Summary :

Since investing in childhood is the natural starting point for investing in human development, the aim of the report is to suggest a tool to measure how all Mediterranean countries are moving toward promoting and achieving children’s well-being. The aim is also to identify the social and economic variables which determine the hardship of the children in the Mediterranean countries, starting from the point of view that child well-being is a multidimensional concept that can be assessed through multiple dimensions and domains, and using a combination of indicators to capture each one of the dimensions.
We examined some factors related to children’s health, education, and social and economic welfare in an attempt to build a more comprehensive index for estimating and understanding differences in child condition within the Mediterranean region: the Med-CWI (Mediterranean Child Well-being Index).
Some bivariate associations between U5MR and selected indicators for the countries belonging to the Mediterranean area were prepared. Strong and significant correlations are found between U5MR and HDI (r2=-0,836), GNI per capita (r2=-0,768), government expenditure on health (r2=-0,729), enrolment ratio in pre-primary education (r2=-0,510), and also telephone lines density per 100 inhabitants (r2=-0,677). Our findings however indicate that child mortality correlates more strongly with social development than economic development. The associations between child mortality and social development indicators are fairly linear, but the corresponding association with GDP per capita average annual growth rate between 1990 and 2005 is non-linear and non-significant. In addition, the association of the U5MR average annual reduction rate with GDP per capita average annual growth rate in the period 1990-2005 is non-significant too.
Given the diversity in the levels and patterns of children’s welfare indicators across countries and groups of countries within the Mediterranean region, a simple summary measure of child well-being is desirable. A literature review on child poverty and well-being also shows some early attempts to develop a measure of human development that goes beyond economic status to consider all aspects of human development, and child well-being in particular.
An empirical analysis carried out on the basis of the Principal Components Analysis (PCA) allowed the verification of certain aspects relating to the intertwined relationships existing between the child well-being and structural, social, economic and political factors.
The first factor extracted (which accounts for 54.6% of the original variance) presents highest correlations with indicators which significantly determine the child well-being level reached by a country. HDI is the indicator with the maximum “weight” on the positive semi-axis: it synthesizes the three dimensions of human development (living a long and healthy life, measured by life expectancy; being educated, measured by adult literacy and enrolment at the primary, secondary and tertiary level; and having a decent standard of living, measured by purchasing power parity, PPP, income). Than follow life expectancy at birth, since higher life hope is positively linked to child well-being, and the availability of physicians compared to the number of inhabitants. No wonder that among the first variables there is also the degree of diffusion of information and communication technologies: a sign of the attainment of higher thresholds of prosperity, not only material, because ICTs provide easier access to information and are instrumental in raising the general cultural level.
The analysis confirms, however, the existence of a positive relationship between children’s well-being and per capita public expenditure on health, a number of indicators related to school participation and the rate of literacy among young people, the availability of hospital beds. It may be noted that the phenomenon is characterized, although gradually in lesser degree, by the access to improved drinking water sources, the possibility to obtain qualified assistance in childbirth, and by an indicator of social development such as the access to the Internet.
At the opposite side, a group of different variables seems to be negatively correlated to the children’s well-being. Of course we find here some fundamental demographic aspects. A low U5MR, a low maternal mortality ratio, and a little number of deaths of children under age five due to pneumonia are all indicators of welfare for children. Similarly, a low pupil/teacher ratio in primary schools positively correlates with child well-being. With declining shares of importance, we have two purely demographic indicators: the adolescent fertility rate and the crude birth rate. Regarding the indicators on education, we note that the number of children without access to the primary school is negatively correlated to the child well-being. The same holds with the percentage of infants with low birthweight.
We can observe not only the high correlation of Med-CWI with HDI (r2=0.925), but also the inverse relation, strongly significant, with U5MR (r2=-0.831). In addition, figure shows the relation of the child well-being index with the per capita total expenditure on health (r2=0.792). A positive linear correlation exists also between the Med-CWI and the GNI per capita, but it is weaker (r2=0.729).
The success cases in the pursuit of the children’s well-being in the Mediterranean region are France and Italy, respectively the first and second ranked. Then we have Spain, Israel, and Portugal. In a central position we have Lebanon, Libya, Jordan, and Tunisia. While the last places are occupied by Morocco, Egypt, and Algeria.
The fact that some countries present a better score regarding child well-being compared to the region in general is confirmed by the measure that correlates the average income of the population with the level of Med-CWI reached (the range of GNI per capita minus the range of the Med-CWI). If a country’s position on the Med-CWI is better than its range on the GNI per capita ranking, this means that it has made greater progress in orienting the acquired economic wealth towards improving the overall condition of its children. It has done this by using its investments towards reducing the deprived conditions of the children, by extending their access to social protection services and the instruments that are able to strengthen human resources, thus enhancing individual opportunity. This is, then, the case of the Occupied Palestinian Territory (+5), Jordan (+3) and Syria (+2), and Portugal and Malta in Europe, which present a positive coefficient compared, for example, with Turkey (-4), Algeria, Morocco and Greece (-3).
Income emerges as an important determinant of child survival and well-being across countries. This is certainly the case in the Mediterranean region as indicated by significant associations between income and child health and well-being in the northern shore of the basin. However, a closer look at the data reveals that more national wealth does not necessarily bring better health and welfare for childhood.
Income growth and improved educational levels, and consequent improvements in food intake and sanitation, have accounted for part of the dramatic decline in child mortality in the Arab countries of the Mediterranean region. But access to new knowledge, drugs and vaccines appears to have been substantially more important.