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Objectives To examine associations between child wellbeing and material living standards (average income), the scale of differentiation in social status (income inequality), and social exclusion (children in relative poverty) in rich developed societies.

Design Ecological, cross sectional studies.

Setting Cross national comparisons of 23 rich countries; cross state comparisons within the United States.

Population Children and young people.

Main outcome measures The Unicef index of child wellbeing and its components for rich countries; eight comparable measures for the US states and District of Columbia (teenage births, juvenile homicides, infant mortality, low birth weight, educational performance, dropping out of high school, overweight, mental health problems).

Results The overall index of child wellbeing was negatively correlated with income inequality (r=−0.64, P=0.001) and percentage of children in relative …