Social Indicators: Literacy, Health, and Clean Water

Social indicators of development are measures of people’s well-being that go beyond income, such as the literacy rate (the share of adults who can read and write), health indicators (life expectancy, infant mortality, maternal mortality, doctors per population) and access to clean water and sanitation. In brief: they show how well a country meets basic needs. Infant mortality is the number of deaths of children under one year per 1,000 live births, and life expectancy is the average number of years a newborn would live. Where incomes are low, social indicators are generally poorer, but some countries with modest incomes have achieved good health and education.

Social indicators add important information to income figures and are used to set goals and monitor progress. This guide explains the main education, health and water indicators, how they are calculated and interpreted, compares them in a table, works through example calculations, outlines the history of social measurement and corrects common mistakes.

How is education measured?

The adult literacy rate is the percentage of people aged 15 and over who can read and write a short simple statement. According to UNESCO, global adult literacy is around 87%, with the lowest rates in parts of Sub-Saharan Africa and South Asia, and women are less likely to be literate than men in many countries. Other measures are school enrolment rates (the share of children of school age who attend school), completion rates, the mean and expected years of schooling and the pupil-teacher ratio. Education raises incomes, improves health, lowers birth rates and strengthens participation in society, and education of girls is particularly beneficial.

How is health measured?

• Life expectancy at birth: the average number of years a newborn would live if current death rates stayed the same. It is above 80 in countries such as Japan and Switzerland, and below 60 in several of the poorest countries.
• Infant and under-five mortality rates: deaths per 1,000 live births before the age of one or five. They are sensitive to nutrition, infections, sanitation and access to health care.
• Maternal mortality ratio: maternal deaths per 100,000 live births.
• Health workers and facilities: doctors, nurses and hospital beds per 1,000 people, and the share of births attended by skilled staff.
• Immunization and disease burden: the share of children vaccinated and rates of diseases such as malaria, HIV and tuberculosis.
• Nutrition: the share of children who are underweight or stunted.

How are water and sanitation measured?

The WHO/UNICEF Joint Monitoring Programme tracks the share of people with safely managed drinking water (water from an improved source, available at home when needed and free of contamination) and safely managed sanitation (toilets that safely dispose of waste). Estimates show that more than 2 billion people still lack safely managed drinking water, and more than 3 billion lack safely managed sanitation. Unsafe water and poor hygiene cause diarrheal diseases, cholera and typhoid, which are a major cause of child deaths, and women and girls often spend hours collecting water, which limits their time for school and work. Clean water is part of Sustainable Development Goal 6.

How are the indicators linked?

Social indicators influence each other. Educated mothers tend to have healthier children and fewer births, healthy people can learn and work better, and clean water reduces illness, which keeps children in school. Higher income allows more spending on health, education and water systems, but the link is not automatic: Sri Lanka, Cuba and the Indian state of Kerala achieved high literacy and long life expectancy at modest incomes through public investment in schools and health care. Averages also hide differences between rich and poor, urban and rural, and men and women.

The indicators compared

Worked example: calculating indicators

The figures are hypothetical and illustrate typical calculations.

1. Literacy rate: in a survey of 2,000 adults, 1,540 can read and write. The literacy rate is 1,540 ÷ 2,000 = 77%.
2. Gender gap: literacy is 84% for men and 70% for women. The gap is 14 percentage points, and the female-to-male ratio is 70 ÷ 84 = 0.83.
3. Infant mortality rate: a region has 40,000 live births in a year and 1,600 babies die before their first birthday. The rate is 1,600 ÷ 40,000 × 1,000 = 40 per 1,000.
4. Decline over time: if the rate was 80 per 1,000 twenty years ago, it fell by 80 − 40 = 40 points, which is 40 ÷ 80 = 50%.
5. People per doctor: a country of 30 million has 6,000 doctors, so there are 30,000,000 ÷ 6,000 = 5,000 people per doctor, or 6,000 ÷ 30,000 = 0.2 doctors per 1,000 people. A country with 3 doctors per 1,000 has about 333 people per doctor.
6. Water access: in a country of 50 million, 32 million have safe water, so 32 ÷ 50 = 64% have access, and 18 million do not.
7. Time for water: a family fetches water twice a day, and each trip takes 45 minutes. This takes 90 minutes a day, or 90 × 365 = 32,850 minutes, which is 547 hours per year (more than 68 working days of 8 hours).

How have social goals developed?

In the 19th century, public health reforms such as clean water supply and sewers sharply reduced child deaths in Europe. After 1945, the United Nations and the World Health Organization promoted vaccination and disease control, and smallpox was declared eradicated in 1980. The 1978 Alma-Ata Declaration stressed primary health care. The Millennium Development Goals (2000–2015) set targets for education, child and maternal health and water, and the Sustainable Development Goals (2015–2030) extended them. Progress has been large: child mortality fell by more than half since 1990, but progress has been uneven between regions and has slowed in some places.

Which mistakes are common?

Mistake 1: Reading life expectancy as the age at which people die

It is an average that is strongly affected by child deaths. In places where many children die young, the life expectancy is low even though many adults live to old age.

Mistake 2: Confusing infant and child mortality

Infant mortality covers children under one year. Under-five mortality covers children under five.

Mistake 3: Treating “access to water” as “clean water”

Having a nearby source does not mean the water is safe, available when needed and free of contamination.

Mistake 4: Using national averages as if everyone were equal

Rates can be much worse among the poor, in rural areas and for girls, so data broken down by group are more informative.