UNICEF’s 2013 comparative report on child well-being in rich nations, AKA the Innocenti Report Card 11 (see page two of the report for a handy visual summary of findings) deserves our consideration. The news is Not Good for children in some of the richest nations amongst the group:  the U.S., for instance, ranks with a number of rather worse-off—by GDP—Baltic nations.  Geography also is no clear indicator: whereas the U.S. comes in 26^th overall out of 29, fellow North American nation Canada comes in middle-of-the-pack at 17^th.  The top five in order are Netherlands, Norway, Iceland, Finland, and Sweden.

The report measures well-being on five dimensions, attempting to account for the overall well-being of individuals: material well-being, health and safety, education, behaviors and risks, and housing and environment.  Health and safety is determined based on several component measures which are classic indicators of good (or poor) public health:

1. low birthweight
2. infant mortality rate (defined as deaths under 12 months of age per 1,000 live births)
3. national immunizaton rate (on major childhood diseases, namely polio, measles, diptheria, pertussis, and typhus)
4. overall youth mortality rate (deaths per 100,000 aged 1-19)

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Many nations are inconsistent in where they fall on the five measures of overall well-being. For instance, Canada is 15^th on material well-being, 27^th on health and safety (behind the U.S.’s 25^th), 14^th on Education, 16^th on behaviors and risks, and 11^th on housing and environment. Those at the top of the pack also have some inconsistencies, though less pronounced: Netherlands is 1^st on three measures and 5^th and 4^th on two others.  Those at the bottom of the pack, including the U.S. and nations such as Latvia and Romania, are depressingly consistent across the board in their low performance.

As the report notes, the U.S has one of the highest GDPs in the category of “rich nations”, while its companion nations at the bottom consistently have the lowest.  As in much of health care, money ≠ health.  Rather, it’s how the money is spent.  Is it an issue of to whom the care is distributed?  One of overemphasis on acute vs. preventive care?

Regardless of the cause, there are many notions of justice that would find such a state of affairs to be deeply troubling on all measures, including health and safety.  Certainly egalitarians in the mold of John Rawls and Norman Daniels would take issue with what this means for both fair equality of opportunity and the difference principle, which holds that inequalities must benefit the worst off.  When children as a whole are not doing well on measures of basic well-being, there are definite implications for both measures of justice-as-fairness.  Those who ascribe to a capabilities approach to justice, such as Sen & Nussbaum or Powers & Faden, would surely draw our attention to what such poor prospects for children mean for the possibility of human flourishing.

And of course, it is worth noting that these results are for rich nations, only.  For the children of the world, in some surprising places, all is most decidedly not well.