Inequality and child wellbeing

Kate E Pickett, PhD FRSA FFPH

Fig 1 All cause mortality in children aged 0-14 years in European countries (three year moving average)10.

Wolfe I et al. BMJ 2011;342:bmj.d1277

©2011 by British Medical Journal Publishing Group

The UNICEF Index of Child Well-being, 2007

Child Well-being is Better in More Equal Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Child wellbeing and income inequality in US States

Correlations and p-values Income inequality Average income

Foundation for Child Development 25-item index 0.43

(0.002)

-0.61

(<0.001)

Kids Count 10-item index (shown in graph) 0.51

(<0.001)

-0.53

(<0.001)

Child outcomes related to income inequality

• In rich countries– Infant mortality– Low birth weight– Overweight– Educational

achievement– Peer relations– Bullying– Teenage births– Social mobility

• In US states– Infant mortality– Low birth weight– Overweight– Educational

achievement– Mental health

problems– Teenage pregnancy– Juvenile homicides

More children are overweight in more unequal countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

Elgar FJ, Craig W, Boyce W, Morgan A, Vella-Zarb R. Income inequality and school bullying: multilevel study of adolescents in 37 countries. J Adolesc Health. Oct 2009;45(4):351-359.

Income inequality and school bullying by 11-year-olds in 37 countries (r = .62)

www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level

Social mobility is lower in more unequal countries

0

5

10

15

Singlemothers

Low HighFather's social class

Infa

nt

de

ath

s p

er

10

00 England & Wales Sweden

0

5

10

15

Singlemothers

Low HighFather's social class

Infa

nt

de

ath

s p

er

10

00 England & Wales Sweden

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Infant mortality rates by social class

Literacy Scores of 16-25 year olds by Parents' Education

-1.5

-1

-0.5

0

0.5

1

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Parents' Education (years)

Lit

erac

y sc

ore

Sweden

Canada

United States

Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.

Why are children so sensitive to inequality?

• Effects of relative poverty on material resources?

• Impact on family life and relationships?

• Direct experience of increased status differentiation?

Inequality affects family life & relationships

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Inequality affects family life & relationships

Source: Bowles S, Park Y. Economic Journal 2005; 115 (507): F397–F412. 2005.

Iacoviello M. Household Debt and Income Inequality, 1963–2003. Journal of Money, Credit and Banking 2008;40(5):929-65.

The Effect of Caste Identity on Children's Performance

Caste Unannounced

Caste Announced

0

1

2

3

4

5

6

High Caste

Low Caste

Num

ber

of m

azes

sol

ved

Source: Hoff K, Pandey P, World Bank Policy Research Working Paper 3351, June 2004

Status differentiation has a direct effect on cognitive performance

Inequalities become entrenched early in life

• Cognitive scores at 3 years of age (MCS)

• Children with the most educated parents 12 months ahead of those with the least educated parents

• Children in families with incomes below our poverty line had scores

about 8 months behind those with incomes above it

• White children about half a month ahead of the all-UK average, followed by children from a mixed ethnic background, about half a month behind

• Bangladeshi and Pakistani children lowest vocabulary scores, with averages around 35, characteristic of the lowest tenth in the population at large

http://www.cls.ioe.ac.uk

Prenatal exposures have long-term effects

• PRENATAL STRESS– Alcohol– Nutrition– Cigarette smoke– Breastfeeding– BIRTH WEIGHT/GESTATION

Cardiovascular disease Diabetes Mental health/behaviour IQ and education Reproductive health Social status (marriage) Birth weight of next generation Health-related behaviours Birth weight of next generation

Postnatal exposures have long-term effects

• Poor attachment• Maternal depression• Breastfeeding• Poor parenting

Failure to thrive Mental health/behaviour IQ and education Social mobility Health-related behaviours

A two stage process: parental experiences of inequality shape child development

Parenting styles prepare children for the kind of social relations they may have to deal with in adulthood

Preparation for a society dependent on:- • trust, cooperation, reciprocity, empathy?

or:• fending for yourself, not trusting others?

Low Income Inequality (Gini) High

Ch

ild

Wel

lbei

ng

Inequality and Child Wellbeing (UNICEF Rpt 2013)

Pickett & Wilkinson, Pediatrics. (forthcoming)

Inequality change 2000-2010 (gini)

Ch

ild

wel

lbei

ng

Ch

ang

e 20

00-2

010

Changes in inequality and child wellbeing (UNICEF Index)

Pickett & Wilkinson, Pediatrics. (forthcoming)