Childhood injury prevention
Online posting: January 10, 1997
Published in print: Feb. 15, 1997 (CMAJ 1997;156:479)
See response from: I.B. Pless
Re: Childhood injury prevention: time for tougher measures, by I.
Barry Pless, CMAJ 1996;155:1429-31 [full text / résumé]
Dr. I. Barry Pless addresses how injury prevention among children
and adolescents is (or is not) addressed by our federal
government. He advocates that we establish a national centre for
injury prevention and control and "provide it with strong teeth,"
plus, of course, money. Is that what we need ?
An unpublished statistical profile of child health was released
in British Columbia in 1979. Called Child Health Profile, it
showed that, in 1961, the social causes of child and adolescent
mortality in the province began to outstrip the traditional
medical or biologic causes. Among adolescents, 85% of deaths were
due to injury. This report caused a great stir in the province
and influenced subsequent provincial injury-prevention
strategies. Indeed, the injury-related rates of hospital
admission and mortality for children and youth in British
Columbia have shown important improvements since then.
I believe that this experience speaks to the importance of
regionally and provincially based strategies and suggests that a
national centre may not be the wisest or most effective approach.
Pless is correct in stating that the Canadian Hospitals Injury
Reporting and Prevention Program is a world-renowned statistical
base on childhood injury. But is it effectively used or
adequately plugged in at the local, regional or provincial level?
I suggest not, and I propose that such systems be encouraged to
be more locally relevant before new, national centres are
advocated. Without a locally or provincially based system to
pressure them, the "sporadic nature of the interest of
professional bodies" will continue. Our federal system and the
geographic size of our country dictate the need for a strong
regional approach if we are to respond rapidly enough to safety
issues such as drawstring-related strangulations. After all, Ms.
Jackie Petruk and associates' article "Fatal asphyxiations in
children involving drawstrings on clothing" (CMAJ
1996;155:1417-9 [full text / résumé]) emerged from such a strong, provincially based
injury-prevention program.
Pless' editorial makes many important points and reflects his
years of experience and his important place on the national
research and child-advocacy stage. He is correct in stating the
need for a national child and adolescent injury prevention
program but incorrect in emphasizing it without having adequately
addressed the need for tougher measures at the regional and
provincial level, which must form the foundation for a national
program.
Roger S. Tonkin, MD
Gabriola Island, BC
tonkiaah@mail.islandnet
.com
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