Reducing Accidents is Key to Lower Child Mortality
"Between 1960 and 1990 the death rate for children aged five to14 fell 48 percent ... a growing share of the accelerating reduction in child mortality arises from a sharp drop in deaths from unintentional injury or accident."
Over the past three decades, child mortality has declined sharply in the United States. For children between the ages of one and four, the rate of death dropped 57 percent between 1960 and 1990. The death rate for children aged five to 14 fell 48 percent during that period. One reason for the decline is revolutionary developments in medicine. But a growing share of the accelerating reduction in child mortality since 1970 stems neither from medical advances nor from immunization campaigns, notes NBER researcher Sherry Glied. Rather, it arises from a sharp drop in deaths from unintentional injury or accident. Among children under five, deaths from these causes dropped from 44 per 100,000 children in 1960 to 18.6 per 100,000 in 1990. Among children five to nine, the mortality rate from injury or accidents fell from 19.6 to 9.8 per 100,000.
Many different factors contributed to this decline in accidental injury, Glied explains. "The late 1960s and early 1970s were the heyday of the U.S. consumer protection movement," she notes. Washington's Consumer Product Safety Commission produced a range of mandatory and voluntary standards to increase the safety of products that children might contact. All states passed legislation between 1977 and 1984 requiring children to be in a child safety seat when in a car. In some areas, homeowners were required to fence in swimming pools to avoid drowning deaths. Building laws required smoke detectors. In the mid-1960s, a New York City Department of Health study found that on average 30 to 50 children under five were dying per year, mostly in Manhattan and the Bronx, when they fell out of apartment building windows; a campaign followed to encourage and eventually require landlords to install window guards, and the annual number of such deaths fell to four by 1980.
Some improvements may have followed fear of litigation, as tort lawyers swung into action alleging that defective products led to injury. Others are a consequence of medical advances, as the availability and quality of trauma care for children in hospital emergency rooms improved.
Many improvements are a consequence of a change in family behavior. Older children are less likely to walk to school than was the case 20 years ago, perhaps helping reduce pedestrian accidents. Manufacturers developed a host of child-proofing products as different causes of injury became better known.
What ties these changes together is the increased availability of information on how to protect children, enabling parents to look after their children's safety more effectively. All parents can now read mandatory safety labels on products and must take other steps required by regulations. In addition, parents, especially those who are well-educated, have more information today to help them best use their time and money to protect their children. For example, the amount of safety information in Dr. Benjamin Spock's popular manual of baby and child care increased from three pages to 13 pages between 1957 and 1992. This advantage of education may have contributed to growing inequality between the mortality rate for children of more-educated parents and that for children of less-educated parents.
Examining all these factors, Glied concludes that governmental regulations, though not unimportant, explain "relatively little" of the significant decline in child mortality. She reckons that improvements in the information on child safety given parents (some derived from regulations) are "a more probable cause" of the decline. When publicly-funded epidemiologists and statisticians identify frequent causes of injury and that information becomes widely available, parents rapidly make use of their new knowledge to assure the safety of their children. Those measures offset the fact that more mothers are working and fewer are married in the 1990s, and thus have less time to watch their children personally, than in the 1960s. Parents' time has become a less important factor in producing health, Glied writes.
Glied puts a value on the economic savings to society of this plunge in death rates. She estimates the number of lives saved and then uses a conservative estimate that a single child's life is worth $100,000 per life year, or about $3 million in total present value. (Lawyers use similar calculations in lawsuits involving the death of children.) Glied then calculates that the total value of savings to society from the lower accidental death rate for the under-five group of children amounts to between $8 billion and $16 billion each year. That is $430 to $870 per living child per year. In an economic sense only, that represents the value for parents of the new measures they are taking to ensure the safety of their children. For the older group of children, the total savings amount to between $7 billion and $9 billion each year, or $280 to $360 per living child per year.
-- David R. Francis
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