Child wellbeing and income inequality in rich societies: ecological cross sectional study

doi:10.1136/bmj.39377.580162.55

BMJ 2007;335:1080 (24 November), doi:10.1136/bmj.39377.580162.55 (published 16 November 2007)

Research

Child wellbeing and income inequality in rich societies: ecological cross sectional study

Kate E Pickett, senior lecturer in epidemiology¹, Richard G Wilkinson, professor of social epidemiology²

¹ Department of Health Sciences, University of York, Heslington, York YO10 5DD, ² Division of Epidemiology and Public Health, University of Nottingham Medical School, Queens Medical Centre, Nottingham NG7 2UH

Correspondence to: R G Wilkinson Richard.Wilkinson{at}nottingham.ac.uk

Objectives To examine associations between child wellbeing andmaterial living standards (average income), the scale of differentiationin social status (income inequality), and social exclusion (childrenin relative poverty) in rich developed societies.

Design Ecological, cross sectional studies.

Setting Cross national comparisons of 23 rich countries; crossstate comparisons within the United States.

Population Children and young people.

Main outcome measures The Unicef index of child wellbeing andits components for rich countries; eight comparable measuresfor the US states and District of Columbia (teenage births,juvenile homicides, infant mortality, low birth weight, educationalperformance, dropping out of high school, overweight, mentalhealth problems).

Results The overall index of child wellbeing was negativelycorrelated with income inequality (r=–0.64, P=0.001) andpercentage of children in relative poverty (r=–0.67, P=0.001)but not with average income (r=0.15, P=0.50). Many more indicatorsof child wellbeing were associated with income inequality orchildren in relative poverty, or both, than with average incomes.Among the US states and District of Columbia all indicatorswere significantly worse in more unequal states. Only teenagebirth rates and the proportion of children dropping out of highschool were lower in richer states.

Conclusions Improvements in child wellbeing in rich societiesmay depend more on reductions in inequality than on furthereconomic growth.

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