2009 Europe Summary for 24 countries

A

Europe Summary for 24 countries

CHILD SAFETY REPORT CARD2009

Text or parts of the text may be copied, provided that reference is made to the authors, title of the publication and publisher. Suggested citation: MacKay M and Vincenten J. Child Safety Report Card 2009: Europe Summary for 24 Countries. Amsterdam: European Child Safety Alliance, Eurosafe; 2009.

The findings and views expressed are those of the authors and do not necessarily reflect the views of the partner organisations.

ISBN 978-90-6788-381-8 © April 2009

European Child Safety AllianceP.O. Box 751691070 AD AmsterdamThe NetherlandsTel: +31 20 511 4513Fax: +31 20 511 4510Email: [email protected]

Message by Arlene McCarthy, MEP, Chair of Internal Market and Consumer Protection Committee In order to reduce the number one cause of death for children in the European Union we need to ensure that child safety is at the heart of EU policy. European politicians have a responsibility to ensure that “a high common level of consumer protection” is fully upheld, especially for our most vulnerable European citizens - children.

The key policies identified in this report card represent the practical and common basis for improving child safety. Some measures already exist as EU legislation, but are not always fully implemented or enforced within countries. “The Child Safety Report Card 2009: Summary for 24 Countries” provides an overview of the situation with respect to over 100 policy measures that research has shown reduce child deaths. We need to work towards greater adoption, implementation and enforcement at the EU and Member State level.

I am pleased to support the European Child Safety Alliance and endorse this summary report card and its recommendations to make Europe safer for children.

Message by Androulla Vassiliou, European Commissioner for HealthInjuries are a leading public health threat to children with over 25 children dying each day in the EU 27 as a result of an unintentional injury. Regrettably inequities exist between the Member States, with a fourfold difference between countries with the highest and lowest child injury death rates.

We have identified child and adolescent safety as a priority for the European Union in the Communication and Council Recommendation on the prevention of injury

and the promotion of safety. The “Child Safety Report Card 2009: Summary for 24 countries” from the European Child Safety Alliance provides policy makers with an assessment of the current level of safety in Member States and the actions and priorities that will make a valuable contribution to reducing child deaths.

The European Union and European countries must ensure all children’s right to safety. This could be achieved by developing and resourcing implementation of national child safety action plans using the results of these report card assessments in order to ultimately raise the level of all children’s health.

Message by Meglena Kuneva, European Commissioner for Consumers Despite injury reductions and safety improvements over the last 20-30 years, injury remains a major leading cause of death for children and youth in every Member State in Europe. Commitment to invest in child injury prevention from all relevant sectors at the national and EU level to date has not been commensurate with the size of the problem.

As part of my mission to inform, protect and empower consumers, I am pleased to lend my support to the European Child Safety Alliance’s “Child Safety Report Card 2009: Summary for 24 Countries” and its recommendations, which have direct and practical implications for the work we are undertaking in safety of products and services.

The most effective response to preventing child injuries will be multi-sectoral, involving all sectors with a role to play in child safety, not only consumer protection and health, but other key stakeholders such as transport, education, justice and industry. Together we can save lives and reduce injuries to children.

What is a child safety report card?Child injury is the leading cause of death for children and adolescents aged 5-19 in Europe and the leading cause of death for children and adolescents in aged 0-19 years in most high-income countries. The child safety report cards are overviews that summarise countries’ levels of safety provided to their youngest and most vulnerable citizens through national policy. They are based on an examination of evidenced good practice policies to support child and adolescent safety in each country (for the 2009 report cards this is based on data to July 2008). Included are policies in nine injury areas (passenger/driver safety, motor scooter and moped safety, pedestrian safety, cycling safety, water safety/drowning prevention, fall prevention, burn prevention, poisoning prevention, choking/strangulation prevention) and leadership, infrastructure and capacity strategies to support child injury prevention efforts.

The child safety report cards, including this summary, were developed as part of the Child Safety Action Plan project (CSAP), a European initiative led by the European Child Safety Alliance of Eurosafe with co-funding and partnership with the European Commission, the Health and Environmental Alliance (HEAL), UNICEF, the Universities of Keele and West of England, the WHO Regional Office for Europe and the partners from 26 countries: Austria, Belgium, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Northern Ireland, Portugal, Scotland, Slovenia, Spain, Sweden and Wales. More information on the CSAP initiative is available at: www.childsafetyeurope.org

The child safety report cards are designed to provide a starting point for countries to identify priorities and as a means of measuring progress toward reducing injury-related death and disability among children and adolescents. They also facilitate countries’ assessment as part of planning to enhance the level of safety for children in their country by identifying both strengths to be built upon and areas of weakness needing improvement, thereby providing guidance on where to focus action. The 2009 report cards represent first time report cards for 10 countries and updates for the remaining 14.1

The assessment conducted to produce this report card covered both written and practical policies. It focused on those policies where there is good evidence that adoption, implementation and enforcement at the national level has a positive impact on child safety (children were defined as ≤ 17 years of age, however as mortality data on this age group are not readily available, data presented within this report are for children 0-19 years).

Country partners contacted the relevant government department to assess whether each of the policies existed, had been partially or wholly implemented and was being partially or wholly enforced. As such the assessment provides an indication of current levels of policy but should not be considered absolutely definitive as it was subject to the availability of data. Further, the assessment examined what countries have done to address child and adolescent safety, but did not extend to an assessment of how well those policy actions are working.

Data on deaths due to the various injury causes are included as a reference point to assist in interpreting the policy scores. However it is important to note that many other factors, including exposure to hazards and socio-demographics, need to be considered when attempting to understand the relationship between injury rates and policy scores. As such this assessment represents an important starting point in attempts to benchmark differences in safety between countries in Europe. The uncertainties merely stress that the information can still be improved with better data and increased understanding of the determinants of injury at the population level. A detailed description of the methods used in the development of the report cards is provided in appendix one on page 36.

1

1) First report cards: Cyprus, England, Finland, Iceland, Ireland, Israel, Latvia, Lithuania, Slovenia and Wales; 2 others Malta and Luxembourg did not complete assessments in time for inclusion and report cards will be produced once information becomes available. Updates: Austria, Belgium, Czech Republic, Estonia, France, Germany, Greece, Hungary, Italy, Netherlands, Portugal, Scotland, Spain and Sweden.

2

What is different in 2009?In this round of report cards we have assessed eight new policies in addition to those that were assessed in 2007. As a result we present two series of scores, one including the new policies for all 24 countries and a comparison of progress on the original set of policies for the 14 countries who participated in both 2007 and 2009 (the comparison can be found on pages 8-9).

Why a child safety report card?When looking to enhance the level of safety for children and adolescents nationally and in Europe it is essential to reflect on how well individual countries are currently doing. Further several different areas need to be assessed in order to get a clear indication of current performance.

Assessment of the burden of injury is needed as injury still kills more children and adolescents 5-19 years than all other causes.

Assessment of the adoption, implementation and enforcement of national level policy measures is needed when there is evidence that the policies will reduce child and adolescent injury. The measurement of this action provides an indication of governments’ commitment and leadership to improve children’s right to safety.

Monitoring and reporting on countries’ commitment to provide the needed leadership, infrastructure and capacity to successfully address the injury issue is needed to measure progress toward commitments that are commensurate with the magnitude of the issue and adequate to ensure effective adoption, implementation, enforcement and evaluation of evidenced good practices.

Regular monitoring and communication of progress is a straightforward way of encouraging countries to take steps to address child safety, and comparisons can be inspirational and motivating when they provide examples of what can be achieved and encourage forward motion.

How do the countries measure up?

Despite the injury reductions and safety improvements over the last 20 to 30 years, injury remains a leading cause of death for children and adolescents in every Member State in Europe, and in most high income countries, the leading cause of death.

NetherlandsUnited Kingdom

IrelandSweden

GermanyFranceIsrael

HungaryItaly

FinlandAustria

SloveniaSpain

Czech RepublicEU-27

GreeceBelgiumPortugalEstonia

LithuaniaLatvia

GreeceItaly

United KingdomSpain

PortugalNetherlands

FranceGermany

SwedenCzech Republic

HungaryEU-27Ireland

BelgiumSloveniaAustria

IsraelFinlandLatvia

EstoniaLithuania22.43 8.21

6.25

5.69

4.01

3.78

3.64

3.51

3.46

3.00

2.93

2.91

2.53

2.50

2.08

1.84

1.65

7.04

7.86

8.16

5.83

5.93

6.52

8.30

8.43

8.63

9.08

9.42

9.61

9.71

10.44

11.25

12.44

12.62

13.70

21.30

21.90

1.28

1.16

1.12

1.07

0.74

Source: WHO Mortality database as averages for 3 years for 2003-2005 or most recent three years of data; Cyprus and Iceland excluded due to small populations and data for the constituent countries of the United Kingdom (England, Northern Ireland, Scotland and Wales) were not available so they are presented together as the United Kingdom.

Unintentional and intentional injury deaths for children and adolescents(rate per 100 000 population 0-19 years in 20 CSAP countries and EU27)

Unintentional injury Intentional injury

3

Of the over 52,000 children under 20 years who die each year in the EU27, about 20% or roughly 10,000 deaths, are due to unintentional injuries. There is great variability between the best performing countries compared to poorer performing countries with injury rates up to 4 times higher in the countries with poorer performance. Of the 24 countries that participated in these report card assessments, the highest over all injury rates are seen in Latvia, Lithuania and Estonia.

It has been estimated by researchers that if strategies currently known to be effective were uniformly implemented that approximately 90% of injuries could be prevented. One way to quantify the potential gains for injury prevention in Europe is to examine the deaths in excess of what would have been expected if all countries had the same injury death rate for children and adolescents as the EU Member State with the lowest rate. It is estimated that in 2005 alone, there would have been over 3000 fewer deaths to children and adolescents in the countries participating in the CSAP report cards if rates in all countries had matched the Netherlands’s injury rate2. And beyond that, there are still gains to be had in the Netherlands, which means the potential life savings across the countries are even greater.

Unintentional and intentional injury deaths for children and adolescents(rate per 100 000 population 0-19 years in 20 CSAP countries and EU27)

number of deaths at European lowest rate

SloveniaEstoniaIrelandFinlandLatvia

AustriaHungary

IsraelLithuania

Czech RepublicGreece

PortugalSwedenBelgium

SpainItaly

United KingdomFrance

GermanyNetherlands

number of potential lives saved

total number of reported deaths

1480

364

841

1027

1425

62986

4141011

290737

299

270

254

241

224

140

146

287

275

268573

202162

156144

148151

140147

145 130

21456

266

90164

94147

104120

11135

5882

300

1048

104

89

2777

6821

2127 48

3601120

266

Source: WHO Mortality database; 2005 or most recent year available; Cyprus and Iceland excluded due to small populations; data for the constituent countries of the United Kingdom presented together.

Potential for life saving in children and adolescents in participating CSAP countries

(number of deaths using the European country with lowest rate [the Netherlands] as reference2)

2) The measure of potential for life savings compares countries to the EU Member State with the lowest overall injury rate in the reference year, the Netherlands.

4

Overall child safety grades

All countries in Europe have adopted, implemented and enforced some policy actions that support child and adolescent safety, but much more can be done to make life safer for children and adolescents. Overall level of safety provided to children and adolescents in the 24 participating countries participating in these report cards was assessed by examining and grading the level of adoption, implementation and enforcement of evidenced based national policies in:

1) Nine areas of safety relevant to children and adolescents • moped/motor scooter safety • passenger/driver safety • pedestrian safety • cycling safety • water safety/drowning prevention • fall prevention • poisoning prevention • burn/scald prevention • choking/strangulation prevention

2) Three areas looking at strategies to support child safety efforts • leadership • infrastructure • capacity Countries were given a score out of 5 stars, where 5 stars was the best possible score for each of these 12 areas based on their adoption, implementation and enforcement of national policy specific to each area. An overall grade was calculated by adding together the number of stars over the 12 areas out of a total of 60. The detailed results for individual policies for each injury area are not in this summary report card, but available in the country specific report cards available on the European Child Safety Alliance website at www.childsafetyeurope.org

5

Key findings

Countries that participated in the report card assessments received middle grades indicating room for improvement in all countries. Ten countries (Austria, Czech Republic, England, Finland, France, Germany, Iceland, the Netherlands, Slovenia and Sweden) received an overall grade of good performance and the remainder received an overall grade of fair performance.

No country received a grade of excellent, although several are close in this assessment, but encouragingly no country received a grade of poor or unacceptable either. This is an improvement over 2007 when there were two countries with poor scores.

Generally speaking child safety grades based on adoption, implementation and enforcement of evidenced good practice policy correspond reasonably well to the overall rate of injury deaths (i.e., countries with lower injury rates achieved higher safety grades in this assessment).

There is room for improvement in all countries, as none have adopted and implemented all the recommended evidence-based policies.

Countries with lower overall grades can look to the experiences and successes of countries with stronger grades to assist in making their countries safer for children and adolescents.

Netherlands

Belgium

Scotland

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpainPortugal

Hungary

Germany

France

Iceland

Cyprus

Israel

England

Finland

WalesIreland

Latvia

Slovenia

Lithuania 49 – 60 excellent

37– 48.5 good

25 – 36.5 fair

13 – 24.5 poor

0 – 12.5 unacceptable

non-participants

Performance grade out of 60 stars

CSAP average: 35.5 stars

Overall child safety grades in Europe(24 countries)

6

Moped/motor scooter safety

Passenger safety

Pedestrian safety Cycling safety

Water safety/ drowning prevention

Fall prevention

Poisoning prevention

Burn/scald prevention

Choking/ strangulation prevention

Child safety leadership

Child safety infrastructure

Child safety capacity Overall score Overall grade

Austria 4.5 4 5 4 3 3 3 2.5 2.5 2 3 4 40.5 Austria

Belgium 3 3.5 4 1.5 2.5 2 4 3 2.5 1.5 1 1.5 30 Belgium

Cyprus 4.5 2 3 2.5 0.5 2.5 2 2 2 4.5 2 4 31.5 Cyprus

Czech Republic 5 3 4 4.5 3.5 2.5 3 2.5 2 4.5 3.5 4 42

Czech Republic

England 4 3.5 4 4 1.5 3 2.5 2.5 2.5 4 3.5 4.5 39.5 England

Estonia 5 2.5 3.5 4 2 2 3.5 2 2.5 2.5 2.5 3 35 Estonia

Finland 5 3.5 4 4.5 2 3 3 2.5 2.5 1.5 3 4 38.5 Finland

France 5 3.5 4 4 3.5 2.5 3 3 3 2.5 3 3 40 France

Germany 3.5 3.5 4 4 1 2 3 2.5 3 4.5 3 5 39 Germany

Greece 4 3.5 4 0 2 1 2 0.5 1.5 1 3.5 4 27 Greece

Hungary 4.5 3.5 4 3 1.5 1.5 3.5 1.5 2 2 4.5 5 36.5 Hungary

Iceland 4.5 4 4 4.5 4 4 4.5 4.5 3 2.5 4 5 48.5 Iceland

Ireland 4.5 2.5 4 2 2.5 2 1 2 2.5 1 3 4 31 Ireland

Israel 4 3 2 3 3 1.5 2 1.5 1.5 2.5 4 3.5 31.5 Israel

Italy 4 2 1,5 0 3 2 3.5 1 2 4 3 4 30 Italy

Latvia 4 4.5 3.5 3 1.5 1.5 2 2 2.5 2.5 4 3 34 Latvia

Lithuania 4.5 3.5 2.5 4 2 1.5 2.5 2 3 1.5 3 2.5 32.5 Lithuania

Netherlands 5 3.5 3.5 4 2 3.5 4.5 3 2.5 4.5 4.5 5 45.5 Netherlands

Portugal 3.5 3.5 1.5 1.5 2 1 3 1.5 2 2 2 4 27.5 Portugal

Scotland 4.5 3.5 3.5 2.5 1.5 2 3 2.5 2.5 1.5 3.5 5 35.5 Scotland

Slovenia 4.5 3.5 5 5 3.5 2.5 2.5 1.5 2 3 4 3.5 40.5 Slovenia

Spain 5 3.5 1.5 2 2 0.5 4.5 2 1.5 1.5 2 3 29 Spain

Sweden 4.5 3.5 1 5 2 2.5 4.5 3.5 3 4 4 5 42.5 Sweden

Wales 3.5 3 3 2.5 0.5 1 2.5 2.5 1.5 1 4 4.5 29.5 Wales

CSAP average 4.5 3.5 3.5 3 2 2 3 2.5 2.5 2.5 3 4 35.5 CSAP

average

= 49-60 stars – excellent performance, = 37-48.5 stars – good performance, = 25-36.5 stars – fair performance,

Child Safety Scores in 24 countries

The table below provides the overall safety performance grade and 12 issue area scores (each out of 5 stars) in 24 countries as of July 2008.

The scores for the individual issue areas and overall score and grade differ between countries.

None of the 24 countries received a grade of excellent performance on policies relating to the nine sub-areas of safety relevant to children and adolescents and leadership, infrastructure and capacity to support child safety efforts. Ten countries (Austria, Czech Republic, England, Finland, France, Germany, Iceland, the Netherlands, Slovenia and Sweden)

7


Passenger safety



Fall prevention






Child safety capacity Overall score Overall grade

Austria 4.5 4 5 4 3 3 3 2.5 2.5 2 3 4 40.5 Austria

Belgium 3 3.5 4 1.5 2.5 2 4 3 2.5 1.5 1 1.5 30 Belgium

Cyprus 4.5 2 3 2.5 0.5 2.5 2 2 2 4.5 2 4 31.5 Cyprus

Czech Republic 5 3 4 4.5 3.5 2.5 3 2.5 2 4.5 3.5 4 42

Czech Republic

England 4 3.5 4 4 1.5 3 2.5 2.5 2.5 4 3.5 4.5 39.5 England

Estonia 5 2.5 3.5 4 2 2 3.5 2 2.5 2.5 2.5 3 35 Estonia

Finland 5 3.5 4 4.5 2 3 3 2.5 2.5 1.5 3 4 38.5 Finland

France 5 3.5 4 4 3.5 2.5 3 3 3 2.5 3 3 40 France

Germany 3.5 3.5 4 4 1 2 3 2.5 3 4.5 3 5 39 Germany

Greece 4 3.5 4 0 2 1 2 0.5 1.5 1 3.5 4 27 Greece

Hungary 4.5 3.5 4 3 1.5 1.5 3.5 1.5 2 2 4.5 5 36.5 Hungary

Iceland 4.5 4 4 4.5 4 4 4.5 4.5 3 2.5 4 5 48.5 Iceland

Ireland 4.5 2.5 4 2 2.5 2 1 2 2.5 1 3 4 31 Ireland

Israel 4 3 2 3 3 1.5 2 1.5 1.5 2.5 4 3.5 31.5 Israel

Italy 4 2 1,5 0 3 2 3.5 1 2 4 3 4 30 Italy

Latvia 4 4.5 3.5 3 1.5 1.5 2 2 2.5 2.5 4 3 34 Latvia

Lithuania 4.5 3.5 2.5 4 2 1.5 2.5 2 3 1.5 3 2.5 32.5 Lithuania

Netherlands 5 3.5 3.5 4 2 3.5 4.5 3 2.5 4.5 4.5 5 45.5 Netherlands

Portugal 3.5 3.5 1.5 1.5 2 1 3 1.5 2 2 2 4 27.5 Portugal

Scotland 4.5 3.5 3.5 2.5 1.5 2 3 2.5 2.5 1.5 3.5 5 35.5 Scotland

Slovenia 4.5 3.5 5 5 3.5 2.5 2.5 1.5 2 3 4 3.5 40.5 Slovenia

Spain 5 3.5 1.5 2 2 0.5 4.5 2 1.5 1.5 2 3 29 Spain

Sweden 4.5 3.5 1 5 2 2.5 4.5 3.5 3 4 4 5 42.5 Sweden

Wales 3.5 3 3 2.5 0.5 1 2.5 2.5 1.5 1 4 4.5 29.5 Wales

CSAP average 4.5 3.5 3.5 3 2 2 3 2.5 2.5 2.5 3 4 35.5 CSAP

average

= 13-24.5 stars – poor performance, = 0-12.5 stars – unacceptable performance

received an overall grade of good performance and the remainder received an overall grade of fair performance.

None of the participating countries have adopted and implemented all of the recommended evidence-based policies for all sub-areas examined, although the Czech Republic, Estonia, Finland, France, the Netherlands and Spain have for moped/motor scooter safety; Austria and Slovenia have for pedestrian safety; Slovenia has for cycling safety and Germany, Hungary, Iceland, the Netherlands, Scotland and Sweden have for child safety capacity.

Countries with lower issue area scores can look to the experiences and successes of countries with higher issue area scores to assist in making their countries safer for children and adolescents.

8

Comparison of 14 countries that participated in both 2007 and 2009 assessments

If the eight new policies added in 2009 are excluded, a comparison can be made between assessment scores in 2007 and 2009 for participating countries. The table below provides scores for each sub-area and the overall safety performance score for 2009 with the eight new policies excluded and the change in the number of stars (∆) from 2007.

The CSAP average overall safety performance score increased by 4.5 stars between 2007 and 2009, representing a 14.5% increase.


Passenger safety



Fall prevention






Child safety capacity Overall score

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

Austria 4.5 +0.5 3 +0.5 5 +2 4 +2.5 3 +1.5 2.5 +1 3 +2 2.5 +1.5 2.5 +0.5 1.5 +0.5 3 -1 4 0 38.5 +11.5 Austria

Belgium 3 0 3 +0.5 4 +0.5 1.5 0 2.5 0 2.5 -0.5 4 +0.5 3 0 2.5 0 1 0 1.5 0 1.5 0 30 +1 Belgium

Czech Republic 5 +2 3 -0.5 4 +1 4.5 +1.5 3.5 +1.5 2 +1.5 2.5 +1 3 +1.5 2 0 4.5 +1.5 4 0 4 0 42 +11 Czech

Republic

Estonia 5 +1 3 +1 3.5 +1 4 0 2 0 2 +1.5 3.5 +1 2.5 +1 2.5 0 2 +1.5 3 +1 3 0 36 +9 Estonia

France 5 +0.5 3.5 +0.5 4 +0.5 4 +1 3.5 +1 3 0 2.5 -1 3.5 +0.5 3 0 2 0 3 +1 3 -1 40 +3 France

Germany 3.5 0 3 0 4 0 4 0 1 0 1.5 0 2.5 0 2.5 +0.5 3 +0.5 4.5 +1 3 0 5 0 37.5 +2 Germany

Greece 4 0 4.5 +1.5 4 +2.5 0 -1.5 2 +0.5 1 -0.5 1.5 +1.5 0.5 0 1.5 0 1.5 +1.5 4 +0.5 4 +1 28.5 +7 Greece

Hungary 4.5 -0.5 3 0 4 +1 3 -1 1.5 0 2 +0.5 3.5 +1 2 +1 2 0 2.5 +0.5 4.5 +2 5 +1 37.5 +5.5 Hungary

Italy 4 0 2 0 1.5 0 0 -1.5 3 +0.5 2 0 3.5 +1.5 1.5 +0.5 2 0 4 +2.5 4 +1 4 0 31.5 +4.5 Italy

Netherlands 5 +0.5 3 0 3.5 0 4 +1.5 2 0 3 +0.5 4.5 +0.5 3 0 2.5 0 4.5 0 4.5 +0.5 5 +1 44.5 +4.5 Netherlands

Portugal 3.5 +0.5 3 0 1.5 +0.5 1.5 0 2 +1.5 1 +0.5 2.5 +1 1.5 +1 2 +1.5 1.5 0 2.5 0 4 +0.5 26.5 +7 Portugal

Scotland 4.5 +0.5 3 0 3.5 0 2.5 +1 1.5 +0.5 2 +1 3 0 3 0 2.5 0 1.5 0 3.5 +1 5 0 35.5 +4 Scotland

Spain 5 0 4 +0.5 1.5 0 2 0 2 0 0.5 +0.5 4 +0.5 2 +0.5 1.5 +1 1.5 +0.5 2.5 +1.5 3 +2 29.5 +7 Spain

Sweden 4.5 -0.5 3.5 0 1 -0.5 5 0 2 0 2 0 4 0 4 +1 3 0 4 +1.5 4.5 0 5 +1 42.5 +2.5 Sweden

CSAP Average 4 0 3 0 3 0 3 +0.5 2 0 2 +0.5 3 +0.5 2.5 +0.5 2.5 +1 2.5 +0.5 3.5 +0.5 4 +0.5 35.5 +4.5 CSAP

Average

score in 2009 higher than in 2007 score in 2009 lower than in 2007

* scores with eight new policies excluded

9

All sub-area average scores showed an increase of 0.5 stars across the 14 countries except for moped/motor scooter, passenger, pedestrian and water safety.

The areas with the most improved scores were poisoning prevention, burn/scald prevention and child safety leadership, where 10/14 countries showed an improved score.

Encouragingly all countries appear to have made progress in the two years between assessments, with 2009 overall safety scores 3.4% to 42.6% higher than 2007 scores. The greatest improvements in score were found in Austria and the Czech Republic.

In 2007 the overall performance grades of the 14 countries represented a ratio of good:fair :poor performance of 3:8:3 and in 2009 this had changed to 7:7:0, demonstrating a marked improvement.


Passenger safety



Fall prevention






Child safety capacity Overall score

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

2009

*

∆ 2

007

Austria 4.5 +0.5 3 +0.5 5 +2 4 +2.5 3 +1.5 2.5 +1 3 +2 2.5 +1.5 2.5 +0.5 1.5 +0.5 3 -1 4 0 38.5 +11.5 Austria

Belgium 3 0 3 +0.5 4 +0.5 1.5 0 2.5 0 2.5 -0.5 4 +0.5 3 0 2.5 0 1 0 1.5 0 1.5 0 30 +1 Belgium

Czech Republic 5 +2 3 -0.5 4 +1 4.5 +1.5 3.5 +1.5 2 +1.5 2.5 +1 3 +1.5 2 0 4.5 +1.5 4 0 4 0 42 +11 Czech

Republic

Estonia 5 +1 3 +1 3.5 +1 4 0 2 0 2 +1.5 3.5 +1 2.5 +1 2.5 0 2 +1.5 3 +1 3 0 36 +9 Estonia

France 5 +0.5 3.5 +0.5 4 +0.5 4 +1 3.5 +1 3 0 2.5 -1 3.5 +0.5 3 0 2 0 3 +1 3 -1 40 +3 France

Germany 3.5 0 3 0 4 0 4 0 1 0 1.5 0 2.5 0 2.5 +0.5 3 +0.5 4.5 +1 3 0 5 0 37.5 +2 Germany

Greece 4 0 4.5 +1.5 4 +2.5 0 -1.5 2 +0.5 1 -0.5 1.5 +1.5 0.5 0 1.5 0 1.5 +1.5 4 +0.5 4 +1 28.5 +7 Greece

Hungary 4.5 -0.5 3 0 4 +1 3 -1 1.5 0 2 +0.5 3.5 +1 2 +1 2 0 2.5 +0.5 4.5 +2 5 +1 37.5 +5.5 Hungary

Italy 4 0 2 0 1.5 0 0 -1.5 3 +0.5 2 0 3.5 +1.5 1.5 +0.5 2 0 4 +2.5 4 +1 4 0 31.5 +4.5 Italy

Netherlands 5 +0.5 3 0 3.5 0 4 +1.5 2 0 3 +0.5 4.5 +0.5 3 0 2.5 0 4.5 0 4.5 +0.5 5 +1 44.5 +4.5 Netherlands

Portugal 3.5 +0.5 3 0 1.5 +0.5 1.5 0 2 +1.5 1 +0.5 2.5 +1 1.5 +1 2 +1.5 1.5 0 2.5 0 4 +0.5 26.5 +7 Portugal

Scotland 4.5 +0.5 3 0 3.5 0 2.5 +1 1.5 +0.5 2 +1 3 0 3 0 2.5 0 1.5 0 3.5 +1 5 0 35.5 +4 Scotland

Spain 5 0 4 +0.5 1.5 0 2 0 2 0 0.5 +0.5 4 +0.5 2 +0.5 1.5 +1 1.5 +0.5 2.5 +1.5 3 +2 29.5 +7 Spain

Sweden 4.5 -0.5 3.5 0 1 -0.5 5 0 2 0 2 0 4 0 4 +1 3 0 4 +1.5 4.5 0 5 +1 42.5 +2.5 Sweden

CSAP Average 4 0 3 0 3 0 3 +0.5 2 0 2 +0.5 3 +0.5 2.5 +0.5 2.5 +1 2.5 +0.5 3.5 +0.5 4 +0.5 35.5 +4.5 CSAP

Average

10

Mopeds and motor scooter use by adolescents is very common in southern Europe and is increasing across the EU as the density of road traffic increases and mopeds are seen as a good alternative to a car. In several countries mopeds are the major means of transportation to school, work and social events for adolescents.

Inequities in deaths due to motorized two-wheelers for children and adolescents exist with a 6 times greater risk for moped or motor scooter injury in the lowest performing country compared to that of the best performing country for which data are available. While the highest rates were seen in the Latvia, Finland and Spain for males and Latvia, the Netherlands and Austria for females, males are killed in accidents on motorized two-wheelers in much greater numbers than females. It is particularly unfortunate that data are not available for Greece and Portugal as country partners have indicated moped/motor scooter use is an important issue.


Source: WHO Mortality database (as 3-year averages for 2003-2005 or most recent 3 years of data). Cyprus and Iceland excluded due to small populations, data for the constituent countries of the United Kingdom not available so presented together as the United Kingdom and data not available for Belgium, Greece, Ireland and Portugal.

Deaths due to motorised two-wheelers for children and adolescents (rate per 100 000 population 0-19 years in 16 CSAP countries by sex)

Comparison of moped/motor scooter scores

The level of moped/motor scooter safety for children and adolescents was assessed on national level laws or policies:

• limiting the legal age to drive a moped/motor scooter,

• requiring a minimum qualifications for licensing,

• limiting speed for mopeds/motor scooters,

• limiting age or number of child passengers,

• requiring compulsory use of a helmet,

• mandating a national ministry/government department with responsibility for child and adolescent moped or motor scooter safety,

• establishing a government approved national injury prevention strategy with specific targets and timelines related to child and adolescent moped or motor scooter safety and

• establishing a national media campaign at least once in the past five years targeting child and adolescent moped or motor scooter safety.

Israel

France

Czech Republic

Italy

Hungary

Austria

Germany

Sweden

Estonia

United Kingdom

EU-27

Netherlands

Slovenia

Lithuania

Spain

Finland

Latvia

malesfemales

1.33

1.00

1.09

1.13

1.26

0.08

0

0.38

0.11

0.64

0.60

0.50

0.44

0.33

0.24

0

0

0.60

0.60

0

0.26

0.09

0.02

0

0.07

0.06

0.15

0.06

0.02

00

0

0.67

1.25

11

INJU

RY A

REA

SCO

RES

Moped

/moto

r scooter safety

Key findings

Road safety related policies related to moped/motor scooters were the most likely to have been adopted and implemented compared to all other injury areas with an average score across the 24 countries participating of 4.5 out of 5 stars.

Moped/motor scooter safety scores do not correspond to motorcycle related deaths for all countries. For example, Latvia with the highest death rate also has a fairly high safety score. This lack of correspondence between mortality rate and score likely reflects that the category used to calculate the mortality rates includes more than just moped/motor scooter-related incidents and also that levels of exposure and implementation and enforcement of policy measures vary between the countries.

All countries had a law limiting the legal age to drive a moped/motor scooter and all required use of a helmet, although helmet laws were reported as not well enforced in Italy.

All countries but one (Belgium) require minimum qualifications and all had specific speed limits, although Israel and Italy reported that the speed limits are not well enforced.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected adoption or increased enforcement of laws limiting age or number of passengers on mopeds/motor scooters and establishment of government approved strategies to address these types of injuries.

Current coding of death data in some countries does not allow for a breakdown to examine moped/motor scooter related injuries separately, which makes European level comparisons difficult.

Countries were assessed based on the good practice measures on the previous page and given a score out of a possible 5 stars.


Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpainPortugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants

Score out of 5 stars

Moped/motor scooter safety in Europe

12

Children and adolescents spend an increasing amount of time in motor vehicles as family car ownership in Europe has increased. Inequities in motor vehicle passenger or driver deaths for children and adolescents exist with over 40 times greater risk in the lowest performing country compared to that of the best performing country participating for which data were available. The highest rates for countries where passenger/driver data were available were seen in Lithuania, Latvia and Slovenia for males and Latvia, Estonia and Hungary for females.

Comparison of passenger/driver safety scores

The level of passenger safety for children and adolescents was assessed on national level laws or policies:

• requiring the use of child passenger restraints and seat belts including specific requirements regarding positioning of child restraints and children within the vehicle,

• driving restrictions on new drivers through a graduated licensing programme (new policy measured in 2009),

• restrictions on children driving or riding on tractors and all terrain vehicles (new policies measured in 2009),

• mandating a national ministry/government department with responsibility for child passenger safety issues,

• establishing a government approved road safety strategy with specific targets and timelines related to child passengers and

• establishing a national media campaign addressing child passenger safety in the past five years.

Countries were assessed based on the above good practice measures and given a score out of a possible 5 stars.

Passenger/driver safety

Source: WHO Mortality database (as 3-year averages for 2003-2005 or most recent 3 years of data). Cyprus and Iceland excluded due to small populations, data for the constituent countries of the United Kingdom not available so presented together as the United Kingdom and data not available for Belgium, Greece, Ireland and Portugal.

Motor vehicle passenger or driver deaths for children and adolescents(rate per 100,000 population 0-19 years in 16 CSAP countries by sex)

France

Italy

Czech Republic

Austria

Netherlands

Sweden

Germany

United Kingdom

EU-27

Israel

Estonia

Hungary

Finland

Spain

Slovenia

Latvia

Lithuania 7.11

3.31

3.38

3.65

6.69

1.31

1.40

3.80

1.03

1.32

3.04

2.10

2.02

1.93

1.83

1.42

2.87

2.57

1.57

3.02

1.25

1.23

0.66

0.69

0.64

0.60

0.87

0.810.85

0.170.22

0.06

3.24

5.00

malesfemales

13

Passenger/driver safetyIN

JURY

AR

EA SC

OR

ESP

assen

ger/d

river sa

fety

Key findings

Currently many of the recommended evidence-based national level policies in passenger safety are adopted, implemented or enforced in the majority of countries assessed and the average score across the participating countries of 3.5 out of 5 stars reflects this. This most likely reflects the fact that road safety measures have been around for a long time and countries have been more likely to investment in the area of road safety compared to other areas, such as home safety.

Interestingly, passenger safety policy scores do not correspond to motor vehicle related deaths. Latvia and Lithuania, two countries with high policy scores for passenger/driver safety, rank at the bottom in terms of injury deaths. This likely reflects different levels of exposure and implementation and enforcement between the countries.

All countries reported legislation requiring use of appropriate child passenger restraints although Cyprus and Hungary indicate increased enforcement was needed.

Although several countries have laws that require children to remain seated rear facing until older than a year, only Greece reported a law requiring children to remain seated rear facing until age 4 years; the age that research suggests would keep them safest. Of note, although there is no law, the majority of children in Sweden also remain seated rear facing until age 4 years and they have reduced their child passenger death rate in very young children to almost zero.

Eight countries (Czech Republic, France, Greece, Hungary, Ireland, Latvia, Lithuania, Portugal and Spain) reported a law requiring children to remain seated in the back seat of the motor vehicle until at least age 12 years or they reach 150 cm in height which is the height current research supports. However several countries indicated the law is only partially implemented or enforced.

Over half the countries have some form of multi-staged programme to require new drivers initial on-road experience under conditions of reduced risk such as: zero tolerance for alcohol, no driving at night, limiting passengers, etc.

All countries except Estonia, France, Ireland and Italy have a law banning children from riding/driving farm tractors, but age limits vary and in some countries it only applies to driving on official roads.

All countries except Estonia, Ireland, Italy, Spain and Wales have laws banning children from riding/driving all terrain vehicles (ATVs), although several indicated the law is only partially implemented or enforced.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected increased enforcement of existing passenger restraints laws.

Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpainPortugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Passenger safety in Europe

14

Walking is being encouraged to battle the obesity epidemic and children are being challenged to walk more often. At the same time, as countries continue to become more motorised, the environment is becoming less friendly for pedestrians.

Inequities in pedestrian deaths for children and adolescents exist with over a 13 times greater risk in the lowest performing country compared to that of the best performing country for which data were available. The highest rates were seen in Estonia, Lithuania, Israel and Latvia for males and Latvia, Estonia, Israel and Lithuania for females.

France

Italy

Netherlands

Sweden

Austria

Germany

Slovenia

Spain

Finland

United Kingdom

Hungary

EU-27

Portugal

Czech Republic

Latvia

Israel

Lithuania

Estonia

3.15

1.41

1.54

1.74

2.10

1.79

1.33

3.671.72

1.44

0.96

1.13

1.12

0.94

0.90

0.79

0.72

0.72

0.95

0.94

1.00

0.89

0.58

0.28

0.49

1.16

0.49

0.75

0.29

0.390.53

0.270.37

0.14

1.20

2.09

malesfemales

Comparison of pedestrian safety scores

The level of pedestrian safety for children and adolescents was assessed on national level laws or policies:

• requiring reduced speed in residential areas (e.g. schools and playgrounds),

• assuming driver responsibility in a crash involving a child pedestrian,

• providing incentives to support vehicle redesign to reduce risk of pedestrian injury (e.g. pedestrian friendly bumper heights),

• mandating a national ministry/government department with responsibility for child and adolescent pedestrian safety,

• establishing a government approved national injury prevention strategy with specific targets and timelines related to child and adolescent pedestrian safety and

• establishing a national media campaign at least once in the past five years targeting child and adolescent pedestrian safety.


Pedestrian safety

Source: WHO Mortality database (as 3-year averages for 2003-2005 or most recent 3 years of data). Cyprus and Iceland excluded due to small populations, data for the constituent countries of the United Kingdom not available so presented together as the United Kingdom and data not available for Belgium, Greece and Ireland.

Pedestrian related deaths for children and adolescents(rate per 100 000 0-19 years in 17 CSAP countries by sex)

15

INJU

RY A

REA

SCO

RES

Pe

de

strian

safe

ty

Key findings

Currently many of the recommended evidence-based national level policies in pedestrian safety are adopted, implemented or enforced in the majority of countries assessed and the average score across the participating countries of 3.5 out of 5 stars reflects this.

Pedestrian safety scores did not correspond to pedestrian deaths for all countries. For example, Sweden which had one of the lower pedestrian safety scores also had one of the lowest death rates. However Sweden has invested heavily in infrastructure at the local level in the last 20 plus years and this is not captured in the policy measures assessed. Thus the lack of correspondence between pedestrian death rates and safety scores reflects the fact that only national level policies were assessed and that there are differing levels of exposure as well as differing levels of implementation and enforcement of policy measures between the countries.

All countries but two, the Netherlands and Portugal, have a national law requiring reduced speed in residential areas, although in the Netherlands municipal level laws do exist. In addition, Cyprus, Israel, Lithuania and Wales report their national laws are only partly implemented or enforced.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected increased adoption of national laws addressing liability in the event of a child pedestrian incident and the introduction of national media campaigns targeting child pedestrian safety.

Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Pedestrian safety in Europe

Pedestrian safety

16

As with walking, cycling is being encouraged to battle the obesity epidemic and children are being encouraged to use non-motorised transportation more often. Unfortunately, few countries have invested in infrastructure to make the environment friendlier for cyclists.

Inequities in cycling deaths for children and adolescents exist with over 40 times greater risk in the lowest performing country compared to that of the best performing country for which data were available. The highest rates were seen in Lithuania, Latvia, Estonia and the Netherlands for males and the Netherlands, Estonia and Latvia for females.

Israel

Portugal

France

Spain

Sweden

Austria

Italy

United Kingdom

Germany

Czech Republic

Hungary

EU-27

Finland

Slovenia

Netherlands

Estonia

Latvia

Lithuania

0.48

0.53

0.77

1.27

1.210.08

0.25

0

0.22

0.35

0.21

0.18

0.15

0.14

0.06

0.34

0.25

0.17

0.21

0.15

0.17

0.06

0.07

0.08

0.07

0.03

0.020.05

0

00

0.44

0.820.43

0.72

0.82

malesfemales

Comparison of cycling safety scores

The level of cycling safety for children and adolescents was assessed on national level laws or policies:

• requiring use of bicycle helmet while cycling,

• mandating a national ministry/government department with responsibility for child and adolescent cycling safety,

• establishing a government approved national strategy with specific targets and timelines related to child and adolescent cycling safety and

• establishing a national media campaign at least once in the past five years targeting child and adolescent cycling safety.


Cycling safety

Source: WHO Mortality database (as 3-year averages for 2003-2005 or most recent 3 years of data). Cyprus and Iceland excluded due to small populations, data for the constituent countries of the United Kingdom not available so presented together as the United Kingdom and data not available for Belgium, Greece and Ireland.

Deaths due to cycling for children and adolescents (rates per 100 000 population 0-19 years in 17 CSAP countries by sex)

17

INJU

RY A

REA

SCO

RES

Cyclin

g safe

ty

Key findings

Many of the countries have road safety plans that include specific targets for cyclists and have done extensive educational and media campaigns to prevent cycling related accidents and the average score across the participating countries of 3 out of 5 stars reflects this.

Cycling safety scores did not correspond to cycling deaths for all countries. For example, the Netherlands, which has a higher cycling safety score, also had high death rates. This finding reflects the different levels of exposure as cycling is more widely undertaken in the Netherlands, but may also reflect levels of implementation and enforcement of policy measures between the countries.

Nine countries (Czech Republic, Finland, Iceland, Israel, Latvia, Lithuania, Slovenia, Spain and Sweden) reported a national law requiring use of a bicycle helmet by all cyclists while cycling, although only Slovenia and Sweden indicate that laws well enforced. Although an increasing number of countries have adopted helmet laws, given the evidence supporting helmet use and the impact of legislation on helmet use, it is surprising that so few countries have adopted this good practice. Improving on the current situation will require work to increase cultural acceptance of helmet wearing so that children and adolescents attain the life saving benefit of these safety devices.

Of note the policy assessment did not examine environmental modifications such as cycling lanes as these are most often adopted, implemented and enforced at the municipal level, which was outside the scope of the national policy assessment.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected the establishment of government approved plans with specific targets related to child cycling safety.

Cycling safety in Europe

Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Cycling safety

18

Drowning is the second leading cause of unintentional death for children and adolescents in the EU. Inequities in drowning deaths for children and adolescents exist with an almost 16 times greater risk in the lowest performing country compared to that of the best performing country. The highest rates were seen in new member states, Latvia, Lithuania and Estonia for both males and females.

United Kingdom

Slovenia

Sweden

Italy

Germany

Israel

Netherlands

Greece

Austria

Ireland

France

Spain

Portugal

Czech Republic

Belgium

Finland

Hungary

EU-27

Estonia

Lithuania

Latvia7.46

1.75

2.14

6.89

1.71

3.56

1.57

0.77

1.33

1.18

1.13

1.02

0.97

0.96

1.30

1.28

0.49

0.55

0.67

0.50

0.51

0.31

0.42

0.30

0.34

0.950.41

0.85

0.74

0.72

0.70

0.43

0.20

0.27

0.260.62

0.170.48

0.14

1.37

4.07

malesfemales

0.50

Comparison of water safety/drowning prevention scoresThe level of water safety/drowning prevention for children and adolescents was assessed on national level laws or policies:

• requiring barrier fencing for public and private pools,

• requiring regular recertification for lifeguards and a minimum number of lifeguards at public pools or on beaches or other area specifically specified for water leisure activities,

• requiring use of personal floatation device/lifejacket while on the water,

• requiring water safety education, including swimming lessons, as part of compulsory school curriculum,

• requiring attainment of a standard for public swimming pools that mandates pool design, operation and maintenance for safety,

• requiring attainment of a standard for water safety signs and symbols,

• requiring attainment of minimum safety standard for leisure/recreational programming at the community level (e.g., minimum levels of supervision, training or safety equipment, etc.),

• mandating a national ministry/government department with responsibility for water safety,

• establishing a government approved national injury prevention strategy with specific targets and timelines related to child and adolescent water safety,

• establishing a national program of child home visits that includes education on child water safety and

Water safety/drowning prevention

Source: WHO Mortality database (as 3 year averages for 2003-2005 or most recent three years of data). Cyprus and Iceland excluded due to small populations and data for the constituent countries of the United Kingdom not available so presented together as the United Kingdom.

Drowning deaths for children and adolescents (rate per 100 000 population 0-19 years in 20 CSAP countries by sex)

19

Water safety/drowning preventionIN

JURY

AR

EA SC

OR

ES W

ater sa

fety

/dro

wn

ing p

reve

ntio

n

Key findings

Currently the recommended evidence-based national level policies in water safety are not adopted, implemented or enforced in the majority of countries assessed. The average score across the participating countries was 2 out of 5 stars.

Water safety/drowning prevention scores did not correspond to drowning deaths for all countries with no clear pattern of reduced mortality for those countries with higher water safety scores. Again this lack of correspondence likely reflects different levels of exposure and implementation and enforcement of policy measures between the countries. For several countries many of the water safety/drowning prevention policies are addressed at the regional level. Germany is one example of regional policy for water safety/drowning prevention and this may explain why their score was low.

Only four countries France, Iceland, Lithuania and Sweden have a law that requires barrier fencing for private pools and the law in Iceland is not well enforced. Seven countries reported laws requiring barrier fencing around public pools (Austria, Czech Republic, Iceland, Israel, Italy, Slovenia and Sweden).

Only one country, Ireland, requires and enforces use of personal floatation devices (PFD) while on the water, while two others have such legislation but indicate it is not fully implemented and enforced (Portugal) or is limited to open water craft smaller than 24 metres (Estonia). Eight others (Austria, Czech Republic, Finland, France, Greece, Hungary, Iceland, Lithuania and Slovenia have existing legislation that requires only that the PFD be present while on the water and does not specify that it should be worn. This is not seen as providing adequate protection for children.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected increased government leadership through clarifying mandated responsibility for child water safety, establishment of government approved strategies, adoption of national laws addressing lifeguard supervision and recertification and introduction of laws requiring at presence of personal floatation devices; although as noted above these need to be strengthened to require actual use.

Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Water safety/ drowning prevention in Europe

• establishing a national media campaign at least once in the past five years targeting child and adolescent water safety.


20

Falls are the third leading cause of unintentional death for children and adolescents in the EU. Yet in countries where data are available for hospitalisations and emergency department visits we see that falls are the leading cause of admissions and emergency department visits for children and adolescents. Inequities in deaths due to falls for children and adolescents exist with over a 10 times greater risk in the lowest performing country compared to that of the best performing country. The highest rates were seen in Latvia, Austria and Portugal for males and Estonia, Belgium and Latvia for females.

Sweden

Finland

Netherlands

United Kingdom

Hungary

Germany

France

Belgium

Israel

Spain

Italy

Czech Republic

Ireland

EU-27

Greece

Slovenia

Lithuania

Estonia

Portugal

Austria

Latvia

0.73

0.92

0.97

1.22

1.110.39

0.30

0.16

0.23

0.63

0.48

0.45

0.45

0.43

0.56

0.54

0.31

0.24

0.06

0.21

0.590.25

0.24

0.05

0.47

0.18

0.19

0.27

0.26

0.21

0.12

0.350.12

0.12

0.10

0.22

0.03

0.69

1.010.21

0.87

1.02

malesfemales

Comparison of fall prevention scores

The level of fall prevention for children and adolescents was assessed on national level laws or policies:

• requiring playground equipment and landing surfaces to meet safety standards,

• requiring environmental changes in buildings with more than one storey/level to prevent children from falling out of windows (e.g., window guards or locks) or from balconies or stairs in buildings (new policy measured in 2009),

• banning the marketing and sale of baby walkers,

• mandating a national ministry/government department with responsibility for child and adolescent fall prevention,

• establishing a government approved national injury prevention strategy with specific targets and timelines related to child and adolescent fall prevention,

• establishing a national program of child home visits that includes education on child fall prevention and

• establishing a national media campaign at least once in the past five years targeting child and adolescent fall prevention.



Deaths due to falls for children and adolescents (rate per 100 000 population 0-19 years in 20 CSAP countries by sex)

Fall prevention

21

INJU

RY A

REA

SCO

RES

Fall p

reve

ntio

n

Fall prevention

Key findings

Currently the recommended evidence-based national level policies in fall prevention are not adopted, implemented or enforced in the majority of countries assessed. The average score for countries participating was 2 stars out of 5.

Fall prevention scores more closely correspond to rates of deaths due to falls than other injury issues. However, there are still differences likely reflecting different levels of exposure and implementation and enforcement of policy measures between the countries.

Every country except Cyprus, Scotland and Spain reported a policy requiring playground equipment and landing surfaces to meet safety standards, but seven others indicated that the standard was only partially implemented or enforced (Belgium, Greece, Israel, Italy, Lithuania, Portugal and Wales).

Ten countries (Cyprus, England, Greece, Iceland, Ireland, Lithuania, the Netherlands, Scotland, Slovenia, Sweden) have a national law requiring environmental changes to prevent children from falling out of windows in buildings with more than one storey or level and all but Ireland and Lithuania report it is also enforced.

All but seven countries (Belgium, France, Greece, Hungary, Latvia, Portugal and Spain report a national regulation for public and private buildings requiring safe design for guardrails to prevent falls from balconies and stairs, although three others who report they have laws indicate they are not well enforced (Israel, Lithuania and Wales).

For the 14 countries where a historical comparison in sub-area scores was possible, for the most part improved scores reflected increased government leadership through clarifying mandated responsibility for child fall prevention and increased educational efforts such as national media campaigns and programmes educating new parents.

Netherlands

Belgium

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

Ireland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Scotland

WalesEngland

Fall prevention in Europe

22


Poisoning is the fifth leading cause of unintentional death for children and adolescents in the EU. The youngest children are at greatest risk where curiosity and a natural tendency to put things in their mouths puts them at increased risk of poisoning over older children and adults. Inequities in poisoning deaths for children and adolescents exist with over a 55 times greater risk for poisoning in the lowest performing country compared to that of the best performing country. The highest rates were seen in Estonia, Lithuania and Latvia for both males and females.

Comparison of poisoning prevention scores

The level of poisoning prevention for children and adolescents was assessed on national level laws or policies:

• requiring child resistant packaging of medications and of household cleaners,

• funding or supporting national or regional poison control centres (new policy measured in 2009),

• mandating a national ministry/government department with responsibility for child and adolescent poisoning prevention,

• establishing a government approved national injury prevention strategy with specific targets and timelines related to child and adolescent poisoning prevention,

• establishing a national program of child home visits that includes education on child poisoning prevention and

• establishing a national media campaign at least once in the past five years targeting child and adolescent poisoning safety.



Poisoning deaths for children and adolescents (rate per 100 000 population 0-19 years in 20 CSAP countries by sex)

Italy

Netherlands

Austria

France

Israel

Germany

Spain

Portugal

Sweden

United Kingdom

Ireland

Hungary

Slovenia

Czech Republic

Belgium

EU-27

Greece

Finland

Latvia

Lithuania

Estonia

*3 yr averages

5.50

0.97

1.05

1.32

2.46

0.77

1.49

0.85

0.22

0.25

0.41

0.40

0.32

0.30

0.26

0.59

0.47

0.40

0.59

0.41

0

0.43

0.06

0.24

0.22

0.180.25

0.150.20

0.20

0.15

0.15

0.08

0.05

0.13

0.110.12

0.100.10

0.04

0.85

1.35

males*females

23

INJU

RY A

REA

SCO

RES

Po

ison

ing p

reve

ntio

n

Key findings

Although slightly better than the other areas of non-traffic injury, the recommended evidence-based national level policies in poisoning prevention are still not adopted, implemented or enforced in the majority of countries assessed. The average score for countries participating was 3 stars out of 5.

Poisoning prevention scores correspond reasonably well to poisoning deaths. However, there are still examples where they do not correspond and this likely reflects different levels of exposure and implementation and enforcement of policy measures between the countries. Of note is Estonia with an extremely high rate of deaths due to poisoning, and Germany with a low rate; both countries have a mid-range safety scores. Estonia’s higher mortality rates are likely due in part due to carbon monoxide poisoning, a problem associated with burning of hydrocarbon fuels that was not an issue assessed in the report cards, however alcohol poisoning in adolescents may also play a role in those countries with higher rates of unintentional poisoning.

While most countries have educational strategies in place, only 13 countries have well-enforced laws requiring child resistant packaging of both medications and household cleaners (Czech Republic, England, Estonia, Finland, Germany, Hungary, Iceland, Latvia, the Netherlands, Scotland, Spain, Sweden and Wales). Three countries (Cyprus, Greece and Ireland) have no national law for either.

All countries have a national policy regarding poison control centres, although England and Cyprus indicated more could be done to support the efforts in their countries.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected increased adoption and enforcement of laws related to child resistant packaging of medications, government leadership through clarifying mandated responsibility for child poisoning prevention, establishment of government approved strategies and increase education efforts such as national media campaigns and programmes educating new parents.

Netherlands

Belgium

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

Ireland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


England

Scotland

Wales

Poisoning prevention in Europe


24

Burn prevention

Burns, scalds and fire make up the fourth leading cause of unintentional injury death for children and adolescents in the EU. In addition to deaths, non-fatal burn injuries are life-altering events, requiring extended hospital stays and multiple surgeries and often resulting in permanent disability and disfigurement. Inequities in burn, scald and fire deaths for children and adolescents exist with over a 29 times greater risk for burns and scalds in the lowest performing country compared to that of the best performing country. The highest rates were seen in Estonia, Lithuania, Latvia and Finland for males and Estonia, Lithuania and Latvia for females.

Comparison of burn prevention scores

The level of burn prevention for children and adolescents was assessed on national level laws or policies:

• requiring a scald preventing maximum temperature (≤ 50°C) for tap water in domestic settings,

• requiring working smoke detectors in all private and public dwellings,

• requiring sale of reduced ignition propensity (RIP) cigarettes (e.g., “fire-safe” cigarettes) (new policy measured in 2009),

• requiring child resistant design for cigarette lighters,

• requiring flame retardant fabrics in children’s nightwear*,

• controlling the sale of fireworks to children,

• mandating a national ministry/government department with responsibility for child and adolescent burn prevention,

• establishing a government approved national injury prevention strategy with specific targets and timelines related to child and adolescent burn prevention,

• establishing a national program of child home visits that includes education on child burn prevention and

Source: WHO Mortality database (3 year averages for 2003-2005 or most recent three years of data). Cyprus and Iceland excluded due to small populations and data for the constituent countries of the United Kingdom not available so presented together as the United Kingdom.

Deaths due to burns, scalds and fire for children and adolescents

(rate per 100 000 population 0-19 years in 20 CSAP countries by sex)

Italy

Netherlands

Austria

France

Israel

Germany

Spain

Portugal

Sweden

United Kingdom

Ireland

Hungary

Slovenia

Czech Republic

Belgium

EU-27

Greece

Finland

Latvia

Lithuania

Estonia1.78

0.23

0.44

1.30

0.45

0.60

2.06

0.67

0.40

0.36

0.14

0.17

0.13

0.10

0.24

0.60

0.18

0.30

0.29

0.28

0.26

0.28

0.21

0.21

0.20

0.170.13

0.160.16

0.11

0.07

0.24

0.16

0.14

0.12

0.090.03

0.090.09

0.07

0.17

0.87

malesfemales

* Given the concern regarding toxic effects of flame retardants, it is recommended that countries consider only those flame retardants that are considered safer from an environmental health perspective.

25

Burn preventionIN

JURY

AR

EA SC

OR

ESB

urn

pre

ven

tion

Deaths due to burns, scalds and fire for children and adolescents

(rate per 100 000 population 0-19 years in 20 CSAP countries by sex)

Key findings

Currently the recommended evidence-based national level policies in burn prevention are still not adopted, implemented or enforced in the majority of countries assessed. The average score for countries participating was 2.5 stars out of 5.

Burn prevention scores currently do not correspond well to the rates of deaths from burns, scalds and fire. For example, Portugal and Greece, two countries with low death rates also have low burn prevention scores. Again, this may reflect different levels of exposure and implementation and enforcement of policy measures between the countries.

Only one country, Iceland, reported requiring a scald preventing maximum temperature (not higher than 50°C) for tap water in domestic settings. While several others have legislation regarding hot water temperatures, the legislation does not apply to all dwellings, still specifies a temperature that is not scald preventing, or exists for bacterial deterrent purposes and thus reflects an increased risk of scalds for children.

Only Estonia, Finland and Iceland require smoke detectors in all public and private dwellings, but while Estonia’s law came into effect for public dwellings in 2007 it did not come into effect for private dwellings until 2009, after the timeframe of this data collection. Most other countries have legislation that requires smoke detectors for only new buildings or only public buildings, a situation that does not adequately protect children and families from lower socio-economic settings. Cyprus, Greece, Hungary and Israel have no legislation regarding smoke detectors at all.

All countries have a law controlling the sale of fireworks to children, but the laws vary widely and are reported as not well enforced in Greece, Ireland, Israel, Lithuania, Portugal and Spain.

For the 14 countries where a historical comparison in sub-area scores was possible, increased scores reflected adoption and implementation of national regulations requiring child resistant cigarette lighters and working smoke detectors in newly built private dwellings, increased government leadership through clarifying mandated responsibility for child burn/scald prevention, establishment of government approved strategies and increased educational efforts such as national media campaigns and programmes educating new parents.

Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Burn prevention in Europe

• establishing a national media campaign at least once in the past five years targeting child and adolescent burn prevention.


26

Choking/strangulation prevention

Although they occur less often than other causes of injury death, airway and breathing related injuries are often fatal injuries. Inequities in choking/strangulation deaths for children and adolescents exist with over a 50 times greater risk for choking/strangulation in the lowest performing country compared to that of the best performing country. The highest rates were seen in Estonia, Lithuania and Czech Republic for males and Estonia, Latvia and Lithuania for females.

Comparison of choking/strangulation prevention scores

The level of choking/strangulation prevention for children was assessed on national level laws or policies:

• enabling restriction or banning of unsafe products, such as unsafe child care products,

• requiring informative warning labels on products (e.g., toys) to prevent choking, suffocation or strangulation,

• banning production and sale of latex balloons,

• prohibiting use of inedible materials in food products,

• prohibiting drawstrings in children’s clothing,

• regulating design and sale of blind cords and crib design,

• mandating a national ministry/government department with responsibility for child and adolescent choking/strangulation prevention,

• establishing a government approved national injury prevention strategy with specific targets and timelines related to child and adolescent choking/strangulation prevention,

• establishing a national program of child home visits that includes education on choking/strangulation prevention,

• establishing a national media campaign at least once in the past five years targeting child and adolescent choking/strangulation prevention.


Source: WHO Mortality database (as 3-year averages for 2003-2005 or most recent 3 years of data). Cyprus and Iceland excluded due to small populations, and data for the constituent countries of the United Kingdom not available so presented together as the United Kingdom and data not available for Belgium, Greece and Ireland.

Deaths due to choking/strangulation for children and adolescents(rate per 100 000 population 0-19 years in 17 CSAP countries by sex)

Israel

Sweden

Austria

Slovenia

Italy

Spain

Germany

Finland

Netherlands

France

United Kingdom

Hungary

Portugal

EU-27

Latvia

Czech Republic

Lithuania

Estonia 4.68

1.18

2.102.57

1.17

0.91

0.65

0.57

0.51

0.48

1.01

0.99

0.94

1.28

0.64

1.04

0.40

0.36

0.34

0.27

0.220.43

0.340.39

0.35

0.31

0.29

0.21

0.17

0

0.300.18

00.08

0.25

1.12

malesfemales

27

Choking/strangulation preventionIN

JURY

AR

EA SC

OR

ESC

ho

kin

g/stran

gulatio

n p

reve

ntio

n

Key findings

Currently the recommended evidence-based national level policies in choking/strangulation prevention are still not adopted, implemented or enforced in the majority of countries assessed. The average score for countries participating was 2.5 stars out of 5.

Choking/strangulation prevention scores do not currently correspond well to the rates of choking deaths. For example, Lithuania had a score of 3 stars, the highest choking prevention scores achieved and yet also had one of the highest rates of death from this cause. This likely reflects different levels of child exposure to risks for choking and strangulation and of implementation and enforcement of policy measures between the countries.

All countries except Wales report a law that enables restriction or banning of unsafe products, but only 11 countries have a law that prohibits the use of inedible materials in food products (Austria, Belgium, England, Estonia, Finland, France, Germany, Ireland, Lithuania, Portugal and Scotland); only two, Latvia and Lithuania, report banning latex balloons and only Ireland and Latvia report regulating design and sale of blind cords.

All countries except Austria, Cyprus, Estonia and Spain have a national standard regulating safe crib design, however, Finland and Portugal both note the need for stronger enforcement.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected strengthening of national laws enabling restrictions or banning of unsafe products, regulation of unsafe products such as inedible materials in food products and increased educational efforts such as national media campaigns and programmes educating new parents.

Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Choking/strangulation prevention in Europe

28

ACTIONS TO SUPPORT CHILD SAFETY EFFORTSLEADERSHIP, INFRASTRUCTURE AND CAPACITY are essential to supporting child and adolescent safety prevention and promotion efforts at a national level. Commitment of top political leaders is critical to ensuring establishment of injury as a priority issue and the allocation of requisite resources, both human and financial, that are commiserate with the size of the injury problem. National leadership is important to both sustaining and building on initial child injury prevention efforts and to achieving successful partnerships and service delivery at regional and local levels. Basic infrastructure tools like adequate data to describe the issue, monitor progress and identify new threats or trends are essential. As well organisations with a clear mandate to support prevention efforts are necessary to ensure effective use of scarce resources. A knowledgeable and connected group of stakeholders are necessary to provide the needed capacity in a country to carry out effective planning, implementation and evaluation of prevention strategies, to ensure exchange of knowledge on what works and coordinated efforts between national, regional and local levels.

Leadership to support child safetyA country’s level of child safety leadership was assessed based on its adoption, implementation and enforcement of evidence-based national level policies relating to leadership and included policies:

• establishing responsibility for lead on national coordination of child and adolescent safety activities within a government department/ministry,

• establishing a specific contact or focal point identified for child and adolescent safety for each of the departments/ministries involved in the issue,

• identifying injury prevention as a national priority by government (e.g., is it listed as a priority issue within a government document or health plan),

• establishing a government led national injury prevention strategy with specific targets relating to child and adolescent safety,

• existence of a national alcohol policy (new policy measured in 2009),

• committing dedicated funds within government budget for the development/support of national prevention programmes, research, capacity building, a national steering group or a network or organisation to coordination activities related to child and adolescent safety and

• identifying and supporting an organisation responsible for national coordination of child and adolescent safety activities.


29

AC

TIO

NS TO

SUPPO

RT C

HILD

SAFET

Y EFFO

RTS

Le

ade

rship

, infrastru

cture

an

d ca

pacity

Key findings

The weakest area amongst child safety leadership, infrastructure and capacity was child safety leadership with 2.5 stars out of 5.

Encouragingly all but four countries (Greece, Israel, Spain and Sweden) indicate that injury prevention has been identified as a national priority by the government.

All but six countries (Greece, Ireland, Latvia, Slovenia, Sweden and Wales indicated that a government led national injury prevention strategy existed, although only nine countries reported a strategy with child and adolescent specific targets (Cyprus, Czech Republic, Estonia, Finland, France, Germany, Iceland, Italy and the Netherlands).

11 countries reported having a government department/ministry that is responsible for national coordination of child and adolescent safety activities, although all countries indicated that they had government departments/ministries with some responsibility for child and adolescent safety activities. Only four countries (Cyprus, Czech Republic, Germany and Latvia) indicated that a specific focal point had been identified for child safety within each of the departments/ministries involved in the issue.

12 countries indicated that government departments have a dedicated budget for the development/support of national prevention programmes related to child and adolescent safety, but for four of those programmes were specific to only one area of child injury prevention (e.g., traffic safety).

11 countries reported dedicated funding for a national steering group/task force to address national child and adolescent safety, in many cases related to developing a Child Safety Action Plan and nine indicated there was a coordinating network/organisation, although again for many of these the coordination was only occurring in one area of child injury prevention (e.g., traffic safety).

10 countries reported some dedicated budget for research and eight some dedicated funding for capacity building related to child and adolescent safety.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected increased identification of a government department/ministry responsible for national coordination of child safety activities, progress towards national injury prevention strategies with child specific targets and increased funding for programmes, coordination and national steering committees/task forces.

Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Leadership to support child safety in Europe

30

Infrastructure to support child safety

A country’s level of child safety infrastructure was assessed based on its adoption, implementation and enforcement of evidence-based national level policies relating to infrastructure to support child safety activities and included policies:

• mandating an organisation (e.g., government department, NGO or other agency) with specific responsibility to coordinate injury data and produce reports to support action;

• establishing an annual or biannual report that includes minimum information on all child and adolescent injury deaths is regularly produced;

• conducting studies to explore link between the risk of child and adolescent injury death with the social and economic circumstances of the family, rural/urban residence or other factors;

• publishing a burden of injury report that includes data on children and adolescents;

• ensuring the necessary data to perform an analysis of the burden of child and adolescent injury (e.g., mortality data, estimates of duration of disability, etc.);

• ensuring data for child and adolescent (0-17 years) accidents and injuries are reasonably available at the national level (e.g., mortality and morbidity data);

• ensuring a mechanism to allow early identification of and rapid response to emerging safety hazards (new policy measured in 2009).


Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Infrastructure to support child safety in Europe

31

AC

TIO

NS TO

SUPPO

RT C

HILD

SAFET

Y EFFO

RTS

Le

ade

rship

, infrastru

cture

an

d ca

pacity

Key findings

While many of the recommended policies relating to child safety infrastructure have been implemented in the participating countries as reflected by the average score of 3 out of 5 stars, much more can be done to support child safety actions.

All countries except Belgium, Cyprus, Germany and Lithuania, indicated the existence of an organisation whose mandate specifically includes coordinating injury data and producing reports to support action and all but Finland and Wales reported producing a regular report that includes at least minimum information on injury deaths in children and adolescents.

All countries have population-based mortality data, but access, availability, coding and coverage of hospitalisation and emergency department data vary greatly by country.

11 countries indicated they had published a burden of injury report that included children and adolescents, however these reports most often express injury burden in strict terms of mortality and do not include burden of injury-related disability, therefore the true burden of childhood injury is not calculated to show the large impact injury has. Others that include additional measures of burden have not presented data separately for children and adolescents.

Only 3 of the 24 countries (Czech Republic, Finland and Germany) were assessed as having the data necessary to conduct a full burden of child and adolescent injury study (i.e. have country specific data on duration of disability).

15 countries reported a mechanism that allows early identification of and rapid response to emerging safety hazards.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected establishment of an organisation with specific mandate to coordinate injury data and publishing of a burden of injury report that includes data on children.

Capacity to support child safetyA country’s level of child safety capacity was assessed based on the countries’ adoption, implementation and enforcement of evidence-based national level policies relating to capacity to support child safety activities and included policies:

• mandating one or more organisations (e.g., government department, NGO or other agency) with responsibility to distribute information on evidenced good practice and/or facilitate or encourage uptake of evidenced good practice in the area of injury prevention or safety promotion,

• establishing a network/structure or healthcare system that can facilitate accident prevention education for expectant parents and/or parents of children 0-4 years old and is currently using it for that purpose,

• establishing national capacity building initiatives for those working in the area of injury prevention that are either specific to injury prevention or include injury prevention content,

• establishing a network for child and adolescent injury prevention practitioners and researchers and

• establishing a national conference or regional meeting on child and adolescent injury prevention or a national conference where child and adolescent injury is part of a larger agenda.


32

Netherlands

Belgium

England

Scotland

Iceland

Cyprus

Sweden

Czech Rep

Austria

Estonia

Italy

GreeceSpain

Portugal

Hungary

Germany

France

Israel

Finland

WalesIreland

Latvia

Lithuania

Slovenia

5

4 or 4.5

3 or 3.5

2 or 2.5

1 or 1.5

less than 1

non-participants


Capacity to support child safety in Europe

Key findings

Child safety capacity was the strongest area of the supporting actions for child safety compared to leadership and infrastructure with an average score of 4 out of 5 stars.

All countries except Belgium report one or more organisations whose mandate includes distributing information on evidenced good practice and/or facilitating or encouraging uptake of evidenced good practice in the area of injury prevention or safety promotion.

All countries except Belgium, Cyprus and Latvia indicated the existence of national capacity building initiatives for those working in the area of injury prevention that are either specific to child and adolescent injury prevention, or include child and adolescent injury prevention content. However these vary greatly in target group and content and only one of two countries reported attempts to comprehensively address basic levels of knowledge in key groups of child and adolescent injury stakeholders.

All countries except the Czech Republic, France, Greece, Lithuania and Spain report a network/structure or healthcare system that can facilitate accident prevention education for expectant parents and/or parents of children 0-4 years old; although the degree to which it is used for that purpose varied as did the capacity of those delivering the education.

14 countries reported the existence of a national network to facilitate exchange of information on injury prevention for children and adolescents although two of those indicated the network was limited.

All countries except Austria, Belgium and Estonia reported hosting a regional meeting or conference in the past three years that contained some content on child and adolescent injury. Some of these were specific to child and adolescent injury, but most were broader events where child and adolescent injury was included as one of many issue areas covered.

For the 14 countries where a historical comparison in sub-area scores was possible, improved scores reflected development of national networks for child safety for injury prevention practitioners and researchers, in large part as the result of child safety action plan development.

33

SUMMING UPAction to address child and adolescent injury is happening, but more can be done now and in the future. If Member States adopted the proven good practice policies noted in this report card, researchers estimate that 90% of injury deaths could be reduced. Thousands of children’s lives would be saved each year. Currently the investment in the child and adolescent injury issue is not commensurate with the size of the problem and it is clear that the price of doing nothing is the huge loss of Europe’s youngest citizens each year and the untold heartache for the families left behind. What investment are countries willing to make to ensure their youngest and most vulnerable citizens are adequately protected from injury and grow up to be healthy contributors to their community and country? We know what works to prevent child and adolescent injuries, we need more commitment and further action now, as stated in both the World and European Reports on child injury prevention released in 2008 by WHO and UNICEF.

Overall, countries vary in their strengths and areas for improvement both in terms of their injury rates and in their policy scores for the various sub-area of injury. For the most part there is no country consistently at the top or at the bottom for mortality rates or safety scores for each sub-area. However, the countries that have traditionally had lower injury rates, Sweden, the United Kingdom and the Netherlands all have relatively high overall performance grades, and in particular high scores for leadership, infrastructure and capacity. Further, the high injury rates in the new Member States of Estonia, Latvia and Lithuania are noteworthy and highlight the issue of inequities, reflecting the higher rates of injuries for all ages generally seen in countries in Central and Eastern Europe. They point to the specific need to ensure transfer of evidence-based good practices occurs from western to eastern and central Europe and the need for long-term commitments to ensure adequate time for adoption, implementation and evaluation of injury prevention efforts. The variation of sub-area scores within countries and the lack of direct correspondence between death rates and safety scores for the different injury areas underlines the importance for countries of having exposure data and assessing their own situation nationally and developing action plans that build on their strengths and address their specific gaps. Further interpretation of the individual safety scores is best done at the level of individual policy where issues such as specificity of a policy, levels of strictness, penalty and investment in enforcement and education to support implementation and enforcement, along with length of time a policy has been in place should also be examined.

Encouragingly improvements were seen in all but one of the countries for which this was a repeated assessment, particularly for non-traffic areas, which typically have lower scores and thus were perhaps in greater need for action. While for the most part these improvements indicated increased government commitment, clarity of responsibility for the various child injury areas and enhanced educational efforts to support other policy areas, such as national media campaigns and programmes educating new parents, it is hoped that this in turn will lead to future policy changes. The other areas where an improved score was observed were leadership, infrastructure and capacity to support child safety efforts. These three areas support the creation of a culture of safety within a country and it is thought that the improvements observed in these areas are at least in part directly due to the efforts of country partners working towards child safety action plans.

While there are limitations to the assessment approach used in the development of the child safety report cards and this comparison, the report cards are invaluable as a starting point to monitor and benchmark progress and the results have clearly pointed out the gaps in information. A particular gap is the lack of evaluations of national policy effectiveness that assess how well child safety policies have worked over time in the countries where they have been implemented. While the policies assessed are based on the current state of evidence, much of that evidence comes from studies at a local level and it is the potential impact of extrapolation of those results to the national level that leads to recommendations for national level policy. Issues related to measuring levels of implementation and

SUM

MIN

G U

PR

eco

mm

en

datio

ns fo

r action

on

child

safe

ty

enforcement at the national level are critical to better understanding the impact of policies and how well they are working. This type of information is needed in order to maximise effective transfer between countries and ensure successful adoption, implementation and enforcement of evidence-based good practices in those countries where they are lacking and is of particular importance given the inequities in injury rates between and within countries.

Finally, good mortality, morbidity and exposure data provide a foundation for both the development and monitoring of child safety related policy. Mortality data could be improved in several countries, allowing better descriptions and breakdowns of specific types of injury and almost all countries could improve their data on injury morbidity and the circumstances surrounding injury incidents. Almost no exposure data exist to support prevention efforts and this is an area needing urgent attention.

Recommendations for action on child safetyOverall the country report card grades for leadership, infrastructure and capacity indicate that the commit-ment and resources for the child and adolescent injury issue do not correspond with the magnitude of the issue, which is the number one cause of death for children in the EU.

There is a need for action today and in the future in the areas of:

Leadership Member States and EU institutions need to make child injuries a priority and provide leadership

on issues affecting the safety of their children and youth by bringing together the sectors necessary to address the child and adolescent safety issue and determine who will take lead and ownership of specific injury issues and coordinate the actions and resources needed.

Member States need to develop and implement national action plans as part of children’s overall health needs and to ensure both targeted and adequate resources to build infrastructure and capacity to support prevention activities that are commensurate with the size of the problem. Member States should benchmark their performance and measure and monitor their progress towards achieving action plan goals.

The European Commission and international organisations such as WHO and UNICEF can encourage and support Member State efforts in building leadership, infrastructure and capacity to support child and adolescent safety. Examples of this include the recent WHO regional resolution and European Commission recommendation calling for national plans and improved data systems and capacity to support injury prevention and the WHO led World and European reports on child injury prevention.

Member States need to provide leadership by acting to adopt, implement, enforce and evaluate policy measures that have been shown to work at the national level and encourage and support uptake and enforcement of good practice strategies that have been shown to be effective at the regional or local level. There is also a need to share the results of evaluation so that other Member States can benefit from their experience.

The European Commission needs to continue to work with appropriate parties to develop EU level policies based on evidenced good practice where action will reduce the risk of injury and provide equitable protection to children and adolescents across the EU. The development of these policies should be followed by timely publication and follow-through with countries to assess adoption, implementation and enforcement within national policy frameworks and to evaluate their impact.

The European Commission and international organisations such as WHO and UNICEF can encourage and support Member State efforts in adopting, implementing and enforcing evidence-based policies to support child and adolescent safety.

34

Infrastructure Member States should ensure that mortality data are annually submitted to the WHO so that

timely data are available and the European Commission and international organisations such as WHO and UNICEF should encourage and support this practice.

Data should be made available in age classifications that match the UN definition of children (0 to 17 years) by all countries in Europe and European databases managed by WHO (e.g., Health For All database) and Eurostat should provide data for this age group. Currently due to standard age groupings 15-19 year olds are grouped together and individual years are not available, which means data to examine injury deaths for children and adolescents using the UN definition of the child are not available.

Member States and the European Commission should make the necessary investments to ensure that comparable injury morbidity data (e.g., hospital discharge data) are collected and that consistent estimation methods are developed and used for the existing Injury Data Base.

The European Commission should work with Member States to investigate, select and use standard measures for socio-economic status that are relevant to child and adolescent injuries across the European Union and broader European region to allow comparative data.

Member States and the European Commission should support research into injury hazards, including tracking/reporting of dangerous products, and invest in the collection of exposure data, to allow a better understanding of the variation in injury risk within and across countries. In addition, more research should be conducted to better understand the influence of socio-demographic and economic status as a determinant of child injury, particularly with respect to allowing international comparisons.

Capacity building It would facilitate communication and action requests greatly if the EU and Member States

established and supported inter-sectoral governmental committees to deal with the crosscutting issue of injury and assign a focal point from each department/ministry involved in child safety.

Member States should support the development of child safety expertise in their countries and the establishment and/or enrichment of national child safety networks to enhance prevention efforts, dissemination of evidence-based good practice and exchange of knowledge and experience.

Member states and the European Commission should support research into effective transfer of evidence-based good practices, including demonstration research and case studies of examples of both effective and ineffective transfer, to increase knowledge of what is needed to ensure effective adoption, implementation and evaluation of child injury prevention efforts.

Our commitment from the European Child Safety Alliance

To continue supporting action for child safety in Europe the European Child Safety Alliance commits to:

Repeating the assessment of the child safety policies including those examining leadership, infrastructure and capacity periodically to allow for measurement of progress and benchmarking both within country and across the EU and explore other means of supporting and monitoring progress. This will include sharing the policy action indicators with countries in the broader European region to provide a standard way of assessing progress in child safety policies across all of Europe to enable comparisons to the current 2009 report card assessments.

Continuing to work cooperatively with UNICEF, WHO and the European Commission to advance the recommended actions in this report card and the recent World and European reports on child injury prevention in order to move child safety forward in Member States and Europe overall.

Continuing to support Member States and their child safety networks as they work to develop and implement Child Safety Action Plans.

Continuing to promote evidence-based good practices and advocate their adoption, implementa-tion and enforcement.

SUM

MIN

G U

PR

eco

mm

en

datio

ns fo

r action

on

child

safe

ty

35

36

Appendix OneMethods to prepare country and summary report cards

Policy measures for individual country report cards and this 24 country summary addressed both written and practical policy at the national level. Policy measures for nine injury areas (moped/motor scooter safety, passenger/driver safety, pedestrian safety, cycling safety, water safety, fall prevention, burn prevention, poisoning prevention, choking/strangulation prevention) were developed where there is evidence that adoption, implementation and enforcement at the national level are effective in reducing child and adolescent injuries.* Policy strategies known to be effective, but more likely to be established at regional or local levels were not included, e.g., traffic calming measures to reduce risk of pedestrian or cycling injuries. Measures addressing child safety leadership, infrastructure and capacity were taken from work conducted by other indicator initiatives.

Data on deaths were obtained from the WHO Mortality Database and death rates and avoidable injury rates were calculated at the Kuratorium für Verkehrssicherheit (KfV) in Austria. Data are presented are for the most recent year(s) of data available at the time of data acquisition, with constituent countries of the United Kingdom presented together as data for the individual countries were not available. As deaths from injury may be rare, a three-year average was used to increase reliability. Similarly, countries with a small population of less than 1 million, Cyprus and Iceland, were excluded from mortality comparisons in this report. Charts were constructed in order of rank.

Data for the policy indicators were obtained during 2008 from CSAP country partners using English language computer-based survey tools developed in conjunction with an expert advisory group made up of members from the Health and Environment Alliance (HEAL), UNICEF, the WHO Regional Office for Europe and experts in child and adolescent indicators and evidence-based prevention of child and adolescent injuries. The primary data collection required the country partners to contact the appropriate government department to ascertain correct information regarding adoption, implementation and enforcement of current policies; policy information is accurate to July 2008. Eight new policy measures were added in 2009 and two others were reworded based on lessons learned during the 2007 assessment. Each policy was assessed on a three point scale of 2 = policy existing, clearly stated, fully implemented and enforced; 1 = policy existing, clearly stated but only partly implemented or enforced; or 0 = policy does not existing or is not clearly stated. Ratings out of five stars were calculated for each of the 12 sub-areas by multiplying the composite score for each area (sum of allotted points for all questions in the sub-area with no weighting of items, divided by total possible points) by five and rounded off to the nearest half star. The overall safety grade was based on a summation of the sub-area scores ( = 49-60 stars, = 37-48.5 stars, = 25-36.5 stars, = 13-24.5 stars, = 0-12.5 stars). Weighting of individual items and sub-area scores was not done as this would require data on exposure to specific injury hazards and/or studies comparing the effectiveness of the various policies within a given area, neither of which are available consistently across injury areas or countries involved in the CSAP initiative. Comparisons between the 2009 assessment and the previous assessment were made using the same method, but by limiting the items included in 2009 to those assessed in 2007 and comparing the ratings out of five stars and overall safety score.

* MacKay M, Vincenten J, Brussoni M, Towner L. Child Safety Good Practice Guide: Good investments in unintentional child injury prevention and safety promotion. Amsterdam: European Child Safety Alliance, Eurosafe; 2006.

xxxvii

Acknowledgements

The authors would like to acknowledge the Child Safety Action Plan expert group, Genon Jenson, Health and Environment Alliance; Leda Nemer, Francesca Racioppi and Dinesh Sethi, WHO Regional Office for Europe; David Parker, UNICEF; Michael Rigby, Keele University; Elizabeth Towner, University of the West of England and our other technical advisors Robert Chantry-Price, RAM Consulting; Dafina Dalbokova, Michal Krzyzanowski and Rokho Kim, WHO Regional Office for Europe; and Christian Farrar-Hockley and Diana Smith, Health and Environment Alliance for their input at various times into the different aspects of the Child Safety Action Plan initiative. In addition we acknowledge and thank Inge Ronde, Natalie Norman and Justin Cooper of the European Child Safety Alliance, Eurosafe for project support, Georg Nossek, Kuratorium für Verkehrssicherheit (KfV) and Steven Macey of CAPIC, Swansea University for analysis of mortality and morbidity data, D’Anna Little and Francesca Valent, University of Udine for their work on the feasibility study examining burden of injury studies specific to children and adolescents; Candida Lacey and Corinne Pearlman of Myriad Editions and Ernst van Leeuwen of STENCO OFFETDRUKKERIJ for document design. We also acknowledge the previous work conducted by many partners, including contributions to the activities of CSAP I, upon which the current project is based.

We would also like to acknowledge Arlene McCarthy, Member of the European Parliament and Chair of the Internal Market and Consumer Protection Committee; Meglena Kuneva, European Commissioner for Consumers; Androulla Vassiliou, European Commissioner of Health and Gwenn Straszburger of DG SANCO and all their teams for supporting the launch and distribution of this report and the related child safety report cards and profiles.

Most importantly we would like to acknowledge the hard work of our dedicated country partners who completed the assessments that formed the basis for the Child Safety Report Cards and have worked tirelessly to make the Child Safety Action Plan development process come alive in each of their countries. We wish them continued success and look forward to working with them to see their plans implemented.

Austria Gudula Brandmayr, Grosse schützen Kleine/Safe Kids Austria; Belgium - Carine Renard, CRIOC-OIVO; Cyprus - Olga Kalakouta, Ministry of Health; Czech Republic - Veronika Benešová, Charles University; England - Janice Cave, Royal Society for the Prevention of Accidents (RoSPA); Estonia - Koidula Saun, Department of Public Health, Ministry of Social Affairs of Estonia; Finland - Jaana Markkula, National Institute for Health and Welfare; France - Florence Weill, Commission de la Sécurité des Consommateurs; Germany - Martina Abel and Thomas Atlgeld, BAG Mehr Sicherheit für Kinder e.V./Safe Kids Germany; Greece - Aghis Terzidis, Center for Research and Prevention of Injuries among the Young (C.E.RE.PR.I); Hungary - Gabriella Páll, National Institute of Child Health; Iceland - Herdis Storgaard, The Icelandic Safety House; Ireland - Mary Roche, Population Health, Children & Young Peoples Team, HSE; Israel - Liri Endy-Findling, Beterem – The National Center for Children’s Safety & Health, Safe Kids Israel; Italy - M. Giuseppina Lecce, Ministry of Labour, Health and Social Policies; Latvia - Jana Feldmane, Ministry of Health; Lithuania - Aida Laukaitiené, State Environmental Health Centre; Netherlands - Margien Veling, Consumer Safety Institute; Portugal - Helena Menenzies, APSI-Portuguese Association for Child Safety Promotion and Ana Cristina Bastos Office for the High Commissioner for Health; Scotland - Elizabeth Lumsden, Royal Society for the Prevention of Accidents (RoSPA); Slovenia - Mateja Rok-Simon, Institute of Public Health of the Republic of Slovenia; Spain - Jorge Parise Methol, Sociedad Española de Cirugia Infantil; Sweden - Katarina Rydberg and Åsa Olsson, Swedish Civil Contingencies Agency (MSB); Wales - Karen McFarlane, Children in Wales.

Finally we would like to acknowledge the funding that made the Child Safety Action Plan initiative possible. Thanks goes to the European Commission Public Health Programme, Eurosafe, HEAL, the Universities of Keele and the West of England, WHO and our Alliance partners in each of the participating countries.

Photo creditscover P. Zierpage 10 Learning to drive/iStockphoto.compage 12 B. Lloydpage 14 Boy and crosswalk/iStockphoto.compage 16 Family cycling in nature/iStockphoto.compage 18 Splashing in Lake Erie/iStockphoto.com

page 20 P. Zierpage 22 Child holding a sparkler/iStockphoto.compage 24 Baby with toy blocks/iStockphoto.compage 26 Digital Visionpage 28 Digital Visionpage 30 Digital Vision

For more information on the CSAP project and report cards for the other 17 participating countries go to

www.

The Child Safety Report Card 2009: Europe Summary for 24 Countries

was developed as part of the second phase of the Child Safety Action

Plan (CSAP) project; a large-scale initiative whose purpose is to use

standardised tools and processes to facilitate development of national

action plans to enhance child and adolescent safety in Europe. The

initiative is led by the European Child Safety Alliance of Eurosafe, with

co-funding and partnership from the European Commission, the Health

and Environment Alliance (HEAL), UNICEF, the Universities of Keele

and the West of England, the WHO Regional Office for Europe and

active partners in 26 countries and observing partners in eight others.

One of the objectives of the CSAP initiative was to establish a set

of indicators and standardised data collection tools focussing on

child and adolescent injury to identify a baseline level of child and

adolescent injury burden and action in the participating countries.

This was seen as important to supporting planning and providing

a means of benchmarking and evaluating progress in reducing

child and adolescent injury as the countries move from planning

to implementation. The Child Safety Report Card 2009: Europe

Summary for 24 Countries and the country specific child safety

report cards and profiles are the result of this activity.

For more information on the CSAP initiative, the child safety report

cards and profiles for the 24 countries go to the European Child

Safety Alliance website at: www.childsafetyeurope.org

European Commission

in partnership with

Documents

2009 Europe Summary for 24 countries