Injury Risks For Children Vary Around The World

Preventing childhood injuries would seem a daunting task. But there's a long list of proven ways to make the world safer for children.

The World Health Organization wants its 193 member nations -- and especially those in the developing world, where most deaths from injury occur -- to know that accidents don't have to happen. That's why it released a 211-page "World Report on Child Injury Prevention," three years in the making, early this month.

One of the document's many messages is that injury deaths can be reduced to an astonishing degree when societies put their minds and money to the task. Sweden is perhaps the best example.

In 1969, the death rate from injury for boys younger than 18 was 24 per 100,000 children, and for girls it was 11 per 100,000. By 1999, it had fallen to 5 and 3, respectively. In 2004, the global rate for both sexes combined was 39 deaths per 100,000 children -- about 10 times as high.

Many prevention strategies endorsed (if inconsistently applied) by rich societies are only now being adopted in the developing world. They include strict drunken-driving laws; requirements that wells be covered and swimming pools fenced off; installing window guards in upper-story apartments; having standards for child-resistant lighters; requiring child-resistant packaging of drugs, stove fuel and poisons; and establishing poison-control centers and burn units.

Traffic injuries are perhaps the most dramatic example of how much could be gained if strategies that have been shown to prevent injury were put in place more broadly.

Traffic injuries are the leading cause of death worldwide for 15-to-19-year-olds and the second-leading cause for children 5 to 14. But the use of seat belts, child seats and helmets, and the institution of "graduated licensing" of new drivers is essentially unknown in many countries.

In some places, though, that's changing in a big way.

Last December, Vietnam began requiring that people on motorbikes wear helmets, including children. Helmet use went from 10 percent to more than 90 percent in a few weeks.

"They were taking motorbikes away from people in the street if they didn't have helmets," said Etienne Krug, the Belgian physician who headed the WHO injury project. Severe head injuries from motorbike accidents in Vietnam have fallen 20 to 30 percent in the past year, he said.

For society, the payoff of prevention efforts is huge. For every $1 invested in bike helmets and child seats, for example, $29 is saved in health care, disability and lost-income costs.

But for individuals, prevention is often economically burdensome.