sou · GRB3127d1 · 2004-01-01 00:00:00 — En viktig del av säkerhetsarbetet i har varit inriktat på att försöka bygga in säkerheten i de miljöer där barn och unga vistas. För vissa typer av olyckor finns det begränsade möjligheter till att bygga in säkerheten. Många skadeförebyggande program har därför inriktats på att försöka påverka beteenden antingen genom lagar och regelverk (exempelvis mopedhjälm) eller genom information och utbildning (exempelvis simskolor). Det är viktigt att åtgärder genomförs parallellt på samtliga nivåer i samhället. Erfarenheter visar att samråd med barn och ungdomar bör bli en naturlig del av arbetet inom många verksamheter. Ofta är det vuxna barnsperspektivet styrande, vilket innebär att utgångspunkten är vuxnas uppfattning om vad som är bäst för barn och ungdomar. När vi tar del av deras egna erfarenheter och kunskap framträder en annorlunda bild av verkligheten, vilket medför att arbetet kan inriktas på de områden som verkligen har betydelse för barns och ungdomars vardagsliv. Det finns goda exempel där kommuner och myndigheter har involverat barn och ungdomar i arbetet. Vanligt är att barn informeras och konsulteras och att deras synpunkter utgör en del av besluts- underlaget. Barnsäkerhetsdelegationen framhåller att det är ange- läget att detta arbete fortgår och utvecklas. Den stora utmaningen ligger sedan i att låta barns och ungdomars synpunkter få genom- slag i beslutsfattandet. Barnomsorg och skola har en viktig roll som demokratisk aktör i närsamhället och flera av de lokala projekt som vi presenterar visar hur ett långsiktigt samarbete med skolan kan byggas upp. Det är även angeläget att utveckla elevdemokratin i skolan. Erfarenheter visar att när eleverna involveras i skolans arbetsmiljöarbete kan detta leda till en skolgård som erbjuder utmaningar utöver det vanliga – utan att antal skador ökar. Det finns ingen nedre åldersgräns för barns delaktighet, utan det handlar om hur de involveras och i vilka frågor. Slutligen kan konstateras att avgörande för en dialog mellan barn och vuxna är ömsesidig respekt vilket också innebär att våga bemöta och ifrågasätta varandras synpunkter. Chapter 1 The Commissions terms of reference and procedures In the report The Office of the Childrens Ombudsman – an advocate for children and young people (SOU 1999:65), it was proposed that official responsibility for the coordination of child and youth safety issues should be clarified and transferred to some other agency. In Government 2001/02:96, Strengthening the Office of the Childrens Ombudsman, which was presented to Parliament in February 2002, it was proposed that, as part of the process of refining the role of the Childrens Ombudsman, the area of child safety should be reassigned to another authority. It was also observed in the that responsibility for the play and outdoor environments of children had not been transferred to the Childrens Ombudsman or any other agency from the former . In addition, the Government had taken note of research results pointing to social differences in the injury risks of children and young people. Against this background, in October 2001 the Government appointed a Child Safety Commission to work with issues relating to the environments of children and young people, with a focus on safety, injury prevention, and the right to play and recreation (S 2001:05). The Commission has also had the official coordinating responsibility for efforts to promote child and youth safety. The members and Secretariat of the Commission were appointed in the autumn of 2001, and began their work in January 2002. The assignment entrusted to the Commission was to be completed in its entirety by , and prior to that an interim report was to be submitted on the question of which agency should in future have overall responsibility for child safety issues. In February 2003 the Commission published this interim report, entitled The right of children to safe environments conducive to their development. The future lead agency (SOU 2003:19). We hereby present, in accordance with our terms of reference, our final report: From child accidents to the right of the child to safety and development (SOU 2003:127). Under its terms of reference, the Commission has had the task of reviewing and working with issues of safety and prevention of injuries in the environment of children and young people. The terms of reference have also required the Commission, in its work, to pay particular attention to and take into account the differing basic conditions and needs of children and young people, reflecting their gender, disability, ethnicity, and socio-economic and regional circumstances. The Secretariat has reviewed studies, reports and research in this field and invited researchers and representatives of different bodies and programmes to Commission meetings and round tables, both to broaden its general understanding of the area and to provide information on specific activities. Four reference groups have been attached to the Commission, to information and reflect on its proposals. In addition, in the course of our inquiry we have paid fact-finding visits to various institutions and projects and held consultations with public authorities and organizations. We have also conducted numerous individual interviews with representatives of different bodies. Chapter 2 The right of the child to safety and development By ratifying the UN Convention on the Rights of the Child (the Childrens Convention), has undertaken to ensure to the maximum extent possible the survival and development of the child. In its work, the Commission has primarily taken into account the four main principles of the Convention: that the best interests of the child are to be a primary consideration (Art. 3); that all children have the same rights and are of equal worth (Art. 2); the right to life and development (Art. 6); and the right of the child to express his or her views (Art. 12). We would argue that, if due regard is paid to these principles – in the light of which the other articles of the Convention are to be interpreted – they provide a value base for the task of creating environments for children and young people which are safe and conducive to their development, and of involving youngsters themselves in this process. Views of children have gradually changed in recent years, in research, politics and other arenas. The Childrens Convention and new knowledge relating to children and childhood have together helped bring about a shift from a view of children as the object of upbringing and other actions by adults to a view of them as competent actors with expert knowledge of their own. In efforts to promote childrens safety and development, it is important to remember that children have a right to protection and care, while also having a right to participation and a say in decision-making. people are growing up in an increasingly changing society, which means that it is no longer possible for them to take over the cultures, life patterns and identities of their parents generation. The traditional norm and value systems that once shaped peoples lives are becoming less influential. It might be imagined that all the choices available and the growing emphasis on the individual would mean that everyone had the same life chances, but major differences in basic terms of existence still exist between young people from different social backgrounds. While these are the tendencies that emerge from sociological research, parents of course still have a significant impact on how the individual young person shapes his or her life. In seeking to promote safe environments conducive to the development of the younger generation, it is important to proceed from an awareness that young people are a heterogeneous group, with varying interests and preferences. The Child Safety Commission has primarily focused on unintentional injuries (accidents), but it has also looked at self- inflicted injuries and those resulting from violence. Our inquiry has concentrated on serious and fatal injuries, and on injuries that can cause long-term suffering or functional impairment. An endeavour to prevent every minor injury could impose excessive restrictions on childrens everyday lives. In the case of injuries due to violence and those that are self- inflicted, a different kind of discussion is of course called for: here, it is not only the injuries as such that we are anxious to prevent, but also the phenomena behind them, such as violence and mental ill health. Safety and development are mutually dependent. Efforts to promote safety can make children more secure and give them greater scope to play and move about freely. But they are no guarantee that the childrens environment will be stimulating and beneficial to their development. To create such environments, a partly different approach is required. An environment conducive to development offers opportunities for play and independent mobility, allowing children and young people to safely visit their friends, go to school, and to recreational activities and service outlets. It is also important that they themselves feel secure in their environment. Chapter 3 Future efforts to promote safety and development The Child Safety Commissions vision for future work in this area is that all children and young people should be able to safely play and spend time in all environments without being killed or seriously injured. The responsibilities of the future lead agency should include monitoring how different bodies and organizations in society, both public and private, are helping to realize this vision. Today, the situation of children in , including their safety and development, is affected not only by national regulations and strategies, but also by decisions taken for example within Union. We wish to highlight four important aims and principles that should guide future efforts to achieve safe environments conducive to the development of children and young people: Give children and young people a greater say in decisions affecting their everyday lives In our view, the participation of children and young people is essential to carrying the process forward, particularly in terms of new methods and approaches and new phenomena that require attention. A more in-depth understanding of the social background factors behind injuries is needed A modern approach to child safety promotion needs to take into account psychosocial, socio-economic and physical aspects of childrens and young peoples environments. Research reveals clear social differences in the risk of being injured; now a deeper understanding of the causes of these differences is needed. Attention should also be paid to injuries resulting from violence and self-destructive acts. Safety and development are mutually dependent It is important to see the development of children and young people in context. Youngsters have a right to grow up in an environment in which they can play and move about freely, accept challenges, and gradually extend their radius of action and their independence, without risking being killed or seriously injured. Adolescents are a forgotten group To a large extent, Swedish injury prevention efforts have focused on younger children. It is important to maintain these efforts, but also to step up preventive action for the benefit of adolescents. In our opinion, the future lead agency should primarily focus on the following areas of work: coordination, knowledge development, methods development, surveillance and the task of serving as a unifying force for education, information and campaign activities. We propose that the future lead agency should be commissioned to study the feasibility of establishing regional knowledge centres. In the area of coordination we propose that the agency, in consultation with the for School Improvement and the for Education, should examine the need and scope to address safety and development issues in pre-schools, after-school centres, pre-school and schools, and make recommendations as to how such work could be naturally integrated into the educational activities of these facilities. There are a number of areas and groups to which we feel attention needs to be devoted in the future. We have noted the existence of social differences in injury risks among children and young people, and therefore consider it important to achieve a better understanding of ways of reducing such differences. We therefore propose that the future lead agency, working with the sectoral authorities concerned and with researchers, should develop methods to diminish social differences in the occurrence of injuries. We believe that it is also important, from the viewpoint of future efforts in this area, to monitor the social distribution of injuries among children and young people and to make the results known to decision-makers. Accordingly, we propose that the future lead agency should monitor the social distribution of injuries among children and young people and make the resultant data known to politicians and decision-makers at all levels. Up to now, much of the work done in to promote child safety has had a focus on younger children. In future, special responsibility should be assumed for developing new knowledge relevant to promoting the safety of adolescents. Environments conducive to the development of this age group are another important area of work. We have noted a lack of knowledge concerning the pattern of injuries across different categories of housing. We therefore propose that and the , in collaboration with , and Planning, should initiate and monitor the implementation of analyses of injury patterns in neighbourhoods of different types. Our discussions with our have demonstrated the importance of involving young people in the process. It is vital to continue to develop arrangements that will enable children and young people to participate at different levels in society. Involving the young generation and listening to their views and expertise will allow safety promotion activities to be developed and highlight areas in particular need of attention. year around 100 children under the age of 18 in die as a result of injuries, violence or suicide. Roughly half of these children are killed on the roads, this category being followed by those dying as a result of deliberate self-inflicted injuries, drowning or fires. The Commission considers it important to investigate cases with a fatal outcome, since such inquiries can provide valuable knowledge for preventive efforts. We therefore propose that from Accidents (NCO) should be commissioned, first, to investigate – where this would not otherwise be done – cases in which children and young people under the age of 18 have died as the result of an accident, suicide or violence; and second, to summarize and publish on an annual basis the results of other agencies inquiries into deaths, in collaboration with the agencies concerned. The Child Safety Commission has identified a number of areas in which more needs to be done at the national level, and in which responsibilities need to be clarified. These areas are injuries resulting from violence and self-destructive acts; sports injuries; drowning; and safe outdoor environments conducive to childrens development. A review of the framework documents and activities of relevant authorities shows that several of these areas already fall within the remit of different authorities. As regards sports injuries, no national coordination or methodological development of preventive efforts is currently under way. According to its standing instructions, is to serve as a national knowledge centre for methods and strategies in the field of public health, as well as promoting health and preventing diseases and injuries. We therefore propose that this Institute should be entrusted with developing methods and strategies to prevent sports injuries, in both organized and recreational sport, with a particular emphasis on children and young people. There is no agency at present with overall national responsibility for ensuring the right of children to safe and development- enhancing outdoor environments in the vicinity of pre-schools and schools and in residential areas. These questions have received attention since 1993, when the was replaced with the Office of the Childrens Ombudsman. In our view, therefore, , and Planning should give a national lead in this area, and we propose that it be entrusted with overall responsibility for developing and disseminating knowledge about safe outdoor environments conducive to development, with a particular focus on children and young people. For issues relating to drowning, too, there is no national lead authority at the present time. The principal body currently working with these issues at a national level is , a non-governmental organization. In our view, the is the authority best suited to act as the lead agency in this area, since its mandate includes seeking to reduce the number of accidents and to create a safer society. The new Act that has now been proposed will impose an obligation on municipal authorities to draw up local action programmes to prevent accidents which require the deployment of emergency services. The problem of drowning should be a natural focus of action in this context, and we propose that a national sectoral responsibility for measures to prevent drowning should be established in the appropriation directions of the . In the search for greater security and safety for children and young people, attention needs to be paid to injuries resulting from violence. Such injuries among children and young people are a matter of great concern from a public health point of view, and fall primarily within the remit of for Crime Prevention. Neither of these authorities is currently able to address this issue in an , and we therefore propose that the future lead agency should have a national coordinating responsibility for efforts to prevent injuries caused by violence. Injuries resulting from self-destructive actions, such as suicide attempts, suicide and self-inflicted injuries, have attracted growing attention as knowledge about such phenomena has expanded. The work of covers the policy areas of health care, social services and public health, all of which are relevant in various ways to this complex set of issues. Such questions therefore fall within the Boards sphere of responsibility. Chapter 4 How and in what environments are children and young people injured? In as in other parts of the world, injuries are a major public health problem. Even if the number of deaths in resulting from injuries is low compared with other countries, injuries still represent the commonest cause of death among children and young people. The number of injuries increases as their severity decreases, and the situation can be described as a pyramid, with fatal injuries at the top and minor ones at the bottom. Road traffic accidents account for the largest share of fatal injuries, but when it comes to injuries requiring hospital treatment various types of falls are the commonest cause. Injuries are not randomly distributed over different areas and different social groups in . There are clear regional differences in the risk of being injured and in patterns of injury. These are described in more detail in the Child Injury (SOU 2002:99) prepared at the request of the Commission. National studies show that there are also socio-economic differences in the risk of being injured, a state of affairs described more fully in one of the Child Safety Commissions reports, dealing with social differences in injury risks (SOU 2002:68). Although generally speaking more deaths due to injuries occur among boys than among girls, a similar pattern of causes of death emerges for both sexes. Road traffic accounts for the largest share of deaths throughout childhood and adolescence, the proportion showing a marked rise with increasing age. Drowning, suffocation and violence primarily figure as causes of death in the younger age groups. Between the ages of 13 and 17, injuries resulting from deliberate self-destructive actions cause a large proportion of deaths among both boys and girls. Such injuries are responsible for a larger share of deaths among girls than among boys, but the number of deaths resulting from them is higher for boys than for girls. As regards fatalities resulting from road traffic injuries, injuries associated with car use predominate among both boys and girls and in all age groups. It should be noted, though, that in few children in the youngest age groups are killed on the roads. Among boys aged 13–17, moped and motorcycle injuries account for a large share of deaths. Specific to girls are fatalities arising from horse and pony riding on roads. Injuries caused by falls of various kinds make up more than half the injuries requiring hospital treatment up to the age of 12, and just under half in the case of the 13–17 age group. A clear aged- related pattern emerges for different types of falls. Falls on the same level, from furniture and on stairs are commonest among the youngest children. Between the ages of 4 and 6, falls from furniture become less frequent, while falls from playground equipment become more common. In this age group the number of falls on skis, skates, in-line skates etc. also increases. This type shows a further rise among 7- to 12-year-olds, while falls from play equipment decrease. Same-level falls increase in this age group, largely owing to sports injuries (falls occurring while playing football, floorball etc.). Falls of this kind then increase further in the oldest age group. Chapter 5 Injuries and injury prevention from a national economic point of view The public policy aim of safeguarding peoples lives and health is manifested in both legislation and goal and policy documents. The case for injury prevention measures is rarely based on purely economic arguments, but rather on a valuation of the benefits of reducing injury rates. It is therefore important to establish what measures to prevent injuries will achieve policy objectives at the lowest cost. To this end, cost-effectiveness studies of such measures need to be developed. With regard to children and young people, we need to achieve a better understanding of how safety is valued – both by adults and by children themselves. It is also necessary to develop the effectiveness of different measures for children and young people. We note that society invests considerable resources in injury prevention. It is therefore important to improve our understanding of how the priorities defined by society promote the safety of children and young people. While saving money is not the primary aim of injury prevention efforts, it is important to recognize that personal injuries often entail costs of various kinds over an extended period of time, spread over different cost-bearing entities, such as health services, the social insurance system, local authorities and insurance companies. Existing knowledge about what injuries to children and young people cost society and how they are distributed over different cost bearers is inadequate. Chapter 6 Statistics and other sources of information on safe environments conducive to childrens and young peoples development It is important to be able to monitor changes in areas which we know can affect the safety and development of children and young people. One way of acquiring knowledge about changes over time is to track different types of occurrences that can be linked to safety or development, for example the number of injuries occurring.