Skip to main content
SpringerLink
Log in

Why does Sweden have the Lowest Childhood Injury Mortality in the World? The Roles of Architecture and Public Pre-School Services

  • Article
  • Published:
Journal of Public Health Policy Aims and scope Submit manuscript

Abstract

Of interest is how some countries have achieved a profound reduction of child injury mortality. Still little is reported on the impact of a combination of urban planning, social welfare development and safety measures. We therefore present trends in childhood (0–14 years) injury mortality in Sweden 1966–2001 and discuss the factors behind any reductions observed. Annual total and cause-specific injury mortality rates were computed by age subgroups and gender. Trend analyses were performed with year as independent and mortality rate as dependent variable. A piecewise linear function was fitted to the annual mortality rates. Data were categorized into five 7-year intervals. In total, there were 5,264 deaths due to injury in the study population during the period 1966–2001, of which 3,368 (64%) were of boys and 1,896 (36%) girls. The most frequent external cause of death was transport injury (48%), drowning (14%), homicide (5.8%), fire (5%), and fall (2.7%). About 66% (n=3,474) of deaths occurred during the first half of the study period (1966–1981) with an average incidence rate of mortality 13.0 compared to 5.6 per 100,000 inhabitants during the second half of the period (1982–2001). For total injuries, there was a statistically significant decrease in mortality among all subgroups of children in both sexes. The slopes are greater among the younger children (0–4, 5–9 years) than the older ones (10–14 years). Several factors behind this strong decline of childhood injury mortality of interest to evaluate are (i) the implementation of the functionalist architectural style including transport separation, legislation and safety in cars; (ii) the expansion of public child day-care centers including more organized leisure activities; (iii) the establishment of long-term nationwide mandatory program for swim training among school children and (iv) local child-safety programs considering differences in exposure to risk between urban and rural areas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  • World Health Organization. World Health Statistics Annual. Geneva: WHO; 2000.

  • Mazurek AJ . Epidemiology of paediatric injury. J Accid Emerg Med. 1994;11:9–16.

    Article  Google Scholar 

  • Baker S, O'Neill B, Ginsburg MJ, Guohua Li . The Injury Fact Book, 2nd edition. New York: Oxford University Press; 1992.

    Google Scholar 

  • Jansson B, Svanström L . National inequalities in injury mortality among children and adolescents in Europe. In: Spencer, Lindström, editors. Social paediatrics. London: Oxford University Press; 1995.

    Google Scholar 

  • Murray CJL, Lopez AD, (editors). The Global Burden of Disease. Boston, Harvard School of Public Health: Harvard University Press; 1996.

    Google Scholar 

  • Murray CJL, Lopez AD . Global Health Statistics. A Compendium of Incidence, Prevalence and Mortality Estimates for Over 200 Conditions. Boston, Harvard School of Public Health Harvard University Press; 1996.

    Google Scholar 

  • Backett EM, Johnson AM . Social patterns of road accidents to children: some characteristics of vulnerable families. BMJ. 1959;1:409–413.

    Article  Google Scholar 

  • Avery J, Vaudin JN, Fletcher JL, Watson JM . Geographical and social variations in mortality due to childhood accidents in England and Wales 1975–1984. Public Health. 1990;104 (3):171–182.

    Article  Google Scholar 

  • Östberg V . Social class differences in child mortality, Sweden 1981–86. J Epidemiol Community Health. 1992;46 (5):403–410.

    Article  Google Scholar 

  • UNICEF Innocenti Research Centre. UNICEF: A League Table of Child Death by Injury in Rich Nations, Innocenti Report Card No 2. Unicef Innocenti Research Centre, Florence, 2001.

  • Stefansdottir A, Mogensen B . Epidemiology of childhood injuries in Reykjavik 1974–1991. Scand J Prim Health Care. 1997;15:30–34.

    Article  Google Scholar 

  • Jorgensen IM . Fatal unintentional child injuries in Denmark. Dan Med Bull. 1996;43:92–96.

    Google Scholar 

  • Roberts I, Barker M . Trends in intentional injury deaths in children and teenagers 1980–1995. J Public Health Med. 1998;20:463–466.

    Article  Google Scholar 

  • Roberts I . Why have child pedestrian death rates fallen? BMJ. 1993;306:1737–1739.

    Article  Google Scholar 

  • Parkkari J, Kannus P, Niemi S, Koskinen S, Palvanen M, Vuori I, et al. Childhood deaths and injuries in Finland in 1971–1995. Int J Epidemiol. 2000;29:516–523.

    Article  Google Scholar 

  • Williamsson LM, Morrisson A, Stone DH . Trends in head injury mortality among 0–14 year olds in Scotland (1986–95). J Epidemiol Community Health. 2002;56:285–288.

    Article  Google Scholar 

  • Plitponkarnpin A, Andersson R, Jansson B, Svanström L . Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition. Inj Prev. 1999;5:98–103.

    Article  Google Scholar 

  • WHO Health for All Data Base, www.who.dk.

  • Haddix AC, Teutsch SM, Corso PS . Prevention Effectiveness. A Guide to Decision Analysis and Economic Evaluation. New York: Oxford University Press; 1996.

    Google Scholar 

  • Dowswell T, Towner EML, Simpson G, Jarvis S . Preventing childhood unintentional injuries – what works? A literature review. Inj Prev. 1996;2:140–149.

    Article  Google Scholar 

  • Guldvog B, Thorgersen A, Ueland O . Ulykker, vold og selvpåfort skade. Rapport nr 1 1992, Statens Institutet for Folkehelse: Oslo, 1992, (in Norwegian).

  • Haddon Jr W . Strategy in preventive medicine: passive vs. active approaches to reducing human wastage. J Trauma. 1974;14:353–354.

    Article  Google Scholar 

  • Berfenstam R . Learning from Sweden's experiences in preventing childhood accidents. Pediatr Ann. 1977;6 (11):742–751.

    Article  Google Scholar 

  • Berfenstam R . Prevention of childhood accidents in Sweden. With special attention to the work of the Joint Committee for Prevention of Accidents. Acta Paediatr Scand. 1979;275:88–95.

    Article  Google Scholar 

  • Berfenstam R . Sweden's pioneering child accident programme: 40 years later. Inj Prev. 1995;1 (2):68–69.

    Article  Google Scholar 

  • Sandell S . Young children in traffic. Inj Prev. 1995;1:112–115.

    Article  Google Scholar 

  • Jansson B . A system for injury surveillance in Swedish emergency care as a basis of injury control, Ph.D. thesis. Sundbyberg, Sweden: Karolinska Institutet, Department of Social Medicine; 1988.

    Google Scholar 

  • Rosén M, Jansson B . How to act – implementing health and safety promotion in organisations. Health Policy Planning. 2000;15 (3):247–254.

    Article  Google Scholar 

  • Schelp L . Community intervention and changes in accident pattern in a rural Swedish municipality. Health Promotion. 1987;2:109–125.

    Article  Google Scholar 

  • Roberts I . International trends in pedestrian injury mortality. Arch Dis Child. 1993;68:190–192.

    Article  Google Scholar 

  • Rivara FP . Child pedestrian injuries in the United States. Am J Dis Child. 1990;144:692–696.

    Article  Google Scholar 

  • Statistics, Sweden. Population Data 1800–2000. www.scb.se/sm/MI38SM0101_kommentarer.asp, Stockholm, 2003.

  • Le Corbusier. Maniere de Penser l'urbanisme. Paris: Editions Gonthier; 1946.

  • Le Corbusier. La Rue. L'Intransigeant, May 1929. Reprinted in Le Corbusier and Jeanneret P. TheCompleteArchitecturalWorks, Vol. 1, 1919–1929. Editions d'Architecture, Zurich; Thames and Hudson, London, 1964.

  • Statens Planverk. SCAFT 1968: Riktlinjer för stadsplanering med hänsyn till trafiksäkerhet Publikation nr 5, issued in collaboration with Statens Vägverk. Statens Planverk, Stockholm, 1968, (in Swedish).

  • Spolander K . Staden, bilen, farten. Stockholm: NTFs Förlag; 1999, (in Swedish).

    Google Scholar 

  • Boverket. TRÅD-92. Allmänna råd för planering av stadens trafiknät. Karlskrona: Boverket; 1992, (in Swedish).

  • Larsson B . Stadens språk. Stadsgestaltning och bostadsbyggande i nordiska huvudstäder under 1970- och 1980-talen. Lund: Lunds Tekniska Högskola, Stadsbyggnad, Arkitekur, doktorsavhandling; 1994, (in Swedish).

    Google Scholar 

  • Elvik R, Mysen AB, Vaa T . Trafikksikkerhetshåndbok. Oversikt over virkninger, kostnader og offentlige ansvarsforhold for 124 trafikksikkerhetstiltak. Oslo: Transportokonomisk institutt, tredje utgave; 1997, (in Norwegian).

    Google Scholar 

  • Rosengren B, Strömberg-Lind K . Omsorg om Barns Fritid. Lund: Liber Läromedel; 1979, (in Swedish).

    Google Scholar 

  • Jacobs J . The Death and Life of Great American Cities: The Failure of Town Planning. New York: Random House; 1961, Republished (1965), Hamondsworth: Penguin Books.

    Google Scholar 

  • Holmberg SR . Hur många kan simma? Karlstad: Svenska Livräddningssällskapets jubileumsbok 1898–1998. SLS 100 år; 1998 (in Swedish).

    Google Scholar 

  • Statistics, Sweden. Statistisk Årsbok 1996. Stockholm: Statistiska Centralbyrån; 1996 (in Swedish).

  • Smith GS, Howland J . Declines in drowning. Exploring the epidemiology of favorable trends. JAMA. 1999;281 (23):2245–2247.

    Article  Google Scholar 

  • Svenska Kommunförbundet. Fritidsanläggningar i Sverige. Stockholm; 1999, (in Swedish).

  • Jansson B, Ahmed N . Epilepsy and injury mortality in Sweden. The importance of changes in coding practice. Seizure – Eur J Epilepsy. 2002;11 (6):361–370.

    Article  Google Scholar 

  • Svenska Livräddningssällskapet. SLS 100 år. Jubileumsbok 1898–1998. Karlstad; 1998 (in Swedish).

  • Done AK, Jung AL, Wood MC, Klauber MR . Evaluations of safety packaging for the protection of children. Pediatrics. 1971;48 (4):613–628.

    Google Scholar 

  • Dole EJ, Czajka PA, Rivara FP . Evaluations of pharmacists' compliance with the Poison Prevention Packaging Act. Am J Publ Health. 1986;76 (11):1335–1336.

    Article  Google Scholar 

  • Rodgers GB . The safety effects of child-resistant packaging for oral prescription drugs: two decades of experience. JAMA. 1996;275 (21):1661–1665.

    Article  Google Scholar 

  • Statens offentliga utredningar. Barnmisshandel – att förebygga och åtgärda. Stockholm: SOU 2001:72. Socialdepartementet; 2001, (in Swedish).

  • Somander LK, Rammer LM . Intra- and extrafamilial homicide in Sweden 1971–1980. Child Abuse Neglect. 1991;15 (1–2):45–55.

    Article  Google Scholar 

  • Herman-Giddens ME, Brown G, Verbiest S, Carlson PJ, Hooten EG, Howell E, Butts JD . Underascertainment of child abuse mortality in the United States. JAMA. 1999;282:463–467.

    Article  Google Scholar 

  • Hargrave DR, Warners DP . A study of child homicide over two decades. Med Sci Law. 1992;32 (3):247–250.

    Google Scholar 

  • National Council for Crime Prevention. Barnmisshandel (Violent assaults on children). En kartläggning av polisanmäld misshandel av små barn. BRÅ-Report 2000: 15. Stockholm, 2001 (in Swedish).

  • Rosengren B . Pre-school in Sweden. Facts, trends and future. Oskarshamn: The Swedish Institute; 1973.

    Google Scholar 

  • Wrigley J, Dreby J . Fatalities and the organization of child care in the United States, 1985–2003. Am Sociol Rev. 2005;70:729–757.

    Article  Google Scholar 

  • Pil Cho J, Svanström L . Developing Safe Communities – Two Decades of Experiences. Suwon, Korea: Ajou University School of Medicine and Stockholm, Sweden: Karolinska Institutet; 2002.

    Google Scholar 

  • Bergman AB, Rivara PR . Sweden's experience in reducing childhood injuries. Pediatrics. 1991;88:69–74.

    Google Scholar 

Download references

Acknowledgements

The project was financed by grants from the Swedish International Development Agency (Contract SRP-2000-007). The following institutions and individuals provided valuable information for the development of this study: Nordiska Museet, Stockholm, Krister Spolander and Gunnar Karlsson, NTF, Stockholm, Sweden.

Author information

Authors and Affiliations

  1. Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, S-171 76, Sweden

    Bjarne Jansson

Authors
  1. Bjarne Jansson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonio Ponce De Leon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Niaz Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vibeke Jansson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bjarne Jansson.

Additional information

Conflicts of interest: none declared.

The authors examine how and why mortality from injuries to children declined over a long period in Sweden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jansson, B., Leon, A., Ahmed, N. et al. Why does Sweden have the Lowest Childhood Injury Mortality in the World? The Roles of Architecture and Public Pre-School Services. J Public Health Pol 27, 146–165 (2006). https://doi.org/10.1057/palgrave.jphp.3200076

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1057/palgrave.jphp.3200076

Keywords

Search

Navigation