Injuries are commonly classified based on “intentionality”. Most road traffic injuries, poisoning, falls, fire and burn injuries, and drowning are unintentional. Intentional injuries include interpersonal violence (homicide, sexual assault, neglect and abandonment, and other maltreatment), suicide, and collective violence (war). Evidence suggests that some children and adolescents are more vulnerable to certain types of injuries. For example, poisoning, drowning, burns, and maltreatment by caregivers affect primarily small children, while road traffic accidents, interpersonal violence and sports injuries tend to affect older children and adolescents. In addition, injuries tend to be more prevalent in boys.
Unfortunately, poor children commonly live in unsafe environments and are, therefore, exposed to risks that increase their likelihood of being injured. These children are particularly vulnerable as they have less chance of overcoming these risks, and have fewer advantages such as access to educational opportunities and health services.
The injury rates and patterns differ from country to country, even within the same region, and from urban to rural areas. For example, in the rural areas injuries are related mainly to farming activities, pesticide poisoning, and drowning. In the urban areas, most injuries are traffic related, or linked to gadgets and electrical appliances, falls or poisonings resulting from household chemicals and pharmaceuticals ingested by small children. The environmental factors leading to injury may also be associated with social factors, such as family stress and critical life events (e.g. hospitalization or chronic disease of a parent, or change of residence).
The environmental factors leading to injuries are often associated with other environmental health risks. For example, home and school construction and furnishing materials can lead to unintentional injuries, and poisoning may result from exposure to chemicals unsafely used or stored. Intentional injuries resulting from child maltreatment are associated with physical and cognitive deficits in the abused infants, poor parenting skills, marital conflict, and lack of social support systems for families. Urban transport, land use patterns, and recreation areas are linked to road traffic injuries, as well as to exposure to air pollution and noise. Workplaces pose specific physical and chemical risks to adolescent workers, whose vulnerability is increased by unsafe behaviours.
There is a need to identify how these multiple environmental health risks cluster in certain settings in order to plan preventive strategies that can lead to cost-effective health gains among children and adolescents. The key settings to consider include, for example, the home, the school and the route to the school, playgrounds, leisure and sports areas, the rural-agricultural environment, and urban transport.
Community-based interventions using relevant information on local patterns of injury and their causes have reduced the rates of injuries in many countries (especially the industrialized ones). The prevention of injuries is achieved through environmental modifications, changing the designs or structures (engineering), applying and/or reinforcing regulatory measures, and, overall, changing unsafe behaviours through education.
Further work is required on reviews of the existing evidence on the links between environmental factors and injuries occurring in specific settings. The preparation and dissemination of reports on the magnitude of those risks, their common determinants, and on the most susceptible groups would help communities to plan interventions.
Strategies for action should be defined and proposed for each of the settings considered (home, school, playground, other), based upon the priority issues identified and the experience with preventive interventions and their effectiveness. Pilot projects to address childhood environmental and injury risks through integrated preventive strategies and their evaluation especially in developing countries will stimulate the policy process and ensure that interventions are based on evidence.
Regulatory measures, environmental changes, and education play a crucial role in the prevention of injuries and accidents in children’s environments. However, the most successful interventions are those where these three approaches are combined.