Feature

Killing Our Kids

New Zealand leads nine developed countries in one area -- in injuries to our children and adolescents.

Frances Caldwell

New Zealand's rates of child and adolescent injury are the worst in almost every category of a study comparing nine developed countries. These are the sobering results of an HRC-funded project by a group at the University of Otago's Injury Prevention Research Unit (IPRU).

The results were presented by Kypros Kypri, IPRU Junior Research Fellow, at this year's Third National Conference on Injury Prevention and Control in Brisbane. Kypri worked with IPRU deputy director Dr David Chalmers and director, Associate Professor John Langley.

It is already well known that New Zealand has a poor overall record in child and adolescent injury compared with other OECD countries. But prior to this study it was not known whether this was the case in all categories of injury.

"It's quite shocking that New Zealand's results are the worst," says Kypri. "They show that, on average, one person under 20 years old died from an injury nearly every day during the 10-year period which the study covered. In the whole age group, 15-19 year olds made up 61% of deaths. Just over 71% of all deaths were boys."

New Zealand's death rate from injury -- 3,430 over 10 years or 34 deaths per 100,000 person years -- was the highest of all the countries in the study. It was more than twice Australia's rate of 16 per 100,000, and was three times England and Wales' rate of 11 per 100,000. Other countries in the study were the United States, Canada, Netherlands, Norway, Scotland and Sweden.

Motor vehicle crashes were the leading cause of injury death in all countries, with New Zealand leading the way at 18 deaths per 100,000 person years. The United States had the second highest injury rate (10 per 100,000) and England and Wales had the lowest at five per 100,000. New Zealand also had the highest rates for drowning, suffocation, falls and pedestrian injuries.

Infant deaths by suffocation resulted from either accidental inhalation or ingestion of food or from mechanical suffocation, including unintentional parent overlay and smothering by bedclothes. This last subcategory is controversial because it is often difficult to distinguish from Sudden Infant Death Syndrome. The major cause of death for infants is congenital conditions and illnesses. As age increases, injury accounts for an increasing percentage of deaths. In the 15-19 years age group, 78% of all deaths are due to injury.

Suffocation includes suicide -- mostly young men aged 15-19 years hanging themselves. New Zealand's rate by this method was almost twice that of Australia and six times that of England and Wales. Hanging was the preferred method of suicide in all the comparison countries except the US, where the preferred method was shooting.

"Girls seem to prefer poisoning as a suicide method, while boys tend to use hanging," says Kypri. "Also girls are twice as likely as boys to attempt suicide unsuccessfully. Boys are four times as likely to die from suicide."

Kypri says youth suicide rates have been on the rise worldwide for over 20 years.

"Researchers don't really have a handle on this phenomenon," he says.

Driving and Driveways

New Zealand's high motor vehicle death rate is easier to explain, however. New Zealand has the second-highest number of motor vehicles per head of population. Other studies have shown a relationship between injury deaths and young driving age. New Zealand has the lowest legal driving age of all the countries studied. Kypri says other factors include high dependence on road transport; road quality and terrain; drinking behaviour; and the fact that many fatal crashes include head-on collisions on main roads.

Children who suffer fatal injury tend to do so mainly from pedestrian incidents, drowning or suffocation. A previous HRC-funded study showed "a very clear relationship" between car speed and child pedestrian deaths. Kypri is currently examining non-traffic child pedestrian deaths -- usually driveway incidents -- for children aged one to four. He describes these as "some of the most tragic incidents -- usually a parent gets into a car to leave, doesn't notice the child and runs it over".

New Zealand's rate of two per 100,000 person years for this type of fatality was double the US rate and five times that of Australia. Five of the comparison countries had no such fatalities for the period of the study. Kypri says there has been little attention paid to these types of deaths because of the low rate -- about four per year.

"The value of making an international comparison is that this now shows up as a problem for New Zealand. Perhaps the rate is higher here because there may be a higher number of driveways per capita. We don't have high-rise buildings, we are more dependent on car transport and the place where the car is parked is often also the child's play area. It's a lethal combination. Maybe it's an issue of keeping vulnerable people away from heavy machinery. We need some very substantial changes to reduce pedestrian deaths. In Europe they often block off streets or have speed bumps."

Some work on this is being done in Auckland by Safekids, a child safety health promotion group. It has implemented a Safe Routes to School programme -- a combination of engineering and behavioral solutions and supervision.

Drowning predominantly occurs among pre-schoolers, typically in swimming pools. Other drownings are mainly 15-19 year-olds in rivers and the sea. Alcohol is sometimes involved, something Kypri says may become an even bigger factor with New Zealand's drinking age being reduced.

"New Zealand has made a backward step in reducing the drinking age, and this will probably affect all rates of injury where alcohol is involved. In the USA, they raised the drinking age to 21 and the death rates went down. South Australia is considering raising the age from 18 to 21."

Child and adolescent morbidity figures could not be compared to other countries as New Zealand has the only national data base for hospitalisation figures. The statistics used were people under 20 years, hospitalised overnight or longer between 1987 and 1996. Just under 64% of the 160,000 children injured in this time were male. About one third of injuries were due to falls, often in playgrounds. Motor vehicle crashes came second, including vehicle occupant injury, motorcycle injury, pedestrians and cyclists. The third-highest rate was the struck by/against category which included sports, especially rugby tackles. The fourth leading cause was poisoning, mainly intentional overdose by pills. The most common injuries in the study were head injuries followed by limb fractures. Head injuries were particularly common in falls.

Kypri says his study, which will not be completed until the end of the year, has already led to a number of other studies. Proposals have been submitted to work on child drowning; child car restraint use -- "it improved dramatically but has now plateaued out at 75% compliance" -- and reducing car speed in pedestrian areas.

Frances Caldwell is a writer for the Health Research Council newsletter.