1 in 5 child deaths 'preventable'

“One in five child deaths ‘preventable’,” reports BBC News.

The headline was prompted by the publication of a three-part series of papers on child death in high-income countries published in The Lancet.

The reviews outlined the need for child death reviews to identify modifiable risk factors, described patterns of child mortality at different ages across five broad categories. These were perinatal causes, congenital abnormalities, acquired natural causes, external causes, and unexplained deaths. They described contributory factors to death across four broad domains: biological and psychological factors, the physical environment, the social environment, and health and social service delivery.

Although the series did report that one in five child deaths are preventable, it should be noted that this was not a new figure and was published by the government in 2011.

Leading causes of preventable child deaths in the UK highlighted by the authors include accidents, abuse, neglect and suicide.

The authors also argue that child poverty and income inequality have a significant effect on risk factors for preventable child death and they are quoted in the media as calling for the government to do more in tackling child poverty.

Where did the story come from?

The series of papers was written by researchers from the University of Warwick in collaboration with researchers from universities and research institutes around the world. The source of funding for this series of three papers was not reported.

The series was published in the peer-reviewed medical journal The Lancet. All three papers are open-access so are free to read online (though you will need to register with The Lancet website):

• Learning from child death review in the USA, England, Australia, and New Zealand
• Patterns of child death in England and Wales
• Understanding why children die in high-income countries

Child health reviews

The first paper in the series discussed child death reviews, which have been developed in several countries. These aim to develop a greater understanding of how and why children die, which could lead to the identification of factors that could potentially be modified to reduce further deaths.

In England, multiagency rapid-response teams investigate all unexpected deaths of children aged 0-18 years. However, lessons learned from child death reviews are yet to be translated into large-scale policy initiatives, although local actions have been taken.

However, the researchers report that whether child death reviews have led to a reduction in national child death rates has not been assessed.

They also suggest that child death reviews could be extended to child deaths in hospital.

Patterns of death in England and Wales

The second paper in the series discussed the pattern of child death in England and Wales at different ages across five broad categories (perinatal causes, congenital abnormalities, acquired natural causes, external causes, and unexplained deaths).

It found that more than 5,000 infants, children and adolescents die every year in England and Wales.

Mortality is highest in infancy, dropping to very low rates in the middle childhood years, before rising again in adolescence.

Patterns of mortality vary with age and sex; perinatal and congenital causes predominate in infancy, with acquired natural causes (for example infections or neurological, respiratory and cardiovascular disorders) becoming prominent in later childhood and adolescence.

More than 50% of adolescent deaths occur from external causes, which included traffic deaths, non-intentional injuries (for example, falls), fatal maltreatment and death from assault, suicide and deliberate self-harm.

Deaths of children diagnosed with life-limiting disorders (disorders that are likely to reduce a child’s lifespan) might account for 50% or more of all child mortality in England and Wales.

Why do children die in high-income countries?

In the third review of the series the researchers summarised the results of key studies that described contributory factors to child death across four broad domains:

• Intrinsic (genetic and biological) factors that are associated with child mortality include sex, ethnic origin, gestation and growth characteristics, disability and behaviour.
• Physical environment, for example the home and surrounding area, including access to firearms (a particular problem in the US) and poisons.
• Social environment (for example socioeconomic status, parental characteristics, parenting behaviours, family structures, and social support).
• Service delivery (delivery of healthcare including national policy, healthcare services and the individual doctor; and the delivery of other welfare services (such as housing, welfare benefits and social care).

What do the researchers suggest?

In an accompanying editorial the researchers suggest that:

• co-ordinated strategies that reduce antenatal and perinatal risk factors are essential
• further research is needed into preventative interventions for preterm birth
• efforts are needed to prevent child deaths due to acquired natural causes, including improved recognition of severity of illness
• preventative strategies involving collaboration between health authorities and other agencies, including social, education, environmental, police and legal services, industry, and consumer groups are needed to prevent deaths due to external causes

Conclusion

A case could be made that these series of reports are more in the realm of political debate rather than health and medicine.

The lead author, Dr Peter Sidebotham, is quoted in The Daily Telegraph as saying: "It needs to be recognised that many child deaths could be prevented through a combination of changes in long-term political commitment, welfare services to tackle child poverty, and healthcare services.

"Politicians should recognise that child survival is as much linked to socioeconomic policies that reduce inequality as it is to a country's overall gross domestic product and systems of healthcare delivery."

While most of us would agree that reducing child poverty and income inequality is a good thing, exactly how we go about achieving these goals is a matter of heated debate.

Those on the Right of the political spectrum have argued that stimulating the economic activity of the free market will provide opportunities to lift people out of poverty. Those on the Left have argued that redistributing wealth through taxation can help create a safety net that stops children falling into poverty.

Seeing as this argument has been raging for centuries, we do not expect a resolution to the debate anytime soon.