Part 1 of the Report Card presents a league table of child well-being in 29 of the world's advanced economies. Part 2 looks at what children say about their own well-being (including a league table of children’s life satisfaction). Part 3 examines changes in child well-being in advanced economies over the first decade of the 2000s, looking at each country’s progress in educational achievement, teenage birth rates, childhood obesity levels, the prevalence of bullying, and the use of tobacco, alcohol and drugs.

1. UNICEF
Office of Research
Innocenti Report Card 11
Child well-being
in rich countries
A comparative overview

2. Innocenti Report Card 11 was written by Peter Adamson.
The UNICEF Office of Research – Innocenti would like to acknowledge
the generous support for Innocenti Report Card 11 provided by the
Andorran and Swiss National Committees for UNICEF, and the
Government of Norway.
Any part of this Innocenti Report Card may be freely reproduced using
the following reference:
UNICEF Office of Research (2013). ‘Child Well-being in Rich Countries:
A comparative overview’, Innocenti Report Card 11, UNICEF Office of
Research, Florence.
The 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’s work. The
prime objectives of the Office of Research 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
supporting advocacy worldwide. The Office aims to set out a
comprehensive framework for research and knowledge within the
organization in support of its global programmes and policies. Through
strengthening research partnerships with leading academic institutions
and development networks in both the North and South, the Office
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 children and child rights issues and include a wide range of
opinions. For that reason, some publications may not necessarily reflect
UNICEF policies or approaches on some topics. The views expressed
are those of the authors and/or editors and are published in order to
stimulate further dialogue on child rights.
Cover photo © luxorphoto/Shutterstock
©United Nations Children’s Fund (UNICEF), April 2013
ISBN: 978-88-6522-016-0
ISSN: 1605-7317
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Tel: +39 055 2033 0
Fax: +39 055 2033 220
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www.unicef-irc.org

3. UNICEF
Office of Research
Innocenti Report Card 11
Child well-being
in rich countries
A comparative overview
PART ONE presents a league table of child well-being
in 29 of the world’s advanced economies.
PART TWO looks at what children say about their
own well-being (including a league table of
children’s life satisfaction).
PART THREE examines changes in child well-being
in advanced economies over the first decade of the
2000s, looking at each country’s progress in
educational achievement, teenage birth rates,
childhood obesity levels, the prevalence of bullying,
and the use of tobacco, alcohol and drugs.

4. 2 I n n o c e n t i R e p o r t C a r d 1 1
PART 1
A league table of child well-being
The table below ranks 29 developed countries according to the overall well-being of their children. Each country’s overall rank is
based on its average ranking for the five dimensions of child well-being considered in this review.
A light blue background indicates a place in the top third of the table, mid blue denotes the middle third, and dark blue the bottom third.
Overall well-being Dimension 1 Dimension 2 Dimension 3 Dimension 4 Dimension 5
Average rank Material Health and Education Behaviours Housing and
(all 5 dimensions) well-being safety and risks environment
(rank) (rank) (rank) (rank) (rank)
1 Netherlands 2.4 1 5 1 1 4
2 Norway 4.6 3 7 6 4 3
3 Iceland 5 4 1 10 3 7
4 Finland 5.4 2 3 4 12 6
5 Sweden 6.2 5 2 11 5 8
6 Germany 9 11 12 3 6 13
7 Luxembourg 9.2 6 4 22 9 5
8 Switzerland 9.6 9 11 16 11 1
9 Belgium 11.2 13 13 2 14 14
10 Ireland 11.6 17 15 17 7 2
11 Denmark 11.8 12 23 7 2 15
12 Slovenia 12 8 6 5 21 20
13 France 12.8 10 10 15 13 16
14 Czech Republic 15.2 16 8 12 22 18
15 Portugal 15.6 21 14 18 8 17
16 United Kingdom 15.8 14 16 24 15 10
17 Canada 16.6 15 27 14 16 11
18 Austria 17 7 26 23 17 12
19 Spain 17.6 24 9 26 20 9
20 Hungary 18.4 18 20 8 24 22
21 Poland 18.8 22 18 9 19 26
22 Italy 19.2 23 17 25 10 21
23 Estonia 20.8 19 22 13 26 24
23 Slovakia 20.8 25 21 21 18 19
25 Greece 23.4 20 19 28 25 25
26 United States 24.8 26 25 27 23 23
27 Lithuania 25.2 27 24 19 29 27
28 Latvia 26.4 28 28 20 28 28
29 Romania 28.6 29 29 29 27 29
Lack of data on a number of indicators means that the following countries, although OECD and/or EU members, could not be included in the league table
of child well-being: Australia, Bulgaria, Chile, Cyprus, Israel, Japan, Malta, Mexico, New Zealand, the Republic of Korea, and Turkey.

5. I n n o c e n t i R e p o r t C a r d 1 1 3
Introduction
The league table opposite presents » The bottom four places in the Change over a decade
the latest available overview of child table are occupied by three of Although changes in methods and
well-being in 29 of the world’s most the poorest countries in the structure make it difficult to make
advanced economies. survey, Latvia, Lithuania and comparisons between the first two
Romania, and by one of the issues of the UNICEF overview of
Five dimensions of children’s lives
richest, the United States. child well-being (see Part 3) it is
have been considered: material
well-being, health and safety, » Overall, there does not appear nonetheless clear that there have
education, behaviours and risks, and to be a strong relationship been some significant changes over
housing and environment. In total, between per capita GDP and the first decade of the 2000s.
26 internationally comparable overall child well-being. The » Overall, the story of the first
indicators have been included in the Czech Republic is ranked higher decade of the 2000s is one of
overview (see Box 1). than Austria, Slovenia higher widespread improvement in
than Canada, and Portugal most, but not all, indicators of
The table updates and refines the
higher than the United States. children’s well-being. The ‘low
first UNICEF overview of child well-
being published in 2007 (Report » There are signs that the family affluence’ rate, the infant
Card 7) .i Changes in child well-being countries of Central and Eastern mortality rate, and the percentage
over the first decade of the 2000s Europe are beginning to close of young people who smoke
are examined in Part 3. the gap with the more cigarettes, for example, have
established industrial economies fallen in every single country for
Key findings (see Part 3). which data are available.
» The Netherlands retains its
position as the clear leader and
is the only country ranked among Data sources and background papers
the top five countries in all
dimensions of child well-being.
» The Netherlands is also the
clear leader when well-being is
The data sources used for this report are set out in the three background
evaluated by children themselves papers detailed below and available at http://www.unicef-irc.org
– with 95% of its children rating
their own lives above the mid- Martorano, B., L. Natali, C. de Neubourg and J. Bradshaw (2013). ‘Child Well-
being in Advanced Economies in the Late 2000s’, Working Paper 2013-01.
point of the Life Satisfaction Scale
UNICEF Office of Research, Florence.
(see Part 2). http://www.unicef-irc.org/publications/pdf/iwp_2013_1.pdf
» Four Nordic countries – Finland, Martorano, B., L. Natali, C. de Neubourg and J. Bradshaw (2013). ‘Child Well-
Iceland, Norway and Sweden – sit being in Economically Rich Countries: Changes in the first decade of the 21st
just below the Netherlands at the century’, Working Paper 2013-02. UNICEF Office of Research, Florence.
top of the child well-being table. http://www.unicef-irc.org/publications/pdf/iwp_2013_2.pdf
» Four southern European countries Bradshaw, J., B. Martorano, L. Natali and C. de Neubourg (2013). ‘Children’s
– Greece, Italy, Portugal and Spain Subjective Well-being in Rich Countries’, Working Paper 2013-03. UNICEF
Office of Research, Florence.
– are placed in the bottom half of
http://www.unicef-irc.org/publications/pdf/iwp_2013_3.pdf
the table.

6. 4 I n n o c e n t i R e p o r t C a r d 1 1
» Spain has slipped down the The case for national commitment school achievement, or
rankings – from 5th out of 21 to child well-being is therefore immunization rates, or the
countries in the early years of compelling both in principle and in prevalence of risk behaviours,
the decade to 19th out of 29 practice. And to fulfil that for example, are not likely to be
countries in 2009/2010. commitment, measuring progress significantly changed in the short
in protecting and promoting the term by the recessions of the last
» The United Kingdom has risen well-being of children is essential to three years.
up the rankings from bottom policy-making, to advocacy, to the
place (21st out of 21 countries) For the time being, it must be
cost-effective allocation of limited
in 2000/2001 to a mid-table accepted that data-lag is part of
resources, and to the processes of
position today. the entry price for international
transparency and accountability. comparisons of child well-being.
Part 3 of this report examines And although national-level
International comparability
changes over the first decade of monitoring of children’s lives is the
the 2000s in more detail. The measurement of child well-
more important task, UNICEF
being, however, is a relatively new
Measuring progress for children believes that international
area of study and the overview
comparison can also play a part.
The league table of child well-being presented here remains a work in
It is international comparison that
is designed to measure and progress. Chief among its
can show what is achievable in the
compare progress for children limitations is the fact that
real world, highlight strengths and
across the developed world. Its internationally comparable data on weaknesses in individual countries,
purpose is to record the standards children’s lives are not sufficiently and demonstrate that child well-
achieved by the most advanced timely. Between the collection of being is policy-susceptible. And it
nations and to contribute to debate data in a wide variety of different is international comparison that
in all countries about how such settings and their publication in can say to politicians, press and
standards might be achieved. quality-controlled, internationally public everywhere – ‘This is how
As a moral imperative, the need to comparable form the time-lag is your performance in protecting
promote the well-being of children typically two to three years. This children compares with the record
is widely accepted. As a pragmatic means that most of the statistics on of other nations at a similar level
imperative, it is equally deserving child well-being used in this report, of development.’
of priority; failure to protect and though based on the latest available
data, apply to the period 2009– Finally, any single overview of a
promote the well-being of children
2010. Such a delay would be complex and multidimensional
is associated with increased risk
frustrating at the best of times. But issue carries a risk of hiding more
across a wide range of later-life
the last three years have been far than it reveals. The following pages
outcomes. Those outcomes range
from the best of times. Beginning therefore set out to make this
from impaired cognitive
in late 2008, economic downturn overview of child well-being as
development to lower levels of
in many developed nations has transparent as possible by
school achievement, from reduced
seen rising unemployment and falls examining each of its dimensions
skills and expectations to lower
in government expenditures which in turn.
productivity and earnings, from
higher rates of unemployment to cannot but affect the lives of many
increased dependence on welfare, millions of children. Data from
from the prevalence of antisocial 2009 and 2010 capture only the
behaviour to involvement in crime, beginning of this turbulence.
from the greater likelihood of drug Nonetheless, for the most part,
and alcohol abuse to higher levels of the data used in this overview track
teenage births, and from increased long-term trends and reflect the
health care costs to a higher results of long-term investments in
incidence of mental illness.ii, iii children’s lives. Average levels of

7. I n n o c e n t i R e p o r t C a r d 1 1 5
Box 1 How child well-being is measured
The table below shows how the overview of child well-being has been constructed and sets out the full list of
indicators used. The score for each dimension has been calculated by averaging the scores for each component.
Similarly, component scores are arrived at by averaging the scores for each indicator.
Dimensions Components Indicators Figure no.
Relative child poverty rate 1.1a
Dimension 1 Monetary deprivation
Relative child poverty gap 1.1b
Material well-being
Child deprivation rate 1.2a
Figure 1.0 Material deprivation
Low family affluence rate 1.2b
Infant mortality rate 2.1a
Dimension 2 Health at birth
Low birthweight rate 2.1b
Health and safety
Preventive health services Overall immunization rate 2.2
Figure 2.0
Childhood mortality Child death rate, age 1 to 19 2.3
Participation rate: early childhood
3.1a
education
Participation rate: further education,
Dimension 3 Participation 3.1b
age 15–19
Education
NEET rate (% age 15–19 not in
Figure 3.0 3.1c
education, employment or training)
Average PISA scores in reading,
Achievement 3.2
maths and science
Being overweight 4.1a
Eating breakfast 4.1b
Health behaviours
Eating fruit 4.1c
Taking exercise 4.1d
Dimension 4
Teenage fertility rate 4.2a
Behaviours and risks
Smoking 4.2b
Figure 4.0 Risk behaviours
Alcohol 4.2c
Cannabis 4.2d
Fighting 4.3a
Exposure to violence
Being bullied 4.3b
Rooms per person 5.1a
Dimension 5 Housing
Multiple housing problems 5.1b
Housing and environment
Homicide rate 5.2a
Figure 5.0 Environmental safety
Air pollution 5.2b

8. 6 I n n o c e n t i R e p o r t C a r d 1 1
Dimension 1 Material well-being
Figure 1.0 An overview of
Netherlands children’s material well-being
Finland The league table of children’s material
Norway well-being shows each country’s
Iceland performance in relation to the average
Sweden for the 29 developed countries under
review. The table is scaled to show
Luxembourg
each country’s distance above or
Austria
below that average.
Slovenia
Switzerland The length of each bar shows each
France country’s distance above or below the
average for the group as a whole. The
Germany
unit of measurement is the ‘standard
Denmark
deviation’ – a measure of the spread
Belgium
of scores in relation to the average.
United Kingdom
Canada
Czech Republic
Ireland
Hungary
Estonia
Greece
Portugal
Poland
Italy
Spain
Slovakia
United States
Lithuania
Latvia
Romania
-3.5 -3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5
Assessing material well-being
COMPONENTS IND IC ATOR S
Relative child poverty rate (% of children living
in households with equivalent incomes below
Monetary 50% of national median)
deprivation Child poverty gap (distance between national
poverty line and median incomes of households
below poverty line)
Index of child deprivation (% of children lacking
Material specific items)
deprivation Family affluence scale (% of children reporting
low family affluence)

9. I n n o c e n t i R e p o r t C a r d 1 1 7
Children’s material well-being
The table opposite (Figure 1.0) Figure 1.1a Relative child poverty rates
presents an overview of children’s % of children aged 0–17 living in households with equivalent incomes
material well-being in developed below 50% of national median
countries. Overall, it suggests that
Finland
material well-being is highest in
Netherlands
the Netherlands and in the four
Denmark
Nordic countries and lowest in
Iceland
Latvia, Lithuania, Romania and the Norway
United States. Slovenia
Two components of material well- Sweden
Austria
being have been considered in
Ireland
arriving at this overview – relative
Switzerland
income poverty and material
Germany
deprivation. The strengths and France
weaknesses of both measures were Czech Republic
discussed in detail in the previous United Kingdom
report in this series (Report Card 10)iv Hungary
which argued that both measures are Belgium
necessary to achieve a rounded view Luxembourg
of children’s material well-being. Estonia
Slovakia
Relative poverty: Poland
child poverty rates Canada
Two separate indicators have Portugal
been used to measure monetary Greece
deprivation. They are the relative Italy
child poverty rate (Figure 1.1a) and Lithuania
Spain
the ‘child poverty gap’ (Figure 1.1b).
Latvia
The relative child poverty rate shows United States
the proportion of each nation’s Romania
Cyprus
Countries with grey bars have not been Malta
included in the ranking tables, or in the Australia
overall league table of child well-being,
New Zealand
as they have data for fewer than 75% of
Japan
the total number of indicators used.
Bulgaria
0 5 10 15 20 25
children living in households where
disposable income is less than 50% Findings
of the national median (after taking » Finland is the only country with a relative child poverty rate of less
taxes and benefits into account than 5% and heads the league table by a clear margin of more than
and adjusting for family size and two percentage points.
composition). This is the definition
of child poverty used by the
» The countries in the top half of the league table all have relative child
poverty rates of less than 10%.
majority of the world’s developed
economies. Broadly speaking, it » Four southern European countries – Greece, Italy, Portugal and Spain –
shows the proportion of children have child poverty rates higher than 15% (along with Latvia, Lithuania,
who are to some significant extent Romania and the United States).

10. 8 I n n o c e n t i R e p o r t C a r d 1 1
Figure 1.1b Child poverty gaps excluded from the advantages and
Gap between the poverty line and the median income of those opportunities which most children
below the poverty line – as % of the poverty line in that particular society would
consider normal.
Luxembourg
Hungary Relative poverty:
Netherlands the poverty gap
Austria
The relative child poverty rates in
Finland
Figure 1.1a show what percentage
France
Norway
of children live below each nation’s
Sweden relative poverty line. But they reveal
Germany nothing about how far below that
Slovenia line those children are being
Iceland allowed to fall. To gauge the depth
Switzerland of relative child poverty, it is also
Canada necessary to look at the ‘child
United Kingdom poverty gap’ – the distance between
Czech Republic
the poverty line and the median
Belgium
incomes of those below the line.
Poland
Greece Figure 1.1b shows this ‘child
Portugal poverty gap’ for each country.
Latvia
Denmark Considering ‘rate’ and ‘gap’ together
Estonia shows six countries in the bottom
Slovakia third of both tables. They are Italy,
Romania Latvia, Lithuania, Romania, Spain
Italy and the United States. By contrast,
Ireland
there are also six countries that
Lithuania
feature in the top third of both
United States
tables – Austria, Finland,
Spain
Netherlands, Norway, Slovenia
Cyprus and Sweden.
Malta
What this means for the children
Australia
of Spain or the United States, for
New Zealand
Japan
example, is that 20% or more fall
Bulgaria below the relative poverty line and
that, on average, they fall almost
0 5 10 15 20 25 30 35 40
40% below that line. In the
Findings Netherlands or Austria, on the other
hand, 6% to 8% of children fall
» Hungary and Luxembourg have the smallest child poverty gaps. below the relative poverty line and,
» Denmark is an exception among Nordic countries in having a high child on average, they fall approximately
poverty gap (almost 30%). Only a small proportion of Danish children 16% below.
(6.3%) fall below the country’s relative poverty line; but those who do,
Taken together, these two child
fall further below than in most other countries.
poverty indicators – the rate and the
» Several countries have allowed the child poverty gap to widen to more gap – make up the relative income
than 30%. They are Bulgaria, Ireland, Italy, Japan, Lithuania, Romania, component of children’s material
Slovakia, Spain and the United States. well-being.

11. I n n o c e n t i R e p o r t C a r d 1 1 9
Material deprivation: example, does not mean that Again, two indicators have been
the Child Deprivation Index children’s actual living standards are used. The first is the UNICEF Child
Relative income measures, however, lower in Canada (only that a greater Deprivation Rate (introduced in
have little to say about the actual proportion of Canadian children live Report Card 10) v which shows what
living conditions of children in in households where disposable percentage of children in each
different countries. The fact that a income is 50% of the median). In nation lack two or more of the
higher percentage of children live in order to arrive at a more complete following 14 items:
relative income poverty in Canada picture of child poverty, a measure 1. Three meals a day
than in the Czech Republic, for of actual material deprivation has
2. At least one meal a day
therefore also been included.
with meat, chicken or fish
Figure 1.2a Child deprivation rates (or vegetarian equivalent)
% of children lacking two or more specific items – see text
3. Fresh fruit and vegetables
Iceland every day
Sweden 4. Books suitable for the child’s
Norway age and knowledge level (not
Finland including schoolbooks)
Denmark
Netherlands 5. Outdoor leisure equipment
Luxembourg (bicycle, roller-skates, etc.)
Ireland 6. Regular leisure activities
United Kingdom (swimming, playing an
Spain
instrument, participating in
Slovenia
youth organizations, etc.)
Austria
Czech Republic 7. Indoor games (at least one per
Germany child, including educational baby
Belgium toys, building blocks, board
France games, computer games, etc.)
Estonia
8. Money to participate in school
Italy
trips and events
Greece
Slovakia 9. A quiet place with enough room
Lithuania and light to do homework
Poland
10. An Internet connection
Portugal
Latvia 11. Some new clothes (i.e. not all
Hungary second-hand)
Romania 12. Two pairs of properly fitting
shoes
Cyprus
Malta 13. The opportunity, from time
Bulgaria to time, to invite friends home
to play and eat
0 10 20 30 40 50 60 70 80
14. The opportunity to celebrate
Findings special occasions such as
» The five Nordic countries and the Netherlands claim the top six places. birthdays, name days, religious
events, etc.
» Luxembourg and Ireland are the only other countries with child deprivation
rates below 5% (although the United Kingdom comes close at 5.5%). Figure 1.2a presents the child
deprivation rate for 26 countries
» France and Italy have child deprivation rates higher than 10%. (no comparable data are available
» Four countries have child deprivation rates of more than 25% – Hungary, for Canada, Switzerland or the
Latvia, Portugal and Romania. United States).

12. 1 0 I n n o c e n t i R e p o r t C a r d 1 1
Figure 1.2b Percentage of children reporting low family affluence The results are computed into the
Family Affluence Scale used in
Iceland Figure 1.2b to show the percentage
Norway of children in each country living in
Netherlands ‘low affluence’ families.
Denmark
Switzerland As might be expected, the child
Sweden deprivation rate and the low family
Luxembourg affluence rate produce broadly
Finland similar league table rankings. They
Slovenia are, however, different in that one
France
focuses on the child and the other
Belgium
on the family. Taken together, they
Canada
provide a more secure overview of
Germany
Spain
children’s material deprivation.
Austria
Ireland
Real and relative
United Kingdom The differences between the two
United States components of children’s material
Portugal well-being – relative poverty and
Italy material deprivation – are often
Greece misunderstood. It is not the case
Estonia
that one is a relative measure and
Czech Republic
the other absolute. Both are relative
Poland
measures. Deprivation rates may
Lithuania
Latvia appear to measure absolute poverty
Hungary because they are based on a
Slovakia specific list of possessions rather
Romania than the median income of each
0 5 10 15 20 25 30 35 40
nation. But those possessions are
chosen to represent what most
Findings people consider normal for a child
» The Netherlands and the Nordic countries, along with Luxembourg growing up in any wealthy country
and Switzerland, have the smallest percentage of children reporting in the early 21st century. They are
low family affluence. therefore relative to both time and
place. The true difference between
» Low family affluence rates are highest in eight Central and Eastern the two approaches is that one
European countries – the Czech Republic, Estonia, Hungary, Latvia,
measures poverty in relation to an
Lithuania, Poland, Romania and Slovakia.
income norm that varies from
country to country (the national
median income) whereas the other
Material deprivation: » Does your family own a car, van measures poverty by a common
low family affluence or truck? standard for all of the countries
The second indicator used to » During the past 12 months, how under review.
measure material deprivation is many times did you travel away
based on written questionnaires
on holiday with your family?
completed by representative
samples of children aged 11, » How many computers does your
13, and 15 in each country.vi family own?
The relevant part of the » Do you have your own bedroom
questionnaire asks: for yourself?

13. I n n o c e n t i R e p o r t C a r d 1 1 1 1
Dimension 2 Health and safety
Figure 2.0 An overview of child
Iceland health and safety
Sweden
The league table of children’s health
Finland
and safety shows each country’s
Luxembourg
performance in relation to the average
Netherlands for the 29 developed countries under
Slovenia review. The table is scaled to show
Norway each country’s distance above or
Czech Republic below that average.
Spain
The length of each bar shows each
France country’s distance above or below
Switzerland the average for the group as a whole.
Germany The unit of measurement is the
Belgium ‘standard deviation’ – a measure of
Portugal the spread of scores in relation to
Ireland the average.
United Kingdom
Italy
Poland
Greece
Findings
Hungary » Nordic countries again
Slovakia head the table, with Iceland,
Estonia Sweden and Finland claiming
Denmark the top three places.
Lithuania » Austria, Canada and Denmark
United States are to be found towards the
Austria foot of the league table along
Canada with the United States. (In all
Latvia of these cases the low ranking
Romania is partly attributable to low
-3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0 immunization rates.)
Assessing health and safety
COMPONENT S IND IC ATOR S
Infant mortality rate (deaths under 12 months old
per 1,000 live births)
Health at birth
Low birthweight rate (% babies born below
2,500 grammes
National immunization rate (average coverage
Preventive health
for measles, polio and DPT3 for children age
services 12 to 23 months)
Child and youth Overall child and youth mortality rate
mortality (deaths per 100,000 aged 1 to 19)

14. 1 2 I n n o c e n t i R e p o r t C a r d 1 1
Health and safety
The health dimension of children’s Figure 2.1a Infant mortality rates
well-being is based on three Deaths under 12 months old per 1,000 live births
components for which
internationally comparable data are Iceland
Slovenia
available. The components are:
Sweden
a) health at birth – as measured Luxembourg
by the infant mortality rate and Finland
the percentage of babies born Norway
with low birthweight (below Portugal
2,500 grammes). Estonia
Italy
b) the availability of children’s
Denmark
preventive health services –
Czech Republic
as measured by national
Germany
immunization levels for measles, Ireland
polio and DPT3. Austria
c) child health and safety – as France
measured by the death rate of Netherlands
children and young people Belgium
(aged 1 to 19) from all causes. Spain
Greece
The chart on the previous page Switzerland
(Figure 2.0) combines these three United Kingdom
components into a league table of Canada
child health for the 29 developed Lithuania
countries under review. Poland
Hungary
Health at birth: United States
infant mortality Slovakia
Latvia
In all developed countries, infant
Romania
mortality rates (IMRs) have been
reduced to fewer than 10 infant Japan
deaths per thousand live births. Cyprus
The relatively small differences Australia
between countries therefore reflect New Zealand
not variations in the fundamentals Malta
of public health such as safe water Bulgaria
and sanitation but variations in the 0 2 4 6 8 10 12 14
commitment and the capacity to
deliver whatever services are Findings
necessary to protect every mother- » Three Nordic countries – Finland, Iceland and Sweden – plus
to-be, every birth, and every infant Luxembourg and Slovenia – head the table with infant mortality rates
in the earliest days and weeks of of fewer than 2.5 deaths per 1,000 births.
life. The IMRs set out in Figure 2.1a
» 26 of the 35 countries have reduced infant mortality to 5 or fewer
may therefore be read as a measure
per 1,000 births.
of commitment to maternal and
child health for all – including the » The only countries with infant mortality rates higher than 6 per
mothers and children of the poorest 1,000 births are Latvia, Romania, Slovakia and the United States.
and most marginalized families. » Three of the richest nations in the developed world – Canada, the
United Kingdom and the United States – are placed in the bottom
third of the infant mortality league table.

15. I n n o c e n t i R e p o r t C a r d 1 1 1 3
It is possible that the low ranking Figure 2.1b Low birthweight
of the United States in the league % babies born below 2,500 grammes
table of infant mortality is not
justified: there is an as yet Iceland
unresolved debate about whether Sweden
infant mortality rates in the United Finland
States might include the deaths of Estonia
extremely premature and/or low Ireland
birthweight babies who are kept
Norway
alive for a time by advanced neo-
Netherlands
natal care but who, in other
Slovenia
countries, might not be classified
Poland
as ‘live births’.
Canada
Health at birth: Denmark
low birthweight Luxembourg
The second indicator used to Switzerland
measure health at the beginning France
of life is the proportion of babies Belgium
who are born with low birthweights Germany
(below 2,500 grammes).
Italy
According to the United States United Kingdom
Centers for Disease Control and Austria
Prevention, “The birthweight of an Slovakia
infant is the single most important Czech Republic
determinant of its chances of
Spain
survival and healthy growth.” vii
United States
It is also a guide to the general
Portugal
health, and health behaviours, of
pregnant women and mothers, both Hungary
of which are important to every Greece
other dimension of child well-being.
Low birthweight is also known to New Zealand
be associated with increased risk Australia
across a range of health problems Japan
in childhood and on into adult life.
0 2 4 6 8 10 12
Figure 2.1b shows the percentage
of babies born with low birthweight Findings
in each of the 29 countries for » Five European countries – Estonia, Finland, Iceland, Ireland and Sweden –
which data are available. have succeeded in reducing the incidence of low birthweight below 5%.
» Only in Greece, Hungary, Portugal and the United States does the low
birthweight rate exceed 8%.

16. 1 4 I n n o c e n t i R e p o r t C a r d 1 1
Figure 2.2 Immunization rates Preventive health services:
Average coverage for measles, polio and DPT3 for children aged 12 to 23 months immunization
Hungary The second component chosen
Greece to evaluate child health is the
Slovakia availability and effectiveness of
Finland each country’s preventive child
Czech Republic health services. This has been
Luxembourg measured by each country’s
Poland immunization rate (average
Sweden
vaccination coverage for measles,
Belgium
polio and DPT3).
Portugal
Netherlands Routine immunization rates in the
Spain developed nations are generally
Romania maintained at high levels, averaging
France
close to 95%. As with infant
Slovenia
mortality rates, the relatively
United Kingdom
Lithuania
small differences between countries
Iceland can therefore be said to mirror
Germany commitment to the ideal of
Estonia reaching out to every single child,
Italy including the most marginalized,
Switzerland with an essential preventive health
United States service to which all children have
Norway a right.
Ireland
Latvia Figure 2.2 presents an immunization
Denmark league table for 29 countries.
Canada
Austria
It might be suspected that low
immunization rates in countries
Japan such as Austria, Canada and
Bulgaria Denmark have been affected by
Cyprus rumours, based on discredited
Australia research, linking the triple MMR
New Zealand vaccine (measles, mumps and
Malta
rubella) with autism. This would
70 75 80 85 90 95 100 not really be an ‘excuse’ for low
coverage rates, as running a first-
Findings class immunization programme
» Greece and Hungary head the table with 99% immunization coverage. means making sure that the public
is well informed and that false
» Three of the richest countries in the OECD – Austria, Canada and
information is not allowed to put
Denmark – are the only countries in which the immunization rate falls
children at risk. But in fact the MMR
below 90%.
scare would not appear to be the
major cause of low immunization
rates in Austria, Canada and
Denmark – all of which have low
rates even when measles
vaccination is excluded from the
calculations (in Canada, the measles

17. I n n o c e n t i R e p o r t C a r d 1 1 1 5
immunization rate is higher than Figure 2.3 Child and youth mortality rates
for DPT3 or polio). Deaths per 100,000 aged 1 to 19
Child health: Iceland
the 1 to 19 death rate Luxembourg
The third component used to build Switzerland
an overall picture of child health is Netherlands
the death rate among children and Sweden
young people between the ages Spain
of 1 and 19. Germany
Deaths in this age group are rare Norway
in advanced economies and the Slovenia
causes go beyond disease and Italy
the efficacy of health services United Kingdom
to include deaths from suicide, Finland
murder, traffic injuries, drownings, Denmark
falls and fires. Differences between France
countries in the death rate for Portugal
children and young people in this Ireland
age group may therefore be said Austria
to reflect overall levels of health Czech Republic
and safety throughout childhood Belgium
and adolescence. Greece
Figure 2.3 presents the 1- to Hungary
19-year-old death rate for each Poland
country. In absolute numbers, Slovakia
the differences between countries Estonia
are clearly small. But it is worth Lithuania
noting that if all European countries Latvia
had the same child death rate as Romania
Iceland or Luxembourg then over
8,000 child deaths a year could Cyprus
be prevented – each one Malta
representing unimaginable anguish
Bulgaria
for the family concerned.
0 5 10 15 20 25 30 35 40
Taken together, the three
components set out above provide Findings
an approximate guide to the health » Iceland, Luxembourg, the Netherlands, Spain, Sweden and Switzerland
dimension of children’s well-being. head the table with child death rates below 15 per 100,000.
Ideally, such an overview would also
have included some indicator of » Central and Eastern European countries occupy the bottom third of the
children’s mental and emotional table – along with Belgium and Greece.
health, and of the prevalence of
child abuse and neglect. But such
issues are difficult to define and
measure even within an individual
country; internationally, no
comparable data are available.

18. 1 6 I n n o c e n t i R e p o r t C a r d 1 1
Dimension 3 Educational well-being
Figure 3.0 An overview of
Netherlands children's educational well-
Belgium being
Germany
The league table of children’s
Finland
educational well-being shows each
Slovenia country’s performance in relation to
Norway the average for the 29 developed
Denmark countries under review. The table
Hungary is scaled to show each country’s
Poland distance above or below that average.
Iceland The length of each bar shows each
Sweden country’s distance above or below the
Czech Republic average for the group as a whole. The
Estonia unit of measurement is the ‘standard
Canada deviation’ – a measure of the spread
of scores in relation to the average.
France
Switzerland
Ireland
Portugal
Lithuania
Findings
Latvia » Educational well-being is
Slovakia seen to be highest in Belgium,
Luxembourg Finland, Germany and the
Austria Netherlands – each of which
United Kingdom achieves an overall score
Italy significantly above average
Spain for the 29 countries.
United States » Greece, Romania, Spain and
Greece the United States show the
Romania lowest levels of educational
-4.0 -3.0 -2.0 -1.0 0.0 1.0 2.0 well-being.
Assessing educational well-being
COMPONENTS IND IC ATOR S
Preschool participation rate (% of those aged
between 4 years and the start of compulsory
education who are enrolled in preschool)
Participation Further education participation rate (% of those
aged 15 to 19 enrolled in further education)
NEET rate (% aged 15 to 19 not in education,
employment or training)
Average score in PISA tests of reading, maths
Achievement and science literacy

19. I n n o c e n t i R e p o r t C a r d 1 1 1 7
Educational well-being
In gauging educational well-being, Figure 3.1a Preschool enrolment rates
two main components have been % of children aged between 4 years and the start of compulsory education who are
considered – participation rates and enrolled in preschool
achievement levels. Taken together
France
they provide an approximate
Netherlands
guide to both quantity and quality
Spain
of education. Figure 3.0 (opposite)
Belgium
combines the two into a single
Denmark
overview of children’s educational
Italy
well-being for 29 developed countries.
Norway
Participation: United Kingdom
early childhood education Germany
Iceland
The first component – participation –
Sweden
has been assessed by three
Luxembourg
indicators:
Hungary
a) participation in early childhood Austria
education Slovenia
Estonia
b) participation in further education
Portugal
c) the proportion of young people, Czech Republic
aged 15 to 19, who are not Latvia
participating in education, Ireland
training or employment. Romania
Switzerland
In recent times it has been widely
Lithuania
acknowledged that the foundations
Slovakia
of educational success are laid down
Poland
before formal education begins.viii
United States
In response to this and other
Greece
pressures, all governments in
Finland
developed countries have invested
to a greater or lesser degree in free
Japan
or subsidized preschool education.
Malta
The quality and quantity of that early Cyprus
years education is difficult to measure Bulgaria
on an internationally comparable 60 65 70 75 80 85 90 95 100
basis – a difficulty highlighted in
Report Card 7 (2007) which noted Findings
that the lack of any indicator of » Early childhood education is virtually universal in Belgium, France,
participation in early childhood the Netherlands and Spain.
education is a “glaring omission”
from the attempt to build an overall » Preschool enrolment rates exceed 90% in half of the 32 countries listed.
picture of children’s well-being.ix » In only eight countries do participation rates in early childhood education
The present report begins to make fall below 80% – Bulgaria, Finland (but see Box 2), Greece, Lithuania,
good that omission by including the Poland, Slovakia, Switzerland and the United States.
preschool participation rate for 32
developed countries (Figure 3.1a).

20. 1 8 I n n o c e n t i R e p o r t C a r d 1 1
Figure 3.1b Participation in further education Findings
% of children aged 15 to 19 in education
» Five countries enrol 90% or more
of their young people in further
Belgium
education – Belgium, Ireland,
Poland
Ireland
Lithuania, Poland and Slovenia.
Lithuania » Seven of the wealthiest OECD
Slovenia countries fall into the bottom
Hungary third of the further education
Netherlands
league table – Austria, Canada,
Czech Republic
Italy, Luxembourg, Spain,
Latvia
the United Kingdom and the
Germany
United States.
Sweden
Finland » The further education enrolment
Norway rate exceeds 80% in all of the
Slovakia more populous developed
Iceland
countries except the United
Switzerland
Kingdom. The United Kingdom
Estonia
is the only developed country
Portugal
in which the further education
France
Denmark
participation rate falls below
Greece 75%; this may be the result
Italy of an emphasis on academic
Spain qualifications combined with a
Canada diverse system of vocational
United States qualifications which have not
Austria yet succeeded in achieving
Romania either ‘parity of esteem’ or
Luxembourg an established value in
United Kingdom employment markets.
New Zealand
Australia
Bulgaria
Cyprus
Malta
60 65 70 75 80 85 90 95
Note: It is possible that some countries with very small populations, for example Luxembourg and
Malta, may show low rates of participation in further education because a proportion of the relevant
age group are continuing their studies outside their own countries.
The age at which compulsory Further education colleges. Participation in further
education begins varies between education reflects ‘educational well-
At the other end of the educational
4 and 7. The preschool participation being’ in as much as it indicates
ladder is the further education
rate is here defined as the successful passage through the
percentage of children between participation rate (Figure 3.1b) years of compulsory schooling. It is
the age of 4 and the beginning of which shows the percentage of also, of course, associated with a
compulsory education who are young people aged 15 to 19 who wider range of opportunities at the
enrolled in preschools. are enrolled in schools and beginning of adult life.

21. I n n o c e n t i R e p o r t C a r d 1 1 1 9
Figure 3.1c NEET rate Findings
% of children aged 15 to 19 not in education, employment or training
» At the top of the table, Denmark,
Norway and Slovenia have NEET
Norway
rates below 3%.
Slovenia
Denmark » At the foot of the table, Ireland,
Luxembourg Italy and Spain have NEET rates
Czech Republic of more than 10%.
Netherlands
Poland
Germany
Lithuania
Slovakia
Finland
Research in different countries
Sweden
has also shown associations
Hungary
between NEET status and mental
Belgium
health problems, drug abuse,
Austria
involvement in crime, and long-term
France
unemployment and welfare
Portugal
dependence.x
Switzerland
Greece Figure 3.1c records the NEET rate
Estonia for 33 advanced economies.
Latvia
Canada
To make international comparisons
United States fair, the data must refer to a similar
United Kingdom period of time. Unfortunately, the
Romania latest available common year for
Ireland NEET rates is 2009–2010. Figure
Italy 3.1c may therefore not reflect the
Spain current situation. It does however
reflect the major impact of the
Cyprus current economic downturn on
Australia youth unemployment rates (which
Malta reached a peak of 18.3% in
New Zealand November 2009 and were slightly
Bulgaria below that level in 2012). In total,
0 2 4 6 8 10 12 14 16 18 more than 23 million young people
in OECD countries now fall into the
NEET category and more than half
of this total are reported to have
NEET rate and employment opportunities as
given up looking for work.xi
The third indicator of educational well as by the effectiveness of
well-being looks at participation education systems in preparing Commenting on the impact of
young people for the transition to economic crisis on the transition
from a different perspective – the
work. Equally obviously, a high from school to work, the OECD
percentage of young people (aged
NEET rate represents a threat to the noted in 2011 that “High general
15 to 19) who are not participating
present and future well-being of unemployment rates make this
in either education, employment or
young adults, a disincentive to transition substantially more difficult,
training (the so-called ‘NEET’ rate).
those still in the education system, as those with more work experience
In all countries, NEET rates are and a waste of educational are favoured over new entrants into
affected by economic conditions investment and human resources. the labour force.” xii

22. 2 0 I n n o c e n t i R e p o r t C a r d 1 1
Figure 3.2 Educational achievement by age 15 Findings
Average score in PISA tests of reading, maths and science literacy
» Finland is a remarkable outlier –
registering a score almost 20
Finland
points clear of the second placed
Canada
country (see Box 2).
Netherlands
Switzerland » Canada and the Netherlands take
Estonia second and third places.
Germany
Belgium
» Three of Europe’s wealthiest
Poland
countries, Austria, Luxembourg
Iceland and Sweden, find themselves in
Norway the bottom half of the educational
United Kingdom achievement table, as do all four
Denmark countries of southern Europe.
Slovenia
» Romania is also an outlier,
Ireland
registering a score more than
France
40 points below the next lowest
United States
country in the table.
Hungary
Sweden » Australia, Japan and New Zealand
Czech Republic would all have been placed in the
Portugal top five places had it been possible
Slovakia to include them in the main league
Austria table (see note page 7).
Latvia
Italy
Spain
Luxembourg (PISA) which measures pupils’
Lithuania abilities in three basic competences
Greece – reading, maths and science.
Romania Repeated every three years, the
tests are administered to
Japan representative samples of 15-year-
New Zealand olds and are intended to measure
Australia knowledge and skills in relation to
Bulgaria the demands of managing lives
400 420 440 460 480 500 520 540 560 and careers in the modern world.
In total, 34 member countries of
the OECD, plus non-member
Educational achievement factors such as the development partner countries, participate in
of social understanding and value this evaluation of educational
The second component of
formation (including education for achievement.
educational well-being is the quality
citizenship) as well as the Figure 3.2 presents an overview of
of the education received.
opportunity to develop the diverse the results of the latest PISA survey
This key element of child well-being abilities and potentials of young for the countries under review. In
is of course difficult to define and people. But this lies in the future. each case, the scores shown are an
measure on an internationally At present, the only practical average of results in reading, maths
comparable basis. Ideally, the measure of quality in education is and science. All scores have been
concept of ‘quality’ in education provided by the OECD’s Programme re-presented on a common scale
would embrace a broad range of of International Student Assessment based on an unweighted average