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

Objectives: To examine associations between child wellbeing and material living standards (average income), the scale of differentiation in social status (income inequality), and social exclusion (children in relative poverty) in rich developed societies. Design: Ecological, cross sectional studies. Setting: Cross national comparisons of 23 rich countries; cross state comparisons within the United States. Population: Children and young people. Main outcome measures: The Unicef index of child wellbeing and its components for rich countries; eight comparable measures for the US states and District of Columbia (teenage births, juvenile homicides, infant mortality, low birth weight, educational performance, dropping out of high school, overweight, mental health problems). Results: The overall index of child wellbeing was negatively correlated with income inequality (r=-0.64, P=0.001) and the percentage of children in relative poverty (r=-0.67, P=0.001) but not with average income (r=0.1 5, P=0.50). Many more indicators of child wellbeing were associated with income inequality or children in relative poverty, or both, than with average incomes. Among the US states and District of Columbia all indicators were significantly worse in more unequal states. Only teenage birth rates and the proportion of children dropping out of high school were lower in richer states. Conclusions: Improvements in child wellbeing in rich societies may depend more on reductions in inequality than on further economic growth