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| Journal of the New Zealand Medical Association,
21-May-2004, Vol 117 No 1194
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The New Zealand child work-related fatal injury study:
1985–1998
Rebbecca Lilley, Anne-Marie Feyer, John Langley, and John
Wren
Childhood injury is a major public health problem in New
Zealand. Injury among New Zealand children and teenagers (<20 years of age)
accounts for 34% of fatalities in this age group, and is the leading cause of
death for this age group, with the exception of those less than 1 year
old.1 Comparisons with other OECD countries
show that New Zealand’s injury mortality rate of 13.7 per 100,000 for
children aged <14 years ranked New Zealand poorly at
22nd out of 26 OECD
countries.2
Although not traditionally viewed as part of the formal
workforce, children under 15 years of age do participate in work under less
formal work arrangements, such as casual holiday work, or part-time after-school
work, and may be exposed to workplace hazards when they visit, or live on,
worksites (eg, farms). There is evidence to suggest that children below official
working age are at considerable risk of work- related fatal injury (WRFI).
From recent Australian data, WRFIs to children were
identified as a substantial proportion of work-related
deaths.3 Furthermore, the Australian data
revealed that 47% of workplace bystander WRFIs were to those aged <15 years.
These data also revealed that those children living on (or visiting) farms were
more likely to sustain WRFIs, with 54% of all WRFI in children occurring on
farms.3 Given the similarities between New
Zealand and Australia, the New Zealand experience of WRFI to children is also
likely to be similar. For instance, a New Zealand study of fatal injuries on
farms revealed that 17% of fatal injuries on farms occurred in children aged
<16 years.4
In New Zealand, the Health and Safety in Employment Act
(1992) clearly requires that employers and the Occupational Safety and Health
Service protect all people who come into ‘contact’ with workplaces.
Indeed, there is a clear legislative mandate to investigate and prevent child
work-related deaths, yet comprehensive and reliable data on child WRFIs in New
Zealand is non-existent. This study aimed to address this gap by identifying and
describing work-related fatal injuries in children aged <15 years of age.
MethodsIdentification
of work-related deaths—This study followed the protocol used by
Feyer et al5 to create an adult WRFI data set.
Potential cases of work-related injury were identified from the New Zealand
Health Information Service (NZHIS) electronic national mortality
file—using the external cause of injury coding, commonly known as E-codes.
The same E-codes, as used previously,7 were
used to identify all potential work-related cases. Additional E-codes (E810-829,
846-848, and 919) were considered for the child work-related fatal injury study
(CWRFIS)—to capture the potential work-related fatal injuries that
occurred due to traffic crashes on public roads, thus allowing for a more
complete capture of WRFI. This differs from the adult WRFIS, which excluded all
deaths that occurred due to traffic crashes on public
roads.5 For the purposes of this study, a child
was defined as any person less than 15 years of age.
Coronial files were reviewed in random sequence to
determine work-relatedness. A detailed description of the selection process
followed is described by Feyer et al (2001).5
Deaths classified as definitely work-related were included in the
study.
Data
coding—Information in each coronial file was coded to obtain an
electronic description of each work-related case. Data for the CWRFIS was
simultaneously coded with that for another study investigating work-related road
traffic crash fatal injuries using the same coders. Although rater agreement was
not undertaken specifically for the CWRFIS, it was undertaken for the traffic
crash study. Inter-rater agreement was found to be better than 91% for case
determination by the same coders. Coding of variables has been described
previously by Feyer et al (2001).5 Additional
coding of the child’s activity at the time of fatal injury was undertaken
by categorising coronial descriptions of the child’s activity at the time
of the incident.
Analysis—Rates
(including 95% confidence intervals) were calculated for work-related injuries
per 100,000 children per year; counting each individual in the denominator
equally as described previously.5 Census data
from 1986, 1991, 1996, and 2001 were used to estimate denominator data for the
calculation of rates. The contribution of work to all fatal injury to children
was calculated as a percentage of all child injury fatalities recorded by NZHIS.
All child injury fatalities were identified from the NZHIS electronic national
mortality file using cases coded within the range E800–E999.
The inclusion criteria and categorisation for fatally
injured persons were as follows:8
Workers—Children
employed for pay, profit, payment-in-kind, in a job or business or on a farm;
and children who worked without pay in a family business, or on a
farm.
Bystanders—Children
not engaged in work but who were fatally injured as a direct consequence of the
work of another person. Bystanders were further divided into workplace and road
bystanders. Workplace bystanders were children who were not working but were
fatally injured as a result of workplace activities, generally not associated
with public roads or public transport. As an exception, some incidents involving
public roads and public transport were included in the workplace category where
the child was exposed to similar hazards to those faced by the working person
controlling or working the vehicles—for example, child passengers in the
cabin of a working truck. Road bystanders were children who were not working but
who were fatally injured in a motor vehicle incident on a public road (or on
public transport) as a result of other people’s work.
Students—Students
were those from primary school age or older where the incident occurred during
school time, on school premises, or while they were performing a task directly
connected with their course.
The intention of this study was to describe (for
children <15 years of age) the total burden of WRFI by considering additional
E-Codes that captured potential cases of WRFI that occurred due to traffic
crashes on public roads. While sufficient information was available from
coronial files to identify the WRFI events that occurred due to motor vehicle
traffic crashes, any further information regarding the road-bystander deaths, in
particular, was limited.
In contrast to non-traffic crashes (eg, vehicle crash
on farm), there was often insufficient information for traffic crashes (eg.
vehicle crash on public road) on the bystander. Typically, the coronial report
focused on the driver of the motor vehicle. Motor vehicle death on public roads
are contributors to the total burden of work-related deaths differing from other
motor vehicle deaths by virtue of a working vehicle being involved in the fatal
incident. Motor vehicle deaths to New Zealand children have been described
in-depth elsewhere.6 This paper, while
quantifying the total burden of WRFI for children aged <15 years of age, only
describes the worker and workplace bystander deaths in more detail. The data set
described in detail in this paper is comparable with published Australian
data.3
Data were analysed using the SPSS Version 9.0
statistical package.
ResultsDuring the period 1985–98, a
total of 238 work-related fatalities were identified for children aged <15
years of age. This was an average of just over 17 work-related fatalities per
year. The majority of fatalities were deaths to children who were bystanders to
someone else’s work (Table 1).
The bystander fatalities were mostly road bystanders (66%)
on a public road, with the remainder of bystander deaths having occurred at a
place of work. The most common scenarios for road bystander fatalities were
vehicle versus vehicle incidents (eg, a child travelling in a car that crashed
into a working vehicle), or pedestrian versus vehicle incidents (eg, a child hit
by working vehicle while crossing the road), which contributed to 34% and 42% of
all road bystander fatalities, respectively.
Table 1. Work status of child work-related fatal injury
(WRFI): 1985–98
*Per 100,000 children
per year.
For the purposes of this paper, as indicated earlier, only
deaths that occurred to workers (n=12) or workplace bystanders (n=75) (hereafter
collectively referred to as workplace fatalities) are described in further
detail.
Gender, age, and
ethnicity—Of the 87 workplace fatalities, 41% were in children aged
<5 years old (Table 2). The majority (82%) of child fatalities were male.
Ethnicity could not be determined from the coronial files in over half of all
child fatalities. For the 41 cases where ethnicity could be determined, 27 were
New Zealand European/Pakeha and 9 were Maori. Males had a higher incidence rate
of WRFI than females. In particular, males aged 0–4 years had the highest
gender/age-group-specific rate of WRFI (Table 3). During the study period, WRFI
accounted for 6% of all fatal injuries in male children and 2.5% of all fatal
injuries in female children.
Table 2: Age-related characteristics of the child
workplace WRFI: 1985–98
Table 3. Child workplace WRFI by age and sex:
1985–98
*Per 100,000
population per year;
†Work-related
fatal injuries as a percent of all fatal injury to children
(1985–98).
Work involvement in
fatality—Workplace bystander involvement varied with age. All
workplace fatalities in children aged <5 years old were bystander deaths.
Eighty-five percent of workplace fatalities in the group aged 5–9 years
were bystander deaths—while 68% of workplace fatalities in 10–14
year olds were bystanders. Only 12 children were identified as working at the
time of the fatal incident, with two thirds of the working children aged
10–14 years. The most common working scenario at the time of the fatal
incident was working riding a motorbike to shift stock on a farm.
Location of fatal
incident—Fatalities on farms dominated the 0–4 years age
group with just over half of all fatalities occurring on a farm; while for older
children, close to a third of all deaths occurred on a farm. Even with road
bystander fatalities excluded, workplace fatalities on public roads were notable
with 36% of fatal incidents in 10–14 year olds occurring on a public
road.
Time of
injury—Overall, a quarter of all child work-related deaths occurred
on the weekends with close to a third of all deaths for children aged 5–9
years occurring on weekends. Exclusion of incidents during official school hours
on a weekday reveals that 62% of 10–14 year olds (and 55% of 5–9
year olds) were fatally injured before, or after, official school hours on a
weekday.
Agency and mechanism of
fatal incident—For children aged <5 years, the most common
mechanism of injury (Table 4) was being hit by a moving object (56%). Drowning
(14%) and vehicle crashes (17%) were also common mechanisms of fatal injury for
these young children.
Table 4. Mechanism and agent of child WRFI:
1985–98
*All terrain vehicle;
†Power take off;
‡Not elsewhere classified.
Vehicle crashes (off the public road) were the most common
mechanism of fatal injury for children aged 5–9 and 10–14 years of
age. For children aged 5–9 years, drowning (23%), and being hit by moving
objects (19%), were common.
The agents most commonly involved in fatal injury were
vehicular agents such as trucks, and cars/utilities, as well as aircraft and
tractors (Table 4). Apart from vehicles, farm machinery (such as tractors) and
bodies of water (such as dams and rivers) were common agents of the fatal
incident among 0–4 year olds.
For older children, vehicular agents were the most common
agents of the fatal incident. Notably, bodies of water (such as a public pool or
irrigation dam) contributed to 19% of fatalities in 5–9 year olds.
Activity at time of fatal
incident—The most common activities being performed at the time of
the fatal injury were being a passenger in, or on, a vehicle (37%) and
‘playing’ in or near the workplace (34%). Ambulatory activities,
especially playing (53%), at the time of fatal incident were much more common
for very young children than vehicular activities (Table
5). As children increased in age, being
a passenger in (or on) a vehicle was a more common activity at the time of the
fatal incident with 42% of 5-9 year olds, and 48% of 10–14 year olds,
killed as passengers.
Table 5. Main activity of child at time of child
workplace WRFI: 1985-98
Occupation and
industry—Of the 12 children identified as working at the time of
fatal injury; 2 were working as street milk vendors, 1 was delivering
newspapers, and the remaining 9 were working as farm labourers.
A third of all workplace WRFIs in children occurred in the
agricultural industry. Other industries with notably high representation of
workplace WRFIs in children include the road transport (14%), air transport
(10%), and the sport and recreation industries (10%). It should be noted that
while the air transport industry represented 10% of work-related fatal injuries
in children, there were only 3 incidents—each involving multiple
deaths.
DiscussionThis study found that it was
unusual for children in New Zealand to be fatally injured while involved in
work. We identified 87 workplace fatalities in children (<15 years of age)
from 1985 to 1998. We identified 10 children who were performing work tasks at
the time of the fatal incident; and we identified 2 children commuting to (or
from) work who were fatally injured. The vast majority (86%) of workplace
fatalities were in workplace bystanders. During the period 1985–98, WRFI
accounted for at least 6% of total child fatal injuries in males, and 2.5% of
total child fatal injuries in females. In males aged 5–9 years, at least
8% of all child injury fatalities were work-related. Male WRFI, in particular,
contributes to a significant proportion of all child fatal injuries.
That it was more likely that a child sustained fatal
injuries as a bystander to someone else’s work, rather than as a worker,
is significant. Bystander deaths reflect inadequate control over hazards in the
workplace and, as such, can provide insight into aspects of the breakdown in the
control of hazards in the work setting.8
Among adult WRFIs,9 67
workplace bystander deaths were identified for persons aged 15–84 in the
period 1985-94 while (over the same period) the present study identified 58
workplace bystander deaths in children <15 years of age. Therefore, children
<15 years of age accounted for 46% of New Zealand’s total workplace
bystander deaths (excluding motor vehicle traffic crashes) in the period
1985–94.
Similarly, Australian children aged <15 years contributed
to 47% of Australia’s total workplace bystander
deaths.8 This highlights that children are an
important and particularly vulnerable group who are exposed to hazards in the
workplace which, for the most part, are under the control of others.
In this study, the level of bystander involvement changed
with age. With children aged 0–4 years old, 100% of WRFIs were as
workplace bystanders. By age 10–14 years, 68% of fatalities were
classified as workplace bystander deaths, with the remaining fatalities in this
age group classified as worker deaths. The observed increase in the proportion
of worker fatalities with increasing age reflects the movement of older children
towards informal employment (eg, newspaper deliveries) as they get closer to the
official working age. With increasing age, the movement into the informal
workforce changes the exposure of the child to workplace hazards, and the
pattern of fatalities becomes more like that of adults
3.
Males were identified as being at greater risk of
work-related fatal injury, with only 18% of deaths overall occurring in females.
A similar proportion of male and female work-related fatal injuries were
identified in Australia.3 Within male workplace
fatalities, there was a preponderance of males aged 0–4, thus suggesting
that this group of very young and vulnerable males may be at greater risk of
WRFI.
The most common location of the fatal incident was on a
farm. On the farm, home and work activities overlap, and informal participation
in farm work is commonplace amongst New Zealand children. A survey of 160 New
Zealand farms found that 77% of 4–7 years olds, 90% of 8–11 year
olds, and 85% of 12–16 year olds living on farms participate in work
activities on the farm.10
On farms, children are more likely to face (and have contact
with) the well-documented and prevalent hazards of motor vehicles and farm
machinery. Early involvement in informal
farm work further exposes rural children to workplace hazards at an early age.
With nearly one fifth of all injury on New Zealand farms occurring in children
aged <16 years,4 children represent a
significant proportion of all farm injuries.
A high proportion of the fatal incidents occurring on a farm
were in children aged 0–4 years. This may reflect a number of factors
specific to rural work environments. Firstly, there is a lack of access to
childcare services in rural areas,11 with rural
parents perhaps being more likely to take a child out to work with them while
the other partner is away, for example. Children aged <5 years were likely to
be playing at the time of the fatal incident; often they were playing around a
parent in the workplace while the parent was working. The difficulty in
providing constant supervision while parents are performing farming duties could
explain why young children in rural farm environments are particularly
vulnerable to work-related hazards.
The type of fatal incident varied by age. Fatal incident
involving vehicles were common across all ages with children aged <5 years
most likely to be hit by a moving vehicle and those aged 5–14 most likely
to be a passenger in (or on) a vehicle. Drowning was another notable mechanism
of fatal incident in children aged 0–9 years old. The agency of fatal
incident reflects the mechanism of injury with vehicular agents being the most
common cause for all age groups, and bodies of water being a relatively common
cause in younger children. These common mechanisms and agents of fatal incident
reflect those identified in other countries as being of high risk to
children.12,13
Agriculture is a significant contributor to the overall WRFI
burden for children—with well over a third of all child fatalities
(identified in this study) occurring on farms. This is not surprising. The
agricultural sector is consistently identified as being one of the highest risk
groups for fatal injury in adult workers,7 as
well as in children.12,14,15
The patterns of child WRFI identified in this study are not
unique to New Zealand. In New Zealand, as elsewhere, these common patterns of
fatal injury have been found to be associated with: (1) inadequate supervision
of small children in work settings; (2) permitting children to be in the area of
moving or unguarded machinery; (3) allowing children to accompany workers using
machinery; and (4) having children performing work-related tasks inappropriate
for their age and physical size13,16. The
preponderance of farm and vehicle injuries observed in this study could indicate
the existence of similar risk factors in New Zealand. Compared with adults,
children lack work experience, physical size, physical strength, and attention
to task,17 thus placing children at greater
risk of fatal injury in the workplace. Children are also more vulnerable to
severe injury when injury events occur due to the child’s physical
fragility.
The findings of this study have important implications for
the way workplace hazards are controlled in New Zealand. The results indicate
that children contribute significantly to the overall burden of WRFI in New
Zealand, especially as bystanders to other peoples work—and the results
also indicate that work-related incidents contribute to the total burden of
child injury deaths. The high contribution to workplace bystander deaths by
children aged <15 years indicates that hazard control in certain work
settings is lacking. Greater attention needs to be paid to managing hazards and
children’s activities in (or near) workplaces; a priority in this respect
is farms and vehicles.
Author information:
Rebbecca Lilley, Assistant Research Fellow, New Zealand Environmental and
Occupational Health Research Centre, University of Otago, Dunedin; Anne-Marie
Feyer, Associate Professor, New Zealand Environmental and Occupational Health
Research Centre, University of Otago, Dunedin; John Langley, , Professor, Injury
Prevention Research Unit, University of Otago, Dunedin; John Wren, Senior
Analyst, SafeKids, Auckland.
Acknowledgements:
This project was funded by an Otago Research
Grant. The New Zealand Environmental and
Occupational Health Research Centre and Injury Prevention Research Unit are
supported by the Accident Compensation Corporation (ACC) and the Health Research
Council (HRC). The authors acknowledge the contributions of Nicola Dow, Bronwen
McNoe, Shaun Stephenson, and Heather Walker to the study.
Correspondence:
Rebbecca Lilley, Department of Preventive and Social Medicine, University of
Otago, PO Box 913, Dunedin. Fax. (03) 479 7298; email: rebbecca.lilley@stonebow.otago.ac.nz
References:
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