Tuesday, December 23, 2008

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.

According to the WHO report, a factory laborer in a low-income country must work 11 times as long as his counterpart in a high-income country to buy a bicycle helmet. (For a child seat, it's 16 times as long.) That's why injury prevention programs increasingly feature product giveaways paired with education.

At the same time, some countries have risks not widely shared by others.

Death rates from burns are 11 times as high in developing countries as in industrialized ones. But the discrepancy doesn't stop there.

European and American boys and girls have virtually equal rates of death from fire. In South Asia and Southeast Asia, however, girls' mortality is three times that of boys. The explanation, at least in part, is the confluence of three hazards.

Girls assist in family cooking at an early age; the heat source is often an open flame on the ground; and female attire is long and flowing.

Prevention in those societies may need to include changes as simple -- and as difficult -- as getting the stove up to waist height.

-- David Brown