One of the greatest triumphs in health over the past century has been the dramatic decrease in childhood mortality. And yet, children still die, and that suggests that we should be looking carefully at what kills our children, and asking what we can do about it.
In 2016 there were, in the United States, about 38,000 deaths of children under the age of 19. Roughly half of deaths occur in early childhood due to genetic conditions, chromosomal abnormalities, and other perinatal conditions, many of which we do not know how to treat. But the majority of the other half we should be able to do something about. The vast majority of these deaths are due to injury, a combination of car accidents, and gun-related deaths, suffocation in early childhood, drowning, drug overdose.
Let us look at the two largest causes of these injury deaths: motor vehicle deaths (nearly 4,000) and gun-related deaths (nearly 3,000). Nearly all of these deaths are in theory preventable.
We are step by step tackling motor vehicle deaths. The Vision Zero initiative, passed by the Swedish parliament 20 years ago, aims to reduce traffic fatalities to zero by 2020. The effort—which includes monitoring traffic flow and vehicle technology solutions such as novel automatic braking systems—has reduced fatalities dramatically not only for those in cars, but also for pedestrians whose fatality rate has decreased by more than 50%. A number of US cities, including New York City, Chicago, and San Francisco, have adopted the Vision Zero approach and are also showing success.
The success of the Vision Zero initiative is predicated on a simple idea: “We are human and make mistakes” and as such we need to design safer roads and cars—in other words the world around us—to keep us safe.
We have done very little on the other major injury cause of death—guns. But just like motor vehicle accidents, child death from guns will not improve unless we reduce the availability of guns and make them safer. Multiple low-tech firearm features can prevent accidental gun discharges, including heavier trigger pulls and grip safeties. No federal agency oversees how guns are designed or built, even though federal safety regulations are standard for other consumer products like cars.
The National Cancer Institute spends about $200M annually on childhood cancer, which kills about 2,000 children a year. By contrast, our spending on preventing injury, including gun injury, is abysmally low. System design takes human fallibility into account and can protect children. Let’s spend some of our research dollars there.
Warmly,
Michael Stein & Sandro Galea