1. Inequality and child wellbeing Kate E Pickett, PhD FRSA FFPH

3. 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

4. The UNICEF Index of Child Well-being, 2007

8. Child Well-being is Better in More Equal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

9. Child wellbeing and income inequality in US States Correlations and p-valuesIncome inequalityAverage income Foundation for Child Development 25-item index0.43 (0.002) -0.61 (<0.001) Kids Count 10-item index (shown in graph)0.51 (<0.001) -0.53 (<0.001)

10. 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

11. More children are overweight in more unequal countries Source: Wilkinson & Pickett, The Spirit Level (2009)

15. 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)

16. www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level Social mobility is lower in more unequal countries

17. Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk Infant mortality rates by social class

19. 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?

20. Inequality affects family life & relationships Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

22. Inequality affects family life & relationships Source: Bowles S, Park Y. Economic Journal 2005; 115 (507): F397–F412. 2005.

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

24. The Effect of Caste Identity on Children's Performance Caste Unannounced Caste Announced Number of mazes solved Source: Hoff K, Pandey P, World Bank Policy Research Working Paper 3351, June 2004 Status differentiation has a direct effect on cognitive performance

25. 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

26. 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

27. 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

28. 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?

29. Low Income Inequality (Gini) High Child Wellbeing Inequality and Child Wellbeing (UNICEF Rpt 2013) Pickett & Wilkinson, Pediatrics. (forthcoming)

30. Inequality change 2000-2010 (gini) Child wellbeing Change 2000-2010 Changes in inequality and child wellbeing (UNICEF Index) Pickett & Wilkinson, Pediatrics. (forthcoming)