What Shapes Child

Innocenti Report Card 16
Worlds of Influence
Understanding aWht Shapes Child

Well-being in Rich Countries
Innocenti Report Card 16 was written by Anna Gromada, Gwyther Rees and
Yekaterina Chzhen with contributions from Dominic Richardson, Céline Little and
David Anthony. The report was fact-checked by Alessandro Carraro, supervised
by Gunilla Olsson and Priscilla Idele and edited by Madelaine Drohan.
The United Nations Children’s Fund Office of Research – Innocenti (UNICEF
Innocenti) would like to acknowledge the generous support for Innocenti Report
Card 16 provided by the Government of Italy.
Any part of this Innocenti Report Card may be freely reproduced using the
following reference:
UNICEF Innocenti, ‘Worlds of Influence: Understanding what shapes child
well-being in rich countries’, Innocenti Report Card 16, UNICEF Office of
Research – Innocenti, Florence, 2020.
The Innocenti 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 work. The prime objectives of the
UNICEF Office of Research – Innocenti 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, and to support
advocacy worldwide. The Office aims to set out a comprehensive framework for
research and knowledge within the organization, in support of its global policies
and programmes. Through strengthening research partnerships with leading
academic institutions and development networks in both the North and the
South, UNICEF Innocenti 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
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views expressed are those of the authors.
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©United Nations Children’s Fund (UNICEF), 2020
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Innocenti Report Card 16
Worlds of Influence
Understanding What Shapes Child
Well-being in Rich Countries
EXECUTIVE SUMMARY
2 INNOCENTI REPORT CARD 16
EXECUTIVE SUMMARY
A new look at children from the
world’s richest countries offers a
mixed picture of their health, skills
and happiness. For far too many,
issues such as poverty, exclusion
and pollution threaten their mental
well-being, physical health and
opportunities to develop skills.
Even countries with good social,
economic and environmental
conditions are a long way from
meeting the targets set in the
2030 Agenda for Sustainable
Development. Focused and
accelerated action is needed if
these goals are to be met.
The evidence from 41
Organisation for Economic
Co-operation and Development
(OECD) and European Union (EU)
countries tells its own story: from
children’s chances of survival,
growth and protection, to whether
they are learning and feel listened
to, to whether their parents have
the support and resources to give
their children the best chance for
a healthy, happy childhood. This
report reveals children’s
experiences against the backdrop
of their country’s policies and
social, educational, economic and
environmental contexts.
What makes a good
childhood?
Good mental well-being
Feeling positive and being in good
mental health are key aspects of
quality of life. However, a striking
number of children in rich countries
do not have good mental well-being:
ƒ In 12 of 41 countries, less than
75 per cent of children aged 15
have high life satisfaction.
ƒ There are no reliable, comparable
data on children’s mental health
across this set of rich countries.
But suicide is one of the most
common causes of death for
adolescents aged 15 to 19.
Good physical health
Health indicators also highlight
areas of concern:
ƒ 1 in 15 infants in rich countries is
born with low weight – a key risk
to survival.
ƒ In 10 countries, more than one in
three children is overweight or
obese. The number of obese
children (aged 5–19) worldwide
is expected to grow from 158
million to 250 million by 2030.
Skills for life
Many also lack basic academic and
social skills by the age of 15:
ƒ Two in five children (on average)
do not acquire basic reading and
mathematics skills by age 15. In
seven countries, the number
drops to less than one in two.
ƒ For an equally important skill
set – feeling confident in
developing interpersonal
relationships – most children
agree that they make friends
easily. But in 18 countries more
than one in four children
disagree.
Why do all children in rich
countries not have a good
childhood?
Poor-quality relationships
ƒ Children view good relationships
as crucial. Those with more
supportive families have better
mental well-being.
ƒ Many children feel that they lack
opportunities to participate in
decisions at home and at school.
EXECUTIVE SUMMARY
INNOCENTI REPORT CARD 16 3
ƒ Bullying by peers remains a
serious problem; it has a lasting
negative impact on relationships
and health. Children who are
frequently bullied have lower
mean life satisfaction.
ƒ In some countries, at least 1 in
10 parents report no family or
friends they can count on for help
with looking after their children.
Lack of resources
ƒ In almost half of rich countries,
more than one in five children
live in poverty. In many countries,
the poorest children are at
greater risk of depression,
obesity and low academic
achievement.
ƒ Children without books at home
to help with school work suffer
academically.
ƒ More time playing outside is
linked to much higher levels of
happiness. Yet many children say
that good play and leisure
facilities are not available in their
neighbourhoods.
Gaps in services
ƒ Measles immunization rates have
dropped in 14 out of 35 countries
with available time-series data.
ƒ Public provision of high-quality
childcare provides a stimulating
social and learning environment –
and helps to reduce socioeconomic disadvantage. And yet,
on average, across 29 European
countries, one in seven parents
with a child under 3 has unmet
childcare needs.
ƒ Adolescents disengaged from
education and the labour market
face a difficult start to adult life.
In five rich countries, more than
10 per cent of young people
aged 15 to 19 are not in
education, training or work.
Gaps in family policy
ƒ In five rich countries, parental
leave is less than 10 weeks (fullpay equivalent). Leave reserved
for fathers makes up only one
tenth of all parental leave.
ƒ Expectations to prioritize work
can lead to long hours and stress
that reduce the time and energy
parents have for their children.
On average, two out of five
employees in Europe found it
difficult to fulfil family
responsibilities at least several
times per month.
The broader context
ƒ Unemployment – which affects
family relationships and child
well-being – has still not dropped
below its pre-Great Recession
levels in some countries.
ƒ In 11 of 41 countries, at least
5 per cent of households do not
have safely managed water.
ƒ High levels of air pollution still
threaten the physical and mental
health of children – who suffer
the greatest harms.
What needs to be done?
For every child to enjoy a good
childhood, UNICEF calls on
high-income countries to act
on three fronts:
ƒ Consult children. They see
things from a different viewpoint
and express serious concern for
the future of the environment,
how much they value
relationships and participating
in decisions.
ƒ Connect policies. Carefully
integrated policies that
complement and strengthen one
another are key to improving
child well-being.
ƒ Create strong foundations. The
Sustainable Development Goals
provide a roadmap to ensuring
child well-being now and for the
future. Governments should
intensify and accelerate their
efforts to meet these goals,
including:
1. Reduce poverty, and ensure
that all children have access to
the resources they need.
2. Improve access to affordable
and high-quality early years
childcare for all children.
3. Improve mental health
services for children and
adolescents.
4. Implement and expand familyfriendly policies related to the
workplace.
5. Reduce the stubbornly high
levels of air pollution.
6. Strengthen efforts to
immunize children against
preventable diseases.
EXECUTIVE SUMMARY
4 INNOCENTI REPORT CARD 16
responsibilities of governments,
families and communities to help
realize children’s rights and
promote their well-being.
This report finds that many of the
wealthiest countries do not
manage to convert good economic
and social conditions into
consistently high child well-being
outcomes. It shows that no country
is a leader on all fronts, and that all
41 countries have significant room
for improvement. Such
improvement is urgently needed if
the world’s most affluent nations
are to meet the commitments they
made five years ago when they
endorsed the 2030 Sustainable
Development Goals. Yet there are
worrying signs of back-sliding on
aspects such as immunization,
learning and mental health.
The COVID-19 crisis adds to these
challenges. What started as a
health crisis will spread to touch all
aspects of economies and
societies. Children will not suffer
the worse direct health effects of
INTRODUCTION
SECTION 1
The COVID-19 crisis that has
engulfed the world during 2020
presents new threats to child wellbeing. Even before the crisis, in the
world’s richest countries, the daily
lives of millions of children fell far
short of what anyone would call a
good childhood. They suffered
stress, anxiety and depression,
lagged behind their peers at school,
and were physically unwell. Living in
a wealthy country did not bring them
happiness. Nor did it guarantee
them better health or education.
For the last 20 years, the Innocenti
Report Card series has led the way
in comparing children’s well-being
across rich countries. Report Card
16 develops this further through a
multi-level approach to show that
children’s well-being is influenced
by children’s own actions and
relationships, by the networks and
resources of their caregivers, and
by public policies and the national
context. This approach is aligned
with the 1989 United Nations
Convention on the Rights of the
Child, in that it recognizes the
the virus. But, as we know from
previous crises, they will be a
group that experiences the
longer-term negative impacts most
acutely. In this report, we present
a baseline picture of children’s
well-being in rich countries at the
start of the current crisis. In a
companion paper, we look ahead to
how the crisis may affect child
well-being over the coming years.
The time is right for countries to
step up efforts to realize the rights
of all children. A multi-level
approach to child well-being can
support this goal because it
delivers a realistic picture. It
clarifies the links between the
outcomes of individual children, the
people and communities around
them, and the nation in which they
live. Many countries have all the
requisites – wealth, a clean
environment and generous social
policies – to support high levels of
child well-being. Yet too many
children in these countries still do
not experience a good childhood.
SECTION 1 INTRODUCTION
INNOCENTI REPORT CARD 16 5
The world at large entails Policies
and Context (the two outer circles
in light blue). Policies refer to
national programmes of direct
relevance to the child, including
social policy, education and health.
Context includes broader
economic, social and environmental
factors that influence child wellbeing either directly or indirectly.
Policies and Context are national
conditions for well-being that
potentially explain variations in child
well-being between countries.
Our framework
We view a good childhood as one
in which children have a positive
experience of childhood and the
prospect of a good future.1 We
develop a multi-level approach to
well-being and adapt it for
international comparisons. Our
model of concentric spheres of
influence is similar to the one
developed by American
psychologist Urie Bronfenbrenner
to explain how children interact
with their environment and how
this influences their development
(see Figure 1).
2
The child stands at the heart of the
framework. Child well-being
outcomes can be objective, such
as child mortality or educational
achievement. They can also be
subjective and expressed from the
child’s point of view, for example
whether they are satisfied with life
or feel they can make friends easily.
Outcomes are influenced by the
world of the child, the world around
the child and the world at large.
The world of the child (in dark blue)
represents factors experienced
directly by a child: the child’s
Activities and Relationships, such
as those with family and peers. The
world around the child (in medium
blue) consists of Resources and
Networks. Resources include
children’s household economic
status and the quality of the
neighbourhoods they live in.
Networks are the connections
between people around the child,
which the child may not directly
experience, but which can affect
their well-being. An example is
work pressure on their parents.
These four inner circles of the
framework can explain variations
between children within countries.
Figure 1: A multi-level framework of child well-being
The world of the child
The world around the child
The world at large
Outcomes
Activities
Relationships
Networks
Resources
Policies
Context
SECTION 1 INTRODUCTION
6 INNOCENTI REPORT CARD 16
This is our third study of multidimensional child wellbeing in rich countries and it builds on our previous
work. Report Card 7 broke new ground by
comparing child well-being across 21 countries.
It had a major impact on public discourse and on
policymakers. Report Card 11 extended the number
of countries to 29 and updated the rankings. Report
Cards 7 and 11 took a dashboard approach,
assessing aspects of children’s physical, cognitive
and mental well-being side-by-side.
Report Card 16 introduces a multi-level framework
and expands the coverage of child well-being both
conceptually and geographically. It covers 41 highincome countries (members of the OECD and/or the
EU). The report also adopts a broader outlook on child
well-being. For example, we consider social skills to
be of equal value to academic skills so we included a
new indicator for making friends easily. We also pay
more attention to environmental factors given how
worried children are about the future of the planet.
These innovations, along with missing data, reduced
the potential for comparisons of Report Card 16 with
Report Cards 7 and 11. Yet, to help with tracking
well-being trends, we updated those elements of the
previous Report Cards for which we have new data.
Criteria for data selection
Report Card 16 employs an array of data from highquality administrative datasets and international
surveys. Indicators were chosen to represent key
concepts within our framework (see Figure 1). Our
selection of key indicators for the league tables was
guided by the following criteria:
ƒ Coverage. Data should be available for the large
majority of the 41 Report Card countries.
ƒ Recency. Data relating to 2016 or later should
be available.
ƒ Relevance. The data should be relevant to crossnational comparisons.
ƒ Variability. There should be enough variability in
the indicators between countries to be
informative.
ƒ Comparability. The indicators should have the
same meaning across cultures.
The last criterion presents challenges for objective
and subjective indicators. For example, the number
Spotlight 1 About the data used in this report
of books that a child has at home is often used as an
objective measure of home educational resources, but
it may have different significance in different
countries.3 Subjective indicators may also vary in
meaning. For example, there may be cultural
differences in self-evaluations of life satisfaction,4
although it is possible to explain most of the variation
between countries in mean life satisfaction scores
based on national social and economic conditions.5
Where a number of options met these criteria, we
prioritized the continuity of indicators from previous
multidimensional Report Cards.
Data gaps
In many cases our choices were limited or there was
a lack of comprehensive data. Some of the most
important data shortages or gaps that we highlighted
in our search for indicators were:
ƒ Mental well-being. There are limited data on
children’s positive sense of well-being and flourishing.
The best indicator we could find – life satisfaction –
was only available for 33 of the 41 countries. There is
also a shortage of comparable international data on
children’s mental ill-health. We have used suicide
rates as a proxy but for many countries these data
were only available up until 2015.
ƒ Violence and protection. We were not able to find
any comparable indicators either on children’s
experience of violence or on child protection policies.
ƒ Participation. Children’s experiences of being able
to participate, have their views heard or make
choices are hardly covered in most international
surveys. Only one such survey – Children’s Worlds –
which currently covers a minority of OECD/ EU
countries, asks about these issues or about
children’s knowledge of their rights.
These are three topic areas that urgently need to be
addressed by government statistical departments and
the international research community.
The application of the well-being framework to the
COVID-19 crisis can be found in Rees, Gwyther, Anna
Gromada, Dominic Richardson and Alessandro Carraro,
Childhood in a Time of Crisis: Understanding how the
COVID-19 pandemic is shaping child well-being in rich
countries, United Nations Children’s Fund Office of
Research – Innocenti, Florence, 2020.
SECTION 1 INTRODUCTION
INNOCENTI REPORT CARD 16 7
Figure 2: Overview of the application of the framework for this report
Outcomes
Activities
Networks
Policies
R
elationships
Resources
Co
ntext
The world of the child
The world around the child
The world at large
Physical health
Overweight/obesity,
mortality
Skills
Reading/mathematics,
making friends
Learn
Play
Socialise
School
Work
Community
School
Household
Neighbourhood
Health
Education
Family
Economy
Society
Environment
$ %
Mental well-being
Life satisfaction,
suicide
Family
School
Friends/peers
Figure 2 shows how we have
applied the framework presented
in Figure 1 for this report. Our
selection of dimensions within each
sphere of the framework reflects
available data. Future work using
the framework could include
additional dimensions. For example,
child protection and
implementation of children’s rights
could be added to the Policies
sphere, and peace and security to
the Context sphere.
SECTION 1 INTRODUCTION
8 INNOCENTI REPORT CARD 16
Dimension Components Indicators Source
Outcomes
Mental well-being
Life satisfaction Percentage of children with high life satisfaction at 15 PISA, 2018
Adolescent suicide Suicide rate for 15- to 19-year-olds WHO Mortality
Database, 2015
Physical health
Child mortality Child mortality rate (all causes), 5–14 UN IGME project, 2018
Overweight Percentage of children overweight, 5–19 State of the World’s
Children, 2016
Skills Academic proficiency Percentage proficient in mathematics and reading
at 15 PISA, 2018
Social skills Percentage who make friends easily at school at 15 PISA, 2018
Activities
Play Playing outside Frequency of playing outside at 10 years old
(days per week) Children’s Worlds, 2017–19
Digital Internet use Average duration of Internet use by children EU Kids Online, 2018–19
Relationships
Family
Family support Level of family support reported by children at
15 years old HBSC, 2017/18
Family participation Percentage of children aged 10 totally agreeing that
they participate in decision-making at home Children’s Worlds, 2017–19
Peers Being bullied Frequency of children being bullied at 15 years old PISA, 2018
School
School belonging Sense of belonging at school at 15 years old PISA, 2018
School participation Percentage of children aged 10 totally agreeing that
they participate in decision-making at school Children’s Worlds, 2017–19
Networks
Parent–community Parental support
networks
Main sources of support for parents in looking
after children
European Quality of Life
Survey, 2016
Parent–work
Work–family balance Percentage of employees struggling to fulfil family
responsibilities
European Quality of Life
Survey, 2016
Hours worked Average weekly hours worked on main job OECD based on Labour
Market Statistics, 2017
Parent–school Relationship with school Parents’ rating of their relationship with school European Quality of Life
Survey, 2016
Resources
Household resources School books at home Percentage of children aged 15 having books at
home to help with school work PISA, 2018
Neighbourhood
resources Local play facilities Percentage of children aged 10 who agree that
there are enough places to play in their local area Children’s Worlds, 2017–19
Policies
Family policy
Parental leave Weeks of full-rate equivalent parental leave
in early childhood
OECD Family Database,
2018
Child poverty Percentage of children in households below 60% of
median income
Eurostat, HILDA, LIS and
national statistical agencies,
2018
Education
Early childhood
education and care
Percentage of children attending early childhood
education and care one year before school
UNESCO, 2017, Report Card
15 and UNSTATS
NEET Percentage of 15- to 19-year-olds out of school,
employment or training
OECD Family Database and
Eurostat, 2018
Health
Immunization Measles immunization WHO/UNICEF, 2018
Low birthweight Percentage of newborns weighing less than
2,500 grams
OECD Health Database and
WHO, 2017
Context
Economy
Income Gross national income per capita in international dollars World Bank, 2018
Jobs Unemployment rate (percentage of active population) World Bank, 2019
Society Social support Percentage of adults who have someone to count on Gallup World Poll, 2016–18
Violence Homicide rate World Bank, 2017
Environment
Air pollution Mean levels of fine particulate matter PM2.5 Global Burden of Disease
Study, 2017
Water quality Percentage of population using safe water WHO/UNICEF Joint
Monitoring Programme, 2017
Box 1: Indicators used in the report
SECTION 1 INTRODUCTION
INNOCENTI REPORT CARD 16 9
OUTCOMES
SECTION 2
For this section, we consider two
questions.
1. How do children experience their
lives in the present?
2. And what are their prospects for
the future?
These questions are related. For
example, having good health leads
to both current and future wellbeing. To address these questions,
we focus on indicators that directly
describe the well-being outcomes
of the child.
Our league table of child well-being
outcomes corresponds to the
innermost circle of our model (see
Figure 3). It consists of three
dimensions (see Box 1):
ƒ Mental well-being: This includes
both positive and negative aspects
of a child’s mental well-being – life
satisfaction and suicide rates.
ƒ Physical health: This includes
rates of overweight and obesity,
which affect children now and in
future, and child mortality.
ƒ Skills: This dimension focuses
both on academic skills –
proficiency in reading and
mathematics; and social skills –
feeling able to make friends easily.
The rationale for the inclusion of
these components, indicators and
their sources is explained later in
this section. We were unable to
include 3 of the 41 countries –
Israel, Mexico and Turkey – in the
league table of well-being
outcomes due to shortages of data
(see note to Figure 3). However,
these three countries are included,
where possible, throughout the
rest of the report.
The Netherlands ranks highest in the
league table of outcomes, followed
by Denmark and Norway. These
three countries along with
Switzerland and Finland are in the
top third of rankings in all three
outcomes. Chile, Bulgaria and the
United States of America are at the
bottom of the table. Only Chile, the
United States and Malta are in the
bottom third of rankings for each of
the three well-being outcomes.
National income is clearly no
guarantee of the best outcomes.
Each third of the league table
contains a mixture of countries with
contrasting income levels. For
example, Slovenia ranks above
Sweden in the top third, while in the
bottom third Lithuania fares better
than the United States.
The rankings of some countries vary
widely from one well-being outcome
to another. For example, the Republic
of Korea is in the top third for
physical health and skills, but in the
bottom third for mental well-being.
In contrast, Romania is ranked fourth
highest for mental well-being but is
in the bottom third for the physical
health and skills dimensions.
The physical health and skills
dimensions are moderately
correlated (r=0.58), meaning that if
a country reports good results in
one of these dimensions, it is likely
to report good results in the other.
But skills are less strongly correlated
with mental well-being (r=0.30),
while physical health and mental
well-being are even more weakly
linked (r=0.10). This highlights the
multidimensional nature of child
well-being outcomes.
SECTION 2 OUTCOMES
1 0 INNOCENTI REPORT CARD 16
Figure 3: A league table of child well-being outcomes: mental well-being, physical health, and academic
and social skills
Overall ranking Country Mental well-being Physical health Skills
1 Netherlands 1 9 3
2 Denmark 5 4 7
3 Norway 11 8 1
4 Switzerland 13 3 12
5 Finland 12 6 9
6 Spain 3 23 4
7 France 7 18 5
8 Belgium 17 7 8
9 Slovenia 23 11 2
10 Sweden 22 5 14
11 Croatia 10 25 10
12 Ireland 26 17 6
13 Luxembourg 19 2 28
14 Germany 16 10 21
15 Hungary 15 21 13
16 Austria 21 12 17
17 Portugal 6 26 20
18 Cyprus 2 29 24
19 Italy 9 31 15
20 Japan 37 1 27
21 Republic of Korea 34 13 11
22 Czech Republic 24 14 22
23 Estonia 33 15 16
24 Iceland 20 16 34
25 Romania 4 34 30
26 Slovakia 14 27 36
27 United Kingdom 29 19 26
28 Latvia 25 24 29
29 Greece 8 35 31
30 Canada 31 30 18
31 Poland 30 22 25
32 Australia 35 28 19
33 Lithuania 36 20 33
34 Malta 28 32 35
35 New Zealand 38 33 23
36 United States 32 38 32
37 Bulgaria 18 37 37
38 Chile 27 36 38
OUTCOMES
Note: A light blue background indicates a place in the top third of rankings, medium blue denotes the middle third, and dark blue the bottom third. The rankings in the
table were produced as follows: (1) We calculated a z-score for each indicator (reversed where necessary so that a higher score represents a more positive outcome); (2)
we calculated the mean of the two z-scores within each dimension; (3) we calculated the z-score for each mean; and (4) for the overall ranking, we then calculated the
mean of the mean z-scores for each dimension. This table includes the 38 OECD/EU countries which had data of sufficient quality across at least five of the six Outcomes
indicators listed in Box 1. We were unable to include Mexico and Turkey due to low coverage rates in the Programme for International Student Assessment (PISA) 2018
survey (which provides three of the six indicators that make up the league table). We were also unable to include Israel as data were missing on two of the six indicators.
SECTION 2 OUTCOMES
INNOCENTI REPORT CARD 16 1 1
Mental well-being
Mental well-being means not only
the absence of mental ill-health
but also a broader sense of positive
functioning.6 We represent both
of these aspects in the first
league table.
Positive functioning encompasses
various components including
emotions such as feeling happy,
satisfaction with life and a sense of
flourishing. The league table
includes a question about life
satisfaction from the Programme
for International Student
Assessment (PISA) study, based on
the criteria for indicator selection
(see Spotlight 1). Children aged 15
years were each asked to say how
satisfied they felt with their life as a
whole using a scale from 0 (worst
possible life) to 10 (best possible
life). In all countries, most children
were reasonably satisfied with their
lives (a score above the midpoint
on the scale), but there was
variation between countries in this
regard – ranging from less than
55 per cent of children in Turkey
to 90 per cent of children in the
Netherlands (see Figure 4).
The fact that most children are
reasonably satisfied with their lives
is encouraging. We still need to
consider what these percentages
mean in terms of the large
numbers of children who have low
life satisfaction. This is more than
merely a question of momentary
‘happiness’. For example, a study in
the United Kingdom showed that,
compared with children with
average to high life satisfaction,
those with low life satisfaction
were about eight times as likely to
report family conflict, six times as
likely to feel that they could not
express their opinions, five times as
likely to be bullied, and more than
In some countries, less than two thirds of children have high life satisfaction
Figure 4: Percentage of children with high life satisfaction at 15 years of age
Note: Percentage of children scoring more than 5 out of 10 on the Cantril Ladder for satisfaction
with life as a whole. No data available for Australia, Belgium, Canada, Cyprus, Denmark, Israel,
New Zealand and Norway.
Source: Programme for International Student Assessment (PISA) 2018.
0 20 40 60 80 100
Percentage of children with high life satisfaction (>5 out of 10)
Turkey
Japan
United Kingdom
Republic of Korea
Malta
United States
Poland
Chile
Ireland
Slovenia
Bulgaria
Czechia
Germany
Luxembourg
Greece
Sweden
Italy
Hungary
Slovakia
Austria
Latvia
Portugal
Estonia
France
Iceland
Lithuania
Spain
Switzerland
Croatia
Finland
Romania
Mexico
Netherlands
84
85
86
90
53
62
64
67
70
71
72
72
72
72
73
73
75
76
76
76
76
77
77
77
78
78
78
80
81
82
82
82
82
SECTION 2 OUTCOMES
1 2 INNOCENTI REPORT CARD 16
twice as likely not to look forward
to going to school.7 Only 64 per
cent of children with low selfreported well-being felt they had
people who supported them,
compared with 93 per cent of other
children. And 24 per cent of
children with low well-being said
that they did not feel safe at home,
compared with only about 1 per
cent of other children.
There is a lack of reliable,
comparable data on mental illhealth among children globally. As
in previous Report Cards, we used
the suicide rate among adolescents
aged 15–19 years as the best
available indicator. Unfortunately,
data were only generally available
up to 2015. Suicide rates in this age
group were above 10 per 100,000
in Lithuania, New Zealand and
Estonia, and lowest in Greece,
Portugal and Israel.
Physical health
The full extent of the health
outcomes associated with
childhood and adolescence only
becomes apparent later in life.
There are, however, some useful
indicators relating to children’s
physical health during childhood.
Here we look at two indicators that
have also been included in previous
Report Cards: child mortality and
overweight (including obesity).
For child mortality, we use the
mortality rate for children aged 5–14
years, provided by the United
Nations Inter-agency Group for Child
Mortality Estimation.8
More than 10 in 100,000 adolescents aged 15–19 years commit
suicide in some rich countries
Figure 5: Suicide rate per 100,000 adolescents aged 15–19 years
Notes: Figures are three-year averages for 2013–2015, except that: (1) data were only available for two of
these three years in Greece, New Zealand and Slovakia; and (2) five-year averages are used for the following
three countries that had fewer than 50,000 people in this age group – Cyprus, Iceland and Luxembourg.
Source: World Health Organization Mortality Database (numbers of suicides) and World Bank database
(population estimates).
0 2 4 6 8 10 12 14 16 18 20
Suicide rate per 100,000 people aged 15–19 years
(three-year moving average)
Lithuania
New Zealand
Estonia
Iceland
Australia
Latvia
Canada
Poland
United States
Finland
Chile
Japan
Republic of Korea
Sweden
Austria
Mexico
Switzerland
Malta
Czechia
Croatia
Ireland
Belgium
Luxembourg
Slovenia
Romania
Norway
Netherlands
Hungary
Germany
Bulgaria
Slovakia
United Kingdom
Denmark
France
Spain
Italy
Turkey
Cyprus
Israel
Portugal
Greece 1.4
2.1
2.2
2.4
2.4
2.5
2.6
3.4
3.6
3.7
4.2
4.3
4.4
4.5
4.8
5.1
5.1
5.6
6.0
6.1
6.4
6.6
6.7
6.8
7.0
7.1
7.2
7.3
7.3
7.5
8.0
8.2
8.7
8.8
9.0
9.5
9.7
9.7
13.9
14.9
18.2
SECTION 2 OUTCOMES
INNOCENTI REPORT CARD 16 1 3
Figure 6 shows a wide range of
rates, with child mortality about
four times higher in Mexico than it
is in each of the six countries with
the lowest rates. Among the 41
countries, the child mortality rate is
the outcome indicator most closely
associated with national income
and inequality (see Spotlight 6).
Among the richer countries in our
list, the United States stands out.
It has a higher child mortality rate
than countries with similar levels
of per capita income.
The second indicator of physical
health is overweight and obesity.
Being overweight is defined as
having a body mass index (BMI) of
over 25, while obesity is indicated
by a BMI of over 30. Obesity is a
serious problem for both medical
and psychological reasons. It
contributes to diabetes,
cardiovascular diseases,
hypertension, cancer, gallbladder
disease and a shorter life
expectancy.9 It takes a social and
emotional toll by limiting
participation in social life and
lowering self-esteem.
In recent years, rates of overweight
and obesity have increased
substantially in high-income
countries. For example, obesity
among children and adolescents
aged 2–19 years in the United
States has risen by more than one
third in the last 15 years.10 The
global picture is bleak. The number
of obese children and adolescents
aged 5–19 years worldwide is
expected to grow from 158 million
0 0.5 1.0 1.5 2.0 2.5 3.0
Mortality rate per 1,000 children aged 5–14 years
Turkey
Japan
United Kingdom
Republic of Korea
Malta
Australia
United States
Poland
Chile
Ireland
Slovenia
Bulgaria
Czechia
Germany
Luxembourg
Denmark
Greece
Sweden
Italy
Hungary
Canada
Slovakia
Austria
Latvia
Portugal
New Zealand
Cyprus
Israel
Estonia
France
Belgium
Iceland
Lithuania
Spain
Switzerland
Croatia
Finland
Norway
Romania
Mexico
Netherlands
0.36
0.50
0.60
0.63
0.64
0.66
0.71
0.72
0.73
0.73
0.74
0.75
0.78
0.78
0.79
0.80
0.80
0.80
0.81
0.81
0.84
0.84
0.87
0.87
0.90
0.94
0.97
0.98
1.05
1.13
1.16
1.22
1.34
1.41
1.42
1.46
1.49
1.80
1.93
1.96
2.47
Source: United Nations Inter-agency Group for Child Mortality Estimation project.
In more than a quarter of countries, child mortality rates are
still over 1 per 1,000
Figure 6: Mortality rate per 1,000 children aged 5–14 years, 2018
SECTION 2 OUTCOMES
1 4 INNOCENTI REPORT CARD 16
In 10 countries, more than one in three children and
adolescents is overweight (including obese)
Figure 7: Percentage of young people aged 5–19 years who
were overweight or obese in 2016
Source: United Nations Children’s Fund, The State of the World’s Children 2019. Children, Food and
Nutrition: Growing well in a changing world, UNICEF, New York, 2019.
0 5 10 15 20 25 30 35 40 45
Percentage of children aged 5–19 years
who are overweight or obese
Turkey
Japan
United Kingdom
Republic of Korea
Malta
Australia
United States
Poland
Chile
Ireland
Slovenia
Bulgaria
Czechia
Germany
Luxembourg
Denmark
Greece
Sweden
Italy
Hungary
Canada
Slovakia
Austria
Latvia
Portugal
New Zealand
Cyprus
Israel
Estonia
France
Belgium
Iceland
Lithuania
Spain
Switzerland
Croatia
Finland
Norway
Romania
Mexico
Netherlands
14
20
21
21
22
23
24
24
25
25
25
26
26
27
27
27
27
27
27
28
28
28
28
28
30
30
31
31
32
33
33
34
34
35
36
36
37
37
37
39
42
in 2020 to 254 million by 2030.11
The recent rise in obesity appears
to be linked with lifestyle changes
and insufficient regulation of food
production and advertising,
including predatory commercial
practices, which could be
addressed by governments.12
Unlike the mortality indicator, there
is no clear link between overweight/
obesity rates and national income
among the rich countries included
in this report. There do appear to be
some geographical patterns. Lower
rates tend to be found mostly in
countries in the northern half of
Europe and East Asia. Higher rates
are found primarily in countries
around the Mediterranean and in
the Americas and Oceania.
Skills
Learning new skills can be a
rewarding experience for children in
the present, as well as a foundation
for adulthood. Child well-being
indices often include indicators of
skills development, but the focus
has usually been on academic skills.
Social and emotional skills are also
important both during childhood
and as a foundation for adulthood.
These types of skills are also
increasingly seen as important for
employability. With this in mind, we
aimed to include in our two
indicators for the skills dimension –
a measure of educational
achievement near the end of
compulsory secondary education
and a measure of social skills.
SECTION 2 OUTCOMES
INNOCENTI REPORT CARD 16 1 5
How adolescents feel about their bodies has an impact
on their well-being. A positive body image is linked to
greater self-confidence. A negative body image can
lead to shame, anxiety, depression, isolation and low
self-confidence.13 It is also the strongest contributor to
anorexia and bulimia.14 For example, in the United
States, most adolescent girls and one third of
adolescent boys report unhealthy attempts at weight
control, such as smoking, fasting, vomiting or taking
weight-regulating drugs.15
Spotlight 2 Body image relates to life satisfaction
twice as strongly for girls than for boys
In most rich countries, more than two in five adolescents are dissatisfied with their bodies
Figure 8: Percentage of adolescents aged 11, 13 and 15 years who say they are too fat or too thin
Source: Health Behaviour in School-aged Children (HBSC) 2018. Percentage
Percentage of adolescents who think they are too fat Percentage of adolescents who think they are too thin
0
10
20
30
40
50
60
20
21
24
27
27
24
25
27
30
30
27
29
31
27
31
26
29
24
32
29
28
28
33
31
24
32
32
25
33
34
33
25
36
33
38
13
17
14
13
14
17
16
14
11
12
15
13
12
16
12
18
16
20
13
16
18
18
14
16
23
15
16
23
17
15
17
27
16
21
16
Average: 45%
Belgium (Flemish)
Switzerland
Israel
Hungary
Belgium (French)
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Estonia
Iceland
Poland
Malta
Canada
Italy
UK (England)
Croatia
France
Ireland
Finland
Denmark
Sweden
UK (Wales)
Netherlands
Bulgaria
Greenland
Romania
Lithuania
Slovakia
UK (Scotland)
Slovenia
Portugal
Spain
In those countries for which we have data, the
proportion of children aged 11, 13 and 15 years who
were dissatisfied with their own body ranged from
more than 33 per cent in Iceland to 55 per cent in
Poland. More children overall thought they were too fat
(29 per cent) than too thin (16 per cent). Based on
weight and height measurements, 23 per cent of girls
and 27 per cent of boys aged 15 years were actually
overweight.16 Yet, girls of this age were more likely to
see themselves as fat (34 per cent) than boys (24 per
SECTION 2 OUTCOMES
1 6 INNOCENTI REPORT CARD 16
The link between body image and life satisfaction is twice as strong for girls than boys
Figure 9: Percentage of differences in life satisfaction accounted for by body image
Notes: R-squared from regression model controlled for age with full weights. All regression coefficients significant at p=.01, apart from
for boys in Bulgaria.
Source: Health Behaviour in School-aged Children (HBSC) 2018 (weighted and clustered). Percentage of differences in life satisfaction related to body image
Girls Boys
0
2
4
6
8
10
12
14
16
18
Israel
Belgium (Flemish)
Switzerland
Hungary
Belgium (French)
Czechia
Latvia
Austria
Greece
Germany
Estonia
Poland
Iceland
Canada
Malta
Greenland
Italy
UK (England)
France
Croatia
Ireland
Finland
Denmark
Sweden
UK (Wales)
Netherlands
Bulgaria
Romania
Lithuania
Slovakia
Luxembourg
UK (Scotland)
Portugal
Slovenia
Spain
cent). This suggests that many children with a healthy
weight think they are fat, particularly girls. The numbers
are very similar at the ages of 11, 13 and 15 years,
indicating that these negative feelings may have started
even before adolescence.
Body image is much more closely linked to life
satisfaction for girls. On average, body image explains
10 per cent of the differences in life satisfaction of girls
and 5 per cent of the differences for boys. Yet the link
between body image and life satisfaction varies
enormously (see Figure 9). It does not impact boys in
Bulgaria, where 1 in 10 boys is overweight. It is
strongest for girls in Scotland (United Kingdom),
Finland, the Netherlands and Ireland.
Girls who are satisfied with their bodies typically come
from families and peer groups who express fewer
weight-related concerns and emphasize positive body
behaviours (such as exercising and eating well) as
opposed to negative behaviours (such as dieting).17
SECTION 2 OUTCOMES
INNOCENTI REPORT CARD 16 1 7
Many children still reach 15 years of age without having basic
reading and mathematics skills
Figure 10: Percentage of children aged 15 years with basic
proficiency in reading and mathematics
Note: The percentage of children meeting or exceeding basic proficiency in both reading and
mathematics tests, multiplied by the Coverage Index 3 of the PISA survey.
Source: Programme for International Student Assessment (PISA) 2018, except for Spain (figures for Spain
from PISA 2015, as 2018 data were unavailable).
For educational achievement, we
focus on the proportion of children
who meet basic standards of
proficiency. We also take into
account the percentage of children
who are still in school in each
country at the age of 15. For this
purpose, we use Coverage Index 3
from the PISA study, which can be
viewed as a measure of verified
enrolment.18 Our indicator is the
estimated proportion of the total
child population who are still in
school and have reached a basic
level of proficiency in both reading
and mathematics (see Figure 10). It
can be interpreted as a minimum
estimate of the level of proficiency
in the child population at 15 years
of age. Even in the best-performing
country, Estonia, more than one
in five children do not meet the
basic proficiency standard. In five
countries, less than half of children
do so.
0 10 20 30 40 50 60 70 80 90
Estimated percentage of children aged 15 years who have basic
proficiency in both reading and mathematics
Cyprus
Israel
Japan
United Kingdom
Australia
Republic of Korea
Malta
United States
Poland
Chile
Ireland
Slovenia
Bulgaria
Czechia
Denmark
Germany
Luxembourg
Greece
Sweden
Italy
Hungary
Slovakia
Austria
Latvia
Portugal
Estonia
France
Iceland
Lithuania
Spain
Canada
Norway
Belgium
Switzerland
New Zealand
Croatia
Finland
Romania
Netherlands
32
34
40
45
48
53
54
56
57
58
58
60
61
61
62
63
63
63
64
64
64
65
65
66
67
67
68
68
69
69
69
70
72
73
73
75
78
78
79
SECTION 2 OUTCOMES
1 8 INNOCENTI REPORT CARD 16
Our second indicator focuses on
social skills. We use a question
asked in the PISA study about
whether children feel that they are
able to make friends easily. We view
this indicator as tapping into the
extent to which children feel
confident in developing
interpersonal relationships. This
type of skill is likely to be beneficial
to children both in the present and
in adulthood in all aspect of their
lives. Figure 11 shows the
percentage of children who agreed
or strongly agreed that they make
friends easily. Romania ranks
highest on this indicator and is one
of seven countries where more than
four in five children felt that they
make friends easily. In two countries
– Chile and Japan – less than 70 per
cent of children felt this way.
Our analysis of this range of
important well-being outcomes
presents a challenge to
policymakers. While all countries
can feel positive about their
position in the rankings on one or
more of these key indicators, none
can feel satisfied with their position
on all six. And even in countries at
the top of the rankings, there are
still many children who are falling
behind. In subsequent sections, we
will try to understand what factors
lie behind these variations in child
well-being outcomes and therefore
what improvements can be made.
We begin by looking at factors
close to the child – their daily lives
and their closest relationships –
and then gradually move outwards,
towards the broader conditions
within societies that also have an
impact on children’s experiences
and well-being.
Many 15-year-old children do not feel confident in their skills to make friends
Figure 11: Percentage of children aged 15 years who make friends easily
Note: The percentage of children aged 15 years who agreed or strongly agreed that they make friends
easily at school.
Source: Programme for International Student Assessment (PISA) 2018, except for Cyprus (figures for
Cyprus from PISA 2015, as 2018 data were unavailable) and Israel (no data available).
0 10 20 30 40 50 60 70 80 90
Percentage of children aged 15 years who make friends easily
Turkey
Cyprus
Japan
United Kingdom
Australia
Republic of Korea
Malta
United States
Poland
Chile
Ireland
Slovenia
Bulgaria
Czechia
Denmark
Germany
Luxembourg
Greece
Sweden
Italy
Hungary
Slovakia
Austria
Latvia
Portugal
Estonia
France
Iceland
Lithuania
Spain
Canada
Norway
Belgium
Switzerland
New Zealand
Croatia
Finland
Romania
Mexico
Netherlands
72
72
72
73
73
74
74
68
69
70
70
71
71
71
71
72
74
74
75
75
75
76
76
76
77
77
77
79
79
79
79
79
79
81
81
81
81
82
82
83
SECTION 2 OUTCOMES
INNOCENTI REPORT CARD 16 1 9
THE WORLD OF THE CHILD
SECTION 3
In this section and the next, we
look at the four levels of the
framework closest to outcomes, as
they can help us to understand
why, within the same country,
some children have higher wellbeing than others.19 We start with
‘the world of the child’: the
activities in which children are
involved and their relationships with
people close to them such as
parents, peers and teachers.
Activities
Children’s activities inform us about
their daily lives. These activities
may not always be chosen by
children and may reflect the
priorities of others, for example,
their parents. Indeed, children
spend substantial amounts of time
in compulsory schooling. In 2018,
across OECD countries, the
average compulsory instruction
time per pupil in lower secondary
school ranged from 766 hours per
year in Slovenia and Sweden to
1,200 hours per year in Denmark.20
International comparative studies of
children’s daily lives outside of
school are rare. We use new data
on children’s activities in 15 rich
countries from the latest wave of
the Children’s Worlds survey.
Children were asked how often
during the last week they had done
The world of the child
The world around the child
The world at large
Outcomes
Activities
Relationships
Networks
Resources
Policies
Context
How direct experiences differentiate child
well-being within countries
SECTION 3 THE WORLD OF THE CHILD
2 0 INNOCENTI REPORT CARD 16
0 1 2 3 4 5 6 7 8 9 10
Mean happiness score (0 to 10)
Daily Rarely
Greece (Epirus)
Malta
Croatia
Italy (Liguria)
Romania
Spain (Catalonia)
Poland
Estonia
Hungary
Switzerland
Finland
Israel
UK (Wales)
Belgium (Flanders)
Norway 8.9
7.8
7.9
7.6
8.6
8.5
8.9
9.7
8.5
9.7
8.3
9.0
7.0
9.0
9.0
9.1
9.1
8.1
9.3
7.8
9.3
7.5
7.6
9.4
9.5
8.1
9.5
8.5
9.5
9.6
THE WORLD OF THE CHILD Children who play outside often are happier than children who do not
Figure 12: Mean happiness scores of children who played outside rarely
and those who did so daily
Notes: Children were asked how often they
played outside. They were also asked to rate their
happiness in the past two weeks on a scale from
0 to 10 (least to most happy). The figure
compares the mean happiness scores for children
who said that they played outside less than once
a week and those who said they did so every day.
All differences significant (p<0.01), except
Switzerland (p<0.05).
Source: Children’s Worlds survey, Wave 3,
2017–2019, children aged about 10 years.
15 different activities – for example,
helping around the home, doing
homework, using a computer and
spending time playing outside.
We were interested to see which of
these activities were linked with
children’s sense of well-being,
based on how happy they had felt
in the past two weeks. Here we
choose happiness rather than life
satisfaction as an indicator because
it is likely to be more closely
associated with factors that may
vary over time, such as activities.
The strongest link found was
between happiness and time spent
with family.21 This is consistent with
other research showing the
importance of family relationships
for children. There were also strong
links between happiness and the
frequency of playing outside.22 In
comparison, other factors such as
social media use and doing
housework were weakly, and less
often significantly, linked with
happiness. Figure 12 shows the
differences in happiness between
children who played outside rarely
and those who did so daily. These
differences are large – more than
1 point on a happiness scale of
0 to 10 (from least to most happy) –
in almost every country.
This example illustrates how
children’s activities can be linked to
their subjective experiences. Of
course, children do not necessarily
have a free choice about how they
spend their time. In line with our
framework, this will be affected by
the resources and relationships
around them. For example, how
often children play outside may
depend on parenting styles, cultural
differences, family economic
circumstances, and safety and
facilities available in their local area.
Further analysis of the Children’s
Worlds data shows that all of these
factors are indeed relevant. Children
were more likely to play outside if
their parents involved them in
making decisions about their lives, if
they lived in more affluent families
and if they lived in neighbourhoods
with good play facilities.
SECTION 3 THE WORLD OF THE CHILD
INNOCENTI REPORT CARD 16 2 1
The amount of time children spend online is increasing
rapidly. In the United States, the proportion of
adolescents who say they are connected “almost
constantly” has increased from 24 per cent to 45 per
cent in three years.23 An additional 44 per cent report
using the Internet several times a day. In 11 European
countries, the amount of time children spend online
almost doubled in less than a decade: from an hour
and a half to almost three hours daily (see Figure 13). It
is understandable that parents and educators may be
concerned about the impact of new technologies on
children’s well-being.
Spotlight 3 Screen time has a small negative influence,
and other activities matter more for well-being
Children are online almost twice as long than a decade ago
Figure 13: Average duration of Internet use in minutes per day among 9- to 16-year-olds
Notes: Values have been calculated based on questions about how long children use the Internet a) on a normal weekday, and b) on a weekend
or holiday (approximately 1,000 cases per country). Only children who actively use the Internet were asked to estimate its duration so the Minutes/day
2010 2018/19
0
50
100
150
200
250
Germany
Italy
France
Poland
Lithuania
Czechia
Estonia
Portugal
Romania
Spain
Norway
But does more screen time have a negative impact on
children’s well-being? Despite public concern about
this issue, the link appears to be weak.25 Robust
studies suggest that moderate use is key.26 In these
studies, the highest mental well-being was observed
not among those children who reported no screen
use, but among those who used screens for less than
2 hours per day.
Moderate use (between 30 minutes and 3 hours per
day, depending on device and timing) was associated
with the highest mental well-being. Children who did
increase is not fuelled by increased access to the Internet. For full reports about the surveys see Livingstone et al. (2011), and Smahel et al. (2020).24
For details of the methodology see www.eukidsonline.net.
Source: EU Kids Online.
SECTION 3 THE WORLD OF THE CHILD
2 2 INNOCENTI REPORT CARD 16
The impact of screen time is four times smaller than that of
being bullied
Figure 14: Links between eight different activities and
adolescent mental well-being
Notes: The chart shows median standardized coefficients from the specification curve
analysis based on the UK Millennium Cohort Study. The sample included 5,926 girls and
5,946 boys aged 13–15 and 10,605 primary caregivers. Technology use was measured
through five questions concerning TV use, electronic games, social media use, owning
a computer and using the Internet at home.
Source: Orben, Amy and Andrew K. Przybylski, ‘The association between adolescent
well-being and digital technology use’, Nature Human Behaviour, vol. 3, no. 2, February
2019, pp. 173–182.
-0.25 -0.20 -0.15 -0.10 -0.05 0 0.05 0.10 0.15 0.20 0.25
Effect of a given activity on adolescent well-being
Wearing glasses
Binge drinking
Technology use
Being bullied
Eating fruit
Regularly eating breakfast
Cycling
Getting enough sleep
Children’s relationships
When asked about what matters to
their well-being, children emphasize
good-quality relationships.28 Survey
findings back this up, showing that
positive relationships with family,
with peers and at school are linked
with higher well-being in one or
more dimensions.29
Family relationships
Comparative data on children’s
family relationships are scarce. The
Health Behaviour in School-aged
Children (HBSC) survey, covering
most European countries plus
Canada, asks children aged 11, 13
and 15 years four questions about
how much they feel helped and
supported by their family: whether
their family tries to help them;
whether they get the emotional
help and support they need from
their family; whether they can talk
about problems with their family;
and whether their family is willing
to help them make decisions.
We averaged the responses to
these four questions to create an
indicator of the quality of family
relationships, defining those
children who scored below the
midpoint (which means they were
more likely, on average, to disagree
than agree) as having poor-quality
relationships. Across 35 countries
and territories included in this
report, the percentage of children
who had poor-quality family
relationships ranged from 6 per
cent in Hungary, the Netherlands
and Norway to over 30 per cent
in Bulgaria.
not use technology, as well as those who were very intensive users, had
lower well-being. The impact of technology has been shown to be timespecific – stronger on school days than on weekends. This may reflect
greater pressures on children during the days when they attend school.
However, the impact of screen time should be put into perspective and
assessed against other real-world benchmarks. An analysis of data from the
United States and the United Kingdom suggests that the overall link
between technology use and adolescent mental well-being is negative but
small, explaining only 0.4 per cent of the differences in mental well-being.27
Many common activities that do not draw as much media attention – such
as eating breakfast, cycling or getting enough sleep – have a larger
association with adolescent mental well-being (see Figure 14). Among
negative factors, screen time had an association with adolescent well-being
four times less strong than that of being bullied.
SECTION 3 THE WORLD OF THE CHILD
INNOCENTI REPORT CARD 16 2 3
In all countries, children who have less supportive families tend to have
poorer emotional well-being
Figure 15: Emotional well-being of 15-year-olds according to the quality of
their family relationships
Notes: Excludes Denmark (no data), and England
(UK), Slovakia and Wales (UK) (over 10 per cent
missing data). An index was created from the
mean response to four statement-based questions:
(1) My family really tries to help me; (2) I get the
emotional help and support I need from my family;
(3) I can talk about my problems with my family;
and (4) My family is willing to help me make
decisions. Children were asked to indicate to what
extent they agreed with each statement. The
percentages are of children who scored below the
midpoint on this index – i.e., were more likely, on
average, to disagree than agree. The indicator of
emotional well-being is constructed from four
questions about how often children felt low, felt
nervous, had difficulty sleeping, and felt irritable or
in a bad temper. Children are classified as having
low emotional well-being if they had more than one
of these experiences more than once a week. All
differences are significant (p<0.01) except England
(UK), Scotland (UK) and Greenland (p<0.05).
Source: Health Behaviour in School-aged Children
(HBSC) 2017/18.
0 10 20 30 40 50 60 70 80 90 100
Percentage with high emotional well-being
Children with high family support
Germany
Netherlands
Belgium (Flemish)
Spain
Austria
Switzerland
Norway
Croatia
Luxembourg
Lithuania
Canada
Slovenia
Finland
Ireland
Portugal
Iceland
Czechia
Slovakia
UK (Wales)
Greenland
Estonia
Latvia
Hungary
France
UK (England)
Belgium (French)
UK (Scotland)
Sweden
Malta
Romania
Poland
Israel
Greece
Italy
Bulgaria
Children with low family support
Figure 15 shows the link between
the quality of family relationships
and children’s emotional well-being.
Emotional well-being is measured
by four questions about the
frequency of children feeling low;
feeling irritable or in a bad temper;
feeling nervous; and having difficulty
sleeping. In all countries, children
who reported having supportive
family relationships were also
more likely to have good emotional
well-being. The link between
supportive family relationships and
emotional well-being was much
stronger in some countries, like
Luxembourg and Portugal, than in
others such as Iceland and Scotland
(United Kingdom).
Peer relationships
Peer relationships become
increasingly important for children’s
well-being as they grow up.30 There
is no good indicator of the overall
quality of peer relationships for all
41 countries. This is another major
evidence gap. The PISA study does,
however, contain information on
children’s experiences of being
bullied at school. Being bullied is
associated with children’s
subjective well-being, particularly in
certain European countries.31
SECTION 3 THE WORLD OF THE CHILD
2 4 INNOCENTI REPORT CARD 16
Frequently bullied children are less satisfied with life
Figure 16: Bullying frequency and life satisfaction of 15-year-olds
Note: Frequently bullied means that a child had
experienced at least one of six forms of bullying
at least a few times a month, based on the
question ‘During the past 12 months, how often
have you had the following experiences in
school?’, with the possible experiences listed as:
‘Other students left me out of things on purpose’;
‘Other students made fun of me’; ‘I was
threatened by other students’; ‘Other students
took away or destroyed things that belonged to
me’; ‘I got hit or pushed around by other
students’; and ‘Other students spread nasty
rumours about me’. Excludes Cyprus (data not
available) and Australia, Belgium, Canada,
Denmark, Israel, New Zealand and Norway
(question on life satisfaction not asked). All
differences are significant (p<0.01).
Source: Programme for International Student
Assessment (PISA) 2018.
0 10 20 30 40 50 60 70 80 90 100
Percentage with high life satisfaction
Netherlands
Mexico
Romania
Finland
Iceland
Switzerland
Croatia
Spain
Lithuania
France
Latvia
Estonia
Portugal
Austria
Luxembourg
Hungary
Slovakia
Sweden
Greece
Italy
Czechia
Germany
Chile
United States
Ireland
Bulgaria
Poland
Slovenia
Malta
United Kingdom
Republic of Korea
Japan
Turkey
Frequently bullied Not frequently bullied
As we showed in Report Card 15, it
is also linked to lower educational
performance in most countries.32
Studies primarily from the United
States and the United Kingdom have
shown that being bullied has a
lasting negative impact even up to
the age of 50, both on a person’s
social relationships and on their
mental and physical health.33
Figure 16 shows the relationship at
15 years of age between frequent
bullying – defined as experiencing
at least one of six forms of bullying
at school at least a few times a
month34 – and life satisfaction. In all
countries, children who had been
bullied frequently had lower mean
life satisfaction scores than children
who had not. The gap in life
satisfaction between those who
had and had not been bullied often
was much bigger in some
countries, like the United States and
the United Kingdom, than in others
such as Bulgaria and Lithuania.
SECTION 3 THE WORLD OF THE CHILD
INNOCENTI REPORT CARD 16 2 5
Children with a stronger sense of school belonging do better at school and have higher life satisfaction
Figure 17: Differences in academic proficiency and in life satisfaction for 15-year-olds with a high and low sense
of belonging to school
Note: Excludes Cyprus (data not available) and Mexico and Turkey (more than 20 per cent of children aged 15 years not included in the survey). Data on reading
scores not available for Spain. Question on sense of belonging not asked in Israel. Question on life satisfaction not asked in Australia, Belgium, Canada, Denmark,
Israel, New Zealand and Norway. All proficiency differences are significant (p<0.01), except Bulgaria (ns). All life satisfaction differences are significant (p<0.01).
Source: Programme for International Student Assessment (PISA) 2018.
0 10 20 30 40 50 60 70 80 90 100
Percentage with proficiency in mathematics and reading
0 10 20 30 40 50 60 70 80 90 100
Percentage with high life satisfaction
Romania
Chile
Bulgaria
Greece
Croatia
Malta
Slovakia
Luxembourg
Hungary
Italy
Lithuania
United States
Portugal
Iceland
Latvia
Switzerland
Czechia
Austria
Spain
France
United Kingdom
Slovenia
Sweden
Germany
Poland
Japan
Netherlands
Finland
Republic of Korea
Ireland
Estonia
Japan
Republic of Korea
United Kingdom
Malta
Bulgaria
Chile
Slovenia
Germany
Poland
Czechia
United States
Greece
Slovakia
Ireland
Luxembourg
Austria
Hungary
Italy
Lithuania
Sweden
Portugal
Estonia
Spain
Latvia
France
Switzerland
Croatia
Iceland
Romania
Finland
Netherlands
Low belonging High belonging Low belonging High belonging
Connections with school
Children who have a strong sense of
belonging to school tend to have
higher academic achievement. As
school is such a major part of most
children’s lives, it is reasonable to
suppose that aspects such as
school belonging also contribute to
life satisfaction. Indeed, the PISA
study shows that, in most countries,
school belonging is positively
associated with academic
achievement and with life
satisfaction. Figure 17 shows the
differences in proficiency in reading
and mathematics and the
differences in life satisfaction
between 15-year-olds who agreed
and did not agree with the
statement ‘I feel like I belong at
school’ across 33 rich countries. In
all but one country, more of those
children with a greater sense of
belonging to school tended to have
reached the basic level of
proficiency in reading and
mathematics. This pattern was
particularly strong in the Republic of
Korea. The only exception to the
general pattern was Romania, where
more children with a lower sense of
belonging had met the basic
proficiency standard. In all countries
for which data are available, more
children with a higher sense of
school belonging tended also to
report high life satisfaction, although
the difference was small in
Lithuania. In general, school
belonging appeared to be more
strongly linked with life satisfaction
than with academic proficiency.
SECTION 3 THE WORLD OF THE CHILD
2 6 INNOCENTI REPORT CARD 16
It is important that children have the opportunity to
express their views and are involved in decisionmaking. This is enshrined in Article 12 of the United
Nations Convention on the Rights of the Child. Such
opportunities are vital for children’s well-being in the
present and for their development towards adulthood.
As children grow up, parents and other adults need to
adjust the balance between protecting children and
enabling them to have appropriate levels of autonomy.
Children’s perceived satisfaction with their freedom
contributes independently to their subjective wellbeing, after taking account of their feelings of safety.35
Participation is one of the three Ps of the Convention
on the Rights of the Child, along with protection and
provision. Yet, international monitoring of
opportunities for participation is scarce compared
with monitoring in relation to the other two themes.
Only some countries have data on this topic. In these
countries, children’s sense that their voices are being
heard varies widely. The proportion of children who
totally agree that their parents involve them in
decisions at home ranges from under half in regions
of Belgium and Italy, and in Switzerland, to two thirds
in Romania. In Italy (Liguria) and the Republic of
Korea, fewer than two in five children totally agree
that they are involved in decision-making at school,
compared with at least half of children in six other
countries or territories.
Spotlight 4 Protection and provision do not
suffice – children also need participation
Note: Responses of 10-year-olds to closed questions with five responses to choose from: ‘I do not agree’; ‘I agree a little bit’; ‘I agree
somewhat’; ‘I agree a lot’; and ‘I totally agree’. Chart shows proportion who responded to each question, ‘I totally agree’.
Source: Children’s Worlds, 2017–2019.
0 20 40 60 80
Percentage of children who totally agreed
Involved in decisions at home
Romania
Estonia
Norway
Poland
Israel
Malta
Croatia
UK (Wales)
Finland
Hungary
Republic of Korea
Greece (Epirus)
Spain (Catalonia)
Switzerland
Italy (Liguria)
Belgium (Flanders)
0 20 40 60 80
Percentage of children who totally agreed
Involved in decisions at school
Romania
Estonia
Norway
Poland
Israel
Malta
Croatia
UK (Wales)
Finland
Hungary
Republic of Korea
Greece (Epirus)
Spain (Catalonia)
Switzerland
Italy (Liguria)
Belgium (Flanders)
46 38
39
41
41
41
42
44
45
47
49
51
52
53
56
57
58
47
48
50
50
51
53
57
58
59
62
64
65
65
66
67
Many children do not feel consulted about decisions at home and at school
Figure 18: Percentage of children who participate in decisions at home and at school
SECTION 3 THE WORLD OF THE CHILD
INNOCENTI REPORT CARD 16 2 7
THE WORLD AROUND THE CHILD
SECTION 4
In this section, we look at ‘the
world around the child’: a range
of factors within the child’s
environment that can trickle down
to influence their well-being. These
include the networks of the adults
closest to the child, household
resources and the quality of the
local neighbourhood.
Networks around the child
The networks of relations around
children affect their well-being even
though they do not always
experience them directly. In
contrast to the relationships
described in section 3, which
referred only to relations involving
the child, networks refer to
connections established by the
adults closest to the child –
especially by the parents. They
include: the family support
network, and parents’ relationships
with work and with their child’s
school. Unfortunately, we are
unable to link these connections
with data on child well-being
outcomes as information on
networks is not available within the
same international surveys.
Support for parents
Families that lack social support
networks may find it more difficult
to cope with adversity. This can
negatively affect children’s wellThe world of the child
The world around the child
The world at large
Outcomes
Activities
Relationships
Networks
Resources
Policies
Context
How do immediate surroundings differentiate
child well-being within countries
SECTION 4 THE WORLD AROUND THE CHILD
2 8 INNOCENTI REPORT CARD 16
THE WORLD AROUND THE CHILD
being. That is why the presence of
informal support for families through
social networks is often seen as a
protective factor for children’s
healthy development.36
Figure 19 shows the proportion of
parents who say that they would be
able to seek support from a family
member, friend or service provider
if they needed help to look after
their children. The chart is ranked
by the proportion of parents who
said that they would be able to
seek support from either a family
member or a friend. Only a small
proportion of parents said they
would be unable to seek help from
either of these sources. This ranges
from less than 1 in every 100
parents in Poland, Bulgaria, Greece,
Slovenia and Lithuania to more than
10 in every 100 parents in
Luxembourg and Belgium.
Note: Data were only available for the 27 EU countries, plus Turkey and the United Kingdom. Original question: ‘From whom would you get support if you needed
help in looking after your children? Choose the most important source.’ Ranked by the proportion of parents who said they could count on help from either a
family member or a friend.
Source: European Quality of Life Survey (EQLS) 2016.
Family Friends Service Nobody
Slovenia
Poland
Lithuania
Greece
Bulgaria
Cyprus
Austria
Sweden
Slovakia
Ireland
Hungary
Finland
Estonia
Czechia
Portugal
Spain
Latvia
Denmark
United Kingdom
Italy
Germany
Turkey
Romania
Netherlands
Malta
Croatia
France
Belgium
Luxembourg
0 10 20 30 40 50 60 70 80 90 100
Who can parents count on if they need help to look after their children?
Figure 19: Percentage of parents able to seek support from a family member, friend or service provider
SECTION 4 THE WORLD AROUND THE CHILD
INNOCENTI REPORT CARD 16 2 9
Work pressure on parents
Although not working due to
involuntary unemployment is
economically and socially corrosive,
overworking is not conducive to
well-being either. It can damage the
individual and their relationships
with people around them. A culture
of regularly working overtime leads
to expectations that all employees
(whether parents or not) will
prioritize work. Long hours and
work-related stress can reduce the
time and energy parents have to
interact with their children. And,
indeed, it is in those countries with
long working hours that more
employees find it difficult to fulfil
Inability to fulfil family responsibilities relates to long working hours
Figure 20: Percentage of employees struggling to balance work and family, and average working
hours in European countries Percentage struggling to fulfil family responsibilities (2016)
20
30
40
50
60
70
Average weekly hours worked in main job (2016)
30 35 40 45 50
R=0.84
TR
CZ
GR PL
HU
LV
SI
LT
EE
PT
LU SK
UK
ES BE
IT FR
AT
DE
IE FI
SE
DK
NL
Note: ‘Average weekly hours worked in main job’ includes any paid or unpaid overtime. ‘Percentage struggling to fulfil family responsibilities’ refers to the
percentage of employees who have chosen the option ‘At least several times a month’ under ‘It has been difficult to fulfil family responsibilities because of time
spent on job’. Work–family balance data only available for the 27 EU countries, plus Turkey and the United Kingdom. Data on long working hours unavailable for
Bulgaria, Croatia, Cyprus, Malta and Romania.
Source: Data on work–family balance: European Quality of Life Survey (EQLS) 2016. Data on long working hours: OECD (2017) based on Labour Market Statistics,
2016 or latest available year.
SECTION 4 THE WORLD AROUND THE CHILD
3 0 INNOCENTI REPORT CARD 16
family responsibilities because of
time spent at work (see Figure 20).
On average across the 24 countries
in this figure, 39 per cent of
employees found it difficult to fulfil
family responsibilities at least several
times per month. The proportion of
employees who struggle to balance
work and family varies across
countries, ranging from one quarter
of respondents in Denmark to more
than two thirds of those in Turkey.
The relationship between parents
and schools
Parents’ relationships with their
child’s school is another important
aspect of the Networks around
the child.
Figure 21 shows a rating on a scale
from 1 to 10 (from least to most
satisfied) that averaged the answers
to three questions about whether
parents feel that education
professionals consult them, are
attentive and treat all people equally.
Satisfaction with these relationships
ranges from 6.8 in Turkey to 8.3 in
Bulgaria, Ireland and Malta.
Resources available to children
A good childhood requires
sufficient resources to support the
child both within the household and
within the neighbourhood.
Household resources
The material resources available to
children in their homes can affect
various aspects of their well-being,
including their cognitive
development, physical health and
subjective well-being. Household
resources can mean resources
individual to the child. For example,
does the child have a computer?
Does the child have her/his own
bedroom? Or the term can refer
more broadly to resources for the
entire family. Does the family own
Note: Data only available for the 27 EU countries, plus Turkey and the United Kingdom. The chart presents
an average of parents’ answers to three questions about satisfaction with: (1) personal attention given by
education professionals; (2) being informed or consulted about their child’s education; and (3) all people
being treated equally by education services in the area.
Source: European Quality of Life Survey (EQLS) 2016.
1 2 3 4 5 6 7 8 9 10
Parents’ rating of relationship with school staff (1–10)
Bulgaria
Malta
Ireland
Finland
Denmark
Estonia
Lithuania
Poland
Hungary
Slovenia
Sweden
United Kingdom
Latvia
Germany
Croatia
Spain
Austria
Netherlands
Romania
Luxembourg
Slovakia
Czechia
France
Belgium
Portugal
Cyprus
Greece
Italy
Turkey 6.8
7.0
7.2
7.2
7.3
7.4
7.4
7.5
7.5
7.6
7.6
7.6
7.6
7.6
7.6
7.7
7.7
7.7
7.8
7.8
7.9
8.1
8.1
8.1
8.2
8.2
8.3
8.3
8.3
Parents’ rating of their relationships with their child’s school in
European countries
Figure 21: What do parents think about their relationship with the staff
at their child’s school?
a car? Can the family afford to take
holidays? A lack of resources can
affect children through various
routes. For example, research
indicates that low family affluence
is linked to higher rates of
overweight and obesity through a
variety of mechanisms, including
access to different types of food
and patterns of physical activity.37
SECTION 4 THE WORLD AROUND THE CHILD
INNOCENTI REPORT CARD 16 3 1
A lack of resources can also be a
barrier to academic achievement.
As an example, Figure 22 shows the
proportion of children with basic
proficiency in reading and
mathematics at age 15 for two
groups – those who had books at
home to help with schoolwork and
those who did not. The proficiency
gap between the groups is quite
substantial in most countries.
Neighbourhoods
From a child’s viewpoint, the
environment starts in the child’s
neighbourhood, particularly in those
places in which they spend time
and play. There are scarce
comparative data on this topic
drawn from children themselves,
but the Children’s Worlds survey
gathers children’s views on their
neighbourhoods for a selection of
countries. The proportion of
children who totally agreed that
they have local places to play
ranged from one third in the
Republic of Korea to two thirds in
Estonia and Switzerland.
Figure 23 shows that children who
live in neighbourhoods with places
to play tend to be happier than
those who do not. In Estonia and
Switzerland, 7 in 10 children totally
agreed when asked whether their
neighbourhood had enough places
to play. In the Republic of Korea,
only one third of children did so.
Asked about their happiness, these
same children expressed greater
happiness than those who had said
that their neighbourhood lacked
such amenities. The difference in
mean happiness scores between
the two groups was more than one
point (on an 11-point scale) in the
Republic of Korea and Israel.
Children living in households without educational books
have lower levels of academic proficiency
Figure 22: Percentage of 15-year-olds who have reached basic
proficiency in reading and mathematics, according to whether
or not there were books at home to help with schoolwork
Notes: Children were asked whether or not there were books at home to help with schoolwork. The
measure of academic proficiency is the one introduced in section 3 (see Figure 10). All differences
between the two groups were significant at p<0.01 except Israel, significant at p<0.05.
Source: Programme for International Student Assessment (PISA) 2018.
0 10 20 30 40 50 60 70 80 90 100
Percentage proficient in reading and mathematics
Chile
Romania
Bulgaria
Greece
Israel
Malta
Croatia
Luxembourg
Slovakia
Iceland
Italy
Lithuania
United States
Austria
Portugal
Hungary
Latvia
Australia
New Zealand
United Kingdom
Sweden
Switzerland
Czechia
Norway
Belgium
France
Germany
Slovenia
Denmark
Poland
Canada
Republic of Korea
Netherlands
Japan
Ireland
Finland
Estonia
No educational books at home Educational books at home
SECTION 4 THE WORLD AROUND THE CHILD
3 2 INNOCENTI REPORT CARD 16
Children who live in neighbourhoods with enough places to play are happier
Figure 23: The extent to which children agreed that they have enough places to play in their
neighbourhood, and mean levels of happiness for children who totally agreed and for those who did not
Notes: Data relate to children aged 10 years. The first chart shows responses to the statement ‘In my area, there are enough places to play or have a good time’.
The second chart compares mean scores for happiness in the last two weeks for children who totally agreed with the statement about having enough places to
play and those who did not. All differences significant at 99% level.
Source: Children’s Worlds survey, Wave 3, 2017–2019.
100 90 80 70 60 50 40 30 20 10 0 0 1 2 3 4 5 6 7 8 9 10
Percentage of children who totally agreed
Are there enough places to play?
Mean happiness (0 to 10)
Happiness
Totally agree Did not totally agree
Republic of Korea
Romania
Malta
Italy (Liguria)
UK (Wales)
Norway
Germany
Finland
Belgium (Flanders)
Spain (Catalonia)
Greece (Epirus)
Israel
Poland
Hungary
Croatia
Switzerland
Estonia
34 9.4
9.6
9.5
9.4
9.1
9.0
8.0
8.1
9.0
9.0
9.4
9.6
9.0
9.0
9.1
9.2
9.5
9.0
9.2
8.3
8.2
9.0
8.6
8.5
7.9
8.9
8.9
8.0
8.3
8.8
8.3
9.0
8.2
9.1 36
40
42
50
53
53
57
57
58
60
61
63
65
65
70
70
SECTION 4 THE WORLD AROUND THE CHILD
INNOCENTI REPORT CARD 16 3 3
THE WORLD AT LARGE
SECTION 5
The world of the child and the
world around the child allowed us
to see how well-being varies
between children within the same
country. Yet, children’s experience
of childhood does not exist in a
social vacuum – it is rooted in the
society in which they live.
Therefore, we now broaden our
focus to the world at large,
understood as ‘national conditions
that support child well-being’ – the
outermost levels of our framework
– to see why some countries have
higher child well-being than others.
In the next circle outwards (Policies),
we look at the results of a country’s
social, education and health policies
in providing services to children. In
the outermost circle (Context), we
focus on general quality of life issues
such as air quality and levels of social
support. Comparing policies and
context between countries is
fundamental to understanding why
their child well-being outcomes differ.
Policies
The penultimate circle (Policies),
refers to benefits and services
delivered to children and their
families that can influence current
and future child well-being. We
focus on three policy areas – social,
education and health policy – which
are interrelated and may influence
The world of the child
The world around the child
The world at large
Outcomes
Activities
Relationships
Networks
Resources
Policies
Context
Why do some countries have higher child
well-being than others?
SECTION 5 THE WORLD AT LARGE
3 4 INNOCENTI REPORT CARD 16
THE WORLD AT LARGE
one another. For example, while
low birthweight is treated as an
indicator of health policy, it is also
influenced by policies aimed at
tackling poverty.
Social policies
Governments can use social policy
to support children’s well-being.
One way that they can do this is
through family policies that help
parents to raise their children. Here
we look at one such policy, parental
leave. We also look at the rate of
relative child poverty, which reflects
social policy in terms of the
distribution of income among
families with children after taxes
and government transfers.
Parental leave
Family policies matter for ethical,
social, medical, educational,
economic and demographic
reasons. Maternity leave facilitates
bonding between the child and
mother. It also allows women to
prepare for childbirth and to
recover from pregnancy and it
facilitates breastfeeding. A period
of well-paid, job-protected leave
from work helps eligible employees
to maintain their income and their
attachment to the labour market.
Yet, leave entitlements that are
inflexible, underpaid or have a
gender imbalance can have a
negative effect on the work
prospects of women and, to a
lesser extent, men.38
If taken, leave reserved for fathers
gives children access to both
parents, which is one of their rights
under the Convention on the Rights
of the Child, and supports child–
father bonding. It also promotes
family stability, as men who take
parental leave are more likely to
remain engaged fathers many years
after the leave is over.39
Early adopters of new paternity
leave entitlements can face
professional and cultural barriers
that prevent them from staying
with their child.40 To encourage
uptake, 35 out of the 41 countries
included in this report have
introduced leave reserved for
fathers on a ‘use-it-or-lose-it’ basis.
For example, Iceland has rewritten
its family law to reflect the child’s
right to access both parents –
starting with each of them taking at
least three months of leave during
the period when the child is an
infant.41 Figure 24 shows statutory
parental leave entitlements in terms
of the equivalent number of weeks
of pay at the full rate. There is wide
variation across the countries,
Leave reserved for fathers makes up one tenth of parental leave in rich countries
Figure 24: Weeks of leave available to mothers and reserved for fathers in 2018, in full rate equivalent
Note: The medium blue bar (leave available to mothers) shows a combination of maternity leave and paid parental leave that can be used by the mother and is not
reserved for the father. The dark blue bar shows the leave reserved for fathers on a ‘use-it-or-lose-it’ basis. Number of weeks of maternal and paternal leave each refer
to the full-rate equivalent. For example, if a mother is entitled to 20 weeks of maternity leave at 50 per cent of her usual salary, her full-rate equivalent leave is 10 weeks.
Source: Organisation for Economic Co-operation and Development (OECD) Family Database. Weeks of full pay equivalent
Leave available to mothers Leave reserved for fathers
0
10
20
30
40
50
60
70
80
90
100
United States
Switzerland
New Zealand
Australia
Turkey
United Kingdom
Mexico
Israel
Cyprus
Hungary
Czechia
Belgium
Latvia
Austria
Luxembourg
Greece
Germany
Estonia
Poland
Iceland
Malta
Canada
Italy
Finland
Croatia
France
Ireland
Denmark
Chile
Sweden
Netherlands
Romania
Bulgaria
Lithuania
Japan
Slovakia
Norway
Slovenia
Portugal
Republic of Korea
Spain
97.1
86.4
71.7
69.2
66.1
66.0
55.9
53.1
52.8
52.4
52.3
48.3
47.5
46.0
45.4
45.3
44.6
43.6
40.6
32.9
31.0
27.6
26.6
26.6
26.0
23.4
21.7
20.3
18.0
16.4
15.7
15.0
15.0
13.0
12.1
11.7
8.6
8.4
8.2
7.5
0
Average: 36 weeks of full pay
United States
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 3 5
ranging from no statutory leave in
the United States to more than one
year of leave in several countries.
On average, only 10 per cent of the
total duration of leave is reserved
for fathers.
In many of the countries we cover
in this report, family formations are
becoming increasingly diverse. This
diversity often includes increasing
proportions of lone-parent families,
stepfamilies and two-household
families, where children alternate
their time between the homes of
both parents; a higher incidence of
one or both parents spending
lengthy periods of time working
abroad; and new rights for samesex partnerships. These
developments are gradually being
reflected in family policies. For
instance, in 2019, Canada and
Spain introduced parental leave for
both parents of same-sex couples.42
Child poverty
Children often pay a high price for
growing up in poverty. Children in
poorer families tend to have worse
cognitive and socio-emotional
development, and worse health as
adults.43 Relative child poverty is
defined here as children who live in
households which, taking account
In almost half of rich countries, more than one in five children lives in poverty
Figure 25: Percentage of children living in households with income below 60 per
cent of the national median income in 2008, 2014 and 2018
Notes: Percentage of children living in households with post-tax, post-transfer income – adjusted for family size and composition – below 60 per cent of the
national median income. Equivalence scale: first adult in a household counted as 1; each other household member aged 14 years or above counts as 0.5 person;
each household member aged 13 years or below counts as 0.3 person. Data for 2018 except for Canada, Chile, New Zealand, Turkey (2017); Australia, Iceland,
Israel, United States (2016); and Japan (2015).
Source: EU Statistics on Income and Living Conditions, HILDA wave 17 (Australia), ENIGH, Household Economic Survey (New Zealand) estimates taken from
Perry, B (2017), Canadian Income Survey (estimates from L. Wollf and D. Fox), Survey of Living Conditions (Japan) estimates taken from A. Abe, Luxembourg
Income Study (Chile, Israel, Mexico, United States), combined data of Household Income and Expenditure Survey and Farm Household Economy Survey (Republic
of Korea), courtesy of Statistics Korea and the Korean Committee for UNICEF. Percentage of children in poverty
0
5
10
15
20
25
30
35
40
United States
Switzerland
New Zealand
Australia
Turkey
United Kingdom
Mexico
Israel
Cyprus
Czechia
Hungary
Belgium
Latvia
Austria
Luxembourg
Greece
Germany
Estonia
Iceland
Poland
Malta
Canada
Italy
Finland
Ireland
Croatia
France
Denmark
Chile
Sweden
Netherlands
Lithuania
Bulgaria
Romania
Japan
Slovenia
Norway
Portugal
Slovakia
Republic of Korea
Spain
2018 (or latest available) 2014 2008
10.4
11.0
11.0
11.1
11.5
11.7
13.0
13.1
13.2
13.8
14.5
15.2
15.8
17.3
17.5
17.5
18.8
19.0
19.0
19.2
19.3
19.7
19.9
20.5
20.6
21.0
21.4
22.7
22.7
23.9
24.1
24.4
26.2
26.6
26.8
27.2
27.6
30.0
32.0
32.0
33.0
Average: 20%
SECTION 5 THE WORLD AT LARGE
3 6 INNOCENTI REPORT CARD 16
of household size and composition,
fall below 60 per cent of the
national median per capita income.
This measure shows how effective
a national system of taxes and
transfers is in preventing families
with children from falling into
poverty. In this sense, we treat
national child poverty as an
outcome of multiple social policies.
In 2018, the average relative child
poverty rate across the 41 countries
was 20 per cent. This rate ranged
by country from 10 per cent in
Iceland to 33 per cent in Turkey
(see Figure 25). Yet, as we will
show in the economic context
subsection, the countries with the
lowest relative child poverty
(Iceland, Czechia and Denmark)
only partially overlap with the
countries with the lowest income
inequality (Slovakia, Slovenia and
Czechia) (see Figure 35). This is
partly due to different demographic
structures as well as higher
spending on families with children
in Nordic countries in comparison
with the post-communist countries
(see Figure 26). However, it is not
only a matter of how much is
spent, but also how it is spent.
Tax breaks run the risk of favouring
more middle-class and affluent
families. Conversely, high-quality
public services, if sufficiently
accessible and affordable, can
support all children and their
families.
On average, rich countries spend 2.4 per cent of gross domestic product (GDP) on families –
services account for half of this sum
Figure 26: Public spending on cash transfers, services and tax breaks for families in 2015
Source: Organisation for Economic Co-operation and Development (OECD) Social Expenditure Database, 2015. Percentage of GDP
Cash Services Tax breaks
0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
United States
Switzerland
New Zealand
Australia
Turkey
United Kingdom
Mexico
Israel
Hungary
Belgium
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Estonia
Iceland
Poland
Canada
Italy
France
Finland
Ireland
Denmark
Chile
Sweden
Netherlands
Lithuania
Japan
Norway
Slovakia
Slovenia
Portugal
Republic of Korea
Spain
Average: 2.4% GDP
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 3 7
Poverty is not just a monetary circumstance. It spills
over into other aspects of children’s lives. We looked
at its consequences for depression, obesity and
vocabulary, corresponding to the mental well-being,
physical health and skills dimensions at the heart of
the well-being framework (see Box 1). We used data
from a UK study that followed thousands of children
born in the early 2000s for almost two decades.
We divided households with children into five income
groups. At 14 years of age, children in the poorest
group were 2.6 times more likely to have a poor
vocabulary and 1.8 times more likely to be obese than
children in the richest group. The link between
income and depression was less clear.
To learn whether these patterns change with time, we
grouped 14-year-old children into categories according
to how often they had been in poverty at six points in
time during their childhood (at the age of 9 months
and then at 3, 5, 7, 11 and 14 years of age). Children
who had lived in more persistent poverty had poorer
vocabulary skills (see Figure 27). The effect was
cumulative: the more often children had experienced
poverty, the more likely they were to have a poor
vocabulary. This probably reflects the fact that new
skills build on existing skills. Children who had
experienced poverty were also significantly more likely
to be obese and slightly more likely to be depressed
at 14 years of age. Yet, in the latter case, we found
less evidence of a cumulative effect of poverty.
Spotlight 5 Poor children in the United Kingdom
are more likely to be obese and have low skills
Notes: Children aged 14 years in the United Kingdom. The word score is based on a 20-item test of word recognition. Obesity is defined as
a BMI above 30. Depression is defined as a score of 12 or more using the 13-item Moods and Feelings Questionnaire. The analysis takes
account of survey design and weightings. The values shown in the charts are marginal effects after controlling for age (tenths of a year),
gender and ethnic group. Poverty is defined as having an equivalized household income below 60 per cent of the national median income.
Source: Millennium Cohort Study, United Kingdom, 2000–2016.
Persistent poverty impedes children’s development
Figure 27: History of household income poverty and three child outcomes at
14 years of age in the United Kingdom: vocabulary, obesity and depression Percentage of children aged 14 years
None Once 2 to 4 times 5 or 6 times
0
30
25
20
15
10
5
Number of points in time between infancy and age 14 years when a child lived in poverty
Low word score Obese Depressed
10.0
14.4
15.2
22.2
15.7
19.6
23.2
23.5
13.0
14.4
20.4
19.2
SECTION 5 THE WORLD AT LARGE
3 8 INNOCENTI REPORT CARD 16
Education policies
Preschool participation
Public provision of high-quality
childcare helps to reduce socioeconomic disadvantage before
children start formal schooling.44
It can also provide a stimulating
social and learning environment.
Ensuring that all children have
access to organized learning at
least one year before starting
school is one of the Sustainable
Development Goals. Figure 28
shows that in 17 countries more
than 5 per cent of children are not
in preschool. In three countries, the
figure is more than 15 per cent:
Romania (17 per cent), Slovakia (18
per cent) and Turkey (32 per cent).
Enrolment rates are substantially
lower for younger children. Across
Europe (the 27 EU countries, plus
Iceland, Norway, Switzerland and
the United Kingdom), 15 per cent
of parents with children under 3
years of age would like to use day
care but cannot do so. The main
obstacles include affordability and
availability of places. However,
rates of participation and unmet
childcare needs do not necessarily
go together. In Denmark, where
Notes: Data for the blue bars are from 2017 or the latest year available (2016 for Bulgaria, Canada, Croatia, Malta, Romania, United States; 2015 for Cyprus; 2013
for Japan – figure from Report Card 15). Percentage of children with experience of organized learning one year before starting school is an official Sustainable
Development Goal indicator.
Source: United Nations Educational, Scientific and Cultural Organization (UNESCO). Data for New Zealand from United Nations Statistics Division. Percentage of children one year before school
0
10
20
30
40
50
60
70
80
90
100
United States
Switzerland
New Zealand
Australia
Turkey
United Kingdom
Mexico
Israel
Cyprus
Belgium
Czechia
Hungary
Latvia
Austria
Luxembourg
Greece
Germany
Estonia
Poland
Iceland
Malta
Canada
Italy
Ireland
France
Finland
Croatia
Denmark
Chile
Sweden
Netherlands
Lithuania
Bulgaria
Romania
Japan
Portugal
Norway
Slovenia
Slovakia
Republic of Korea
Spain
2017 (or latest available) 2010
100
99.9
99.9
99.9
99.9
99.8
99.7
99.4
99.3
99.3
99.1
99.1
99.1
99.0
98.8
98.4
98.2
98.1
97.0
96.2
96.2
95.9
95.4
95.4
94.6
94.2
94.1
93.9
93.7
93.6
93.2
93.2
92.7
91.2
91.1
89.4
87.1
86.4
83.4
82.3
67.6
Average: 94.7%
What percentage of children have experienced organized learning before starting school?
Figure 28: Children with experience of organized learning one year before starting school
70 per cent of children under
3 years of age use organized
childcare, 6 per cent of parents said
that they have unmet childcare
needs. This is almost the same
percentage as in Czechia, where
only 5 per cent of children attend
organized childcare. Across the
European countries, about one half
of parents of children under 4 years
of age declared no need for
childcare. This reflects, in part,
cultural differences in childcare
styles and preferences.
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 3 9
Percentage of parents
0
5
10
15
20
25
30
35
Switzerland
United Kingdom
Cyprus
Hungary
Czechia
Belgium
Latvia
Austria
Luxembourg
Greece
Germany
Estonia
Poland
Italy
Croatia
Finland
France
Ireland
Denmark
Sweden
Netherlands
Bulgaria
Lithuania
Portugal
Romania
Slovenia
Norway
Slovakia
Spain
10.7
10.7
10.8
10.9
11.3
11.3
12.9
13.1
14.7
15.2
15.3
15.9
16.8
16.9
17.4
2.0
4.6
5.9
6.5
8.2
8.8
9.1
20.2
20.9
21.9
22.6
24.3
28.5
33.0
Average: 14.5%
In 22 European countries, more than 1 in 10 parents has an unmet childcare need
Figure 29: Unmet needs among parents of children under 3 years of age in European countries
Notes: An ‘unmet need’ for childcare is assessed based on the question ‘Would you like to make (more) use of childcare centres?’. No unmet needs data for Iceland
and Malta.
Source: EU Statistics on Income and Living Conditions (EU-SILC) survey 2016 (for Switzerland, the latest available data were from 2014).
Notes: Satisfaction with childcare (scale from 0 to 10, from least to most satisfied) asked only to parents of a child below 12 years of age who had received formal
childcare in the past 12 months. Data on child enrolment are Eurostat estimates based on information from the EU Statistics on Income and Living Conditions
(EU-SILC) survey. No data on child enrolment for Turkey. Data for Iceland are from 2015.
Source: European Quality of Life Survey (EQLS) 2016; Eurostat, ‘Children in Formal Childcare or Education by Age Group and Duration – % over the Population of
Each Age Group – EU-SILC Survey’, <https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=ilc_caindformal&lang=en>, accessed 24 February 2020.
Countries with high childcare satisfaction have high enrolment and affordable prices
Figure 30: Satisfaction with childcare mapped against enrolment and affordability Satisfaction with childcare
9
8
7
6
5
4
Percentage of children aged 0–3 years in preschool
0 10 20 30 40 50 60 70 80
Satisfaction with childcare
9
8
7
6
5
4
Percentage of parents struggling with childcare costs
0 10 20 30 40 50 60 70 80
R=0.39
R=-0.56
GR GR
SK SK
PL PL
CZ CZ
RO RO
HR HR
LT LT
HU HU
AT AT
FI FI
EE EE
MT MT
LU SE SE LU
DE DE SI SI
DK DK
NL NL
BE BE
ES ES FR FR
PT PT
IT IT IE IE
GB GB CY LV LV CY
BG BG TR
SECTION 5 THE WORLD AT LARGE
4 0 INNOCENTI REPORT CARD 16
At the country level, the preschool
participation rate is positively
correlated with service satisfaction
(see Figure 30). This may reflect the
fact that parents are more likely to
use preschool if they have a good
opinion of the service. High cost
may be a deterrent. On average,
across the 29 European countries
(the 27 EU countries, plus Turkey
and the United Kingdom), 40 per
cent of parents who had used
preschool had found it difficult to
cover its cost. Between countries,
the proportion of parents who had
struggled to pay childcare costs
ranges from 3 per cent in Sweden
to 78 per cent in Turkey.
Young people not in education,
employment or training
Young people who are disengaged
from both education and the labour
market may face a more difficult
start to adult life. One of the
indicators used to monitor this
issue is the proportion of young
people aged 15–19 years who are
not in education, employment or
training (NEET). Between 2010 and
2018, the NEET rate improved in
30 out of 37 countries – largely
reflecting the subsiding effects of
the 2008 economic crisis. However,
in Turkey, Mexico, Bulgaria, Chile
and Italy, more than 1 in 10 young
people are still receiving neither an
education nor work experience.
Health policies
Vaccines
Some achievements in child health
can lead to complacency. One
example is the herd immunity to
measles established by high
immunization coverage. In some
regions where measles epidemics
had been consigned to the past,
immunization rates have dropped,
putting children once again at risk.
In recent years, some of the
world’s richest countries, including
Czechia, Greece and the United
Kingdom, have lost their measles
elimination status.45
Immunization rates are typically
used as measures of the availability
Note: Data for the blue bars are from 2018 or the latest year available (2015 for Chile).
Source: Data for Bulgaria, Croatia, Cyprus, Malta and Romania: Eurostat 2018. Data for remaining countries: Organisation for Economic Co-operation and
Development (OECD) Family Database Table PF2.1.B (updated 26 October 2017).
In five rich countries, more than 1 in 10 young people are out of school and work
Figure 31: Percentage of all young people aged 15–19 years not in education, employment or training (NEET) Percentage of 15- to 19-year-olds
0
5
10
15
20
30
25
Switzerland
United Kingdom
Cyprus
United States
Belgium
Hungary
Czechia
Iceland
Latvia
Austria
Luxembourg
Greece
Germany
Estonia
Poland
Italy
Chile
Bulgaria
Mexico
Ireland
Malta
France
Croatia
Turkey
Finland
New Zealand
Denmark
Australia
Sweden
Netherlands
Lithuania
Slovakia
Romania
Canada
Slovenia
Norway
Portugal
Spain
Israel
2018 2010
1.5
1.9
2.4
2.5
2.6
2.9
3.3
3.4
3.5
3.5
3.9
3.9
4.0
4.1
4.6
5.1
5.3
5.3
5.6
5.9
6.0
6.3
6.8
6.8
6.8
7.1
7.1
8.1
8.5
8.7
8.9
8.9
9.0
9.2
11.0
11.4
11.8
13.7
15.3
Average: 6%
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 4 1
and affordability of preventive
health services for children. Yet,
with the rise of anti-vaccination
movements, some immunization
rates have also become measures
of the efficacy of public health
communication. They indicate
whether the general public is wellinformed about immunization or
whether false information is putting
children at risk. Additionally, 1 in 10
cases of measles is contracted
while travelling abroad or while in
contact, in one’s own country, with
someone from another country.46
This shows that high immunization
coverage at the country level is
insufficient and emphasizes the
importance of cross-country
collaboration to keep children free
of this preventable disease.
Therefore, of all of the important
child vaccines, including polio and
DPT (diphtheria-pertussis-tetanus),
we focus on the measles vaccine.47
Across 40 countries (all except
Ireland), the measles immunization
rate averages 91 per cent, ranging
from 80 per cent in France to
99 per cent in Hungary, Mexico and
the Republic of Korea. This range of
values is larger than for DPT
vaccines and therefore the measles
immunization rate meets our
variability criterion for data usage
(see Spotlight 1). Moreover, this
rate has dropped between 2010
and 2018 in 14 out of the 35 rich
countries for which comparable
data are available (see Figure 32).
Low birthweight
The second health policy indicator
is the proportion of babies who
weigh less than 2,500 grams at
birth. Birthweight is considered the
most important predictor of an
infant’s chances of survival and
growth.48 At the policy level,
birthweight is treated as an
indicator of the quality of care
available during pregnancy. It is also
related to the health, age and
nutrition of the mother, and whether
there was substance abuse during
Note: Percentage of children who received the measles vaccine second dose (MCV2) administered as per the national schedule. Ireland is omitted as no 2018 data
were available for MCV2.
Source: WHO/UNICEF estimates for 2018. See: World Health Organization, ‘Immunization, Vaccines and Biologicals: Data, statistics and graphics’,
<www.who.int/immunization/monitoring_surveillance/data/en>, accessed 24 February 2020.
Measles immunization dropped in 14 rich countries from 2010 to 2018
Figure 32: Percentage of children who received the second dose of the measles vaccine Percentage of children
0
10
20
30
40
50
60
100
80
Switzerland
United Kingdom
Republic of Korea
Cyprus
United States
Hungary
Belgium
Iceland
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Japan
Estonia
Poland
Italy
Chile
Mexico
Bulgaria
Malta
Croatia
Finland
Turkey
France
New Zealand
Australia
Denmark
Sweden
Netherlands
Slovakia
Lithuania
Romania
Canada
Portugal
Slovenia
Norway
Israel
Spain
70
90
2018 2010
99
99
99
97
96
96
95
95
95
95
94
94
94
94
93
93
93
93
93
93
92
92
90
90
90
89
89
89
88
88
88
87
87
87
85
84
84
83
81
80
Average: 91.1%
SECTION 5 THE WORLD AT LARGE
4 2 INNOCENTI REPORT CARD 16
One in 15 infants born in rich countries is underweight at birth
Figure 33: Number of live births weighing less than 2,500 grams as a percentage of total live births Percentage of live births
0
2
4
6
12
8
Switzerland
United Kingdom
Republic of Korea
Cyprus
United States
Belgium
Hungary
Iceland
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Japan
Estonia
Poland
Italy
Chile
Mexico
Bulgaria
Croatia
Ireland
Malta
France
Turkey
Finland
New Zealand
Sweden
Denmark
Australia
Netherlands
Lithuania
Slovakia
Romania
Canada
Norway
Slovenia
Portugal
Israel
Spain
10
2017 (or latest available) 2010
3.8
4.2
4.2
4.4
4.5
4.6
4.9
4.9
5.2
5.7
5.7
5.9
6.0
6.0
6.2
6.3
6.3
6.4
6.4
6.5
6.5
6.6
6.6
6.7
6.9
7.4
7.4
7.5
7.5
7.6
7.7
7.8
8.1
8.1
8.3
8.3
8.9
9.3
9.3
9.4
9.9
Average: 6.7%
Note: Data for the blue bars are from 2017 or the latest year available (2016 for Australia, Belgium, Chile, France, Sweden; 2015 for Romania; 2013 for Germany).
Starting year data are from 2010, except for Turkey (2012) and Cyprus (2007).
Source: Data for Bulgaria, Croatia, Cyprus and Romania are from: World Health Organization Regional Office for Europe, European Health Information Gateway,
‘% of Live Births Weighting 2500 g or More’, <https://gateway.euro.who.int/en/indicators/hfa_600-7100-of-live-births-weighing-2500-g-or-more>, accessed
7 January 2020. Data for remaining countries are from: Organisation for Economic Co-operation and Development, OECD.Stat, ‘Health Status: Key indicators’,
<https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT>, accessed 7 January 2020.
the pregnancy. Based on the above
threshold, the average percentage
of live births that are underweight
across the 41 countries is close to
7 per cent. This proportion has
remained stable over the last
decade (see Figure 33). There are
substantial differences between
countries in the proportion of
underweight live births, ranging
from 4 per cent in Iceland to almost
10 per cent in Cyprus.
Context
The national context that supports
child well-being includes economic,
social and environmental
components. These components
may affect children directly. For
example, air pollution can damage
their health. Or the components
may affect them indirectly. For
example, parental unemployment
can put a strain on household
resources and relationships, which
can, in turn, affect child well-being.
In this section, we deliberately
choose broad indicators that apply
to the whole population for two
reasons. First, they minimize the
number of people missing from the
data, including marginalized
children, who are often invisible in
surveys. Second, a clean
environment, healthy economy and
strong social fabric contribute to a
good life for all and constitute a
foundation for the well-being of
current and future generations.
Economic context
Jobs
As we’ve seen in the earlier section
about work pressure on parents,
employment does not always
translate into well-being. However,
there are good reasons to include it
as a key factor. Work can provide
the resources, networks, skills and
sense of meaning that facilitate
well-being. Unemployment has
been found to be one of the most
important and persistent factors
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 4 3
affecting adult well-being.49 As a
consequence, it is likely to affect
family relationships and child wellbeing. This issue has been a theme
in previous Report Cards. For
example, in Report Card 12, we
argued that: “Children feel anxious
and stressed when parents endure
unemployment or income loss, and
they suffer family downturns in
subtle and painfully evident ways”.50
Not all adults can or want to work.
To reflect this, we look at the
unemployment rate for people
between the ages of 15 and 64
years who would like to work and
have taken active steps to find
employment. In this way, we avoid
Unemployment still has not dropped below its pre-crisis level in all countries
Figure 34: Unemployment rates from 2007 to 2019
Note: Unemployment as a percentage of the total labour force, modelled on International Labour Organization estimates. Unemployment refers to the share of the
labour force (aged 15–64 years) who would like to work and have taken active steps to find employment – that is, those who are without work but available for and
seeking employment.
Source: World Development Indicators 2019.
making a judgement on choices
such as parents who have decided
to stay at home to look after their
children. In 2019, the average
unemployment rate across the 41
countries included in this report
was 6 per cent, ranging from just
over 2 per cent in Japan to about
18 per cent in Greece. In many
countries, the unemployment rate
has returned to its pre-crisis level,
meaning before 2008, or dropped
further. But this is not universally
the case and, in some countries,
most notably Greece and Spain, the
unemployment rate remains well
above the pre-crisis level (see
Figure 34).
Income
We use the gross national income
(GNI) per capita as a proxy for a
country’s economic context.
Although GNI is an imperfect
measure because it does not
evaluate what is produced or
consider the long-term costs and
benefits of economic growth,51 it is
still one of the most widely used
measures of goods and services
produced in an economy.
Historically, raising GNI resulted in a
surplus of goods that satisfied basic
physiological needs, enabled the
division of labour and, finally, gave
rise to the modern phenomenon of
leisure. Today, a high GNI can help
Unemployed as a percentage of active population
0
2
4
6
20
8
Switzerland
United Kingdom
Republic of Korea
Cyprus
United States
Hungary
Belgium
Czechia
Iceland
Latvia
Austria
Luxembourg
Greece
Germany
Japan
Estonia
Poland
Italy
Chile
Mexico
Bulgaria
Malta
Ireland
Croatia
France
Turkey
Finland
New Zealand
Denmark
Australia
Sweden
Netherlands
Romania
Lithuania
Norway
Slovenia
Canada
Portugal
Slovakia
Israel
Spain
10
12
14
16
18
2019 2007
2.4
2.5
3.0
3.2
3.3
3.4
3.5
3.7
3.8
3.8
3.9
3.9
4.0
4.2
4.6
4.6
4.8
4.8
4.8
4.9
5.3
5.3
5.4
5.5
5.9
6.1
6.1
6.4
6.4
6.6
6.8
7.3
7.4
7.8
7.9
8.2
9.1
9.2
11.9
14.7
18.1
Average: 6%
SECTION 5 THE WORLD AT LARGE
4 4 INNOCENTI REPORT CARD 16
in building high-quality health care,
education and social protection. It
also tends to coexist with labour
arrangements that are conducive to
having more free time.52
The relationship between national
income and inequality
More equal societies tend to report
higher life expectancy and fewer
social problems such as violence,
mental illness, bullying among
children and teenage pregnancy.53
In unequal societies, it is more
difficult for disadvantaged groups to
realize their full potential. Income
inequality correlates with a lack of
trust. It erodes social cohesion and
empathy among citizens, both of
which are preconditions for
meaningful political participation
and democracy.54
In the policies section, we focused
on households with children. In this
section, the Gini coefficient is used
to show the distribution of income
across the whole of society. The
higher the Gini coefficient (on a
scale from 0 to 1), the higher the
level of inequality.
Putting equality at the heart of the
debate raises the concern that
ignoring levels of economic
prosperity could lead to equality in
misery. Figure 35 shows that there
is no obvious trade-off between
inequality and income, however.
Some of the less affluent countries
have high inequality, while most of
the richer countries are more equal.
Only the United States has very
high income and very high
inequality. Its position should be
seen as the exception rather than
the rule.
There is no trade-off between inequality and income
Figure 35: National income and income inequality Income inequality
0.2
0.25
0.3
0.35
0.4
0.45
0.5
National income per person (int. $)
10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000
CL
TR
BG
RO
LT
LV
GR
HR
PT
CY
EE
PL
HU
SK SI
CZ
MT
IT
JP
AU
CA
FR
FI BE
DE
NL SE AT
IS
DK NO
CH
LU IE
US
KR GB
NZ IL
ES
MX
Average: 0.32
Average: $42,925
Notes: Gross national income (GNI) based on purchasing power parity in international dollars (int. $) per capita in 2018 (2017 for Cyprus). Income inequality is
measured as income Gini coefficient from 2017 or the latest year available (2016 for Australia, Austria, Belgium, Czechia, Denmark, Estonia, France, Germany, Greece,
Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Mexico, the Netherlands, Poland, Portugal, Slovakia, Slovenia, Spain; 2015 for Croatia, Cyprus, Iceland, Japan,
Malta, Switzerland, Turkey; 2014 for Bulgaria, New Zealand). Orange lines represent cross-country averages.
Source: Data on GNI for all countries and on the Gini coefficient for Bulgaria, Croatia, Cyprus, Malta and Romania from: World Bank. Data on the Gini coefficient
for all remaining countries from: Organisation for Economic Co-operation and Development.
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 4 5
During the first year of life, survival is measured using the
infant mortality rate. During the remaining years of
childhood, the child mortality rate is used. The two
indicators are driven by different factors and hence are
differently influenced by public policies. Infant mortality
reflects the quality of the health system, especially
prenatal and neonatal care. In contrast, the child mortality
rate in rich countries tells us more about safety and mental
health, as it is driven largely by accidents and suicide.
All countries covered in this report have made impressive
progress in systematically reducing infant mortality. Fifty
years ago, the average rate was 25 deaths per 1,000 live
births. This went down to 16 deaths per 1,000 live births
in 1978; 13 deaths per 1,000 live births in 1988; 8 deaths
per 1,000 live births in 1998; 5 deaths per 1,000 live births
in 2008; and 3.8 deaths per 1,000 live births in 2018.55
Today, the relatively small differences between wealthy
countries reflect less the basic standards of public health
Spotlight 6 Infant mortality relates more
strongly to inequality than to income
Notes: Infant deaths reported per 1,000 live births in 2018. For information on income and inequality, see note beneath Figure 35. The results hold
also when using log GNI (R=-0.57).
Source: Infant mortality rates: World Development Indicators 2018. Data on income and inequality: see Figure 35. Infant mortality
8
10
12
6
4
2
0
National income (int. $1,000)
10 20 30 40 50 60 70 80
Infant mortality
8
10
12
6
4
2
0
Income inequality
0.20 0.25 0.30 0.35 0.40 0.45 0.50
R=-0.49
R=0.66
SK SK
RO RO
CL CL MT MT
NO LU LU NO
US US
IE IE
CH CH
NZ NZ
CA CA
HR HR
LT LT
PL PL
HU HU
PT PT IL
EE EE
CZ CZ
IL
IT IT ES ES
KR KR
CY CY
SI SI JP JP
FI FI IS IS
SE SE
DK DK
NL NL
AT AT
DE DE
BE BE AU AU
GB GB
LV FR FR LV GR GR
BG BG
MX MX
TR TR
Income inequality matters more than national income for infant mortality
Figure 36: Infant deaths per 1,000 live births against national income and income inequality
SECTION 5 THE WORLD AT LARGE
4 6 INNOCENTI REPORT CARD 16
and more the efforts to reach out to every infant in the
earliest days and weeks of life, including those from the
most marginalized families.
In rich countries, infant mortality is more strongly linked to
income inequality than to national income (see Figure 36).
Possibly, infant mortality follows the curve known from
studies of life expectancy: additional economic growth
brings an enormous premium at the early stages of
economic development, then the effect tapers off as the
country grows richer and, finally, more progress can be made
through reducing inequalities than through further growth.
Patterns are slightly different for child mortality. Here
national income is as important as inequality (see Figure
37). The best results are obtained by countries that are
both rich and more equal, such as Denmark, Finland and
Norway. Luxembourg is an outlier because it is rich and
has low child mortality but is less equal than the three
leading countries.
Notes: Child mortality covers all causes of death in the age range 5–14 years, reported per 1,000 children in 2018. For information on income and
inequality, see note beneath Figure 35. The results hold also when using log GNI (R=-0.77).
Source: Child mortality rates: United Nations Inter-agency Group for Child Mortality Estimation 2018. Data on income and inequality: see Figure 35. Child mortality
2.0
2.5
3.0
1.5
1.0
0.5
0
National income (int. $1,000)
10 20 30 40 50 60 70 80
R=-0.70
Child mortality
Income inequality
0.20 0.25 0.30 0.35 0.40 0.45 0.50
2.0
2.5
3.0
1.5
1.0
0.5
0
R=0.66
MX
BG TR
RO
US
CL LV LT
EE
PL HR
GR
HU
LU
CH
NO IE
DK
FI
CA
PT CY IL
MTNZ
CZ
SI ES ITJP
GB FR
AU
BE SE
DE
IS
AT NL KR
SK
MX
CL
TR BG
RO
SK
LU
DK
FI
NO
SI
CZ
CH IE
SE DE
AT
NL
FR
MT
AU
NZ
CYIL
PT
IT ISBE
KR
GB
ES
JP
US
LT LV
EE
PL
HU
HR
GR
CA
Income inequality and national income relate equally strongly to child mortality
Figure 37: Child mortality, gross national income and income inequality
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 4 7
Social context
We measure the social context
within each country as a whole
using two indicators relating to
social support and violence. Social
support reflects a positive aspect of
a community: the possibility to
count on others in times of need.
Violence reveals rips in the social
fabric. A small proportion of people
in high-income countries fall victim
to crime, but many more are
affected by its prospect, including
children. In the United Kingdom, for
example, 41 per cent of adolescents
worry about crime. The environment
and crime are the two public issues
that adolescents worry about most
(see Spotlight 7).
56
Social support
We use the percentage of people
who feel that they have someone
to count on if they are in trouble as
a proxy for social support. On
average, across the 41 countries,
91 per cent of adults reported that
they have someone to count on if
they are in trouble. The proportion
of people who feel this way varies
by country, from 78 per cent in
Greece to 98 per cent in Iceland
(see Figure 38).
Violence
The country-level homicide rate
reflects exposure to violence in its
most extreme form. Using it as a
proxy for social cohesion reduces
bias in international comparisons
linked to definitions, legislation and
data availability. The average annual
homicide rate across the countries
in this study was 2 homicide victims
per 100,000 people in 2017, ranging
from a low of 0.2 homicides per
100,000 people in Japan to 5.3
homicides per 100,000 people in
the United States and 24.8
homicides per 100,000 people in
Mexico. The average rate improved
In almost all countries, more than 1 in 20 adults has nobody to count on
Figure 38: Percentage of people who have someone they can count on in times of trouble
Note: Three-year averages are calculated to minimize survey bias for 2016–2018 and 2010–2012.
Source: World Happiness Report based on the Gallup World Poll. Percentage of people who have someone to count on
0
10
20
30
40
50
60
70
80
90
100
Switzerland
United Kingdom
Republic of Korea
Cyprus
United States
Belgium
Hungary
Iceland
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Japan
Estonia
Poland
Italy
Chile
Bulgaria
Mexico
Ireland
France
Turkey
Croatia
Malta
Finland
New Zealand
Denmark
Australia
Sweden
Netherlands
Lithuania
Slovakia
Romania
Canada
Norway
Slovenia
Portugal
Spain
Israel
2016–18 2010–12
Average: 90.7%
97.6
96.0
95.9
95.5
94.8
94.6
94.4
94.0
93.6
93.5
93.5
93.4
93.3
93.1
93.1
92.7
92.7
92.7
92.0
92.0
91.9
91.8
91.6
91.5
91.3
90.8
90.7
90.6
90.5
90.0
89.7
88.9
88.8
87.0
86.8
85.0
82.6
81.3
81.0
80.5
78.3
SECTION 5 THE WORLD AT LARGE
4 8 INNOCENTI REPORT CARD 16
from around 2.2 homicide victims
per 100,000 people in 2010, despite
the reverse trend in some countries.
Environmental context
The natural environment is the
primary support system for human
life. It has an impact on people’s
health, leisure pursuits and social
relationships. Unsustainable
environmental practices erode
children’s current and future
well-being. The World Health
Organization estimates that
4.2 million people die globally each
year as a result of exposure to air
pollution.57 Toxic air contributes to
more deaths than tobacco.58
Additionally, an estimated
1.5 million premature deaths –
that is, deaths that occur before the
average age of death in a certain
population – are caused each year
by drinking unsafe water.59
Air quality
Air pollution harms everyone but
takes the highest toll on children –
and it starts to harm them before
they are born. Toxic air inhaled by a
pregnant woman can lead to faster
cell ageing of the foetus. Children
are more vulnerable to air pollution
than adults because they have a
smaller lung capacity and a less
well-developed immune system.
They are also shorter and, hence,
closer to the ground level, where
pollution typically accumulates.60
High exposure can lead to longterm health problems such as
asthma. Studies have shown that
some of this damage can be
reversed if action is taken before
the child reaches the age of 18
years, by which time the lungs are
nearly mature.61
The smaller the pollution particles,
the more likely they are to move
from the lungs into the
bloodstream and cause further
damage. For this reason, we use
the average annual concentration of
The homicide rate dropped in 24 countries but remains high and rising in Mexico and the United States
Figure 39: Intentional homicides per 100,000 inhabitants in 2010 and 2017
Note: Data for the blue bars are from 2017 or the latest year available (2016 for Austria, Italy; 2015 for Israel, Malta; 2012 for Turkey).
Source: World Bank, 2017. Homicide (per 100,000)
0
1
2
3
4
5
7
25
Switzerland
United Kingdom
Republic of Korea
Cyprus
United States
Hungary
Belgium
Iceland
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Japan
Estonia
Poland
Italy
Chile
Mexico
Bulgaria
Turkey
France
Croatia
Ireland
Malta
Finland
New Zealand
Denmark
Sweden
Australia
Netherlands
Lithuania
Slovakia
Romania
Canada
Slovenia
Portugal
Norway
Israel
Spain
6
20
2017 or latest available 2010
Luxembourg
24.8
5.3
4.5
4.3
4.3
4.2
2.5
2.2
1.8
1.7
1.5
1.5
1.5
1.4
1.3
1.2
1.2
1.2
1.1
1.1
1.0
0.9
0.9
0.9
0.9
0.8
0.8
0.8
0.7
0.7
0.7
0.7
0.7
0.7
0.6
0.6
0.6
0.5
0.5
0.3
0.2
Average: 2.0%
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 4 9
fine particulate matter (PM2.5) as
an indicator of environmental
context. Ambient PM2.5 pollution
averaged 13.7 micrograms (μg) per
cubic metre (m3) across the 41 rich
countries, ranging from 5.9 µg/m3
in Finland to 44.3 µg/m3 in Turkey.
Water quality
Poor water quality hampers food
hygiene and health. It can also
present a burden on finances and
time and increase plastic waste, if
bottled water is used. We provide
two perspectives on water quality:
the proportion of households with
safely managed water and the
proportion of people satisfied with
water quality in the place they live.
Safely managed water comes from
a protected water source that is
located on the premises, available
when needed and free from
contamination.62 This is a minimum
standard that the countries we
feature in this report should be able
to meet given their historically
unparalleled wealth. In six countries –
Greece, Iceland, Malta, New Zealand,
the Netherlands and the United
Kingdom – over 99.9 per cent of the
population had access to safely
managed water (see Figure 41).
At the other end of the spectrum,
the majority of people living in
Mexico do not have water that
meets this basic standard. In 11 of
the 41 countries, at least 5 per cent
of households do not have safely
managed water. When asked
whether they were satisfied with
the quality of water in the place
where they live, 84 per cent of
people across the countries said
yes. The proportion of satisfied
people ranges from 65 per cent in
Turkey to 99 per cent in Iceland.
Children’s health is threatened by high levels of air pollution
Figure 40: Annual mean PM2.5 concentrations (μ/m3) in all areas in 2010 and 2017
Note: Population-weighted exposure to ambient PM2.5 pollution.
Source: World Development Indicators 2017; Brauer, Michael, et al., 2017, for the Global Burden of Disease Study 2017, ‘PM2.5 Air Pollution, Mean Annual Exposure
(Micrograms Per Cubic Meter)’, World Bank Data, <https://data.worldbank.org/indicator/EN.ATM.PM25.MC.M3>, accessed 25 February 2020; Brauer, Michael, et
al., ‘Ambient Air Pollution Exposure Estimation for the Global Burden of Disease 2013’, Environmental Science and Technology, vol. 50, no. 1, 2016, pp. 79–88. PM2.5 concentrations
0
5
15
20
30
35
Switzerland
United Kingdom
Republic of Korea
Cyprus
United States
Belgium
Hungary
Iceland
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Japan
Estonia
Poland
Italy
Chile
Bulgaria
Mexico
Ireland
France
Malta
Croatia
Turkey
Finland
New Zealand
Australia
Denmark
Sweden
Netherlands
Canada
Norway
Portugal
Lithuania
Romania
Slovenia
Slovakia
Spain
Israel
10
25
40
45
2017 2010
5.9
6.0
6.2
6.4
6.5
6.7
7.0
7.4
8.2
8.2
8.6
9.7
10.0
10.3
10.4
10.5
11.7
11.8
11.9
12.0
12.0
12.5
12.9
13.4
13.9
14.6
15.9
16.0
16.1
16.2
16.8
17.3
17.6
17.9
19.1
20.9
20.9
21.0
21.4
25.0
44.3
Average: 13.7
SECTION 5 THE WORLD AT LARGE
5 0 INNOCENTI REPORT CARD 16
In most rich countries, more than 1 in 10 adults is not satisfied with the quality of water in the place where they live
Figure 41: Percentage of the population with safely managed water in 2017 and percentage of the population satisfied
with water quality in the place they live
Notes: Countries ranked by safely managed water in 2017 (2016 in Australia). No water safety data for Turkey. Water satisfaction data refer to the proportion of
population aged 15 years and above who answered ‘Satisfied’ to the question ‘In the city or area where you live, are you satisfied or dissatisfied with the quality of
water?’. No water satisfaction data available for Bulgaria, Croatia, Cyprus, Malta and Romania.
Source: Data on safely managed water: WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP), 2017 data, <https://
washdata.org>, accessed 25 February 2020. Data on water satisfaction: Organisation for Economic Co-operation and Development (OECD) Better Life Index
based on three-year average from the Gallup World Poll 2014–2016.
Switzerland
United Kingdom
Republic of Korea
Cyprus
United States
Hungary
Belgium
Iceland
Czechia
Latvia
Austria
Luxembourg
Greece
Germany
Japan
Estonia
Poland
Italy
Chile
Bulgaria
Mexico
Turkey
Croatia
Ireland
France
Malta
Finland
New Zealand
Australia
Denmark
Sweden
Netherlands
Romania
Lithuania
Slovakia
Canada
Slovenia
Norway
Portugal
Spain
Israel
Percentage of population satisfied with water in 2016
Percentage of population satisfied with water in 2010
Percentage of population with safely managed water in 2017
Percentage of population with safely managed water in 2010
100 80 60 40 20 0 20 40 60 80 100
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 5 1
It is hardly surprising that children are increasingly
speaking out about the environment. They are
growing up in the midst of the climate emergency
and will have to deal with it for the rest of their lives.
Yet, until recently, children have been largely ignored
in debates about the environment. Young people are
now forcing the world to pay attention to their views,
either as individuals such as Swedish climate activist
Greta Thunberg, or collectively through initiatives
such as Youth for Climate. This international
movement of students organized climate strikes in
125 countries in March 2019, involving more than
1 million young people.63 “We are the voiceless
future of humanity”, said the strike’s organizers.64
What children think about the future relates to their
current well-being. For example, children who worry
about the environment tend to have lower life
satisfaction.65 Research on children’s feelings about
climate change is a new field, and representative data
are available only for a limited number of countries.
In the United Kingdom, young people worry more
about the environment than about the economy,
Brexit, digital security or homelessness. Only
crime merited the same degree of concern. Girls
were more likely than boys to worry about the
environment (see Figure 42).
In Australia, 59 per cent of young people consider
climate change to be a threat to their safety (only
14 per cent disagree). Climate change and plastic
pollution top their list of environmental concerns
(see Figure 43). Almost 90 per cent want to move to
renewable energy, while only 3 per cent want to ‘stay
with fossil fuels’. Three out of four adolescents in
Australia want their government to act.66
Spotlight 7 Environment and
young people’s well-being
Note: Responses of children aged 10–17 years from the United Kingdom. Equally weighted by age and gender.
Source: The Children’s Society, The Good Childhood Report 2019, The Children’s Society, London, 2019.
Girls
Boys
Very worried Quite worried A little worried Not at all worried Not sure
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
18%
13% 23% 21%
27% 15% 6%
7%
34%
36%
Note: Responses of 1,007 children aged 14–17 years; sample representative of Australia.
Source: United Nations Children’s Fund Australia, 2019.
80
Percentage of adolescents who report being worried about a given issue
Extinction of animals
0 10 20 30 40 50 60 70
Climate change
Plastic pollution
Air pollution
Ocean pollution
Deforestation
Damage of the reef
Littering
Recycling crisis
Over-fishing
Extinction of plants
71
64
63
63
63
59
59
56
53
45
42
Two in five young people in the United Kingdom worry about the environment
Figure 42: Attitudes of girls and boys in the United Kingdom towards environmental issues
In Australia, climate change is the biggest environmental concern for adolescents
Figure 43: Environmental concerns of adolescents in Australia
SECTION 5 THE WORLD AT LARGE
5 2 INNOCENTI REPORT CARD 16
Figure 44: A league table of conditions (policies and context) for child well-being
Ranking Country
Policies Context
Social Education Health Economy Society Environment
1 Norway 6 9 8 1 2 7
2 Iceland 10 19 1 6 1 4
3 Finland 5 12 5 22 3 2
4 Germany 9 6 19 7 25 16
5 Denmark 12 16 12 9 4 17
6 Sweden 18 17 2 15 22 3
7 Luxembourg 23 1 24 2 15 11
8 Ireland 26 14 10 5 6 9
9 Netherlands 21 3 23 8 10 15
10 Slovenia 3 11 15 25 11 26
11 Switzerland 30 8 26 3 8 22
12 Estonia 1 33 11 27 18 14
13 Poland 8 5 13 23 26 33
14 Austria 13 13 33 10 21 20
15 Lithuania 15 2 9 30 30 30
16 Latvia 11 4 4 36 31 25
17 Japan 7 23 34 11 29 18
18 Australia 28 32 18 13 7 8
19 Czechia 4 22 36 14 13 28
20 New Zealand 37 20 22 21 5 1
21 Malta 32 15 21 20 12 23
22 Portugal 22 7 27 29 27 13
23 Canada 27 25 29 19 23 5
24 Belgium 29 10 32 17 20 19
25 Republic of Korea 17 21 6 16 38 38
26 Hungary 2 34 17 24 32 36
27 United Kingdom 35 24 30 12 9 10
28 Slovakia 16 38 14 31 19 29
29 United States 41 30 28 4 33 6
30 Croatia 20 27 7 37 36 37
31 Israel 39 26 20 18 28 34
32 France 25 18 39 28 24 21
33 Spain 36 31 25 40 17 12
34 Italy 34 35 31 33 16 31
35 Bulgaria 19 39 37 34 14 32
36 Chile 33 37 16 38 34 35
37 Cyprus 24 28 38 35 37 27
38 Romania 14 40 40 26 39 39
39 Greece 31 29 41 41 40 24
40 Mexico 38 36 3 32 41 40
41 Turkey 40 41 35 39 35 41
Note: A light blue background indicates a place in the top third of rankings, medium blue denotes the middle third, and dark blue the bottom third. The rankings in
the table were produced as follows: (1) We calculated a z-score for each indicator (reversed where necessary so that a higher score represents a more positive
condition); (2) we calculated the mean of the two z-scores within each dimension; (3) we calculated the z-score for each mean; and (4) for the overall ranking, we
then calculated the mean of the mean z-scores for each dimension.
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 5 3
A league table of conditions
for well-being
We conclude this section with a
summary league table of national
conditions that support child wellbeing (see Figure 44). These
conditions consist of the two
outermost levels of our model
(see Box 1):
1. Policies. The social, education
and health services and
programmes that have a bearing
on children’s lives.
2. Context. The overall economic,
social and environmental
context in the country.
We rank all 41 countries on the
various components of Policies and
Context and give each country an
overall ranking.
Norway is ranked highest for the
conditions that support child wellbeing, followed by Iceland and
Finland. Turkey is ranked lowest,
followed by Mexico and Greece.
There is a lot of variation in country
rankings across the six dimensions.
Only Norway ranks in the top third for
all six dimensions, and only Turkey is
in the bottom third for all six. There is
plenty of room for improvement in
the conditions for child well-being
across all 41 countries.
Some countries have large
variations in rankings across the six
dimensions. For example, Australia
is ranked in the top third for each of
the Context dimensions – economy,
society and environment – but in
the middle third for health policy
and the bottom third for social and
education policies to support child
well-being. In contrast, Lithuania is
in the top or middle third for each
of the Policy dimensions, while
being in the bottom third for each
Context dimension. New Zealand is
ranked first for environment
because of its clean air and safe
water. Yet its overall ranking also
takes high child poverty and short
parental leave into account.
The link between conditions
and outcomes
A test of our framework is the
extent to which the national
policies and Context – together
called ‘conditions for child wellbeing’ – are associated with child
well-being outcomes. We would
not expect an exact match, as a
variety of unmeasured factors also
influence well-being outcomes,
including time lags between
improvements in conditions and
outcomes, but we should expect a
reasonably strong association.
Figure 45 shows that this is the
case. In general, countries that rank
highly for the broad conditions
listed in the second league table
also have a high ranking for the
well-being outcomes identified in
the first league table.67
The quadrants on the chart show
whether countries have relatively
good or poor conditions and
outcomes. There is a cluster of
countries in the top right quadrant,
indicating good conditions and high
outcomes. These include Denmark,
Finland, the Netherlands and
Norway. All are in the top 10
countries on both conditions and
outcomes. Six countries are in the
bottom left quadrant, indicating
relatively poor national conditions
for child well-being and low child
well-being outcomes. Most of
these are countries with a lower
national income, but they also
include the United States. There are
also countries with a weaker match
between conditions and outcomes.
France and Spain, in the top left
quadrant, rank much higher for
outcomes than they do for
conditions. On the other hand,
Lithuania, Malta and New Zealand
stand out in the bottom right
quadrant as having above-average
conditions but relatively poor
outcomes. The mismatch between
conditions and outcomes should
prompt reflection, particularly in
countries which rank much lower
for outcomes than they do for
conditions. The reasons for these
patterns are likely to be complex
and to require more detailed
analysis according to each
country’s context.
SECTION 5 THE WORLD AT LARGE
5 4 INNOCENTI REPORT CARD 16
Child well-being outcomes reflect but do not match national conditions for child well-being
Figure 45: Z-scores of country rankings of national conditions plotted against rankings of well-being outcomes
Note: The chart is based on the mean of z-scores for each dimension, for indicators of conditions and outcomes respectively, and so the relative positions of
countries do not exactly match those shown in Figure 3 and Figure 44.
Source: See Figure 3 and Figure 44.
Conditions
-1.5 -1.2 -0.9 -0.6 -0.3 0.0 0.3 0.9 1.2
-0.5
-1.0
-1.5
-2.0
0.6
0.5
1.5
1.0
Outcomes
R=0.42
Good conditions, good outcomes
Denmark, Finland, Netherlands,
Norway, Slovenia, Switzerland
Poor conditions, good outcomes
France, Spain
Poor conditions, poor outcomes
Bulgaria, Chile, United States Good conditions, poor outcomes
Lithuania, Malta, New Zealand
CL
BG US NZ
MT
LT
IS
PL
LV
AU
CA SK GB GR
RO
CY
IT
HR
FR ES
BE
CH
NL
DK
NO
FI
SI
EE
AT
JP
CZ KR
PT HU DE
IE SE
LU
SECTION 5 THE WORLD AT LARGE
INNOCENTI REPORT CARD 16 5 5
WHAT CAN COUNTRIES DO TO
IMPROVE CHILD WELL-BEING?
SECTION 6
Figure 46: The cascading impacts of the COVID-19 crisis on child well-being
The world of the child
The world around the child
The world at large
Falling GDP, job loss
Increased social tensions
Environmental change
Strain on health services
School closures
Rising poverty
The world around
the child acts as a
prism through
which the impact of
societal changes is
lessened or
intensified
Unequal impacts on children:
Poorer physical health
Poorer mental well-being Outcomes Losses in skills
Activities
Relationships
Networks
Resources
Policies
Context
SECTION 6 WHAT CAN COUNTRIES DO TO IMPROVE CHILD WELL-BEING?
5 6 INNOCENTI REPORT CARD 16
The richest countries in the world
are failing to ensure that all their
children have a good childhood.
The extent of the shortcomings
varies between countries, but poor
mental and physical health, and a
lack of satisfactory academic and
social skills are features of many
childhoods in all countries.
Report Card 16 provides a baseline
of how countries were faring in
terms of child well-being at the start
of the COVID-19 crisis. It introduces
a new conceptual framework of
child well-being which can now be
used to understand how effects of
COVID-19 will cascade down from
the national context through the
immediate world around the child
to affect well-being (see Figure 46).
The effects of the COVID-19
crisis on national conditions
ƒ Economy. GDP will probably fall,
even in the best-protected
countries. Its shock effects will
reverberate throughout economies
and strain funding for policies to
support child well-being.
ƒ Society. The impacts of the crisis
are likely to be felt unequally,
putting a pressure on the fabric
of societies, decreasing trust and
engendering tensions.
ƒ Environment. The initial drop in
human-caused pollution during
lockdowns was a temporary
respite for the natural
environment. But it is unlikely to
last. As economies try to make
up lost ground, environmental
damage may increase.
ƒ Health. The huge demands on
health services during the COVID19 crisis are likely to have
crowded out other health needs
and weakened systems, especially
in countries with already underresourced health care.
ƒ Education. School closures were
applied to contain COVID-19 in
almost all countries covered in
this report. Online schooling has
brought mixed results.
ƒ Social protection. Rising
unemployment and job insecurity
will strain many families financially
and psychologically. During an
economic recession, increasing
social protection can be more
difficult but also more needed.
The impacts on children
ƒ Physical health. Children’s
physical health will be affected in
the short and long term. In the
short term, strained health
systems can deprioritize routine
immunizations or treatment of
chronic health conditions. In the
long term, rising levels of poverty
can affect children’s health
through nutrition, housing and
living conditions.
ƒ Mental well-being. The existing
children’s mental health crisis will
probably intensify. The
experiences of lockdown,
bereavement and ongoing strains
on family relationships of
economic uncertainty can damage
many children’s mental well-being.
Children may feel anxious,
insecure and fearful for the future.
ƒ Skills. In most countries, children
have missed months of education
and peer contact. Previous crises
have shown that many children
will never make up for this loss of
learning. This will have longerterm impacts on their lives and on
the societies in which they live.
Rising inequalities
The impacts of the COVID-19 crisis
will be distributed unevenly. The
lockdown has already seen an
increase in gender-based violence.
The new burdens of caring for
children and home schooling have
fallen disproportionately on women.
The initial impacts have also been
unevenly spread across sectors.
Many better-paid workers in office
professions continued to earn
through a switch to working from
home. This has not happened for
many lower-paid manual workers
reliant on government aid schemes.
Informal sector workers have been
hardest hit and some have faced
barriers accessing any financial
support.
The impacts on children will
probably follow the scenario of
rising inequalities. A child living in
a well-off family, with a room of
their own, a good Internet
connection, and parents who have
the time, skills and confidence to
support home learning will suffer
the educational impact of school
closures less than a child in a
family with poorer material and
human resources. The world
around the child can cushion or
intensify the effects of events in
the world at large.
The COVID-19 crisis therefore
presents three challenges for
nations and governments in terms
of maintaining and promoting the
well-being of their children:
1. To minimize the impact of the
COVID-19 crisis on children.
2. To provide effective support for
those children who do suffer
negative impacts.
3. To ensure that these actions
acknowledge and minimize
inequalities.
SECTION 6 WHAT CAN COUNTRIES DO TO IMPROVE CHILD WELL-BEING?
INNOCENTI REPORT CARD 16 5 7
Policies
Based on the evidence presented
in this report, UNICEF calls for all
high-income countries to act on
three fronts:
Consult children: Improve
children’s well-being through a
shift in thinking
Ensuring that all children have a
good childhood requires a shift in
thinking about what ‘well-being’
means and who should decide
about it. Children’s and young
people’s ideas about well-being do
not always match those of adults.
This is evident in findings presented
in this report about their serious
concerns for the future of the
environment, how much they value
good-quality relationships and their
views on personal autonomy. Adult
decision-makers at all levels, from
parents to politicians, need to be
willing to listen to these
perspectives and take them into
account when designing policies
and allocating resources.
Governments should strengthen the
opportunities for children’s voices
to be systematically heard. This can
be achieved through child-friendly,
public policy consultations;
ensuring all children know their
rights; and creating new ways to
take account of children’s views in
schools, communities and nations.
Children’s participation in society is
part of consensus- building
between generations on what
matters most.
Connect policies: Improve
children’s well-being through an
integrated approach
An integrated approach to child
well-being means acknowledging
the links and trade-offs between
child well-being outcomes and
national conditions and coordinating
public policies appropriately. The
report has shown how conditions at
different levels of a child’s world
interact to influence their well-being.
Employment regulation is a good
example. Children’s personal
happiness is linked to family
relationships. Yet parents who work
long hours struggle to find a
balance between work and family.
Employment policy connects with
child well-being, a fact that millions
of families in high-income countries
can attest to. To be effective and
efficient, child well-being
interventions need an integrated
approach that recognizes how
policy actions at one level will
influence another. Governments
typically assess the economic
impact of legislation and policy.
They should also consider routinely
incorporating an equivalent
assessment of their impact on
children’s well-being.68
Create strong foundations: Sustain
improvements for child well-being
through future-proofing
Governments must plan and
prepare for the future to ensure that
improvements in child well-being
are sustained. This means choosing
policies that set a strong
foundation for children and for
society as a whole. The Sustainable
Development Goals provide an
excellent basis for intensifying and
accelerating improvements in child
well-being globally. The evidence in
this report suggests a range of
actions that are essential to
achieving these goals, including:
1. Taking new and decisive action
to reduce income inequality and
poverty, and ensuring that all
children have access to the
resources they need.
2. Improving access to affordable
and high-quality early years
childcare for all children.
3. Improving mental health services
for children and adolescents.
4. Implementing and expanding
family-friendly policies related to
the workplace.
5. Reducing the stubbornly high
levels of air pollution, among a
range of measures to protect the
natural environment.
6. Strengthening efforts to protect
children from preventable
diseases, including reversing
recent falls in many countries in
measles immunization.
These are steps that every
government can take to improve
the lives of children in the present
and the future. Every child deserves
a good childhood.
SECTION 6 WHAT CAN COUNTRIES DO TO IMPROVE CHILD WELL-BEING?
5 8 INNOCENTI REPORT CARD 16
International Standards Organization
international abbreviations for countries
included in Report Card 16
AT Austria
AU Australia
BE Belgium
BG Bulgaria
CA Canada
CH Switzerland
CL Chile
CY Cyprus
CZ Czechia
DE Germany
DK Denmark
EE Estonia
ES Spain
FI Finland
FR France
GB United Kingdom of Great Britain
and Northern Ireland
GR Greece
HR Croatia
HU Hungary
IE Ireland
IL Israel
IS Iceland
IT Italy
JP Japan
KR Republic of Korea
LT Lithuania
LU Luxembourg
LV Latvia
MT Malta
MX Mexico
NL Netherlands
NO Norway
NZ New Zealand
PL Poland
PT Portugal
RO Romania
SE Sweden
SI Slovenia
SK Slovakia
TR Turkey
US United States of America
ABBREVIATIONS
Abbreviations and acronyms used in
Report Card 16
BMI Body mass index
DPT Diphtheria-pertussis-tetanus
EQLS European Quality of Life Survey
EU European Union
Eurostat Eurostat Statistical Office
of the European Union
EU-SILC EU Statistics on Income
and Living Conditions
GNI Gross national income
HBSC Health Behaviour in
School-aged Children
HILDA Household, Income and Labour
Dynamics in Australia Survey
NEET Not in education,
employment or training
OECD Organisation for Economic
Co-operation and Development
PISA Programme for International
Student Assessment
PM2.5 Fine particulate matter
SDG Sustainable Development Goal
UNESCO United Nations Educational,
Scientific and Cultural
Organization
UNICEF United Nations Children’s Fund
WHO World Health Organization
INNOCENTI REPORT CARD 16 5 9
6 0 INNOCENTI REPORT CARD 16
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can increase due to production that
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53. Wilkinson, Richard, and Kate Pickett,
The Spirit Level: Why equality is better for
everyone, Penguin, London, 2010.
54. Packer, George, ‘The Broken Contract:
Inequality and American decline, Foreign
Affairs, vol. 90, no. 6, 2011, pp. 20–31
55. Authors’ calculations based on World
Bank data for 41 countries that, as at
December 2019, are Organisation for
Economic Co-operation and Development
and/or European Union members.
56. The Children’s Society’s household
survey, Wave 18, June–July 2019, 10- to
17-year-olds, Great Britain. Equally
weighted by age and gender.
57. World Health Organization, ‘Air
Pollution: Overview’, <https://www.who.
int/health-topics/air-pollution#tab=tab_1>,
accessed 23 February 2020.
58. United Nations Environment
Programme, Global Resources Outlook
2019: Natural Resources for the Future We
Want. Report of the International Resource
Panel, UNEP, Nairobi, 2019.
59. Ibid.
60. When children are born, they tend to
have only one fifth of the adult lung mass.
Before they reach the teenage years, they
breathe faster, inhale more air and tend to
spend more time outdoors. Then, when the
toxic air is inhaled, the ability to fight its
effects is compromised by an undeveloped
immune system. This means that the same
amount of pollution is more likely to cause
health problems among children than
among healthy adults. Furthermore, in
those places where air pollution stems
primarily from vehicles, it tends to
accumulate close to the ground, meaning
that the lower the human height, the higher
the exposure.
61. Peters, John M., et al., Epidemiologic
Investigation to Identify Chronic Effects of
Ambient Air Pollutants in Southern
California, The Children’s Health Study Final
Report, California Air Resources Board,
2004.
62. <https://www.who.int/water_
sanitation_health/monitoring/coverage/
indicator-6-1-1-safely-managed-drinkingwater.pdf>
63. Estimates of the organizers.
64. <https://www.theguardian.com/
environment/2019/mar/01/youth-climatechange-strikers-open-letter-to-worldleaders, accessed 19 June 2020.>
65. The Children’s Society, The Good
Childhood Report 2019, The Children’s
Society, London, 2019.
66. UNICEF Australia, A Climate for
Change – 2019 Young Ambassador Report,
UNICEF Australia, Pyrmont, 2019.
67. The Pearson correlation between the
z-scores for conditions and outcomes was
0.41.
68. This approach has already been taken
in some of the countries covered in this
Report Card through Child Rights Impact
Assessments.
INNOCENTI REPORT CARD 16 6 3
Innocenti Report Card 16 was written by
Anna Gromada, Gwyther Rees and
Yekaterina Chzhen with contributions from
Dominic Richardson, Celine Little and David
Anthony. The report was fact-checked by
Alessandro Carraro, supervised by Gunilla
Olsson and Priscilla Idele and edited by
Madelaine Drohan.
A panel of advisers and UNICEF reviewers
provided quality assurance. Support and
advice were provided by Laurence Chandy,
Alessandra Guedes, Daniel Kardefelt
Winther, Amenawon Njilan Esangbedo,
Nikita White and all UNICEF National
Committees. Administrative support at the
UNICEF Office of Research – Innocenti was
provided by Cinzia Iusco Bruschi, Lisa
Gastaldin and Flora Zecchi. Production was
led by Sarah Marchant, and communication
and outreach by Dale Rutstein, Patrizia
Faustini and Kathleen Sullivan.
All related materials can be downloaded
from the UNICEF Office of Research –
Innocenti website: www.unicef-irc.org
Authors
Anna Gromada is a Social and Economic
Policy Consultant at the UNICEF Office of
Research – Innocenti, a researcher at the
Polish Academy of Sciences and a
co-founder of the Kalecki Foundation. Prior
to this, she collaborated with the
Chancellery of the President of the
Republic of Poland, the Organisation for
Economic Co-operation and Development
and the Government of France. She holds
degrees in Economics, Development,
Sociology and Politics.
Gwyther Rees is a Social and Economic
Policy Manager at the UNICEF Office of
Research – Innocenti. In addition, he is an
Associate Research Fellow at the
University of York, where he is also
Research Director of Children’s Worlds – a
global survey of children’s views on their
lives and well-being. He has a PhD from
Cardiff University and a research
background in child protection and
children’s subjective well-being.
Yekaterina Chzhen is an Assistant Professor
of Sociology at Trinity College Dublin. She
moved to Trinity in August 2019 from the
UNICEF Office of Research – Innocenti,
where she had been a Social Policy
Manager since 2013. She holds a PhD from
the University of York and publishes on
poverty and inequality across the life
course. She tweets from @kat_chzhen.
Advisory board
Ársæll Már Arnarsson (Health Behaviour in
School-aged Children, Iceland)
Asher Ben-Arieh (Haruv Institute, Hebrew
University of Jerusalem)
Mario Biggeri (Università degli Studi di
Firenze)
Jonathan Bradshaw (University of York)
Dorothy Currie (Health Behaviour in
School-aged Children, University of St
Andrews)
Enrique Delamonica (UNICEF New York
Headquarters)
David Gordon (University of Bristol)
Jo Inchley (Health Behaviour in Schoolaged Children, University of Glasgow)
Bergsteinn Jónsson (UNICEF Iceland
National Committee)
Dagmar Kutsar (University of Tartu)
Gill Main (University of Leeds)
Luisa Natali (UNICEF Office of Research –
Innocenti)
Mario Piacentini (Organisation for
Economic Co-operation and Development)
Laura Speer (KIDS COUNT, Annie E. Casey
Foundation)
Ramya Subrahmanian (UNICEF Office of
Research – Innocenti)
ACKNOWLEDGEMENTS
6 4 INNOCENTI REPORT CARD 16
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 to Educational Disadvantage in Rich Nations
Innocenti Report Card 5
A League Table of Child Maltreatment Deaths in Rich National
Innocenti Report Card 6
Child Poverty in Rich Countries 2005
Innocenti Report Card 7
Child Poverty in Perspective: An overview of child
well-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 in child
well-being in the world’s rich countries
Innocenti Report Card 10
Measuring Child Poverty: New league tables of child poverty in
the world’s rich countries
Innocenti Report Card 11
Child Well-being in Rich Countries: A comparative overview
Innocenti Report Card 12
Children of the Recession: The impact of the economic crisis on
child well-being in rich countries
Innocenti Report Card 13
Fairness for Children: A league table of inequality in child
well-being in rich countries
Innocenti Report Card 14
Building the Future: Children and the Sustainable Development
Goals in rich countries
Innocenti Report Card 15
An Unfair Start: Inequality in children’s education in
rich countries
UNICEF Office of Research – Innocenti
Via degli Alfani 58
50121 Florence, Italy
Tel: +39 055 2033 0
Fax: +39 055 2033 220
florence@unicef.org
www.unicef-irc.org
@UNICEFInnocenti
facebook.com/UnicefInnocenti/
Print ISSN: 1605-7317
Online ISSN: 2519-108X
© United Nations Children’s Fund (UNICEF)
September 2020
Sales no.:E.20.XX.1
ISBN: 978-92-1-103307-6
eISBN: 978-92-1-005303-7
for every child, answers

All assignments are prepared in 12 point Times Roman font, 1.5 line spacing, and page margins of 1″ or 2.54 cm. D

In a five-page essay (do not copy material, do not use quotations, use your own words, answer the following five questions:

1. Describe in your own words the model presented in Figure 2, page 8, giving some indicators of each of the levels of influence used in the report. (20%) (approx. 1 page)

（Provide an overview (summary) of the different levels of each component of Figure 2 providing some examples of the means by which each level is measured in the report）

2. What are some of the indicators in the report in which Canada does well? What are some of the indicators in which Canada does not do well? (20%) (approx. 1 page)

（Use the top third, middle third, and bottom third categories of scores on measures to answer questions 2 and 3）

3. Which nations consistently do well on numerous indicators? Which nations consistently do poorly on numerous indicators? (20%) (approx. 1 page)

（Use the top third, middle third, and bottom third categories of scores on measures to answer questions 2 and 3.   Try and integrate.  If there are some nations doing well across the levels AND indicators in Figure 2, say so, if there nations doing very well in some and not so good in others, say that also.）

4. What are the public policies that are associated with nations doing well? Which public policies are associated with nations doing poorly? What are the reasons that public policies affect child well-being? (40%) (approx. 2 pages)

（Try and provide an overview of what policies seem to have a general positive or negative effect.  If there are policies that seem most important and others less so — by reference to what the report says — indicate that also）

There is no need to use citations or provide a reference list.

A one-line introduction and a one-line conclusion will suffice. Provide a cover sheet