Child injury prevention in Canada: Where we stand

As an author and editor, I am always fascinated by the use and misuse of words. It is not surprising then that one of the first editorials I wrote for Injury Prevention focused on the differences between the words ‘interdisciplinary’ and ‘multi-disciplinary’ (1). These words are often incorrectly assumed to be interchangeable. They are not only different, but the differences are important. Injury prevention is ‘multidisciplinary’ because many disciplines and groups are involved – parents, physicians, government and organizations. But, until recently, the actions of any one of these players was largely independent of the others. Gradually, however, they have begun to work together so that the approach may now warrant the term ‘interdisciplinary’. Nevertheless, those familiar with my rants will have guessed that I still believe that a full-blown manifestation of coordinated complementary activities will only happen when Health Canada takes the lead by creating a national centre for injury prevention. If such a centre was created, with appropriate funding and the powers needed to influence other branches of government, this would address the substantial public health issue that injuries represent. The reasoning reflected in much of what the Naylor Committee recommended following the severe acute respiratory syndrome epidemic applies equally to injury prevention (2,3). Certainly, the time has come for Canada to have an independent centre for disease prevention and control and, following the highly successful example in the United States, this must include injury prevention. In response to prods from me and others, beginning with my Introduction to the Canadian Institute of Child Health report in 1989 (4), health minister after minister has muttered the same words of encouragement. Ironically, however, Health Canada still provides remarkably little leadership in the prevention of injuries. The irony is that it is evident that each health minister has understood how numerous, costly and preventable injuries are, but none has seen fit to act. Recently, some hopeful signs have appeared. One is the encouragement given to researchers by the Canadian Institutes of Health Research, resulting in the Canadian Injury Prevention Strategy – Listening for Direction on Injury initiative (5). Another is the success of the last Ottawa conference, and yet another is the planned reform of the Health Protection Act. At long last consumers, researchers and government may actually be working well together. Having said something nice, it would be out of character if I did not forcefully repeat the main message: we still confront a major, if not the major child health problem of our time. Yet, most provinces are doing little, and Ottawa even less, to address it. To help change this, we now need to take three steps: Paediatricians should counsel parents about safety issues, but the evidence suggests that if this is all that is done, it is unlikely to be effective (6) and caution is needed lest the advice leads to actions that could inadvertently increase the risk of injury. For example, some believe that children can be taught how to take risks successfully. However, until there is solid evidence that the safety message is as potent as the risk-taking message, this is potentially dangerous (7). Paediatricians should fully support the Canadian Paediatric Society in its advocacy roles, especially as one direction of the advocacy is to persuade Ottawa to take injury prevention seriously. At the very least, professional support is needed when legislative solutions to prevention are needed. For example, if passed, the proposal to modernize the Health Protection Act will go far toward enhancing product safety (8). Paediatricians must acknowledge that the current prevention picture is uneven, similar to what we see in diseases that are ‘popular’ and those that are not – the widows and orphans of research funding. This accounts in part for the diversity of papers in this issue. There are many gaps, such as for burns, drowning and sports injuries. Like the disease ‘haves’ and ‘have-nots’, some injuries attract attention while others are ignored. For example, there is no organization equivalent to the Red Cross in its promotion of water safety to come to the aid of burn prevention. The papers in this issue include a systematic review of social disparities – a fundamental, well-studied problem that involves all injuries no matter where or how they occur. The paper on booster seat use and the one addressing helmet use also reflect ongoing problems for which there is much evidence. By contrast, the Canadian Hospitals Injury Reporting and Prevention Program, all-terrain vehicles, risk compensation, hospital injuries, shaken babies, and injuries involving Aboriginals are areas where the knowledge base is much thinner. Nevertheless, overall, the great frustration in this field is that so much is known about prevention that is not fully implemented (9). The ultimate responsibility for this health problem lies with the health departments. If a child with a fractured skull is not a health problem, what is? I repeat, the only way for health departments to respond appropriately to injury prevention is to establish a national centre for injury prevention and control. This proposal has been put forward repeatedly by many others and myself, yet it continues to be ignored. This year, with the active support of the Canadian Paediatric Society and many other groups, the creation of a national centre for injury prevention and control is again being proposed as part of the long overdue establishment of a Center for Disease Control and Prevention-like structure for public health in Canada. This was the principal recommendation in the Naylor Advisory Committee report (3). “The report… argues that while the credibility of the Centers for Disease Control and Prevention (CDC) mitigates jurisdictional tensions in the US, the same cannot be said for the Population and Public Health Branch of Health Canada. As a result, the advisory group calls for the creation of a new Canadian agency that would take responsibility for public health” In contrast to the present situation, the proposed new organization will be run by a chief public health officer who reports directly to the health minister. In Naylor's words, “this will encourage a type of culture change that will promote cooperation among different jurisdictions” (3). What a welcome initiative. But imagine the frustration if this proposal was accepted with a mandate restricted to infectious diseases. To ensure that injury prevention is included as part of the mandate, everyone must acknowledge the seriousness and magnitude of this problem. Their support is needed, along with that of parents, to ensure that this and other long overdue proposals to enhance injury prevention in Canada are promptly enacted.

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