I had one of those itches that only numbers can scratch, so I looked up some numbers. Now, I’m no statistician. I’m scientifically literate enough to know my limitations. Even so, when I look at these numbers, a pattern starts to emerge. Let’s see if you see the same things I do. Should anyone have the math and stats chops I lack and care to educate me as to any error, please drop me a line. I’d love to add your comments as an update to this post.
The following data are from the National MCH Center for Child Death Review website. To start with, I have no idea who these folks are, so let’s find out, shall we? Naturally, I searched for them on Google. Other than returning their website as the #1 result, the rest of the results are from sources that would at least indicate widespread official recognition. Strangely, Wikipedia has no articles on them. I generally find Wikipedia to be a great stopping point for the background on a huge range of organizations, so that’s disappointing. Wikipedia is a great starting point for vetting sources as it provides a wealth of material for fact-checking as well as a chance to detect inherent biases and tendencies to agenda setting.
Maybe I should at least look up their key staff to see if there’s anything to indicate strongly held positions on any particular issues. The About page gives us Theresa M. Covington, MPH, Director and Linda Potter, Policy Director. Neither rings a bell. Back to Google. Good luck finding anything useful on Linda Potter. No offense, Linda, you’re a little generic on the name front.
As for Dr. Covington, no early links to appearances in the news, so quiet on the media front, it seems. The requisite types of links one expects to find for any garden variety professional and private person. Evidence that web phone and data directories must pay dearly to just about dominate the results when searching on private individuals at a cursory level. And possibly that she may be unhappy with her birdcage and likes to watch movies, if those results are indeed for the one we’re looking for. In short, nothing to trigger my Spidey sense.
I checked one article of hers, as found through pubfacts.com which led me to Injury Prevention, an international peer-reviewed journal (about which I know nothing, but that sounds like a solid source). No, really. I couldn’t find anything bad about them either (other than the usual caveats that ought to apply when dealing with the sorts of credibility challenges peer-reviewed journals face) unless they’re a front group for that notorious British Medical Association.
Editor’s note: that’s not a serious insinuation, by the way. If the AMA comes up, all bets are off.
What I learned before I decided I didn’t want to spend $30 for one day of access to a paper was that she’s in the field of public health, and seems to specialize in issues surrounding child death with a keen interest in prevention. In a paper she co-authored, Injury prevention in child death review, we find this statement:
Faced with a child death, communities are predictably interested in understanding what happened, especially for violent deaths of young children. Communities demand the assignment of an accurate cause and manner, with any evidence of intentional injury or criminal neglect addressed by law enforcement. This is the first level of death review: ensuring justice for child victims and safeguarding their survivors.
The formal, multidisciplinary process of child death review (CDR) was developed in the USA in the late 1970s as a direct response to this most basic task.1 Communities became concerned that cases of inflicted injury and child homicide were being overlooked or misclassified.
Pretty laudable, I’d say. The only way I can imagine politicizing this would be for us to break down into two camps, one that says child death is a private matter and none of society’s damned business, and another that says it is absolutely society’s damned business. If that’s the case, I’m in the latter camp. I want to know why it happened, if it could have been prevented, whether there should be consequences, and if preventable, if there are any reasonable steps that can be taken. I’d want to make the most effective difference I could, most efficiently, while mitigating any risks associated with the preventive steps taken.
In another paper she co-authored, Assessment of caregiver responsibility in unintentional child injury deaths: challenges for injury prevention, we find the following abstract:
Most unintentional injury deaths among young children result from inadequate supervision or failure by caregivers to protect the child from potential hazards. Determining whether inadequate supervision or failure to protect could be classified as child neglect is a component of child death review (CDR) in most states. However, establishing that an unintentional injury death was neglect related can be challenging as differing definitions, lack of standards regarding supervision, and changing norms make consensus difficult. The purpose of this study was to assess CDR team members’ categorisation of the extent to which unintentional injury deaths were neglect related. CDR team members were surveyed and asked to classify 20 vignettes-presented in 10 pairs-that described the circumstances of unintentional injury deaths among children. Vignette pairs differed by an attribute that might affect classification, such as poverty or intent. Categories for classifying vignettes were: (1) caregiver not responsible/not neglect related; (2) some caregiver responsibility/somewhat neglect related; (3) caregiver responsible /definitely neglect related. CDR team members from five states (287) completed surveys. Respondents assigned the child’s caregiver at least some responsibility for the death in 18 vignettes (90%). A majority of respondents classified the caregiver as definitely responsible for the child’s death in eight vignettes (40%). This study documents attributes that influence CDR team members’ decisions when assessing caregiver responsibility in unintentional injury deaths, including supervision, intent, failure to use safety devices, and a pattern of previous neglectful behaviour. The findings offer insight for incorporating injury prevention into CDR more effectively.
I can’t speak to the quality of the methodology or the soundness of the conclusions, but it all sounds nice and statistic-ky to me. Without access to the rest of the article (and lacking the analytic acumen to judge the whole anyway), I’m just going to come out with two take-aways. 1) It appeals to my gut sense that parents need to be held accountable. 2) This is science aimed at effecting policy change, but I’m still not detecting a particular agenda.
Ah, but what about other information located directly on the National MCH website? With a little digging, I found their page on preventing child deaths, with a subheading, way down, Effective Prevention Strategies by Type of Death with links to several types, including accidental firearm and homicide – firearm. A-hah! The jig is up! We knew if we dug deep enough, under layer after layer of legitimacy and facts and far broader issues we’d find the secret agenda! </Alex Jones riff>
When I click through to the Accidental Firearm page, I find this under major risk factors:
- Easy availability of and access to firearms.
- Youth living in neighborhoods with high rates of poverty, social isolation and family violence.
- Youth with little or no adult supervision.
Assuming they’ve mastered the fine art of using conjunctions, bullet one covers 2 risks, bullet 2 covers 1 (or maybe they were sloppy and it’s a mix-and-match of poverty, social isolation, and/or family violence, but that’s not what it says), and bullet 3 covers 2. 5 risk factors as I count them. Of those, “easy availability” is ambiguous and undefined. One-fifth of the risk factors might be a threat, but it’s #1. Agenda! Conspiracy!
Unintentional injuries from firearms represent less than two percent of all firearm deaths in the U.S. But of this two percent, children and adolescents are involved in 55% of these deaths. The majority of the injuries occur to children playing with or showing the weapons to friends. The easy availability of firearms is believed to be the number one risk factor for unintentional firearm deaths.
So, if unintentional injuries from firearms are less than 2% of all firearm deaths, how much less? Are we talking 1.99%? 0.01%? Reading all those sources would be nice, wouldn’t it? Let’s roll anyway. If it’s 1.99% and of those children and adolescents are involved in 55%, isn’t that a different way of saying slightly more than 1% involve children and adolescents? Define children. How many? Define adolescent. How many? Clearly trying to obfuscate! Foul! Stop confusing me with science!
But, um, there’s no policy prescription there. That’s a funny way to come after my guns.
What about that Homicide-Firearms page? Surely we’ll find a smoking gun there.
Major Risk Factors
Youth active in drug and gang activity, with prior histories of early school failure, delinquency and violence.
Easy availability of and access to firearms.
Youth living in neighborhoods with high rates of poverty, social isolation and family violence.
Youth with little or no adult supervision.
Prior witnessing of violence
After that, buried under *their* *needs* — Oh, it’s all about them now, and they need, need, need. Waittaminnit. They need more data. Never mind. — and another list of burdens to read, read: sources, they finally do it. They reveal their top secret agenda!
- Intensive, early intervention services for high-risk parents.
- Targeted activities in neighborhoods with high homicide rates, including:
- Enhanced police presence and gun deterrence in hot spots.
- Involvement of political leaders.
- Widespread mobilization of neighbors and community members.
- After-school recreation programs.
- Neighborhood Watch.
- Interdiction of illegal guns and focused prosecution of gun offenders.
- Dropout prevention programs and alternative education opportunities.
- Mentoring, therapy and bullying prevention support programs.
- Multi-systemic therapy for troubled youth.
Wait! Stop the bus! Where’s the gun control? I don’t think interdiction of illegal guns and focused prosecution count. You mean they aren’t doing all this science stuff to push a secret agenda? What the hell?
1600 words in and you’re maybe thinking, “I thought this was going to have math in it. This isn’t so bad. And he’s picking on the right people. Attaboy, Frank. Get em!” That said, let’s start looking at the numbers now that we’ve some idea of the degree of confidence we can put in them. You thought you were getting off easy, didn’t you?
Their data is crunched from CDC data. They also provide a footnote that rates based on 20 or fewer deaths should be used with caution as they may be unstable. No number less than 20 appears in the relevant column, so to hell with caution. We’re playing in the big digits.
The first thing to be clear on is that this data presents a child population aged 0-19. To my way of thinking, that’s a bit sloppy. I’ll just have to assume that common sense will suggest when it’s infants versus toddlers versus teens. They also use x per 100,000 throughout which probably works well for them, but I’m a percentage kind of guy so I’ll convert along the way.
In 2010, there were 83.2 million “children.” Of them, 45,000 died. That’s 54.1! Oh, wait, per 100,000, remember? That’s 0.0541% of the “child” population. Honestly, I’m not sure how to squeeze in the infant mortality figures, so I’m just gonna whistle as I stroll right past that.
The next data presented shows selected causes of death among the “child” population, same age range as before, same “per 100k” figures, so I’ll keep crunching percentages for us. While I’m at it, I’m going to sort the results from Most Deaths to Least Deaths
|Cause of death||Type of cause||# of deaths||Mortality Rate
|Motor vehicle||Unintentional injury||4419||5.3||0.0053|
|Nervous system disease||Natural||1418||1.7||0.0017|
If I wanted to set an agenda based on these numbers, here’s what I come up with in terms of priorities. Throw funding at research for perinatal conditions and congenital anomalies. Their figures for these top two killers combined dwarf the next 5 causes of death combined. Moreover, all other causes of death combined barely edge out these top two causes. As well, I would expect that funding increases for research dedicated to addressing these two issues would result in benefits to society, including the private sector/free market, far beyond just dealing with infant mortality. Women’s health would be affected. Technologies developed may apply to other types of health care. Discoveries along the way may lead to treatments for other conditions at later stages of life.
The third biggest killer of children, according to the data, is motor vehicle accidents. This is a category I would think of as “generally preventable.” Here we start seeing signs of culpability, addressed earlier. Would greater accountability for neglect prevent the deaths of an additional 1,700 children in some future year with similar figures? What kind of policies would address these preventable deaths? At what cost? What about externalities? Would such policies be both cost efficient and socially acceptable? Remember, the cost of developing the political will is an externality. Me, I say go for it. This is something like a supersized 9/11 aimed at children every year.
Neoplasms and SIDS take out another 9/11+ worth of kids. These absolutely merit more R&D funding, for the same reasons I gave above.
When we get down to the 6th biggest killer of kids we finally encounter firearms. Homicides in particular, so unless we’re talking about a secret rash of infant, toddler, and kid-sized mayhem with intent, we’re talking teens. They’ve been mentioned already above, and I agree with the policy suggestions there.
Then we encounter another three natural causes (7th – 9th), two types of accident (10th – 11th), a type of suicide, and a type of accident, (12th – 13th) before we get to the 14th biggest killer of kids, firearm suicide. As before, unless there’s been a spate of angsty infants, toddlers, and kids, we’re talking teens again. While not addressed directly above in the teen homicide policy suggestions, I submit that a great many of those provisions would contribute to a decline in teen suicide overall, with teen firearm suicide declining right along with the whole.
Then we get another accident type and finally, at #16, we find accidental deaths by firearm. As noted above,
Most unintentional injury deaths among young children result from inadequate supervision or failure by caregivers to protect the child from potential hazards.
The majority of the injuries occur to children playing with or showing the weapons to friends.
#17 at the very end is suicide (presumably teen) by poison. No wonder that’s the last on the list. Who the hell wants to go out like that?
Way down the list, at #16, it looks to me as though the very best prevention addresses the overarching subject of parental neglect. If funding R&D improves society at that level, I’m all in favor, especially as such improvements would necessarily address all those other forms of accidental child death between vehicle accidents at #3 and the bottom of the list.
Now, we on the left are occasionally known to address the pro-life contingent with plain, direct reasoning. If the goal is to reduce the overall number of abortions, one should vote pro-choice. I submit that we would do well to apply that same kind of reasoning here. If we wish to address the vast majority of child death, we’ll throw funding at medical R&D and address parental neglect as the top two paths to reducing child deaths of all types, with emphasis on parental neglect having the greatest impact on child firearm deaths of all types.
Gun control just does not factor into it. To dig one’s heels into the bottom rungs of this data ladder and make the case based on emotional appeal is exactly the kind of bogus rhetoric about which we complain so loudly when the “other side” does it. Worse, and it’s been pointed out before with entirely predictable reactions, a chance I’m willing to take, propping up a bully-pulpit on a dead child’s grave is every bit as abhorrent and macabre as setting up soap-boxes on flag-covered coffins filled with dead soldiers. Every time you play the “what about the children” card in this context, unintentionally or otherwise, you cheapen the deaths of the other 35,000+ dead children in this chart. Seriously, you’re supposed to be smarter than your opponents, aren’t you? You’re taking the high road. You’re the adults in the room.
Act like it.
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