National Child Safety Reports: Inconsistencies in Child Safety Policy Adoption in 31 Countries

Countries must increase the adoption of proven child safety policies to protect the most at-risk children in Europe and the generations to come.

Injuries are the leading cause of death, disability, burden, and inequity for children in Europe. They remain the leading cause of death among children and adolescents in all European member states, with some of the lowest and highest injury mortality rates in the developed world. (1)

“Every hour of every day a child dies in the EU due to injury,” says Joanne Vincenten, director of Európskej aliancie pre bezpečnosť detí. “Consistent use of proven preventive strategies across the whole EU could save most of these lives. It could also save billions of euros each year spent on treating injuries and allow children and adolescents to grow up to be healthy and active contributors to Europe's future economic growth.”

National child safety reports have now been published for 31 countries and a Europe summary report, which score countries on the level of adoption, implementation, and enforcement of more than 100 known proven injury prevention strategies and policies—“good practice” for saving children’s lives. (2)

This is the third assessment round conducted by Európska aliancia pre bezpečnosť detí, with 18 countries participating in 2007, 26 in 2009, and 31 in 2012. Trend analysis of countries participating from 2007 to 2012 shows a significant improvement in overall country score. It is encouraging that some of the largest improvements were in countries where prevention investment has been made over the last five years (for example, the Czech Republic, Finland, Hungary, Scotland, and Spain). The decline in the overall 2012 score in Greece likely reflects the country’s economic crisis and may signal a danger of reversing progress achieved in child safety in other countries, including the introduction of austerity measures. (3)

Overall, countries have a much greater understanding of transport-related measures than those related to home-injury prevention. Because home injuries are the leading cause of hospitalization from child injuries and emergency department visits, the same level of commitment and effort and resources should be directed to promoting adoption, implementation, and enforcement of proven measures to reduce drowning, falls, burns and scalds, poisoning, and choking/strangulation, as is done for transport-related measures. (4)

To date, no country has adopted all of the recommended safety measures. In all countries there is room for improvement, particularly given the disparities between countries, with more than a six-fold difference in unintentional injury rates between the countries with the highest and lowest rates. Differences between overall country scores are also large, ranging from 14.5 to 45 points out of a possible 60 points. “The burden of childhood injury falls disproportionately on children from disadvantaged groups and on countries undergoing the largest socio-economic changes,” says Dr. Dinesh Sethi of WHO. “With this unequal distribution of injuries, there is a risk of further widening the gap in health inequality between countries and of causing social injustice.” (5)

Examples of uneven adoption in the 31 participating countries highlighted by the National Child Safety Reports include:

• Only 13 countries (42%) have a national law requiring helmet use while cycling, compared with only 7 in which this law came into force after the first monitoring report. However, only 8 of 13 reports state that the law is fully implemented and enforced.

• No country has a law requiring child restraint systems facing the direction of travel for children under the age of 4, even though this is common practice in Sweden, where the number of deaths of child passengers in this age group has been reduced to near zero.

• Only 7 countries (23%) have a national law requiring safety fencing for private pools, but only in one (France) is the law fully implemented and enforced, and that law allows preventive measures to be selected, with fencing as one protective barrier.

• Only 15 countries (48%) have a national law requiring child safety packaging for medicines, and 3 countries report that the law is not fully implemented and enforced.

• Only 16 countries (52%) have a national law requiring environmental modifications to prevent children from falling from windows of multi-level buildings (for example, window guards), but in more than half of these countries, the law applies only to newly built or reconstructed buildings. (6)

European Commissioner for Health and Consumer Policy John Dalli acknowledges the large burden of child injuries on children in the EU. “I believe that we must do everything possible to secure the safety of the youngest and most vulnerable members of our society across Europe. That is why the EU Health Programme supports initiatives to reduce accidents and injuries. Childhood injury deaths cause unimaginable suffering for the families left behind. The European Union and its member states must work together and act to guarantee the right of every child to safety. Understanding evidence-based strategies presented in these national reports can help improve child safety.”

The addition of four new countries to the National Child Safety Reports in 2012 means there is now a baseline level of use of proven child safety policies across all 27 EU member states (plus Croatia, Iceland, Israel, Norway), from which progress can be measured over time. However, this is not enough—current efforts to assess progress are limited because only few policies are currently being tracked in terms of their impact.

“Policy impact assessment is fundamental, but is not being done,” says MEP Malcolm Harbour, chair of the Internal Market and Consumer Protection Committee. “Monitoring needs to be built in before policy is put into practice, so that the data needed for impact evaluation are available. This will require cooperation and engagement across many sectors, but this is the critical gap right now, and without it we cannot demonstrate which child safety policies have the greatest effect.”

Protecting children is an investment that will save money now and in the future. “Injuries and accidents are a serious issue for children in the region, and it is time for governments to prioritize interventions more focused on addressing this problem. UNICEF supports countries in strengthening families to protect their children,” says Octavian Bivol, UNICEF Regional Health Advisor for CEECIS.

To date, investment in child injury prevention from all relevant sectors at national and European levels is not proportionate to the size of the problem. Securing the child’s right to safety will support increased levels of health, well-being, and growth for European children and for society as a whole.

Selected points from the Child Safety Report 2012: European summary for 31 countries

1. The European Report on Child Injury Prevention and the WHO and UNICEF World Report on Child Injury Prevention confirm the substantial health burden of injuries among children. http://www.childsafetyeurope.org/publications/europeanpolicy/index.html

2. National Child Safety Reports are part of the TACTICS project (Tools to Address Childhood Trauma, Injury and Children´s Safety), funded by the EU and led by Európskej aliancie pre bezpečnosť detí EuroSafe in cooperation with the European Commission, RoSPA, Nordic School of Public Health, Dublin City University, Swansea University, European Public Health Alliance and Association, Schools for Health in Europe, European Transport Safety Council, UNICEF, World Health Organization (WHO), and national partner organisations in each participating country. (The full list of participating organisations is available at http://www.childsafetyeurope.org/tactics/project-partners.html

3. The 2012 National Reports and profiles are part of the TACTICS activities on benchmarking and monitoring child injuries and related actions. The National Child Safety Reports were designed to enable:

• comparative assessment of the burden of unintentional child injuries
• comparative assessment of adoption, implementation, and enforcement of nationally known effective policy measures
• assessment of strengths, weaknesses, and gaps within countries, and thereby provide guidance on where to direct activity
• comparative exercises within countries over time and across countries that can serve as inspiration and motivation for further progress
• a key mechanism for identifying, sharing, using, and adopting knowledge gained from across Europe
• first entry into links between effective policies and health outcomes

National Reports assess the scope of child and adolescent safety measures by examining and categorizing the adoption, implementation, and enforcement of evidence-based national policies focused on unintentional injuries. The 31-country summary report provides a picture from all countries to facilitate planning at European level and support efforts at national level, including a new area on inequality and childhood injuries.

The National Child Safety Reports were awarded at the Gastein European Health Forum, where they received the European Health Prize in 2011.

The Child Safety Report 2012: European summary for 31 countries and individual national reports will be available on 12.6.2012 at www.childsafetyeurope.org

4. Trend analysis was carried out to compare overall scores based on the original 94 indicators introduced in 2007 for 16 countries participating in both 2007 and 2012. The average score for overall child safety compliance increased from 31.5/60 in 2007 to 36/60 in 2012. The average increase of 5.09 was statistically significant (p = 0.019, 95% confidence interval 0.96,9.22).

(For further details see pages 8-11 of the Child Safety Report 2012: European summary for 31 countries and individual national reports, available for download at: www.childsafetyeurope.org

5. Understanding transport-related policies compared with other safety policy areas (domestic safety) may be assessed by comparing average scores by subgroup.

Average score for 2012 based on national reports from 31 countries by subgroup

More detailed country scores by subgroup can be seen on pages 6-7 of the Child Safety Report 2012: European summary for 31 countries, available at www.childsafetyeurope.org or in the PDF appendix.

6. Injury death rate (age-standardized European rates / 100,000 population aged 0-19 in 2010 or the latest available year; source WHO European Detailed Mortality Database)

Total score for 31 countries in 2012 (based on 115 indicators: 94 original indicators from 2007, 8 added in 2009, and 13 added in 2012)

For more information on childhood injuries and inequalities, see pages 46-48 of the Child Safety Report 2012: European summary for 31 countries, available at www.childsafetyeurope.org or in the PDF annex.

7. Details on adoption, implementation, and enforcement of strategy and policy in specific injury areas can be found in the Child Safety Report 2012: European summary for 31 countries, available at www.childsafetyeurope.org or in the PDF annex (Cyclist safety pp. 21-23; passenger safety/motorcycling safety pp. 15-17; water safety pp. 24-27; poisoning prevention pp. 31-33; falls prevention pp. 28-30).

8. The 31 countries in 2012 comprise 24 member states and, additionally, England, Scotland, and Wales as constituent countries of the United Kingdom, Croatia, Norway, Poland, and Israel.

• For 4 countries, the national report in 2012 is the first one: Bulgaria, Croatia, Romania, and Slovakia.
• For 14 countries in 2012, the national report is the second one: Denmark, England, Finland, Iceland, Ireland, Israel, Latvia, Lithuania, Luxembourg, Malta, Norway, Poland, Slovenia, and Wales.
• For 13 countries in 2012, the national report is the third one: Austria, Belgium, Czech Republic, France, Germany, Greece, Hungary, Italy, Netherlands, Portugal, Scotland, Spain, Sweden.

9. More information on actions to prevent childhood injuries under the childhood injury prevention resolution adopted at the 64th session of the World Health Assembly (WHA) of the World Health Organization (WHO) is available at http://www2.ohchr.org/english/law/crc.htm

Appendix: The Child Safety Report 2012: European summary for 31 countries in PDF