377 - Are US Children Thriving? A Temporal and Cross-National Comparison of the Health, Wellbeing, and Resilience of Children Living in the US versus 18 OECD Nations

Publication Number: 377.4010

Christopher B. Forrest, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Lauren J. Koenigsberg, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Francis Eddy Harvey, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Neal Halfon, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States

Background: The foundation of the nation’s health, wellbeing, and resilience (i.e., thriving) is rooted in childhood. Thriving is acquired and optimized within developmental ecosystems—the complex adaptive ecosocial systems where individuals live, grow, and develop. An understanding of children’s temporal trends and cross-national comparisons in thriving can yield insights into the quality of their lives and the opportunities and resources, as well as the barriers and constraints, that influence their thriving in their developmental ecosystems.

Objective: To evaluate temporal trends in US children’s health and to assess cross-national comparisons with 18 comparator countries in the Organization for Economic Cooperation and Development (OECD) in children’s material, relational and personal wellbeing and their resilience.

Design/Methods: Analyses were restricted to individuals 0-17 years old. Temporal trends in health were analyzed in 10 publicly available datasets; each included >10 years of data (range 10-71 yrs) in a national sample of children. Cross-national contrasts between the US and the OECD18 were done in 13 datasets; data were from 2018-2022. To evaluate children’s resilience (i.e., ability to overcome challenge), we evaluated national mortality rates from COVID-19 from 2020-24. We obtained OECD18 estimates by summing country-specific rates weighted by the size of its population of children < 18 years-old.

Results: Across 22 of the 24 health indicators (Table 1), children’s health has been declining, reflecting increasing burden of chronic disease (including allergies, early childhood caries, neurodevelopmental disorders), obesity, poorer mental health (including more suicide attempts), and less sleep. Of the 21 wellbeing indicators (Table 2), US had lower levels compared with the OECD18 for 12, were similar for 5, and better on 6. US children report greater levels of loneliness and bullying, are more likely to commit suicide, have earlier sexual debut, live in families with more financial strain, and grow up in communities with greater income inequality. On the positive side, US children are less like to use tobacco and alcohol and have similar or slightly better life satisfaction and purpose. Finally, as a measure of resilience, US children were nearly 5 times as likely to die from COVID compared with their OECD18 counterparts.

Conclusion(s): The overall pattern of child thriving trends and comparisons is quite concerning. The overwhelming majority of indicators assessed demonstrate a US child population that is languishing and not reaching the same thriving potential of children in other nations.

Table 1.
Table 1.pdf

Table 2
Table 2.pdf