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Reducing unintentional injuries in and around the home among children under five years

Unintentional injuries in and around the home are a leading cause of preventable death for children under five years and are a major cause of ill health and serious disability. The reduction of unintentional injuries in childhood remains an important public health priority.

In 2014 Public Health England, with the Royal Society for the Prevention of Accidents and the Child Accident Prevention Trust, published a five-year trend analysis of these injuries and deaths in England. The report highlighted the scale of this public health issue, and the steps local areas can take to reduce casualty rates. The resources have been used extensively by local authorities, and we have taken the opportunity to refresh the original analysis with the most recently available admissions data from 2012/13 – 2016/17 and deaths data from 2012 to 2016.

Our analysis of the five years of data shows that each year an average of 55 children under the age of five died due to an unintentional injury, 370,000 children attended accident and emergency (A&E) and 40,000 children were admitted to hospital as an emergency.

This document sets out three action areas for local authorities and their partners that aim to reduce the numbers of children injured and killed. It also describes four steps local partnerships can take to build robust injury prevention strategies.

This approach is informed by the evidence base and a new analysis of data, which we are making available alongside this report. It builds on what local authorities are already doing to keep children safer and healthier.

The Chief Medical Officer has made a powerful economic case for preventing unintentional injuries. The majority of unintentional injuries are preventable. A recent programme of evaluation demonstrated a significant association with modifiable risk factors for falls from furniture and on stairs, poisoning and scalds in children aged 0-4 year, with evidence of the effectiveness of home safety interventions, including economic evaluations.

There remains a need for more information about the wider costs and benefits of injury prevention. This will help local areas prioritise investments and is an issue which PHE will continue to work on with leading experts and organisations. Injury prevention can be low cost and there is a large return on investment for young children in terms of preventable years of life lost and disability adjusted life years.

The paper identifies unintentional injuries as a major health inequality. There is a persistent social gradient for unintentional injuries. Our analysis shows that the emergency hospital admission rate for unintentional injuries among the under-fives is 38% higher for children from the most deprived areas compared with children from the least deprived, and previous research indicates that for some injury types this inequality may be much larger.

Health inequalities can be tackled via anti-poverty strategies, by targeting deprived areas, and engaging with local communities and families via proportionate universalism as advocated in the Marmot review of health inequalities in England.

Research has shown what works in preventing unintentional injuries and the National Institute for Health and Care Excellence (NICE) has produced evidence-based guidelines.