Ragnar Berfenstam's legacy
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The comparative study of childhood injury fatality rates in five European countries by Ellsäβer and Berfenstam appearing elsewhere in this issue allows us to examine the reasons why childhood injury statistics vary among five relatively prosperous countries. Because of variations in data collection methods in the Netherlands, Sweden, Switzerland, Austria and Germany, the authors wisely eschew morbidity and hospitalization statistics, and instead examine mortality rates. While there has been a steady diminution in traffic related deaths in all five countries since 1980, the decrease in home and leisure trauma in Sweden is dramatic. The difference in drowning mortality is especially striking. As the authors state, “Despite the large number of lakes and inland waterways in the period studied (1995), the drowning mortality for children aged 1–4 years was three times higher in Germany than Sweden”.
The different organizational approaches to childhood injury prevention in the five countries are examined, as well as how the prevention efforts are funded. They conclude: “we are unable. ...to decide according to scientific criteria which country has the best national program or the most effective national structures for implementing safety policies”. That should not be surprising. The organizational structure of injury control activities, …