2 Public health need and practice
Unintentional injury is a leading cause of death among children and young people aged 1–14 (Audit Commission and Healthcare Commission 2007). In England and Wales in 2008, 208 children and young people aged 0–14 died from such injuries. Around 44% of those deaths were transport-related (Office for National Statistics 2009).
In 2009, 65 under-15s were killed and 18,307 were injured on the roads in Great Britain, 2267 of them seriously. Of those killed or seriously injured, 1507 (65%) were pedestrians. Cyclists (381) and car passengers (380) made up the bulk of the remainder (that is, cyclists and car passengers each accounted for around 16% of the total) (Department for Transport 2010).
A substantial number of children also die from unintentional injuries at home or in leisure environments. For example, in England and Wales in 2008, 55 children died from choking, suffocation or strangling, 17 from drowning and 10 from smoke, fire and flames (Office for National Statistics 2009).
Death rates from unintentional injuries are falling (Edwards et al. 2006). However, in England alone, around 100,000 children and young people aged under 15 were admitted to hospital in 2009/10 as a result of such injuries (The Information Centre for Health and Social Care 2010).
In 2002, nearly 900,000 children and young people in the UK aged under 15 attended hospital following an unintentional injury in the home (Department of Trade and Industry 2002). Over a million children and young people aged under 15 were taken to hospital following an unintentional injury outside their home; 360,000 were injured while at school, 180,000 while playing sport and 33,000 while in a public playground (Department of Trade and Industry 2002).
Unintentional injury can affect a child or young person's social and emotional wellbeing. For example, those who survive a serious unintentional injury can experience severe pain and may need lengthy treatment (including numerous stays in hospital). They could also be permanently disabled or disfigured (Eurosafe 2006).
Minor unintentional injuries are part of growing up and help children and young people to learn their boundaries and manage risks for themselves. The need to balance encouraging them to explore and develop, and managing the risks to prevent serious injury, was recognised in a government review published in 2009 (Department for Children, Schools and Families 2009a).
Children and young people from lower socioeconomic groups are more likely to be affected by unintentional injuries (Towner et al. 2005). Children whose parents have never worked (or are long-term unemployed) are 13 times more likely to die from an unintentional injury compared to children whose parents are in higher managerial or professional occupations. The social gradient is particularly steep in relation to deaths caused by household fires, cycling and walking (Edwards et al. 2006).
A range of other factors also influence the likelihood of an unintentional injury. These include: personal attributes (such as age, physical ability and medical conditions), behaviour (such as risk-taking), the environment (for example, living in a house that opens onto a road or living in poor quality housing) (Audit Commission and Healthcare Commission 2007; Towner et al. 2005; Millward et al. 2003).
While combinations of these factors create the conditions in which unintentional injuries occur, many are preventable (Audit Commission and Healthcare Commission 2007).
Approaches to preventing unintentional injuries range from education (providing information and training) to product or environmental modifications and enforcement (regulations and legislation). The World Health Organization argues that legislation is a powerful tool that has helped reduce unintentional injuries on the road, in the home and in leisure environments (Peden et al. 2008).
It has been suggested that the most effective strategies use a combination of approaches (British Medical Association 2001). Experience from European countries with the best safety records show that positive leadership, together with concerted efforts to provide safer physical and social environments, can reduce unintentional injuries (Sethi et al. 2008).
There are six million visits to A&E departments in the UK each year as a result of unintentional injuries. Around two million involve children and young people – at a cost to the NHS of approximately £146 million a year (Audit Commission and Healthcare Commission 2007). Further treatment costs are significant. For example, £250,000 may be needed to treat one severe bath water scald (Child Accident Prevention Trust 2008).
The cost of unintentional injury is also borne by other public sector services such as transport, the police, fire and rescue services and the criminal justice system (Mallender et al. 2002). The long-term health needs and indirect 'human costs' for the family (Mallender et al. 2002) could include the repercussions of enforced absence from school, including the need for children and young people to be supervised. This, in turn, could involve family and carers having to take time off from work (Audit Commission and Healthcare Commission 2007).
The 'Children's plan' carried forward the 'Every child matters' objective to keep children and young people safe (Department for Children, Schools and Families 2003; 2007; 2008a; 2009b.) The 'Staying safe: action plan' set out a cross-government strategy (Department for Children, Schools and Families 2008b).
Strategic partnerships and local safeguarding children boards have a duty to promote children and young people's safety as part of the action plan.
In addition, the national indicator set for local authorities and local authority partnerships addressed the prevention of injuries among children and young people (Department for Communities and Local Government 2007).
Other relevant government initiatives have included:
the housing health and safety rating system (Office of the Deputy Prime Minister 2006)
the child road safety strategy (Department for Transport 2007)
responsibility for safety in workforce settings (Health and Safety Executive 2009).
The Treasury has also set out guidance on the value of preventing unintended fatalities and injuries (HM Treasury 2003).
Local area agreements have provided an opportunity for local authorities, in partnership with the NHS and other organisations, to focus on preventing unintentional injuries. Practice is variable, however some areas are adopting an innovative approach.
 National indicators NI70: Hospital admissions caused by unintentional and deliberate injuries to children and young people and NI48: Children killed or seriously injured in road traffic accidents.