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Child Safety Report Cards: inconsistency in policy adoption across 31 countries. Countries need to increase adoption of proven child safety policies to protect Europe's most vulnerable citizens and future society
  1. Joanne Vincenten
  1. Correspondence to Joanne Vincenten, European Child Safety Alliance, RoSPA, 28 Calthorpe Road, Birmingham B15 1RP, UK; j.vincenten{at}

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On 12 June 2012, in the European Parliament, MEP Malcolm Harbour, Chair of the Internal Market and Consumers Protection Committee, and John Dalli, European Commissioner for Health and Consumer Policy launched, in conjunction with the European Child Safety Alliance, Child Safety Report Cards for 31 countries, and a European summary. The Report Cards score countries on their level of adoption, implementation and enforcement of over 100 proven strategies and policies to prevent unintentional injury—good practices that are known to save children's lives. This multi-country assessment provides thoughts for similar actions in other countries worldwide.

This is the third round of Child Safety Report Cards to be released by the European Child Safety Alliance, with 18 countries participating in 2007, 26 in 2009 and now 31 in 2012. A trend analysis for countries participating in both 2007 and 2012 found significant improvements in overall country scores over the 5 years. Encouragingly, some of the greatest improvements were reported in countries where investments in unintentional injury prevention have been made in the last 5 years (eg, Czech Republic, Finland, Hungary, Scotland and Spain). A notable decrease in overall score since 2009 in Greece probably reflects the economic crisis in that country and may signal a risk of erosion in the progress made on child safety in other countries as austerity measures are put into place.

To date, no country has adopted all the recommended safety measures. Given the inequalities in unintentional injury rates between countries, with over six times difference between countries with the highest and lowest rates, there is clearly room for improvement across all countries. Differences between countries' overall report card scores are large, with scores ranging from 14.5 to 45 points out of a possible 60 points. This unequal distribution of injuries and actions to address them threatens to further widen health inequalities between and within countries, and is a social injustice that calls for consistent application and enforcement of proven safety policies across all countries.

Examples of inconsistent adoption across the 31 participating countries highlighted by the 2012 Child Safety Report Cards include

  • – Only 13 countries (42%) have a national helmet law requiring use of a bicycle helmet while cycling, with seven of those laws coming into effect since the first report card assessments. However, only 8/13 reported that the law is fully implemented and enforced.

  • – No country has a law requiring children to use a rear-facing child passenger restraint to age 4, although this is normal practice in Sweden where child passenger deaths in this age group have been reduced to almost zero.

  • – Only seven countries (23%) have a national law requiring barrier fencing for private pools, but in just one (France) is the law fully implemented and enforced, and that law allows a choice of prevention measures of which barrier fencing is only one.

  • – Only 15 countries (48%) have a national law requiring child-resistant packaging of medications, and of those, three report the law is not fully implemented and enforced.

  • – Only 16 countries (52%) have a national law requiring environmental changes to prevent children from falling out of windows in buildings with more than one storey/level (eg, window guards), but for over half of those the law only applies to new buildings or renovations.

With the addition of first-time report cards for Bulgaria, Croatia, Romania and Slovakia, the 2012 Child Safety Report Cards mean there is now a baseline measure of the uptake of proven safety policies in all 27 EU Member States (plus Croatia, Iceland, Israel and Norway) from which progress over time can be measured. However, high-level monitoring of progress is not enough—current efforts at evaluating progress are hampered because few policies at the national level are currently monitored as to their impact on short- or long-term benefits, which future efforts need to address.

Injury is the number one cause of death, disability, burden and inequality for children 5–19 years in every Member State in Europe. It is critical that the European Union and national governments identify child injury prevention as a priority to be addressed now. Leadership and commitment is needed to

  • – Adopt, implement and enforce now what we know is proven to work

  • – Monitor and measure policy actions to determine their level of effectiveness

  • – Build and maintain the capacity of the diverse groups of relevant experts and practitioners needed to address the injury issue

  • – Invest funds that are commensurate with the size of the injury issue.

“We are excited that progress is being made”, says Joanne Vincenten, Director of the European Child Safety Alliance. “However it is clear that more consistent uptake of proven prevention strategies across the EU would save children's lives and billions of the Euros spent each year on treating injuries. Children's rights to safety must be honoured and threats to their security should not be compromised by current financial restraints. In the long run failing to address child injury will have negative effects on society as a whole. To ensure children and adolescents grow up to be healthy and active contributors to future economic growth in Europe we need to act now.”

The next meeting of the International Society for Child and Adolescents Injury Prevention in Wellington, New Zealand, on 1 October 2012, will include presentations and discussions on more effective uptake of proven child safety evidence-based measures. The Child Safety Report Cards will be one of the strategies shared at this meeting along with the use of good practice guides and case studies to determine enhanced methods to transfer use of good practice in countries worldwide. Further information on the Child Safety Report Cards can found at

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  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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