Injuries Affect Poor Children Most

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Five out of six childhood deaths from injuries occur in poor countries, but the risk can be equally high for children living in poverty in affluent countries. A report issued today by the WHO Regional Office for Europe – the European report on child injury prevention - calls for action to reduce injuries and describes measures proven to provide safer environments for children. The report is a companion to the joint WHO–United Nations Children’s Fund (UNICEF) World report on child injury prevention launched today in Hanoi, Viet Nam.

Unintentional injuries are the leading threat to children and teenagers in the WHO European Region. Road traffic crashes, drowning, poisoning, fires and falls cause an annual 42 000 injury deaths in people aged under 20 years and 70 million hospital admissions and visits to emergency departments in the WHO European Region. Injuries are an important drain on the resources of not only health systems but also society at large, and can severely reduce families’ income and quality of life in the long term. Globally, unintentional injuries kill 830 000 children every year.

“These figures speak of the urgent need to take action to address this largely preventable problem. The good news is that the successes achieved by some European countries in reducing child mortality from injuries show that most of these deaths can be averted,” says Dr Marc Danzon, WHO Regional Director for Europe. “If all countries in the Region performed like those reporting the lowest mortality, nearly three out of four child injury deaths could be prevented every year and much disability avoided. These figures encourage all countries to address this preventable cause of premature death and suffering.”

The burden from injuries is unequally distributed in the world and in Europe, falling disproportionately on children living in the countries undergoing the greatest socioeconomic changes. Deaths in the countries in the European Region with the highest rates are up to eight times those in the countries with the lowest. High inflation, unemployment, rising income inequality, social disintegration and high levels of poverty, exacerbated by some of the highest levels of alcohol consumption in the world, contributed to a peak of child injury mortality in the early 1990s. Today, death rates for unintentional injuries in the Commonwealth of Independent States (CIS) are declining, but still three times those in the European Union.

Regardless of a country’s income, poor children have the highest risk. Studies from Ireland, the Netherlands, Spain, Sweden and the United Kingdom show that children from less affluent areas suffer and die from injuries up to five times more than their richer peers; a poor child living in the suburbs of an affluent western metropolis, such as London or Paris, might have the same risk of injury as one living in a country with developing economy. An unsafe environment is a major risk factors, as poor children may be exposed to fast traffic, lack of safe areas to play and crowded homes with unsafe structures, such as stairs without rails or gates or windows without bars and locks. Poorer families may not be able to afford safety equipment such as child restraints for cars, smoke alarms or bicycle helmets. Supervision may be difficult in families with a single parent or affected by alcohol or drug abuse. Once injured, poorer children may have less access to high-quality medical and rehabilitation services.

“These inequalities are both a threat and an opportunity. Experience from countries that started tackling injury prevention as a priority decades ago represents a resource for the whole Region,” says Dr Dinesh Sethi, an expert on violence and injury prevention at the WHO Regional Office for Europe. “These countries were successful because they shifted their thinking from trying to change individual behaviour to providing safe environments. This acceptance of a collective societal responsibility in preventing injuries has resulted in sustained reductions in fatalities, and reduced health inequalities.”

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The scope for intervention involves different sectors and stakeholders. The European report on child injury prevention provides evidence on what needs to be done:

* to prevent injuries from occurring: for example, by enforcing drink–driving legislation to reduce the risk of road traffic injuries and mounting stair gates to prevent falls;

* to reduce the risk of injury once an event has occurred: for example, by installing smoke alarms to enable building occupants to escape in case of fire; and

* to minimize harm once injuries have occurred by providing child-specific emergency trauma care and rehabilitation.

Health systems can play a central role in this new approach by documenting the burden, distilling the evidence of what works, prioritizing action and engaging other sectors in partnerships to develop action plans. They need to take account of children’s need for special attention. As childhood encompasses different stages of emotional, physical and mental development, and varies according to cultural contexts, injuries at each stage require different responses.

Such action is central to European countries’ commitments under the Children’s Environment and Health Action Plan for Europe (CEHAPE) , which identifies injuries as one of the leading causes of preventable death from environmental factors, and the WHO resolution on the prevention of injuries in the European Region. These commitments will converge at the 2010 WHO Fifth Ministerial Conference on Environment and Health, which will set the Region’s agenda for protecting children’s health in a changing environment.

WHO counts on good partnerships with different stakeholders to sustain country action. Much progress in injury prevention will continue to depend in part on the support and advocacy of civil-society organizations. Among these, the European Child Safety Alliance, one of the contributors to the European report, is an important partner in reducing the burden of child injuries in the European Union.

The Regional Office web site offers further information on its work on violence and injury prevention and other activities to protect health and the environment.

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