Do family characteristics affect children's health?

This blog, written by Wikichild co-ordinator Melinda Deleuze, provides an overview of the latest World Family Map 2014. The report takes a look at family characteristics across the globe to see if they affect children's health. The post is a part of Wikiprogress' Series on Health.

The World Family Map Project measures and monitors global changes in the family. Last month, the World Family Map 2014 was released and it sure has a lot going on! This second annual edition provides 1) updates on the project’s 16 indicators, 2) an essay on union stability and child health in developing countries, as well as 3) a short analysis of psychological distress among 9 to 16 year olds in the European Union (EU). This blog will provide an overview of the report’s three sections, sharing a few of the findings. 

The Countries included in the World Family Map 2014

The Data Updates, part 1

The first section, representing a bulk of the report, offers an inside view of families within 49 countries. The report presents a description of the data trends, showing regional and country differences, as well as colourful tables and maps for almost every indicator. The report pulls data from a multitude of sources: country-level sources; DHS; FAO; Integrated Public Use Microdata Series-International (IPMUS); LIS; OECD; PISA; UNICEF Innocenti Research Center; World Value Surveys. The blending of these surveys produces 16 indicators divided into 4 domains: family structure; family socioeconomics; family processes; family culture.

The “family structure” dimension includes data regarding living arrangements, marriage and cohabitation rates, fertility rates, and non-marital childbearing rates. Living arrangements is separated into 2-parent households, single-parent households, neither-parent households, and households with extended family members.

The “family socioeconomics” dimension includes poverty, undernourishment, parental education level, parental employment rates, and public family benefits. Poverty measures include both absolute and relative child poverty rates.

The “family processes” dimension includes adult satisfaction with family life, disagreement over household work, teen’s discussion with parents, and family meals around the table with 15 year-olds. Teen’s discussion with parents includes communication frequency measures as well as whether the conversation is about how well the 15 year old is doing in school or about non-school related topics.

Finally, the “family culture” dimension includes measures regarding attitudes toward voluntary single motherhood, attitudes about whether children need both a mother and father, amount of support for working mothers, and family trust.

The Essay, part 2

The report also contains an essay which explores the relationship between family instability and children’s health in developing countries. There are 27 countries observed in Central/South America and the Caribbean, Africa, Asia and the Middle East, using data from the Demographic Health Surveys (DHS). Family instability is measured here by divorce or dissolution of a cohabiting partnership, widowhood, or re-partnership (i.e. re-marriage; cohabitation) during the child’s lifetime. The essay looks into 3 child health measures with varying degrees of severity: diarrhea (acute illness); stunting (longer-term); child mortality (most severe outcome). 

Children of Mothers Who Divorced, Dissolved a Cohabiting Union, and/or Re-partnered More Likely to Have Died in Three Out of Four Regions

The essay suggest that family instability compromises parents’ ability to provide the kind of consistent and attentive care that is most likely to foster good health in children. The essay hypothesizes that union instability may affect children’s health due to additional time and attention consumption, more stress, a disruption of social support networks, and reduction of socioeconomic resources available to parents. The results show that in a number of low-income regions divorce or partnership dissolution and re-partnering are associated with increased negative conditions for all three child health measures. The overall findings suggest that union instability is associated with worse child health outcomes; however, the findings are stronger for diarrhea and death than for stunted growth.

The Analysis, part 3

The third and final section of the report contains an analysis of the 2010 EU Kids Online Survey to determine whether there are links between family structure across Europe and children’s psychological health and if there are variations among countries. The survey contains findings for 1,000 children who use the internet aged 9-16 in each of the 25 EU countries observed. Psychological health is defined as emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and pro-social behaviour (or voluntary behaviour intended to benefit another).

Odds of Elevated Psychological Difficulties in Sole-Parent Families Relative to Two-Parent Families

The results suggest that in the EU as a whole, children’s living arrangements are related to their psychological well-being. Children from more educated households report fewer psychological difficulties, but household socioeconomic status has the opposite effect, with higher status being associated with more difficulties. 

Overall, the World Family Map 2014 brings a good deal of interesting analysis and provides more insight to important questions facing countries all over the world. I am looking forward to see what new understandings next year’s edition brings.

-Melinda Deleuze

See Also:

World Family Map 2013

The OECD Family Database

Child Family and Peer Relationships

Cannabis Use among Adolescents in Europe, 2002-2010: Overall Decrease, but Increasing Inequalities

This blog, written ­by Dr. Margaretha de Looze (researcher and lecturer at Utrecht University, the Netherlands), discusses HBSC's study on cannabis use among adolescents in Europe. The post is part of the Wikichild series on Adolescent health, examining cross-national changes in frequent adolescent cannabis use (40+ times consumed over life-time at age 15) over time and relating these trends to societal wealth, family affluence and gender.

Cannabis use among adolescents in wealthy European countries is decreasing, while in poorer European countries it is on the rise. In particular, Russia, Latvia, Lithuania, and FYR Macedonia experienced increased cannabis consumption amongst adolescents between 2002 and 2010. These findings come from a recent publication by members of the Health Behaviour in School-aged Children (HBSC) study and research network.

Decrease in wealthy countries

 

This analysis, from 14 members of the international WHO collaborative study, looked at trends over time in frequent adolescent cannabis use (40+ times consumed over lifetime at age 15) in 2002, 2006 and 2010. We found that frequent cannabis use has decreased among adolescents in the more affluent western and southern European and North American countries. In some of these countries, the decreases were dramatic. For example, in 2010, frequent cannabis use among German boys decreased from 6.6% in 2002 to 1.2%, and  among Dutch girls it decreased from 4.1% in 2002 to 1.5%.  

This decline in frequent cannabis use in the wealthier countries of Europe is consistent with a general decrease in a range of other risk behaviours among these young people. In many of these countries, adolescent tobacco use, alcohol consumption, sexual risk behaviors and fighting have also declined.

How can this decline in adolescent risk behaviours be explained? One possible answer lies in substance use policies. Legislations to limit underage access and to restrict illicit substance use in general are enforced in all Western countries, with stricter substance use prevention policies coming into action in recent years. Additionally, a stronger focus on educating young people on the harmful effects of substance use has changed social norms leading to lower tolerance and acceptance of substance use among teenagers. 

Increase in Russia, Latvia, Lithuania, and FYR Macedonia

 

In contrast to Western European countries, frequent cannabis use stabilized or increased between 2002 and 2010 in the poorer Eastern European countries. For example, frequent cannabis use among boys in Latvia increased from 1.1% to 3.3%, with Russian girls showing an increase from 0.2% to 0.8%. 

Although the rates in these countries are still lower than those in Western Europe, the increasing trends over time are steady - and thus alarming. Adolescents from less affluent countries seem to be adopting consumption patterns consistent with their peers in richer countries. 

The growing wealth of Eastern European countries appears to have fostered adolescent substance use due to the increased availability of substances and the emergence of a flourishing youth culture. However, this apparent effect of national wealth seems to have leveled off in Western European countries, potentially due to the implementation of stricter cannabis use policies.

Importantly, adolescent cannabis use appears not only to have ‘trickled down’ from richer to developing countries, but also from more affluent to less affluent youth within countries. While cannabis consumption emerged as a central component of the ‘Bohemian’ ideals of the 1960’s and 1970’s and was first popularized by middle class youth, it now appears to have spread to the youth population of a lower socioeconomic status.

Girls do not catch up with boys

While one might have expected that gender differences would narrow between 2002 and 2010, as a result of girls’ and women’s continuing liberation, cannabis use has actually become (even) more characteristic of males during this period. This rather surprising finding might be explained by the de-normalization of cannabis use over the past decade. While cannabis use was widespread and quite ‘normalized’ among well-adjusted, non-risk-taking young people at the end of the 20th century, the recent declining rates may have changed young people’s perception of cannabis use as de-normalized and highly risky behaviour. As risk-taking increases social status among boys but less so for girls, it may be easier for boys to remain part of a cannabis-using scene.

Although it is reassuring that, overall, cannabis use has decreased for both genders, male adolescents have always been, and remain, at higher risk for excessive use, dependence and associated health problems.

What next?

Future studies should closely monitor tendencies for ‘trickle down’ and ‘de-normalization’ effects in frequent cannabis use as fundamental indicators of substance use and health in adolescent populations. Currently, data for the new HBSC cycle are being collected in more than 40 countries in Europe and North America. Within a year, we will be able to conclude whether the observed trends have continued into 2014

The HBSC Study

The HBSC research network is an alliance of researchers who collaborate to collect data on the health, well-being, health behaviours, social environments and economic contexts of adolescents. The HBSC study is currently conducted in 44 countries across Europe and North America, and the network includes over 450 experts from a wide range of disciplines. Members of the HBSC network collaborate to develop a standardized questionnaire, which is used to survey nationally representative samples of school-aged children in each participating country.
HBSC's research themes currently include: chronic conditions, eating and dieting, electronic media, family culture, gender, medicine-use, peer culture, physical activity, positive health, puberty, risk behaviours, school, sexual health, social inequality, and violence and injuries. 

- Dr. Margaretha de Looze
Researcher and lecturer at Utrecht University, the Netherlands 

For more information visit www.hbsc.org 

See also:
- Injury Among Young Canadians: A national study of contextual determinants
- Health Behaviour in School-Aged Children
- Adolescence

Afghan Children Pay the Price of Brutal War

This blog by César Chelala highlights the issues that children are facing in Afghanistan, which heavily impact their health, education and overall well-being. The post is a part of Wikichild's series on under-5 mortality rates, along with it's spotlight on the recent Save the Children report "State of the World's Mothers 2013: Surviving the first day".

Decades of insecurity and war in Afghanistan have provoked a heavy toll on children’s lives and well-being. An under-5 mortality rate of 199 per 1,000 live births as reported by UNICEF is among the highest in the world. That means that more than one out of every five children is dead by the time they are five. In addition, health and education systems suffer from lack of funds and qualified professionals, a situation worsened by the security situation.

The statistics are frightening. More than 60% of all child deaths and disabilities are due to respiratory and intestinal infections, and of vaccine-preventable diseases such as measles. Diarrhea kills tens of thousands of children every year. Many also die from severance of breast-feeding before time. An estimated 7.5 million children and adults are at risk from hunger and malnutrition, the latter affecting children's growth in particular.

According to United Nations statistics, malnutrition among children has increased by 50 percent or more countrywide when compared to 2012. This is happening despite billions of dollars in humanitarian aid by Western governments. One of the most affected places is the malnutrition ward at Bost Hospital, in war-torn Helmand Province, but a similar situation can be found even at Indira Gandhi Children’s Hospital in Kabul.

Although it is difficult to pinpoint the causes for the increase in malnutrition levels, experts indicate several factors that contribute to it such as widespread poverty, difficulties in the implementation of feeding and therapeutic programs, and lack of breastfeeding. Despite low incomes, many mothers are lured by the beautiful pictures on milk cartons, and tend to believe that this milk provides better nutrition for their children.

Children in Afghanistan can also be affected by polio, since Afghanistan is one of only four countries in the world where the disease is still endemic. Despite high vaccination rates, however, there were 47 documented cases of polio in the country.

Some cities, such as Jalalabad, the largest city in eastern Afghanistan, located at the junction of the Kabul and Kunar rivers, are high risk areas for polio due in large part to the massive and continuous population movements from and into polio infected areas. In South Asia in 2000, over 40 percent of the confirmed cases of polio occurred in Pakistan and Afghanistan.

To control the spread of disease, UNICEF and the Department of Public Health in Nangarhar, one of Afghanistan’s 34 provinces, have launched the “Women Courtyard” initiative, aimed at providing local women with information about polio and other vaccine-preventable diseases, as well as such related issues as hygiene and waterborne illnesses.

While this is an important initiative, certain popular traditions still constitute a hindrance to its successful implementation. One such tradition is that babies cannot leave their homes before the 40th day after birth, a tradition which prevents many newborns from being vaccinated at the appropriate time.

To make matters worse, deadly attacks have targeted schools and impeded access to critical health care. According to Daniel Toole, UNICEF Regional Director for East Asia and the Pacific, “We have had attacks on villages and on schools by both anti-government elements as well as by coalition forces and international troops that have hit civilians."

Just in the first four months of 2013 over 400 children were killed and maimed as a result of the protracted conflict. Statistics seem to show that 2013 may well have been the second most deadly year since 2001.

The result of this conflict is that not a single child growing up in Afghanistan today has known peace in his/her lifetime. Deteriorated mental health is one of the consequences of a permanent state of war. A UNICEF study has found that the majority of children under 16 years of age in Kabul suffer from psychological trauma resulting in serious mental health problems including psychiatric disorders and post-traumatic stress syndrome.

Children in Afghanistan are exposed not only to violence related to acts of war but also to violence resulting from accidents, beatings by close relatives or neighbors, or seeing close relatives being beaten or executed. A study published in the Lancet has pointed out, “In Afghan children’s lives, everyday violence matters just as much as militarized violence in the recollection of traumatic experiences.”

Daniel Toole remarked at a press briefing in Geneva, “Afghanistan today is without doubt the most dangerous place to be born,” a sad commentary on the beleaguered country.

- César Chelala

César Chelala, MD, PhD, is an international public health consultant and the foreign correspondent for the Middle East Times International (Australia). He also is a co-winner of an Overseas Press Club of America award for an article on human rights.

This blog first appeared 11 January, 2014 on The WIP blog site. 

See related articles:

Levels and Trends in Child Mortality 
Childhood Under Fire: The impact of two years of conflict in Syria

UNICEF Child Well-being measure

UNICEF - Towards a Post-2015 World Fit for Children

UNICEF Report Card 10: Measuring child poverty

Children and Malnutrition

Sanitation in schools

This blog, written by Wikichild co-ordinator Melinda Deleuze, is a part of the Wikiprogress September spotlight on "Education and skills". Also, in conjunction with the OECD's 2013 World Water Week, the post discusses the need for improved water and sanitation in schools and various organizations' efforts.

It is important to focus on improving school’s sanitation standards, because children are often the most vulnerable to diseases, according to wateraid.org. Children also take new ideas and habits back to their homes and families, increasing programs’ impact. 

Only 49% of schools around the world provide drinking water to its pupils and 11% of schools provide water for handwashing. In Kenya, although 63% of schools provided drinking water, only 27% had treated water. Also, while 63% of schools in Kenya have handwashing water available to its students, only 8% of schools have soap. Studies show that handwashing with soap can reduce the risk of diarrheal disease by more than 42% (Curtis and Caincross, 2003). 

Over the past few years, multiple organizations have been working hard to increase the number of schools with drinking water, sanitation facilities and handwashing stations. According to the Sanitation and Water for All project update (April 2013), in the past year, Nigeria mobilized private sector resources for provision of WASH facilities in over 700 schools.

Sustaining and Scaling School Water, Sanitation and Hygiene Plus Community Impact (SWASH+), also known as "WASH in schools", is a project established to identify, develop, and test innovative approaches to school-based water, sanitation and hygiene in Kenya. Funded by the Bill and Melinda Gates Foundation and the Global Water Challenge, the project has been running since 2006 with the help of CARE, Emory University’s Center for Global Safe Water, the Government of Kenya, Kenya Water for Health Organisation, Water.org, and SANA. SWASH+ has worked in 185 primary schools in four districts in Nyanza Province, gathering data, learning about challenges and testing solutions for school water, sanitation and hygiene (WASH). SWASH+ provides a base package, which includes:

1. Provision of water for drinking in safe storage containers
2. Daily treatment of drinking water with an appropriate technology
3. Provision of water for handwashing
4. Daily provision of soap

After the 5-year project, SWASH+ found that:

• Absenteeism is significantly reduced among girls, with an average of 6 days fewer absences per year.
• There was a 45% overall reduction of ascaris, and an even greater decrease among girls. Also, the intensity of hookworm infection significantly declined among boys.
• Unfortunately, there were higher quantities of E. coli bacteria on pupils’ hands who received hygiene, water treatment and sanitation facilities. A study by the European Journal of Tropical Medicine and International Health (2009) found that only 32% of Kenyans wash their hands after fecal contact.

Sapling handwashing, Malawi. Photo: Plan Malawi

Another program working towards increasing drinking water, sanitation facilities and handwashing stations in schools is the Pan African School Led Total Sanitation (SLTS) program. This program is targeting 742 schools in 6 sub-Saharan countries (i.e. Sierra Leone; Ethiopia; Uganda; Kenya; Zambia; Ghana; Niger; Malawi). In each country, the SLTS program follows the same process to facilitate the necessary activities to trigger the schools’ and communities’ progress:

1. Discuss with the government’s Health and Education sectors, plan at different levels and reach an agreement;
2. Train teachers who then train students how to use the school latrine and surrounding water and sanitation areas, as well as playing games which help internalize sanitation and hygiene concerns;
3. Register households for monitoring;
4. Conduct a school sanitation campaign, cleaning the whole school compound;
5. Group community into Development Units and establish these groups’ meeting places and times (meetings take place at schools);
6. Establish a committee of six for each Development Unit who facilitate discussion and prepare a report;
7. Monitor progress with these reports.

The SLTS program’s 5-year period runs through next year (2014), and this process can be reviewed and changed before the next Pan Africa program begins.

Water and sanitation needs to improve in schools in order to increase school attendance among girls and decrease sickness among all children. Top-down and bottom-up forces are needed to help children become more educated and safer around the world. 

  

 Melinda Deleuze

Schools tackling obesity and malnutrition

This blog, written by Wikichild co-ordinator Melinda Deleuze, is part of the Wikiprogress Series on Health and Child Well-being. Discussing what schools can do to tackle childhood obesity, the post also leads up to the Wikiprogress September spotlight on Education and skills.

Every time I return to the United States, one of the first things that strikes me is the number of overweight children I see in the airport. During the summer months, the focus has been on feeding hungry American children nutritious food. There are hundreds of programs run by churches, nonprofits and civic groups which receive USDA reimbursements for that purpose. In Arkansas alone, more than $97,000 in grant money was distributed. Now that school is back in session, the aim is not only to give children the nutrition they need, but also to tackle the widespread issue of childhood obesity. 

Child and adolescent obesity is exceedingly prevalent in the US, Canada and Greece. It is also on the rise in most developed countries and in Asia. Over the past 3 decades, childhood obesity rates in America have tripled. Today, nearly one in three children in America are overweight or obese. Approximately 12% of children ages 2 to 5 are obese and 18% of those ages 6 to 19 are considered obese. The figures are higher among African American and Hispanic populations, where nearly 40% of the children are overweight or obese. 

          Percent of overweight children*                            Percent of children who eat breakfast every day*

                11, 13 and 15 years old                                                        11, 13 and 15 years old

Obesity has many negative consequences, and last week the American Medical Association pronounced childhood obesity a disease. Obese children and adolescents are at greater risk for bone and joint problems, sleep apnoea, and social problems. Also, school children suffering from obesity are at higher risk of developing psychological problems. An obese child is at a higher risk of becoming an obese adult. Therefore, iIt is important to intervene earlier in life in order to combat and reverse adult weight issues that could cause severe health complications.

Schools play an essential role in tackling obesity among children and adolescents by establishing a healthier diet, increasing activity and educating about food and nutrition. In America, there are 32 million students who eat school lunches and 12 million who eat a school breakfast every school day. Ensuring that these meals are healthy and nutritious is part of the solution to childhood obesity, as well as improving children’s overall health and wellness. In January 2012, standards for school meals in US public schools were updated to the following criteria:  

• Ensure students are offered both fruits and vegetables every day of the week;

• Increase offerings of whole grain-rich foods;

• Offer only fat-free or low-fat milk;

• Limit calories based on the age of children being served to ensure proper portion size;

• Increase the focus on reducing the amounts of saturated fat, trans fats, added sugars, and sodium.

Schools are required to meet these standards in order to receive federal meal reimbursements. Fewer children ate school lunches after the standards began to take effect, especially those who paid full-price for their lunches; however, breakfast consumption at school increased. More schools provided grab-and-go breakfasts, breakfast in the classroom and second-chance breakfasts, as well as traditional breakfasts served in the cafeteria at no charge. Additionally, in July 2014, schools nationwide will be forced to remove junk food, soda and sugary snacks from their vending machines and menus. Some other recommendations in order to improve diets are encouraging parents to bring non-food treats for birthday celebrations and selling non-food options for fundraisers. 

     Percent of children who eat fruit daily*       Percent of children who exercise at least one hour daily*

                   11, 13 and 15 years old                                                        11, 13 and 15 years old

A school’s curriculum and efforts to increase physical activity can have a major impact on reducing obesity. What children eat at school is only part of the problem, because their amount of physical activity has a serious impact on their weight. Quality exercise can burn up just about anything a child ingests. Unfortunately, only 9 states require recess at the elementary level, while 41 states do not. Physical activity could be added to the classroom, for example by having students act out words, instead of sitting in chairs the entire lesson. Also, schools should not allow physical activity to be withheld (e.g. withholding recess) or used as punishment (e.g. making a student run laps). Another idea is to perform a “walkability assessment” to determine the environmental factors which deter students from walking to school, such as unsafe crossings and broken sidewalks. 

 

Schools can also use the classroom to teach children of all ages about eating nutritious, well-balanced meals. Gardens offer great opportunities to educate younger children about how healthy food is produced, while providing a fun and physical activity. Fruits and vegetables could also be used to teach shapes and colors. Teachers of older students could use fruits and vegetables from the garden when learning about weights and measurements. Also, adolescents should learn about counting calories, burning calories and daily nutritional value charts. Children who have a healthy association with food and who understand the benefits of a balanced diet will be at a lower risk for obesity.

Finally, if schools notified parents about their children’s state of health and informed them of ways they could help, then parents could reinforce good eating habits and encourage activity. Several programs have begun sharing students’ body mass index (BMI) scores, along with fitness test results, with parents. This height-to-weight information allows parents to continue conversations with their children and bring in a pediatrician if necessary. This program was piloted in Cambridge, Massachusetts, and obesity among 5 to 13 year old students decreased 6% in less than a decade. If schools decide to notify parents about their child’s BMI, they should respect the sensitivity and confidentiality of the information in order to avoid bullying and eating disorders.

Changes need to be made, in both the school and home settings, in order to improve the health of children. Early interventions are the best way to tackle obesity issues. There are several resources available to schools and parents to facilitate change and increase healthy habits:

 The Let’s Move! campaign

National Institute of Health’s suggestions

Key strategies for schools to prevent obesity

The school "walkability" checklist

Healthy eating tips for preschoolers

Nutrition and wellness tips for younger children

Garden-oriented curriculum

My Plate Pledge for kids

Melinda Deleuze

Wikichild co-ordinator  

*These charts and data are from the UNICEF Report Card 11: Child well-being in rich countries

The U.S. versus the rich world in child well-being

This blog, written by Wikichild coordinator Melinda George, is a comparison between the recently published 2013 KIDS COUNT Data Book on America's child well-being with UNICEF's 11th Report card on rich countries' child well-being. This blog is a part of the Wikiprogress Series on its well-being and progress networks.

Since last week’s launch of the Annie E. Casey Foundation’s 2013 KIDS COUNT Data Book, discussions about America’s child well-being, particularly concerning each states’ rankings, have been a hot topic. (For those of you who missed the highlights, read more here.) The Data Book examine trends of 16 indicators pertaining to 4 dimensions (economic well-being; education; health; and family and community). 

In April 2013, the United Nations Children’s Fund (UNICEF) Innocenti office of research launched its 11^th Report Card on child well-being in rich countries. This report ranks the world’s 29 advanced economies in terms of their overall well-being, using 26 internationally comparable indicators separated into 5 dimensions (material; education; health and safety; behaviors and risks; housing and environment).

According to this UNICEF study, the U.S. was ranked 26^th out of 29 in overall child well-being and was on the lower end for most dimensions and indicators. The Data Book recognises that when the data was disaggregated, the results were strikingly different, particularly the education data for the lowest-income students.

So, how do America’s states and races compare to 

the well-being of children in other advanced economies?

Between these two studies, there are 3 shared indicators (low-birthweight babies; child and youth mortality; teen births) and a 4^th indicator where the observed age range differs by one year (teens not in education, employment or training; i.e. NEET rate). 

I've aligned the state and race data* with the rich countries implementing UNICEF's 3 color system**, showing the first, second and third tiers. I also added a 4th color (the darkest) to indicate the states which are off the country charts. 

Low-birthweight babies

(% born below 2.5 kilograms or 5.5 pounds)

Regarding the percentage of babies born below 2.5 kilograms, Alaska is comparable to Norway, Idaho to Belgium, Georgia to Greece, and Mississippi is off the charts. A majority of the states are in the bottom third of the advanced countries. However, Hispanics and non-Hispanic Whites are in the middle, closer to Germany, while African Americans (at 13.2%) have a much higher percentage of babies below 2.5 grams than the average in Greece (around 9.5%). 

Child and youth mortality rate

(deaths per 100,000 among 1-19 year-olds)

We see the same trend in child and youth mortality rates as we did in the low birthweight percentages. The majority of states are in the bottom third of advanced countries' rates, with only 5 states in the top two-thirds. However, the Asian and Pacific Islanders in the U.S. have the same rate as Sweden and the Netherlands.

Teen births

(per 1,000 15-19 year olds) 

Since the United States has the second highest number of teen births next to Bulgaria, it is not surprising that 21 out of 50 states are off the charts. There are no states in the top two-thirds of the rich countries; however, the Asian and Pacific Islanders are in the middle third, with the same number of teen births (11 births per 1,000 15-19 year-olds) as Greece and the Czech Republic.

NEET rate

Percentage of 15-19 or 16-19 year olds not in education, employment or training 

The percentage of teens in the United States neither attending school nor working varies a lot between the states. In comparing with the advanced country rankings, most states were in the bottom third, and 13 states were in the middle third. Also, Vermont and Wyoming have rather low percentages (4%) and are comparable to Germany. When the U.S. data is disaggregated by race, it also is more evenly spread, covering all three tiers of the advanced countries. American Indians have the lowest percentage (15%), only slightly lower than Bulgaria's percentage. I must note that the UNICEF study observed teens 15 to 19 years old, while KIDS COUNT observed only 16 to 19 year olds in its study.

It’s unfortunate that there were not more shared indicators among the two studies and most of the shared indicators were related to children's health. While the KIDS COUNT data is most likely very relevant to local policy-making, it cannot be compared internationally.

The Data Book recognises childhood obesity as a growing problem; however, the KIDS COUNT index regrettably does not include an indicator for childhood obesity as there is no 50-state data source available. In the 11^th Report Card, the U.S. is almost off-the-charts for its childhood obesity rate in comparison with other rich countries. Comparable data is crucial in order to highlight the problem areas, share best practices, and tackle America’s childhood obesity. 

When considering America's improvements and declines in child well-being, we should look across states, across races and across other advanced economies to get a better understanding of what success looks like. I hope that policy-makers will do the same when deciding where efforts should be spent.

*The data concerning the U.S. is available online at www.datacenter.kidscount.org. 

**The countries with grey bars have data for fewer than 75% of the total number of indicators used in the UNICEF study.

Melinda Deleuze