Intended for healthcare professionals


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

BMJ 2007; 335 doi: (Published 22 November 2007) Cite this as: BMJ 2007;335:1080
  1. Kate E Pickett, senior lecturer in epidemiology1,
  2. Richard G Wilkinson, professor of social epidemiology2
  1. 1Department of Health Sciences, University of York, Heslington, York YO10 5DD
  2. 2Division of Epidemiology and Public Health, University of Nottingham Medical School, Queens Medical Centre, Nottingham NG7 2UH
  1. Correspondence to: R G Wilkinson Richard.Wilkinson{at}
  • Accepted 26 September 2007


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

Design Ecological, cross sectional studies.

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

Population Children and young people.

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

Results The overall index of child wellbeing was negatively correlated with income inequality (r=−0.64, P=0.001) and percentage of children in relative poverty (r=−0.67, P=0.001) but not with average income (r=0.15, P=0.50). Many more indicators of child wellbeing were associated with income inequality or children in relative poverty, or both, than with average incomes. Among the US states and District of Columbia all indicators were significantly worse in more unequal states. Only teenage birth rates and the proportion of children dropping out of high school were lower in richer states.

Conclusions Improvements in child wellbeing in rich societies may depend more on reductions in inequality than on further economic growth.


  • We thank Jonathan Bradshaw for helpful comments and advice and Anna Goodman, who independently discovered the association between income inequality and child mental health in the US, for helpful discussions.

  • Contributors: Both authors participated in the design of the study, interpretation of the results and drafting of the article. KEP conducted the data analysis. Both authors are guarantors.

  • Funding: KEP is supported by a NIHR (National Institute of Health Research) Career Scientist Award.

  • Competing interests: None declared.

  • Ethical approval: Not required.

    Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 26 September 2007
View Full Text