Statistics on drug overdose deaths in that age group would be helpful; although the death statistics themselves are meaningful, it would be a significant insight to have a current estimate of the percentage of "accidents" in which drug or alcohold abuse is a factor in that age group.
Those of us in public health abhor the word "accident." It implies that the injuries mentioned are unavoidable. It is more accurate to refer to "preventable injury."
1
Hmm. I don't see cancer as a top cause of death either. Imagine how many lives we could save if, instead of treating rare cancers in children, we used the money to invest in the things that actually kill children. In fact, maybe we should stop churning out pediatric oncologists and focus instead of training gym teachers and drivers ed instructors to help people live healthier lifestyles. Maybe that would be more cost effective.
2
I am not statistician, but isn't comparing the number of young athletes who die of cardiac arrest with the leading causes of death for children in the general population misleading? I am sure the number of children who die in skiing accidents is also much smaller than the number of kids who die in car crashes, but would that suggest that investing in helmets is a waste of money for people who ski, because the money could better be invested in driver safety classes?
How many student athletes are there, and how much does it cost to have them tested? Furthermore, given the appalling reality in this country that some children do not have good access to healthcare, what are the odds that a student engaging in athletics in this country might be suffering from a condition or congenital heart defect that would otherwise have been detected earlier in another country?
As a pediatrician, why does Dr. Carroll feel we have to make a choice between protecting athletes and caring for children when as a society we seem so willing to lavish money on 85+ year old nursing home residents with alzheimers? http://well.blogs.nytimes.com/2015/02/09/know-the-hard-choices-prolongin...
How many student athletes are there, and how much does it cost to have them tested? Furthermore, given the appalling reality in this country that some children do not have good access to healthcare, what are the odds that a student engaging in athletics in this country might be suffering from a condition or congenital heart defect that would otherwise have been detected earlier in another country?
As a pediatrician, why does Dr. Carroll feel we have to make a choice between protecting athletes and caring for children when as a society we seem so willing to lavish money on 85+ year old nursing home residents with alzheimers? http://well.blogs.nytimes.com/2015/02/09/know-the-hard-choices-prolongin...
1
What Dr. Carroll leaves out is that the test to screen for previously undiagnosed heart disease that could cause sudden death in young athletes is actually not a very good test. That's why it's not used in this country.
Another pediatrician
Another pediatrician
Actually, there's a very good reason why Denmark doesn't screen young athletes for heart problems by using a 12-lead electrocardiogram. It simply doesn't do the job. What DOES is carefully listening to the heartbeat and measuring the pulse while doing what should be a routine physical exam, having the cardiogram done if an irregular heartbeat is detected, and doing a quick ultrasound exam or, if that's not feasible, a chest x-ray - to pick up the enlargement of the heart that results from cardiomyopathy, the most notorious (and, all too often, undetected) cause of sudden cardiac death in young athletes. What's even more important to note - tragically so - is that this condition is often quite preventable. How? By having youngsters refrain from sports or other heavy physical activity for a week after the end of fever from an upper respiratory infection. These are typically viral, but these viruses can affect the heart muscle. Relative rest - that means a week of no gym class - is imperative to avoid that by giving the body enough time to rid itself of the virus, and that means driving that point across to all too many gym teachers who think that it's fine to ignore doctors' notes. (Well, it should be 'fine'. At least $1000 per offense.) 'War on Childhood Obesity' be jolly well damned; lives are at stake. (P.S. In case you're wondering, I'm a family doc. Retired.)
8
One suggestion that may seem nitpicky, but is very important: Please stop using the the phrase "car accident". That makes them all seem like acts of God. They are not - they are the result of dangerous street design and risky individual behavior and most could be prevented. Please use "crash" or "collision" in the future.
7
Good point. I read many reports of "..the car ran off the road and hit a tree at 2 AM. Alcohol may have been involved."
No responsibility is placed on the driver - it's the car's fault !
No responsibility is placed on the driver - it's the car's fault !
4
I have been doing doing something radical: I drive at the posted speed limit. It often infuriates drivers behind me. If the sign says 15 miles and hour on the blind curve I don't drive faster than 15 miles an hour. Preventing speeding — and the mindset that speeding is a harmless crime — will greatly reduce pedestrian deaths. Next we can work on texting and cell phone use. And perhaps limiting the number of teens in a car at one time.
4
Very nicely written. Drunk driving, homicide and suicides are causing unnatural deaths thereby putting end to the dreams of teenagers mostly, causing unending heartbreaks for their families.
I mentioned couple of times that Americans don't need guns for their protection at all. Your policing system is by far better than India, whose population is more than three times than yours. When we don't need guns, why do you need guns.
As one reader rightly mentioned, eligibility for getting driving license should be increased. Similarly, there should be some curbs on teenager drinking even. Many teenagers take split second decisions and commit suicide in no time. So, prioritisation of programmes based on these three aspects alongwith obesity should be looked into with the sole motto of saving as many lives as possible.
I mentioned couple of times that Americans don't need guns for their protection at all. Your policing system is by far better than India, whose population is more than three times than yours. When we don't need guns, why do you need guns.
As one reader rightly mentioned, eligibility for getting driving license should be increased. Similarly, there should be some curbs on teenager drinking even. Many teenagers take split second decisions and commit suicide in no time. So, prioritisation of programmes based on these three aspects alongwith obesity should be looked into with the sole motto of saving as many lives as possible.
2
Where children and guns are involved, there is no such thing as an 'accident.' Nearly 2 children are killed in unintentional shootings each week in our country. American children are sixteen times more likely to be killed in unintentional shootings than their peers in other wealthy countries.
Sadly, our gun violence epidemic has been raging for so long that even babies and toddlers and children shooting other children is seen as our new 'normal.' But it doesn't have to be this way. These tragedies are entirely preventable. First, the safest thing is to not own a gun with children in the home. Second, if parents or grandparents must own a gun, they should be responsible and lock up them up, separate from the ammunition, so children can't gain access.
Safe storage laws, like Nicholas's Law, pending in the NY State legislature, can save young lives by preventing these 'accidents' as well as suicide. Guns that are locked up can't be stolen and end up on our streets. And 68% of the kids who bring guns to school, get them from home.
This year, guns are over-taking cars as the leading cause of death for young Americans. It doesn't have to be this way. Gun violence must be treated as the public health crisis that it is. Surely our kids are worth it.
Sadly, our gun violence epidemic has been raging for so long that even babies and toddlers and children shooting other children is seen as our new 'normal.' But it doesn't have to be this way. These tragedies are entirely preventable. First, the safest thing is to not own a gun with children in the home. Second, if parents or grandparents must own a gun, they should be responsible and lock up them up, separate from the ammunition, so children can't gain access.
Safe storage laws, like Nicholas's Law, pending in the NY State legislature, can save young lives by preventing these 'accidents' as well as suicide. Guns that are locked up can't be stolen and end up on our streets. And 68% of the kids who bring guns to school, get them from home.
This year, guns are over-taking cars as the leading cause of death for young Americans. It doesn't have to be this way. Gun violence must be treated as the public health crisis that it is. Surely our kids are worth it.
10
We have many programs to reduce motor vehicle fatalities in young people. You don't hear about them because most of them work at the state level, not the national level, and they're not controversial enough to warrant national attention. For example, the Ohio Department of Public Safety has recently proposed to levy fines for distracted driving, and then use those fines to pay for driver education programs. Do you think that will make national news? Of course not. "Ohio Implements Teen Driver Safety Program" is right up there with "Worthwhile Canadian Initiative" for the winner of the Most Boring Headline prize.
7
That - using fines for "distracted driving" to fund driver's ed is a fine idea.
1
Since I had my children, I've puzzled about why certain topics become the focus of the public health sector and certain other ones don't.
For example, I've never understood why the public health sector has spent untold sums of money trying to increase breastfeeding rates - when breastfeeding is not all that important of a factor in child health - and not at all a factor in childhood mortality (in a developed country like the US, anyways). The money that has been poured into breastfeeding promotion could be spent on far more important initiatives that could have a real impact - like those mentioned here.
For example, I've never understood why the public health sector has spent untold sums of money trying to increase breastfeeding rates - when breastfeeding is not all that important of a factor in child health - and not at all a factor in childhood mortality (in a developed country like the US, anyways). The money that has been poured into breastfeeding promotion could be spent on far more important initiatives that could have a real impact - like those mentioned here.
4
Interesting that several politicos read this article wrong. It's about prioritizing and putting limited resources to work where they'll do the most good, in this case as applied to public health and safety. E.g,, in NYC and elsewhere, automated external defibrillators were put in all kinds of buildings, elementary schools, public places, etc., where they'll hardly ever result in a saved life: Most cardiac arrests take place at home. The money for the equipment, upkeep, and training could have gone to increasing physical activity and saving many more lives from cardiac arrests. In the instant example, the politicos hear "suicide" and think "gun control," utterly ignoring that there is virtually nil mental health clinical services or outreach for depression or anything else for that matter for middle and high schoolers. It mostly goes undetected and untreated, and suicides of course result, some no doubt preventable. But ideologues here are uninterested in mental health per se, only pet political beefs.
3
Change the age for drivers' licenses from 16 to 18. A large proportion of accidents occur between 16 and 18.
2
Part of the reason that the largest portion of accidents fall in that range is because they are new drives and don't have as much experience on the road, changing the driving age wouldn't effect that.
2
My youngest turns 16 this week. Even upping the age to 17 would help. We are letting her take the test, but will strictly limit when she can drive and how far from home she can drive.
1
Back in the dark ages when I was young I got to see the results of 16 vs. 18. 18 was less pretty.
Where I grew up (Ohio) the driving age was 16. We got our licenses while we were still living with our parents. Some of my friends were good drivers. Some were pretty bad at first but mostly got better. Most of us drove at least some of the time when we were going somewhere with our parents in the car. And if we were ill, or totally stressed out or otherwise unfit we did not have to do the driving.
When moved to NYC after a few years at school in Boston, most of my peers, including my Brooklyn native now-ex husband, had grown up in NYC where the driving age was 18. So they went off to college without learning to drive. In their mid-20s they took driving lessons and then either bought or rented cars. They got little practice, less feedback (no parents in the car) and were mostly bad drivers.
For clarity, these people in Ohio and NYC were mostly from a similar range of middle class households.
As C.C. points out, novices are always going to account for a lot of accidents. I just think that supervised novices are apt to improve more quickly. And the only affordable supervision for most folks is parents who are more apt to be there at ages 16 and 17.
Where I grew up (Ohio) the driving age was 16. We got our licenses while we were still living with our parents. Some of my friends were good drivers. Some were pretty bad at first but mostly got better. Most of us drove at least some of the time when we were going somewhere with our parents in the car. And if we were ill, or totally stressed out or otherwise unfit we did not have to do the driving.
When moved to NYC after a few years at school in Boston, most of my peers, including my Brooklyn native now-ex husband, had grown up in NYC where the driving age was 18. So they went off to college without learning to drive. In their mid-20s they took driving lessons and then either bought or rented cars. They got little practice, less feedback (no parents in the car) and were mostly bad drivers.
For clarity, these people in Ohio and NYC were mostly from a similar range of middle class households.
As C.C. points out, novices are always going to account for a lot of accidents. I just think that supervised novices are apt to improve more quickly. And the only affordable supervision for most folks is parents who are more apt to be there at ages 16 and 17.
2
What about stop and frisk?
1
We must legislate more severe penalties for drunk driving and make the bar higher on tests to get a license. Perhaps adolescents should have temporary licenses, revokable if they break laws.
1
I live and work in a college town, and I think that basic training in impulse control, if there is such a thing, would get at the root of most causes of teen death.
Every time I have to brake because a college student has dashed off the curb in front of my car (while wearing ear buds or a bluetooth), I think, half a mill easy to raise that kid, and nobody taught them how to cross the street?
I worked with kindergarten kids for a while in a poor school district. We taught them how to cross the street.
Every time I have to brake because a college student has dashed off the curb in front of my car (while wearing ear buds or a bluetooth), I think, half a mill easy to raise that kid, and nobody taught them how to cross the street?
I worked with kindergarten kids for a while in a poor school district. We taught them how to cross the street.
10
Here is a fact of life: some children will not make it to adulthood. Some children die as a result of parental negligence, others due to bad luck. Nothing will change this. What would help would be first of all, encouraging women who have no involved co-parent to abort or give up the child for adoption. The second would be to encourage parents to be responsible. I am sick of hearing about parents who kill children in car wrecks while gabbing on cells, parents who leave guns around, parents who beat their kids to death, parents who let their pit bulls eat the kids, and this is not even addressing mothers who leave children with paramours they have known 2 weeks who molest and/or kill the kids.
5
As a single mother of a very successful adult I strenuously object.
6
That's just silly. According to the CDC in 2013 a full 40% of births in this country (or 1,595,873 babies) were born to unmarried mothers. Even if there's an involved co-parent in half of those cases that's still a whole lot of babies you think should be aborted or thrown into the foster care system. I'm a single parent without a co-parent and guess what? I don't own guns, or pit bulls, or talk on the phone while driving, raise a hand to my baby, or leave him in the care of strangers. Why? Because those are risky and/or abusive behaviors and I'm smart enough to know that. Every single example of bad behavior you listed I can guarantee you happens in two parent households just as often as they do in single parent households. The underlying problems in those situations are more likely poverty, lack of education, addiction or mental illness, and poor risk assessment skills not the household size. Here's a fact: Broken people, break people. The kids who are at the highest risk of harm are those who were born to broken parents, not single parents.
16
Suicide risk in teenagers is one of the things that has a statistically significant uptick with a gun in the home. Teenagers are impulsive and apt to think a failed test or relationship is the end of the world, and they can usually access the gun in the home (even though their parents don't always know they can).
Inner city teens have a much higher suicide rate, too, which should give us more insight into their sense of despair than pop culture seems ready to examine.
Inner city teens have a much higher suicide rate, too, which should give us more insight into their sense of despair than pop culture seems ready to examine.
15
Another great disconnect is "stranger danger". 99% (or more) of the bad things that happen to children is NOT from strangers. It is from FAMILY and friends. Of the 800,000 reports of a missing child every year only 115 (0.04%) are verified "classic stranger abductions".
MSM uses the fear for sound and video bites. Politicians use them to pass laws to make themselves feel good and maybe look good to the voters. These all deflect the attention from where it SHOULD be focused. Families know and hide the actions or attribute them to "strangers" because people are much more willing to accept "stranger danger" than "family danger".
WAKE UP AMERICA!
MSM uses the fear for sound and video bites. Politicians use them to pass laws to make themselves feel good and maybe look good to the voters. These all deflect the attention from where it SHOULD be focused. Families know and hide the actions or attribute them to "strangers" because people are much more willing to accept "stranger danger" than "family danger".
WAKE UP AMERICA!
25
I 100% agree with you here. I remember being a kid in the early '80's petrified of being kidnapped by a stranger. The likelihood of that happening (my parents were neither wealthy nor prominent) was so small, but to my mind, it could happen AT ANY TIME!!!
I strongly agree. It seems the "John Walsh" crowd dominates the media and it's reflected in the platforms of politicians.
This is excellent and provides the grain of salt that should be taken before reading any and all of the recent Times articles on precision/personalized medicine or anything President Obama says about that initiative.
Public Health has to start with the facts that apply to an age group and this article makes clear what those facts are: accidents, homicide, suicide.
As an American who frequently points out just FYI facts about Public Health programs and risk-reduction programs in Sweden, I look forward to one or more NYT commenters telling the author Aaron Carroll that anything learned in Denmark is inapplicable in the USA because Denmark is a small country.
The American way is illustrated by the signs one sees in New Hampshire telling us that we really do not need to buckle up, since it is better to Live Free (no seat belt, much alcohol) and Die.
Only-NeverInSweden.blogspot.com
Thanks also to trauma surgeon Sharm for a fine comment.
Public Health has to start with the facts that apply to an age group and this article makes clear what those facts are: accidents, homicide, suicide.
As an American who frequently points out just FYI facts about Public Health programs and risk-reduction programs in Sweden, I look forward to one or more NYT commenters telling the author Aaron Carroll that anything learned in Denmark is inapplicable in the USA because Denmark is a small country.
The American way is illustrated by the signs one sees in New Hampshire telling us that we really do not need to buckle up, since it is better to Live Free (no seat belt, much alcohol) and Die.
Only-NeverInSweden.blogspot.com
Thanks also to trauma surgeon Sharm for a fine comment.
3
A Modest Proposal
The author's supposed life-saving measures are really job-killing ideas. The age group he's focused on are a market - for alcohol (what demographic is featured in alcohol ads?), and for cars (many are marketed to appeal to a young demographic). Any effort to limit the manufacture and sale of guns is going to be a big job-killer, too. And, it seems perverse to make it hard to obtain drugs that kids use for suicide: why single out the owners of some firms when parents can't handle their own kids?
Some readers also took note of the opportunities investors might have in the trauma center business. It takes a huge investment to create a trauma center, so investors need some assurance that the government is not going to pour taxpayer dollars into some nanny-state program that reduces the supply of victims.
Bottom line: some people are making a very nice living off of human suffering. My modest proposal for Mr. Carroll is that he stop thinking of the deaths of children as a "problem" and view it as an "opportunity." Admittedly, it's a crowded field and the competition is fierce.
The author's supposed life-saving measures are really job-killing ideas. The age group he's focused on are a market - for alcohol (what demographic is featured in alcohol ads?), and for cars (many are marketed to appeal to a young demographic). Any effort to limit the manufacture and sale of guns is going to be a big job-killer, too. And, it seems perverse to make it hard to obtain drugs that kids use for suicide: why single out the owners of some firms when parents can't handle their own kids?
Some readers also took note of the opportunities investors might have in the trauma center business. It takes a huge investment to create a trauma center, so investors need some assurance that the government is not going to pour taxpayer dollars into some nanny-state program that reduces the supply of victims.
Bottom line: some people are making a very nice living off of human suffering. My modest proposal for Mr. Carroll is that he stop thinking of the deaths of children as a "problem" and view it as an "opportunity." Admittedly, it's a crowded field and the competition is fierce.
14
I know quite a few adults who loathe smokers, but think laws regarding cell phone use while driving are a joke. Many routinely text while driving. And their kids have the same beliefs--smoking is abhorrent but texting while driving is fine.
If we want to reduce risky behavior by kids, the first step is to make sure their parents aren't doing it, or think it's fine.
If we want to reduce risky behavior by kids, the first step is to make sure their parents aren't doing it, or think it's fine.
30
Exactly. Taking personal responsibility and making sure you - not the state - educate your children and hold them accountable for their behaviors.
1
NOT exactly. You took a general statement that parents should avoid risky behavior (possibly by state oversight) and turned it into a state-free personal-responsibility argument. That may be how you wanted to read it, but that's not how it was read.
Your point of view implies that kids whose parents set a risky-behavior example should not have the state or the schools set a better example, and should thus be at a greater risk of dying. Because to do otherwise would invoke a "nanny state" that tries to educated and protect people. And that's bad, why?
Your point of view implies that kids whose parents set a risky-behavior example should not have the state or the schools set a better example, and should thus be at a greater risk of dying. Because to do otherwise would invoke a "nanny state" that tries to educated and protect people. And that's bad, why?
4
Part of decreasing suicides is increasing access to mental health services for kids who are at risk. Inpatient, outpatient, and community based care is unavailable for most, and can only be accessed through tremendous efforts by family members. And, if you don't know the resources and the "magic words" that will get an admission, you and your child are out of luck. Universal coverage of children would be a step in the right direction.
8
Thank you! As a trauma surgeon it perpetually grates on me that fundraising for children is focussed on cancer and other rare childhood diseases rather than the most common killer which is injury, particularly motor vehicle collisions. What's worse, since "trauma" conjures visions of gangsters shooting each other in dark alleys, our fundraising and political awareness is further hampered since the people likely to donate money or support don't identify with it as a problem that might affect them. While we have made great strides in the treatment of traumatic injuries and the death rate is now surprisingly low, I believe that one of the biggest challenges for the trauma community in coming years will be to bring this into public awareness as a top healthcare priority, in order to secure enough funding to maintain an adequate volume of top tier (i.e. American College of Surgeons Committee on Trauma verified Level 1 and 2 centers) trauma centers to serve our population. To maintain the highest levels of clinical trauma care, quality assurance and research is very expensive, but it is money well spent - and we need people to realize that.
31
Thank you for continuing this conversation about the disconnect between what we think kills children and what really does. A couple of other disconnects to highlight 1) While injury does remain the leading killer of kids, the good news is that death rates among children and adolescents declined nearly 30 percent in the U.S. in the last decade. This is a public health success story showing that meager investments in programs and smart policies are making a difference and saving lives. 2) The United States. spends tens of billions of dollars every year to provide health insurance to children – in part to treat injuries – while last year the entire budget of the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control was only $170 million, with no funding dedicated to childhood injury prevention. Funding for state maternal and child health programs has also been cut over $90 million over the past decade, and is under further threat from sequestration. I recognize its not all about throwing money at problems, but not investing hardly any resources is like sending a kid to college, not paying the tuition and hoping she will still succeed. 3) Can you imagine what could be done if we focused just a small percent of what we spend on treatment upstream on prevention?
18
@ Brent Ewig - you present critical information that I was going to provide, cuts at the CDC and in maternal and child health programs. Those come under the heading of Public Health, and that is not much in fashion since the US is moving to "precision/personal" medicine, whatever the cost.
As an American all too familiar with the sorry statistics concerning pre, peri, post natal mortality in the USa the last thing that should be cut is state maternal and child health programs.
But as Aaron E. Carroll makes clear, health programs focused on the real killers are not anything either politicians or perhaps a big section of the public wants to support. I do not know why.
Only-neverinSweden.blogspot.com
As an American all too familiar with the sorry statistics concerning pre, peri, post natal mortality in the USa the last thing that should be cut is state maternal and child health programs.
But as Aaron E. Carroll makes clear, health programs focused on the real killers are not anything either politicians or perhaps a big section of the public wants to support. I do not know why.
Only-neverinSweden.blogspot.com
6
The article mentions young athletes that die of sudden cardiac arrest, but fails to mention that many of these have hearts which have been damaged or weakened by the stimulants like Adderall or Ritalin, over-prescribed to kids who supposedly have ADHD, the little boys who have difficulty sitting still in class, which we have turned into a medical condition, treatable with medication that has fatal side effects.
What a tragedy.
What a tragedy.
8
Provide documentation for your assertion about the drugs. The vast majority of deaths from cardiac events in young athletes is due to hereditary conditions.
Your concern for over medication and improper medication is valid. Connecting it to hereditary structural conditions degrades the credibility of that argument. You completely left out heart events due to illegal substances.
Your concern for over medication and improper medication is valid. Connecting it to hereditary structural conditions degrades the credibility of that argument. You completely left out heart events due to illegal substances.
8
Sorry, John. You want Jan to provide data to justify a conclusion? That seems unfair.
But wait, that's the point of Carroll's column.
But wait, that's the point of Carroll's column.
1
Thank you for writing this. It is a welcome change from the kind of journalism that hypes minor threats because they are spectacular stories while ignoring major threats that aren't. These stories have left the public, which doesn't have a very good sense of statistics, sadly confused about relative risk.
47
Josh good concise statement but I think that the public is rarely, if ever, given the kind of fairly straightforward information about causes of death and serious illness so even if they knew a bit of statistics they would never reach the point of thinking that way.
Straightforward information about automobile accidents as the avoidable cause of death among the young is one example. As one who has to drive in New England each summer I see all of the situations that could be changed but are not. As a New Englander you probably have a good idea what they are so I will not list.
Only-NeverInSweden.blogspot.com
Straightforward information about automobile accidents as the avoidable cause of death among the young is one example. As one who has to drive in New England each summer I see all of the situations that could be changed but are not. As a New Englander you probably have a good idea what they are so I will not list.
Only-NeverInSweden.blogspot.com
1
Why is this article claiming that there are no national movements to address the leading causes of young deaths.
Re Motor vehicle accidents:
Is the author not aware of the national campaigns against drunk driving, seatbelt enforcement, text-and-driving/distracted-driving, and all the graduated drivers license restrictions passed in most states for young drivers?
Re Homicide:
Is the author not aware of the massive tough on crime campaigns and violet criminal incarceration, stop-and-frisk, data-driven policing, etc, that has brought the murder rate in New York from over 2,000 homicides/year to 300, with the vast majority of the lives saved being those 15-25? It is happening nationwide, with a few exceptions like Detroit. Murder rates of young people are down by a factor of 2.5.
Re Suicide:
Is the author not aware of the anti-bullying, early intervention, respect for gay and alternative lifestyles, sensitivity training in schools, etc, that are all aimed at preventing alienation and suicide?
Really, can we have better research, instead of trying to force fit the "Dutch did it but we didn't" narrative?
Re Motor vehicle accidents:
Is the author not aware of the national campaigns against drunk driving, seatbelt enforcement, text-and-driving/distracted-driving, and all the graduated drivers license restrictions passed in most states for young drivers?
Re Homicide:
Is the author not aware of the massive tough on crime campaigns and violet criminal incarceration, stop-and-frisk, data-driven policing, etc, that has brought the murder rate in New York from over 2,000 homicides/year to 300, with the vast majority of the lives saved being those 15-25? It is happening nationwide, with a few exceptions like Detroit. Murder rates of young people are down by a factor of 2.5.
Re Suicide:
Is the author not aware of the anti-bullying, early intervention, respect for gay and alternative lifestyles, sensitivity training in schools, etc, that are all aimed at preventing alienation and suicide?
Really, can we have better research, instead of trying to force fit the "Dutch did it but we didn't" narrative?
8
Dannes not Duch; but you are on the right track. It is another case of the author pushing for big-government solutions; that have been shown to fail time-after-time as the only possible solutions to the nations problems. Thanks for pointing out that some Americans are working on problems without the big-government the times always pretends is the only possible solution.
This is more about wanting big-government; rather than wanting to resolve any problems we may have.
This is more about wanting big-government; rather than wanting to resolve any problems we may have.
Who is promoting these national movements? it sure isn't private industry.
5
So Tim Fahy and perhaps Baron95 I guess you would rather that all states follow New Hampshire's Live Free or Die approach that sees three-point seat belts as a nuisance.
Look at the record of auto accident deaths in relation to alcohol concentration in the blood and use of seat belts. The only way that those two factors can be effective is by regulation and implementation of the laws - plus education.
Only-NeverInSweden.blogspot.com
Sweden introduced - Two/One divided highways with great success. I have never seen anything like that in my part of the US, New England. Too bad. Government program. Saves lives.
Look at the record of auto accident deaths in relation to alcohol concentration in the blood and use of seat belts. The only way that those two factors can be effective is by regulation and implementation of the laws - plus education.
Only-NeverInSweden.blogspot.com
Sweden introduced - Two/One divided highways with great success. I have never seen anything like that in my part of the US, New England. Too bad. Government program. Saves lives.
3
Guns, access to them. This is how my suicidal brother died. Despite my desperate attempts to get my mother to remove them from her home when my brother moved in with her. She claimed the guns were separate from the bullets, he would never find them and in the end she lied to me and said she got rid of them just to get me to stop harassing her. I told her she was lying and stopped speaking with her. He was dead six weeks later.
44
I'm very sorry for the loss of your brother. I wish he'd gotten the help he needed in time, and that your mother valued his life more than her own guns. Guns are akin to a religion with some people. They believe it is their right to own them, and nothing, not even the protection of their own children, will convince them otherwise. The 16-year-old daughter of a family friend just committed suicide using her father's shotgun. She had attempted suicide several times. She was at serious risk; the house was on lockdown to keep her safe. Yet her father continued to keep a shotgun in his truck. As if she wouldn't find it; as if she wouldn't use it. She did, and now she's dead.
5
Very sorry to hear that your brother took his own life. Do you think he would not have carried through with it without access to a gun? I'm not trying to spark a debate, but I am genuinely interested in your opinion.
1
@Rae- So, in your mother's mind, if a burglar broke into the house she would have ample time to find the gun, then the bullets stored elsewhere, then load the gun, and then shoot accurately, all this while the burglar waited patiently. And yet she must derive a sense of security from having all those guns and bullets somewhere around the house. Totally irrational.
2
Comments often mention in culture, usually disguised in terms which imply, but don't state explicitly, race. But there is an inverse cultural problem which kills children, the belief that white middle class moms know what is best for their children and should not be engaged in such idiocies as believing driving their kids to school is safer than having them in a school bus (false), that there is a greater danger of their kids being kidnapped than being run over in their own driveways by their parents (false), that vaccinating their kids leads to autism (false), and that restrictions on gun possession will in the long run hurt kids more than their being blown sky high in the present (false). Not too many African Americans of any socioeconomic class buy into any of these mythologies.
23
I see you believe in race. Why not just think in terms of the relationship between various SES measures - education, income, etc and how the child gets to school. White includes poor people, rich people, big cars, small cars etc.
Any serious study of the issue you name would not be very serious if all it did was compare the way that all "whites" in America get their kids to school compared with how all "blacks" get their kids to school.
Only-NeverInSweden.blogspot.com
Any serious study of the issue you name would not be very serious if all it did was compare the way that all "whites" in America get their kids to school compared with how all "blacks" get their kids to school.
Only-NeverInSweden.blogspot.com
What Dr. Carroll doesn't tell us is that these screening tests cost considerably more here, than they do in countries like Israel or Italy.
The beauty of the "the money could be better spent elsewhere" is it can be employed regardless of whether or not the money actually will be spent elsewhere on something better. Who in this country is going to invest in motor vehicle safety programs, and how would they differ from the drivers ed we currently already have? WRT suicide, the most obvious place to start in this country is the link between gun ownership and an increased risk of suicide, but does Dr. Carroll see that going anywhere?
When Dr. Carroll talks about money being better spent elsewhere, is he referring to gov't money? Because, unlike in other countries, the gov't is not financing healthcare for middle class children. As for those whose healthcare is financed by gov't - i.e. Medicaid - I am guessing that there are even better ways to spend money on ensuring kids health. On things like asthma, nutritional counseling, good schools and providing strapped families with social support.
I am disappointed in most of Dr. Carroll's posts. He seems to focus on the margins, and avoids commenting on the most glaring deficiencies of our system.
The beauty of the "the money could be better spent elsewhere" is it can be employed regardless of whether or not the money actually will be spent elsewhere on something better. Who in this country is going to invest in motor vehicle safety programs, and how would they differ from the drivers ed we currently already have? WRT suicide, the most obvious place to start in this country is the link between gun ownership and an increased risk of suicide, but does Dr. Carroll see that going anywhere?
When Dr. Carroll talks about money being better spent elsewhere, is he referring to gov't money? Because, unlike in other countries, the gov't is not financing healthcare for middle class children. As for those whose healthcare is financed by gov't - i.e. Medicaid - I am guessing that there are even better ways to spend money on ensuring kids health. On things like asthma, nutritional counseling, good schools and providing strapped families with social support.
I am disappointed in most of Dr. Carroll's posts. He seems to focus on the margins, and avoids commenting on the most glaring deficiencies of our system.
2
I think Dr. Carroll presents the simple facts so that people can grasp them.
Unfortunately, these simple facts are not grasped by the people who make policy. I believe that the Republicans oppose the CDC supporting research on death by gunshot.
So a simple question to you: Do you support the introduction of Universal Health Care in the United States, the only so-called advanced country that does not have UHC?
Your remarks about the subset of children who get health care thanks to Medicaid suggest to me - just suggest - that maybe you think that the poor should not get health care unless they can pay for it.
Your reply?
Only-NeverInSweden.blogspot.com
Unfortunately, these simple facts are not grasped by the people who make policy. I believe that the Republicans oppose the CDC supporting research on death by gunshot.
So a simple question to you: Do you support the introduction of Universal Health Care in the United States, the only so-called advanced country that does not have UHC?
Your remarks about the subset of children who get health care thanks to Medicaid suggest to me - just suggest - that maybe you think that the poor should not get health care unless they can pay for it.
Your reply?
Only-NeverInSweden.blogspot.com
2
Larry, as far as I'm concerned, the simple facts are that physicians and health care economists failed us when it came to advocating for the patient in the ACA. Stupid economic theories took the place of common sense, which tells us that in a well functioning free market, you get what you pay for, and that healthcare that is rationed by ability to pay is not going to serve the needs of the population. The "skin in the game" baloney is simply a mechanism to stick more of the costs onto sick people. The idea that people can predict what insurance is "best for them" is a farce, as is the idea that they are the best people to decide what treatments are or aren't necessary. I cannot imagine any possible benefit of narrow networks for a patient, and fail to understand why, some doctors should be willing to accept lower rates of reimbursement and not others. The fact is that hospitals cannot possibly begin to keep track of which doctors can see which patients, the result of which is that patients in narrow networks are increasingly getting stuck with more out of pocket costs.
The problem with the argument that "the money can be spent better elsewhere" is that it is applied selectively and randomly. Consider this sentence from Jane Brody's column today.
"At 88 and in need of full-time care after 10 years with Alzheimer’s disease, she developed acute kidney failure. Her doctor suggested dialysis."
And apparently only an advanced directive stood in the way of this treatment.
The problem with the argument that "the money can be spent better elsewhere" is that it is applied selectively and randomly. Consider this sentence from Jane Brody's column today.
"At 88 and in need of full-time care after 10 years with Alzheimer’s disease, she developed acute kidney failure. Her doctor suggested dialysis."
And apparently only an advanced directive stood in the way of this treatment.
These are forbidden thoughts in Washington, because they sound like the "rationing" of health care and "death panels". We want everything totally safe, 100%; if not, then someone else is at fault and owes us millions. We want to do everything but have no risk doing anything. We will soon have mandatory heart defibrillator equipment in each car to prevent fatal heart attacks while we drive; we will build the pads into the seat belts. Money is no object, since it is never the money of those deciding how to pretend to protect us, 100%, no expense spared, how dare you put money ahead of safety, blah blah, blah blah.
6
I agree with the sentiment of your comment, but I would like to correct what I perceive as a misstatement. Availability of defibrillators in public places has been a true success in saving lives at a (relatively) low cost. This program has saved many lives and probably saved us hundreds of millions of dollars.
I remember a magazine article some years back about what people fear and what really kills us.
There was a graphic of a pyramid ("What Kills") and at the bottom, as you'd expect, were the great killers of Americans (cancer, heart disease, diabetes, smoking-related illnesses and car accidents).
As the pyramid narrowed, towards the top, were all the things that we obsess about dying from (terrorist attack, plain crash, struck by lightning, shark attack, spider bite, etc.).
Of course, not only are dying from these things extremely unlikely, they are usually not preventable. If you're going to die in a plain crash, there's not much you can do about it.
However, the real killers, the things we are most likely to die from, are the things that we have the MOST control over. Want to live a long life? Don't smoke, eat well, exercise, don't drink to excess, wear your seatbelt, don't drive under the influence, etc.
People are busy worrying about dying in a terrorist attack or by being bit by a rattlesnake when they really need to be worrying about their waistlines and their lifestyles.
There was a graphic of a pyramid ("What Kills") and at the bottom, as you'd expect, were the great killers of Americans (cancer, heart disease, diabetes, smoking-related illnesses and car accidents).
As the pyramid narrowed, towards the top, were all the things that we obsess about dying from (terrorist attack, plain crash, struck by lightning, shark attack, spider bite, etc.).
Of course, not only are dying from these things extremely unlikely, they are usually not preventable. If you're going to die in a plain crash, there's not much you can do about it.
However, the real killers, the things we are most likely to die from, are the things that we have the MOST control over. Want to live a long life? Don't smoke, eat well, exercise, don't drink to excess, wear your seatbelt, don't drive under the influence, etc.
People are busy worrying about dying in a terrorist attack or by being bit by a rattlesnake when they really need to be worrying about their waistlines and their lifestyles.
36
Americans care more about their guns than they do about their childrens' lives. Period.
64
Gun-related deaths? 30K per annum, anno in, anno out. Deaths/woundings? 100+K p.a. Ditto above. Now that's a real-time, big worry for some, but not for our politicians apparently.
4
Nonsense. Please don't pretend to speak for all Americans. As if the right to bear arms and the love of our children are mutually exclusive.
From all the publicity it gets, I would have thought that kidnapping and murder of children by strangers would be the number one cause of death. Where I live, a bike path is being routed well away from a YMCA because of "security" concerns. Seriously?
32
"In 2010, the No. 1 killer of people ages 15 to 24 in the United States was accidents. Car accidents alone accounted for more deaths than any other category."
great reporting by the NYT. it's good to get a dose of reality on occasion. always wear your seat belt, don't drink and drive, don't text and drive, don't even talk and drive. sound simple? then do it, and hope that others will too.
remember ebola virus? i don't. do you know of someone killed in a car accident? i do.
great reporting by the NYT. it's good to get a dose of reality on occasion. always wear your seat belt, don't drink and drive, don't text and drive, don't even talk and drive. sound simple? then do it, and hope that others will too.
remember ebola virus? i don't. do you know of someone killed in a car accident? i do.
21
"There is a limited amount of time and money in the world."
I work in a stroke unit in a large metropolitan hospital and every week we meet stroke survivors who did NOT go to the emergency room at the first notice of stroke-like symptoms, even though those first few hours are crucial for possible decrease in stroke severity, mortality and recovery. Most people are unaware that there is medication that can decrease the consequences of a serious stroke, if applied in the first few hours.
Growing up in the 60s, I remember frequent public service announcements on safety topics such as what to do in case of fire, tornadoes, heart attack etc. Apparently, the decision-makers of our society find it more important to sell tooth paste than to educate people to make wise, health-related decisions.
Keep in mind, the public service ads ran at a time when a one hour TV show had only 10 minutes of advertising - now it is double that. So not only is corporate America getting more far opportunity to show their commercials, they are no longer willing to allow the airing of info that would benefit society.
I work in a stroke unit in a large metropolitan hospital and every week we meet stroke survivors who did NOT go to the emergency room at the first notice of stroke-like symptoms, even though those first few hours are crucial for possible decrease in stroke severity, mortality and recovery. Most people are unaware that there is medication that can decrease the consequences of a serious stroke, if applied in the first few hours.
Growing up in the 60s, I remember frequent public service announcements on safety topics such as what to do in case of fire, tornadoes, heart attack etc. Apparently, the decision-makers of our society find it more important to sell tooth paste than to educate people to make wise, health-related decisions.
Keep in mind, the public service ads ran at a time when a one hour TV show had only 10 minutes of advertising - now it is double that. So not only is corporate America getting more far opportunity to show their commercials, they are no longer willing to allow the airing of info that would benefit society.
43
Urizen, haven't you heard, the experts have concluded that Americans consume too much "unecessary" healthcare? For this reason, they are actively encouraging high deductibles and co-pays, precisely to discourage people from going to the doctor for every little ache and pain. As it is, ER doctors complain about all the whiners who present to them with "the worst headache of their lives", the overwhelming majority of which turn out to be nothing. Who do you expect to bear the costs of all those "unnecessary" tests? Healthy people?
Having PSAs encouraging people to seek care would go against everything our experts are currently trying to achieve.
Having PSAs encouraging people to seek care would go against everything our experts are currently trying to achieve.
1
Actually, there was a public health media campaign several years ago to tell people that "Stroke is an emergency." It's still out there. Search Google.
One of their sponsors was Genentech, when TPA first came out, so they had more money than God. (It's not clear how effective TPA is, it may not be more effective than God, so
remember Pascal's wager.)
I noticed back then that most of the people in the age when stroke starts to get common (cigarette smokers over 50) already knew about stroke.
Public service messages aren't that effective anyway. Do a Google search for
Robertson, L.S.; Kelley, A.B.; O’Neill, B.; Wixom, C.W.; Eiswirth, R.S.; and Haddon, W. Jr. 1974. A controlled study of the effect of television messages on safety belt use. American Journal of Public Health 64(11):1071-1080.
One of their sponsors was Genentech, when TPA first came out, so they had more money than God. (It's not clear how effective TPA is, it may not be more effective than God, so
remember Pascal's wager.)
I noticed back then that most of the people in the age when stroke starts to get common (cigarette smokers over 50) already knew about stroke.
Public service messages aren't that effective anyway. Do a Google search for
Robertson, L.S.; Kelley, A.B.; O’Neill, B.; Wixom, C.W.; Eiswirth, R.S.; and Haddon, W. Jr. 1974. A controlled study of the effect of television messages on safety belt use. American Journal of Public Health 64(11):1071-1080.
Thank you Dr. Carroll.
As an old pediatric intensivist, I cared for too many children to count that were involved in MVAs. I remain terrified of cars in the sense of knowing what their irresponsible use (or bad luck I suppose) can do to little bodies. I have noticed that the technology exists ,and is being slowly released, for cars to recognize people or obstacles in their path and shut off power to the engine. Maybe we can get together to mandate such technology in future auto releases? Every time somebody late for work flies by some children walking to school I find myself feeling so angry, I am weary of it! I am weary of worrying about that potential catastrophe for another family.
As an old pediatric intensivist, I cared for too many children to count that were involved in MVAs. I remain terrified of cars in the sense of knowing what their irresponsible use (or bad luck I suppose) can do to little bodies. I have noticed that the technology exists ,and is being slowly released, for cars to recognize people or obstacles in their path and shut off power to the engine. Maybe we can get together to mandate such technology in future auto releases? Every time somebody late for work flies by some children walking to school I find myself feeling so angry, I am weary of it! I am weary of worrying about that potential catastrophe for another family.
33
I'm too concerned with measles, ebola, and the flu among teens to have time with your issues.
2
How can the writer present the graphic and not discuss the spike in Danish suicides around 2002? It sticks out like a sore thumb.
5
Eyeballing the data, it would seem that the rise in 2002 is a >1 standard-deviation event but not >2. Given that the population in this age group is between 200 and 300 thousand, not withstanding the tendency of suicide deaths to cluster, the spike is not outside of random variation. Note to UPSHOT: I assume the drop is significant, but a bit of analysis, given the small sample size, (what is R^2?), would be appreciated.
3
It looks like it sticks out, but you need to be careful about interpreting the spike. I did go ahead and search to see if there were any articles about a sudden increase in Denmark's suicide rate, but didn't find anything about a spike.
The most likely reason you see that spike is because the entire population of Denmark is only 5.6 million. The U.S. is 316 million. The sample space in Denmark is too small, so you have some volatility (noise) in the data. That's why it looks so jagged. Notice how the U.S. is much smoother? That indicates that the sample space is large enough to be reliably read in greater detail.
The main thing to notice in the graph is what it was designed to show: Denmark has made dramatic improvements over the past 30 years, whereas the U.S. has made little.
The most likely reason you see that spike is because the entire population of Denmark is only 5.6 million. The U.S. is 316 million. The sample space in Denmark is too small, so you have some volatility (noise) in the data. That's why it looks so jagged. Notice how the U.S. is much smoother? That indicates that the sample space is large enough to be reliably read in greater detail.
The main thing to notice in the graph is what it was designed to show: Denmark has made dramatic improvements over the past 30 years, whereas the U.S. has made little.
5
Denmark only has 5.6 million people, 13.1% between ages 15 and 24. So we're talking about 735,000 people in the age cohort.
The US age 15-24 cohort is about 45 million -- over 60 times larger.
At 7 sucides per 100,000 in Denmark -- we're talking about 51 annual suicides. At 12 per 100k, the number is 87 -- an increase of 36.
So the rule of small numbers applies and the Danish data will generally be more volatile from year to year.
The US age 15-24 cohort is about 45 million -- over 60 times larger.
At 7 sucides per 100,000 in Denmark -- we're talking about 51 annual suicides. At 12 per 100k, the number is 87 -- an increase of 36.
So the rule of small numbers applies and the Danish data will generally be more volatile from year to year.
5
Now we should be vigilant and not add a fourth cause to the list- measles, mumps,rubella, polio- all due to some foolhardy skeptical parents.
12
I often hear amazing near miss stories in my Pediatric First Aid classes and sometimes, I hear very sad stories. I think it is good idea for any new parent to take a Red Cross or AHA Pediatric First Aid and CPR class. These classes have large section on prevention which includes thing like car accidents and drowning.
http://sanmateocprcertificationclasses.com/
http://sanmateocprcertificationclasses.com/
8
Wouldn't it be nice if the government could solve all of our problems? Remember the "Just Say No" campaign? The drug problem in the U.S. is only getting worse. Not all suicides are alcohol/drug related. However, let's not pretend that the high rate of suicide in 15-24 year-old's is unrelated to drugs and alcohol. Even if the victim isn't a user, perhaps he/she is being bullied by one. A lot of fatal car crashes involve alcohol in the same age group. The designated driver program has made a difference, and it isn't a government program. People know that drugs are illegal, they know not to drink and drive, they know about suicide prevention hotlines. More money being thrown at programs isn't the answer. People taking responsibility for their own choices and understanding the consequences of their behavior might work. There's also no substitute for a good example. It doesn't matter how many public service announcements a kid sees on t.v. about the dangers of drugs, if mom and dad are sitting on the couch shooting up.
6
If it worked for Denmark, why wouldn't it work here? Maybe it's an example of a government helping to educate people about the consequences of their behavior, and not just through public service announcements.
8
We made a giant difference in this country in reducing the amount of smoking. That reduced the smoking-related illnesses, including lung cancer concommittantly. A bunch of the money spent was by the government. And a bunch more was government mandated that the tobacco companies spend.
You may think that's givt interfering with the free market, but I cast my vote for less cancer.
And can you guess how tiny the percentage of 15-24 year olds who are in MVAs have parents who are shooting up? I'm not saying it's a non-issue but I don't think it's significant in traffic deaths/injuries in young drivers.
You may think that's givt interfering with the free market, but I cast my vote for less cancer.
And can you guess how tiny the percentage of 15-24 year olds who are in MVAs have parents who are shooting up? I'm not saying it's a non-issue but I don't think it's significant in traffic deaths/injuries in young drivers.
14
It's hard to change human behavior. However, some programs work fairly well. Others don't. Even in the 1980s, there was significant evidence "Just Say No" wasn't going to work. But it neatly fit the worldview of the politicians who funded it.
11
"I can’t think of any national politicians who are proposing new ideas to reduce motor vehicle fatalities..." I am going to argue that NYC Mayor is a national political possession for all reasonable intents, and thank Mayor De Blasio for this early and firm focus on auto safety.
19
Yes, but children belong to their parents! So, if Mommy and Daddy don't want their child to receive counseling, even if it's needed, the child will not receive it. I know because I lived through this scenario as a young teen. My parents abused me. I was suicidal. I turned to a guidance counselor in my high school. When he left he recommended the school psychologist. However, because I was underage, my parents had the final say. Since they didn't want me to talk to anyone the school couldn't allow anyone to see me on an official basis.
It was legal for my parents to refuse treatment for me. It was fine for them to abuse me. If I'd reported it or if anyone else did, because we were a middle class family the report would have been disregarded. What I learned was that my extreme distress was less important than my parents right to refuse me treatment. I also learned that cutting myself was more acceptable than getting help. There has to be some point where the parents right to endanger a child doesn't outweigh the child's need for help. Children are not appendages of their parents and should not be treated as such. We get one childhood and when it's messed up the results echo far into the future. I can say that because I'm 56 years old and the effects do not disappear. I've learned how to cover it up.
It was legal for my parents to refuse treatment for me. It was fine for them to abuse me. If I'd reported it or if anyone else did, because we were a middle class family the report would have been disregarded. What I learned was that my extreme distress was less important than my parents right to refuse me treatment. I also learned that cutting myself was more acceptable than getting help. There has to be some point where the parents right to endanger a child doesn't outweigh the child's need for help. Children are not appendages of their parents and should not be treated as such. We get one childhood and when it's messed up the results echo far into the future. I can say that because I'm 56 years old and the effects do not disappear. I've learned how to cover it up.
62
I guess you can only do your best and carry on. Good luck !
3
I'm sorry this happened to you. It's possible that therapy could still help you deal with some of the lasting effects. You have many years ahead of you still and you deserve to feel good.
11
I'm very sorry to hear you suffered and glad you made it to be an adult with empathy. If you had reported it and it hadn't been disregarded it hard to say what the result would have been unless you had somewhere to go ... at least you got to talk to someone unofficially. I hope you got other unofficial help.
3
When kids in the US die due to death by gunfire, one group's automatic answer is "MORE GUNS, MORE GUNS, ARM THE TODDLERS!!!!!"
47
Thank you for your conscientiously hyperbolic pretense.
I am wondering about the prevalence of texting while driving. This must be a major contributor to car deaths of young people. The auto industry can make cars with the ability to monitor cell phone types of use and shut off texting.
34
texting while driving probably kills more people who get hit by the people texting. those texting probably have a higher survival rate than we think.
10
The author's premise that effort to reduce mortality among the young is a I zero sum game -- attending to one cause of mortality will limit attending funding for others -- is simply not true. There are numerous ways to increase funding to combat disease, as well as preventable accidental death (including sports deaths), suicide, and homicide. To begin with, we spend more on the military than all other countries in the world combined. Let other countries bear their own defense burden; close more bases, re-examine military perks. We'll have plenty more to spend to address our children's health.
7
Forget about the other countries. There is an article elsewhere in this publication which discusses in detail military bases in the U.S. that could easily be closed, yet, because of the local politicians and lobbyists, for no apparent reason, they remain open. Deal with that then you will have plenty of money to deal with these issues.
7
"Our countries differ greatly with respect to race, socio-economic status,"
I am shocked that made it into the NYT.
Is the author suggesting that there is a correlation between cultures and homicide or unsafe driving. The inference being that Denmark's pasty white middle class culture has an effect on their society's ability to address child safety issues in contrast to the US's mixed racial and economic culture. Is the inference that if all of the US was pasty white middle class as well that the numbers would be different?
Is there a hint of a suggestion that societal issues must take in account different cultural norms that sometimes tend to organize around race (as a common historical background) and the often intertwined socioeconomic based common backgrounds? Not as a bad thing or good thing but simply an acknowledgment that common socioeconomic culture and historical tradition can have an effect on many of life's issues and is often the most direct and critical variable in addressing society problems.
Appalling! I thought that in the year 2015 we were past the stage of having real life conversations.
I am shocked that made it into the NYT.
Is the author suggesting that there is a correlation between cultures and homicide or unsafe driving. The inference being that Denmark's pasty white middle class culture has an effect on their society's ability to address child safety issues in contrast to the US's mixed racial and economic culture. Is the inference that if all of the US was pasty white middle class as well that the numbers would be different?
Is there a hint of a suggestion that societal issues must take in account different cultural norms that sometimes tend to organize around race (as a common historical background) and the often intertwined socioeconomic based common backgrounds? Not as a bad thing or good thing but simply an acknowledgment that common socioeconomic culture and historical tradition can have an effect on many of life's issues and is often the most direct and critical variable in addressing society problems.
Appalling! I thought that in the year 2015 we were past the stage of having real life conversations.
11
No, the inference you deduce is wrong. It is well-known that socio-demographic variables are confounders when comparing events in different countries. The author is adding a standard disclaimer that unseen (unmeasured variables) might exist to explain differences. He is adding it to a paragraph that ends in speculation as to whether such a program would be successful in the US.
One socio-demographic feature that could make a huge difference is the American insistence that personal liberty triumphs over social responsibility at all times. That alone, could make a program in the US much less successful than in Denmark.
One socio-demographic feature that could make a huge difference is the American insistence that personal liberty triumphs over social responsibility at all times. That alone, could make a program in the US much less successful than in Denmark.
35
Denmark's culture is more mixed than you think. Somalis, Turks, Faroese, for example.
9
He says the word "race" -it's there. Socio-demographic is a nicer way of putting it. At some point we will do the blacks in our community a favor and acknowledge that black youth are being slaughtered in ridiculous numbers by other black youths. After the obligatory self-flagellation of blaming white demographics for guns, economic and societal racism, which is true, maybe at that point we can also have an honest none judgmental conversation about societal factors such as family and cultural values and the effect that has on black youth safety and what we can do if anything to encourage improvement from a community and family standpoint, or if we can't do anything at least acknowledge that as well.
And yes I believe historical family structure, tradition, values, and culture affects every culture in our society for both good and bad but why can't talk about it openly of so many are dying.
And yes I believe historical family structure, tradition, values, and culture affects every culture in our society for both good and bad but why can't talk about it openly of so many are dying.
5
It's all about "the children" or "right to life"...
But, lip service and hypocrisy are the real number one priority.
But, lip service and hypocrisy are the real number one priority.
7
How dare those Danish people think and pursue real help for the young! I cannot imagine even a discussion in our country. Thanks to Denmark for showing the way! Your youth are blessed by your care.
18
I think it shows a socioeconomic bias to prioritize auto accidents ahead of homicide as the number one public health threat in the 15-24 yr-old age group. We should be spending our money where it can make a huge difference--reducing homicide in lower socioeconomic.
According to CDC data:
---For males aged 15-24, blacks are victims of homicide at a per capita rate of 17 to 1 compared to non-hispanic whites.
If young black males were 17 more times likely to die from a specific disease than young white males, it would be considered a public health disaster.
source: Center for Disease Control: "Health, United States, 2013"; Table 34, p. 2 of 4 (scroll down to view non-Hispanic white category). The rates per 100K for the two cohorts are 71 and 4.1 respectively (17.3 to 1)
http://www.cdc.gov/nchs/data/hus/2013/034.pdf
According to CDC data:
---For males aged 15-24, blacks are victims of homicide at a per capita rate of 17 to 1 compared to non-hispanic whites.
If young black males were 17 more times likely to die from a specific disease than young white males, it would be considered a public health disaster.
source: Center for Disease Control: "Health, United States, 2013"; Table 34, p. 2 of 4 (scroll down to view non-Hispanic white category). The rates per 100K for the two cohorts are 71 and 4.1 respectively (17.3 to 1)
http://www.cdc.gov/nchs/data/hus/2013/034.pdf
11
Surely a divine Providence hovered over this paper today in order to give me a chance to expound on another huge threat to our children's lives: childhood obesity. Just last night at dinner, one of the guests included an 11-year old boy whose table manners were as repulsive as his appearance. He ate with unwashed fingers from plates and bowls, devoured an entire sauceboat of velouté that was to have been used for all seven dinners, spilled his drinks three times making a massive mess. All of this could be, and has actually been, forgiven. But this kid is 150 pounds overweight--that's ten stone--at the ripe old age of 11. His 15-year old sister is already into insulin-resistant diabetes, his dad weighs close to 400 pounds...there is no hope for longevity for such a boy, nor for a future free of injections while he lives. Parents need to instill proper eating habits and self-control in their children before they are considered an accessory to the crime of making them food-obsessive and obese.
17
A noble idea, however, the problem is (and it is a LARGE one)these kids spend much of their spare time sitting in front of the television and who is probably the Number One advertiser on the tube? You guessed it, the food industry. When people, in general, are bombarded constantly with these ads(especially fast food)I would imagine it is extremely difficult to break poor eating habits, especially among the parents who choose, even themselves, to ignore proper nutrition for convenience.
5
Obesity prevention and treatment is often hampered by attitudes towards the obese like your own. When people know that others find them "repulsive" they are unlikely to find reason to change.
Obesity has many causes including easy availability of high sugar/fat foods that cause cravings and addictive behaviors, use of food to medicate depression and anxiety, genetic tendency towards overweight, lack of kitchen skills and/or availability of fresh foods. To name just a few.
Treating the obese as "repulsive" puts an added burden of scorn and shame onto people with a medical problem. Not a good start.
Obesity has many causes including easy availability of high sugar/fat foods that cause cravings and addictive behaviors, use of food to medicate depression and anxiety, genetic tendency towards overweight, lack of kitchen skills and/or availability of fresh foods. To name just a few.
Treating the obese as "repulsive" puts an added burden of scorn and shame onto people with a medical problem. Not a good start.
7
@KarenHealy, my spouse is moving down the scale from 350# to her current 190#, so no, sorry to disappoint you, I am not anti-obese person nor am I particularly repelled by the obese. I am anti-obesity for its health impacts. Repulsive table manners in anyone are just that and I refuse to bow to Political Correctness and mealy-mouthed nicety just because you or someone else may be offended at my signifying a breach of courtesy.
5
For both homicide and suicide, national mortality figures show that guns account for a disproportionate share of the deaths, a trend that has been deepening for nearly four decades. If the US teen homicide graphs were decomposed into gun and non-gun deaths, the U.S. trends would much like Denmark's. Guns are not easily replaced as a method of suicide, so removing the gun means avoiding the death. The same is true for non-gun homicide deaths among teenagers. We needn't look to Scandinavian countries for comparisons to bring this point home - our Canadian neighbors have low non-gun suicide and homicide deaths among their teens This conversation is attenuated, to say the least, by avoiding the elephant in the room, even if the minority that opposes sensible gun regulations gets angry. Would they prefer that our children continue to die?
110
Yes, they would.
20
Clearly AND sadly, incidents like "Sandy Hook" and similar ones that went before and after them showed, that ultimately, these children were looked upon by the elephant as just "collateral damage".
20
And don't forget the number of accidental gun deaths in children. Controlling the guns would affect each of the top 3 causes of death.
6
One needn't look beyond the pictures of missing kids on milk cartons to see that our response to risk is generally irrational. Giving a goal a higher priority demands a dramatic and compelling story, not statistics, which can generally be readily manufactured in support of the story. Those with good statistics who lack a good story generally lost. That's what's happened here.
4
I gather the United States works hard to avoid addressing the proportion of children growing up in poverty (very, very high compared to countries we think are privileged like us and even high compared to those counties we don't think are privileged at all like us). That bipartisan priority may explain quite a bit.
27
If Newtown, CT or Virginia Tech were not dramatic or compelling enough a story to make us do something about how guns contribute to the ‘excess mortality’ of children and young adults then there is no such story. If the massacre of a classroom full of first-graders isn’t a watershed event then I don’t know what is.
75
Aaron Caroll is a pediatrician, not a communications director.
The first step is to establish the facts, which we don't do often in our political debate. Then we look for effective solutions.
Among accidents, the main killer of children is automobile accidents. The most effective way to reduce child auto fatalities is with child carriers, and then with seat belts and air bags for older children.
I've reviewed the public health literature. Unless they've come up with something new recently, it's almost impossible to get people to change their safe driving behavior with communications messages. TV spots, women with a beautiful face scarred in a windshield, fathers whose sons are crippled from auto accidents because they didn't wear seat belts -- they've tried it. Didn't work. One of the classic studies was in AJPH by Haddon, if you want to look it up online.
Good stories don't work.
It's a basic engineering principle (Murphy's law) that you can't depend on human intervention. You have to change the machine.
Seat belt laws probably helped.
The first step is to establish the facts, which we don't do often in our political debate. Then we look for effective solutions.
Among accidents, the main killer of children is automobile accidents. The most effective way to reduce child auto fatalities is with child carriers, and then with seat belts and air bags for older children.
I've reviewed the public health literature. Unless they've come up with something new recently, it's almost impossible to get people to change their safe driving behavior with communications messages. TV spots, women with a beautiful face scarred in a windshield, fathers whose sons are crippled from auto accidents because they didn't wear seat belts -- they've tried it. Didn't work. One of the classic studies was in AJPH by Haddon, if you want to look it up online.
Good stories don't work.
It's a basic engineering principle (Murphy's law) that you can't depend on human intervention. You have to change the machine.
Seat belt laws probably helped.
"I can't think of any national politicians who are proposing new ideas to reduce motor vehicle fatalities for people in their teens and 20s."
I suppose it depends on what you mean by "national politician" and what you mean by "new ideas," but anyone pushing for better mass transit and reduced pedestrian fatalities (such as Mayor Bill de Blasio of New York City) is addressing these issues head-on. And states that are permitting experimentation with driverless cars may be leading the way into a future where accidents are greatly reduced and drunk driving is a thing of the past.
I suppose it depends on what you mean by "national politician" and what you mean by "new ideas," but anyone pushing for better mass transit and reduced pedestrian fatalities (such as Mayor Bill de Blasio of New York City) is addressing these issues head-on. And states that are permitting experimentation with driverless cars may be leading the way into a future where accidents are greatly reduced and drunk driving is a thing of the past.
25
Lofty thinking, but how is any of this going to affect non-pedestrian accidents (the vast, vast majority of driving accidents) in the next 40 years?
@T - In NYC a much larger proportion of vehicle accidents victims are pedestrians than is the case elsewhere because we walk a lot, including to and from our public transportation. Hopefully this is one of the energy conservation/climate change control measures where the rest of the US will be catching up to us in the next 40 years.
4
I don't think the truth of the commercial was the thing that 'shocked' so many people. Nationwide is an insurance company. Buying insurance on your child will not prevent any of these things from happening. That is the disconnect.
25
Is the insurance angle perhaps that when accidents happen and there are medical expenses and/or someone who is found to have caused the accident has liability insurance, the insurer is going to pay out.
That said, I think the intended message was, "We care about your kids so you should think of us nicely."
That said, I think the intended message was, "We care about your kids so you should think of us nicely."
4
For what it's worth, I agree with Carol. I think the criticisms that have been levied at Nationwide on the basis that it was trying to peddle insurance to cover such accidents (which would undoubtedly be a repellant proposition) are misplaced. To me, it seemed clear enough that they've created this PSA-like campaign to raise awareness about something that IS a serious -- and overlooked -- fact of life. The risk of preventable childhood accidents can sometimes be overlooked in favor of other higher-profile, but lower-incidence, risks, as this essay points out.
I'm in full agreement that the Nationwide commercial itself could have been framed in a far less jarring way, but I think the goal was to raise awareness and, as Carol points out, build the company's reputation in the community. I found raising awareness through such a campaign to be a respectable goal.
I'm in full agreement that the Nationwide commercial itself could have been framed in a far less jarring way, but I think the goal was to raise awareness and, as Carol points out, build the company's reputation in the community. I found raising awareness through such a campaign to be a respectable goal.
5
Richard Vanderbilt in TRAFFIC pointed out more children are run over by their own parents who insist despite overwhelming evidence to the contrary the kids are safer in the parents' car than in a school bus than are kidnapped by strangers, actually the total run over and killed by parents in the driveway are higher than all kidnappings, 90% of which are from relatives.
2
I agree with the article but would point to much research that shows the relationship between mortality rates of young people and socio economic status. Money matters.
11
Correlations are fine, but not to be confused with cause-and-effect. Poverty does not CAUSE accidents, homicides, or suicides. Yet behaviors that lead to these could be modified if there were ready access to good mentoring, counseling, and vocational guidance. So while having money may matter, how we choose to spend resources within society also matters. Perhaps an expanded companion article about strategies that have been shown to help might serve as a guideline for thoughtful planning for the future.
8
While there is clearly a need to address these categories of children's deaths analytically, I have little confidence that our leaders will follow the numbers and do the right thing.