvia participating in education, Ireland training or employment. Romania Switzerland In recent times it has been widely Lithuania acknowledged that the foundations Slovakia of educational success are laid down Poland before formal education begins.viii United States In response to this and other Greece pressures, all governments in Finland developed countries have invested to a greater or lesser degree in free Japan or subsidized preschool education. Malta The quality and quantity of that early Cyprus years education is difficult to measure Bulgaria on an internationally comparable 60 65 70 75 80 85 90 95 100 basis – a difficulty highlighted in Report Card 7 (2007) which noted Findings that the lack of any indicator of » Early childhood education is virtually universal in Belgium, France, participation in early childhood the Netherlands and Spain. education is a “glaring omission” from the attempt to build an overall » Preschool enrolment rates exceed 90% in half of the 32 countries listed. picture of children’s well-being.ix » In only eight countries do participation rates in early childhood education The present report begins to make fall below 80% – Bulgaria, Finland (but see Box 2), Greece, Lithuania, good that omission by including the Poland, Slovakia, Switzerland and the United States. preschool participation rate for 32 developed countries (Figure 3.1a).
1 8 I n n o c e n t i R e p o r t C a r d 1 1 Figure 3.1b Participation in further education Findings % of children aged 15 to 19 in education » Five countries enrol 90% or more of their young people in further Belgium education – Belgium, Ireland, Poland Ireland Lithuania, Poland and Slovenia. Lithuania » Seven of the wealthiest OECD Slovenia countries fall into the bottom Hungary third of the further education Netherlands league table – Austria, Canada, Czech Republic Italy, Luxembourg, Spain, Latvia the United Kingdom and the Germany United States. Sweden Finland » The further education enrolment Norway rate exceeds 80% in all of the Slovakia more populous developed Iceland countries except the United Switzerland Kingdom. The United Kingdom Estonia is the only developed country Portugal in which the further education France Denmark participation rate falls below Greece 75%; this may be the result Italy of an emphasis on academic Spain qualifications combined with a Canada diverse system of vocational United States qualifications which have not Austria yet succeeded in achieving Romania either ‘parity of esteem’ or Luxembourg an established value in United Kingdom employment markets. New Zealand Australia 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 and Malta, 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 Further education colleges. Participation in further education begins varies between education reflects ‘educational well- At the other end of the educational 4 and 7. The preschool participation being’ in as much as it indicates ladder is the further education rate is here defined as the successful passage through the percentage of children between participation rate (Figure 3.1b) years of compulsory schooling. It is the age of 4 and the beginning of which shows the percentage of also, of course, associated with a compulsory education who are young people aged 15 to 19 who wider range of opportunities at the enrolled in preschools. are enrolled in schools and beginning of adult life.
I n n o c e n t i R e p o r t C a r d 1 1 1 9 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 Norway rates below 3%. Slovenia Denmark » At the foot of the table, Ireland, Luxembourg Italy and Spain have NEET rates Czech Republic of more than 10%. Netherlands Poland Germany Lithuania Slovakia Finland Research in different countries Sweden has also shown associations Hungary between NEET status and mental Belgium health problems, drug abuse, Austria involvement in crime, and long-term France unemployment and welfare Portugal dependence.x Switzerland Greece Figure 3.1c records the NEET rate Estonia for 33 advanced economies. Latvia Canada To make international comparisons United States fair, the data must refer to a similar United Kingdom period of time. Unfortunately, the Romania latest available common year for Ireland NEET rates is 2009–2010. Figure Italy 3.1c may therefore not reflect the Spain current situation. It does however reflect the major impact of the Cyprus current economic downturn on Australia youth unemployment rates (which Malta reached a peak of 18.3% in New Zealand November 2009 and were slightly Bulgaria below that level in 2012). In total, 0 2 4 6 8 10 12 14 16 18 more than 23 million young people in OECD countries now fall into the NEET category and more than half of this total are reported to have NEET rate and employment opportunities as given up looking for work.xi The third indicator of educational well as by the effectiveness of well-being looks at participation education systems in preparing Commenting on the impact of young people for the transition to economic crisis on the transition from a different perspective – the work. Equally obviously, a high from school to work, the OECD percentage of young people (aged NEET rate represents a threat to the noted in 2011 that “High general 15 to 19) who are not participating present and future well-being of unemployment rates make this in either education, employment or young adults, a disincentive to transition substantially more difficult, training (the so-called ‘NEET’ rate). those still in the education system, as those with more work experience In all countries, NEET rates are and a waste of educational are favoured over new entrants into affected by economic conditions investment and human resources. the labour force.” xii
2 0 I n n o c e n t i R e p o r t C a r d 1 1 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 Finland points clear of the second placed Canada country (see Box 2). Netherlands Switzerland » Canada and the Netherlands take Estonia second and third places. Germany Belgium » Three of Europe’s wealthiest Poland countries, Austria, Luxembourg Iceland and Sweden, find themselves in Norway the bottom half of the educational United Kingdom achievement table, as do all four Denmark countries of southern Europe. Slovenia » Romania is also an outlier, Ireland registering a score more than France 40 points below the next lowest United States country in the table. Hungary Sweden » Australia, Japan and New Zealand Czech Republic would all have been placed in the Portugal top five places had it been possible Slovakia to include them in the main league Austria table (see note page 7). Latvia Italy Spain Luxembourg (PISA) which measures pupils’ Lithuania abilities in three basic competences Greece – reading, maths and science. Romania Repeated every three years, the tests are administered to Japan representative samples of 15-year- New Zealand olds and are intended to measure Australia knowledge and skills in relation to Bulgaria the demands of managing lives 400 420 440 460 480 500 520 540 560 and careers in the modern world. In total, 34 member countries of the OECD, plus non-member Educational achievement factors such as the development partner countries, participate in of social understanding and value this evaluation of educational The second component of formation (including education for achievement. educational well-being is the quality citizenship) as well as the Figure 3.2 presents an overview of of the education received. opportunity to develop the diverse the results of the latest PISA survey This key element of child well-being abilities and potentials of young for the countries under review. In is of course difficult to define and people. But this lies in the future. each case, the scores shown are an measure on an internationally At present, the only practical average of results in reading, maths comparable basis. Ideally, the measure of quality in education is and science. All scores have been concept of ‘quality’ in education provided by the OECD’s Programme re-presented on a common scale would embrace a broad range of of International Student Assessment based on an unweighted average
I n n o c e n t i R e p o r t C a r d 1 1 2 1 score for all participating countries (re-set to 500 to make interpretation easier). Box 2 The Finland paradox Disadvantage The indicators used here to measure children’s overall educational well-being broadly reflect each nation’s commitment to fulfilling every child’s right to be adequately prepared for the demands of the world in which he or she will live. Managing and negotiating that world – making decisions about jobs and careers, families and homes, finances and pensions, citizenship and community participation – demands The fact that Finland has the lowest rate of preschool enrolment (Figure 3.1a) and the highest level of educational achievement (Figure 3.2) a highly developed ability to acquire might seem to contradict the idea that preschool education is important and analyse new information and to to success at school. But it is perhaps better interpreted as a warning adapt to changing circumstances. of the care needed in making cross-national comparisons. In such a society, the educationally disadvantaged are likely to be very First, compulsory schooling in Finland does not begin until a child is much more disadvantaged than in seven years old, which means that the age group on which the the past. They are also likely to find preschool enrolment rate is based is the child population between the it ever more difficult to benefit from, ages of four and seven (in many other countries it is the child and contribute to, the complex population between the ages of four and five). If the preschool societies in which they live.1 enrolment rate were to be re-defined as ‘the percentage of children As with the other dimensions of enrolled in preschool education in the year before compulsory schooling child well-being considered in this begins’ then Finland would rank near the top of the table with an report, educational well-being is enrolment rate approaching 100%. therefore a critical measure both Second, preschool enrolment rates say nothing about the quality of the for children today and for their education received. If it were possible to measure quality, then it is societies tomorrow. likely 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 for children between 4 and 6). Most commentators on Finland’s outstanding record of educational achievement cite the quality of the country’s early years education. Sources: Miho Taguma, Ineke Litjens, Kelly Makowiecki, Quality Matters in Early Childhood Education and Care: Finland, OECD, 2012. 1 Report Card 9 in this series focused on this Starting Strong II, Early Childhood Education and Care, OECD, 2006. issue, 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).
2 2 I n n o c e n t i R e p o r t C a r d 1 1 Dimension 4 Behaviours and risks Figure 4.0 An overview of Netherlands behaviours and risks Denmark Iceland The league table of children’s behaviours and risks shows each Norway country’s record in relation to the Sweden average for the countries under Germany review. The table is scaled to show Ireland each country’s distance above or Portugal below that average. Luxembourg The length of each bar shows each Italy country’s distance above or below the Switzerland average for the group as a whole. The Finland unit of measurement is the ‘standard France deviation’ – a measure of the spread of Belgium scores in relation to the average. United Kingdom Canada Austria Slovakia Poland Spain Slovenia Czech Republic United States Hungary Greece Estonia Romania Latvia Lithuania -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0 Assessing behaviours and risks COMPONENTS IND I C ATOR S % overweight % eating breakfast daily Eating and exercise % eating fruit daily % exercising Teenage fertility rate Smoking Risk behaviours Alcohol Cannabis Fighting Exposure to violence Being bullied
I n n o c e n t i R e p o r t C a r d 1 1 2 3 Behaviours and risks The fourth dimension of child well- drawn from questionnaires career prospects; having a baby being incorporated into the overall completed by young people may make all these problems league table of child well-being is themselves. worse, but not having a baby will more difficult to pin down than not make them go away. Risk behaviours material well-being or health or Nonetheless, having a baby at too The second component considered young an age is an indicator of education. Yet the dimension here under ‘behaviours and risks’ is the much that may have gone wrong in labelled ‘behaviours and risks’ prevalence of a second set of the life of a teenager before she includes a range of habits and behaviours that represent became pregnant. And it is for this behaviours critical to the present immediate dangers to children as reason that teenage birth rates are and future well-being of children. well as serious threats to longer- widely regarded as a particularly Three separate components are term well-being. Within the revealing indicator of many aspects included. The first is the extent to limitations of the available data, of child well-being that are which children in each country are four such risk indicators have otherwise difficult to capture. forming healthy, well-informed been chosen: habits of eating and exercise. The threats posed to physical and a) the teenage fertility rate (annual mental health by tobacco, alcohol This has been measured by four number of births per 1,000 girls and cannabis are well established. individual indicators: aged 15 to 19) Figures 4.2a to 4.2d record the a) the percentage who are performance of each country under b) the cigarette smoking rate overweight (as measured by body each indicator. (percentage of children aged 11, mass index computed from self- 13 and 15 who smoke cigarettes Violence reported height and weight) at least once a week) The final component of the b) the percentage of children in c) the alcohol abuse rate ‘behaviours and risks’ dimension of each country who report eating (percentage of children aged child well-being is the degree to breakfast every day 11, 13 and 15 who report having which children and young people c) the percentage who report eating been drunk at least twice) experience violence in their lives. fruit every day Given the known dangers of d) the cannabis use rate d) the percentage who report (percentage of children aged growing up in a violent environment engaging in physical exercise 11, 13 and 15 who report – from immediate suffering and for at least an hour every day. having used cannabis in the last injury to longer-term problems of 12 months). anxiety, depression, behavioural All of these indicators, though of problems, and propensity to use Giving birth at too young an age varying significance, are associated violencexiv – it is unfortunate that puts at risk the well-being of both with long-term health and well- few data are available to compare mother and child. The mother is at being. Regular exercise, for children’s exposure to violence greater risk of dropping out of example, is linked not only to either as victims or as witnesses. school, of unemployment, of physical and mental health but to However, the Health Behaviour in poverty, and welfare dependence – the prevention and/or treatment of School-aged Children surveyxv so helping to perpetuate such specific problems as asthma, does provide data on children’s disadvantage from one generation obesity, anxiety and depression. experiences of both fighting to the next. The child is also at Unhealthy eating patterns in the (Figure 4.3a) and being bullied greater risk – of poverty, of poor early years have also been shown (Figure 4.3b). health, and of underachievement to increase the risk of later-life at school. The direction of causality health problems including diabetes, in these relationships is not heart disease and cancer.xiii necessarily clear cut. Teenage Figures 4.1a to 4.1d show country mothers tend to come from poorer rankings for each of the chosen backgrounds, to be doing less well indicators. In all cases, data are at school, and to have narrower
2 4 I n n o c e n t i R e p o r t C a r d 1 1 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 Netherlands Switzerland Portugal Denmark Denmark France Sweden Latvia Iceland Lithuania Ireland Belgium Belgium Sweden Norway Norway Finland United Kingdom France Slovakia Germany Germany Spain Luxembourg Estonia Iceland Latvia Austria Italy Estonia Canada Romania United Kingdom Czech Republic Poland Hungary Luxembourg Ireland Lithuania Finland Switzerland Poland Slovakia Spain Austria Italy Czech Republic Slovenia Hungary Portugal Greece Canada United States Greece Romania United States Slovenia 0 5 10 15 20 25 30 35 0 10 20 30 40 50 60 70 80 90 Figure 4.1d Exercise Figure 4.1c Eating fruit % of children aged 11, 13, 15 who report at least one hour of % of children aged 11, 13 and 15 who eat fruit daily moderate-to-vigorous physical activity daily Denmark Ireland Canada United States Portugal Austria United States Spain Switzerland Czech Republic Norway Finland Italy Canada Czech Republic Slovakia Romania Luxembourg Austria United Kingdom Slovenia Poland France Slovenia Luxembourg Latvia Spain Romania United Kingdom Hungary Belgium Netherlands Ireland Germany Germany Belgium Slovakia Lithuania Hungary Iceland Iceland Norway Greece Greece Netherlands Estonia Poland Portugal Sweden Sweden Latvia Switzerland Estonia France Lithuania Denmark Finland Italy 0 10 20 30 40 50 60 0 5 10 15 20 25 30 35
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