Report Documents Causes of Child Death
Authors: M J Friedrich
Journal: JAMA (1999)

UNINTENTIONAL INJURIES, HOMIcide, and suicide are major threats to children in the United States today, according to a new report on the risks and trends of child mortality. Health and the American Child, Part 1: A Focus on Mortality Among Children: Risks, Trends, and Priorities for the 21st Century, was published this May by the Public Health Policy Advisory Board (PHPAB). The purpose of the report, said Louis W. Sullivan, MD, former Secretary of the Department of Health and Human Services and founder of the PHPAB, is to raise the public’s awareness of dangers to children’s health and to stimulate efforts to understand them and develop strategies to prevent them. In a recent interview, Sullivan answered questions about the report and the significance of its findings. JAMA: What is the PHPAB and what are its goals? Sullivan: This is a group I put together about 2 years ago to address issues of public policy pertaining to health that are either overlooked or not well understood. The purpose of the board is to advise those involved in making policy decisions on health issues in Washington, DC, or state capitals about ways to improve the health of the public. All of these issues [addressed in the report] are ones that are not subject to easy or overnight resolutions. What we’re trying to do is give a wake-up call to policymakers as well as to the American public, saying that these are dramatic, important issues that are killing or maiming our children, and therefore they need to be paid attention to. JAMA: What are the key findings of the report? Sullivan: The health of American children has increased in this century, and we’ve had dramatic declines in death due to a number of factors, but we also have emerging preventable deaths; that is, deaths due to unintentional injuries, homicides, and suicides. In the report we point out that the top three causes of death for all American children between the ages of 1 and 19 are unintentional injuries (41%), which include motor vehicle accidents, drownings, and accidents in the home; homicide (14%); and suicide (7%). Of these causes of death, a large percentage are preventable, and so we say this is a public health problem we need to understand better so we can develop a series of strategies to prevent these incidents. For example, with unintentional injuries, a large percentage are associated with alcohol use, such as drunk driving. Most children who are killed where there’s a drunk driver [involved] are actually passengers in the car driven by the person under the influence [of alcohol]. So, clearly, this is an issue that needs to be addressed. JAMA: What other factors may contribute to these trends in child mortality? Sullivan: We mention [in the report] that there are broad societal issues that need to be addressed. We note that child poverty has increased in America over the last several decades. This is in marked contrast to the fact that poverty among those 65 years and older has declined. So while we have been successful in reducing poverty among older citizens, poverty in children has increased. Other factors we feel need to be investigated are the fact that we have increasing instability in the American family; now one of every two marriages ends in divorce, so that the percentage of children growing up with