Experiences of childhood adversity are common and have profound health impacts over the life course. Yet, studying health outcomes associated with childhood adversity is challenging due to a lack of conceptual clarity of childhood adversity, scarce prospective data, and selection bias. Using a 65-year follow-up of a Swedish cohort born in 1953 (n = 14,004), this study examined the relationship between childhood adversity (ages 0–18) and premature all-cause mortality (ages 19–65). Childhood adversity was operationalized as involvement with child welfare services, household dysfunction, and disadvantageous family socioeconomic conditions. Survival models were used to estimate how much of the association between child welfare service involvement and mortality could be explained by household dysfunction and socioeconomic conditions. Results show that individuals who were involved with child welfare services had higher hazards of dying prematurely than their majority population peers. These risks followed a gradient, ranging from a hazard ratio of 3.08 (95% CI: 2.68–3.53) among those placed in out-of-home care, followed by individuals subjected to in-home services who demonstrated a hazard ratio of 2.53 (95% CI: 1.93–3.32), to a hazard ratio of 1.81 among those investigated and not substantiated (95% CI: 1.55–2.12). Associations between involvement with child welfare services and premature all-cause mortality were robust to adjustment for household dysfunction and disadvantageous family socioeconomic conditions. Neither household dysfunction nor socioeconomic conditions were related with mortality independent of child welfare services involvement. This study suggests that involvement with child welfare services is a viable proxy for exposure to childhood adversity and avoids pitfalls of self-reported or retrospective measures.

BackgroundRoad traffic injuries are the leading cause of premature death in young people aged 5–29 years in the WHO European Region. The Decade of Action for Road Safety 2011–2020 was adopted by the United Nations General Assembly in 2010 to reduce the global toll of road traffic injuries by 2020.MethodsThis fact sheet describes the status of road safety in 52 out of the 53 Member States of the WHO European Region, representing 95% of the Region’s population. Experts from several sectors in each country reached consensus to complete a self-administered questionnaire. Furthermore, an independent expert analysis of national legislative documents was conducted.ResultsIn 2013, there were almost 85 000 deaths from road traffic injuries in the WHO European Region. Although the regional mortality rate is the lowest when compared to other WHO regions, with 9.3 deaths per 100 000 population, there are wide disparities in the rates of road traffic deaths between countries of the Region. This requires more systematic efforts if the global target of a 50% reduction in road crash deaths is to be achieved by 2020. Laws and practices on key risk factors such as regulating speed appropriate to road type, drink–driving, and use of seat belts, motorcycle helmets and child restraints are assessed to reduce the risk of road traffic injury. While 95% of the population in the Region is covered by comprehensive laws in line with best practice for seat belts, only 47% of the population is adequately protected by laws for speed, 45% for helmet use, 33% for drink–driving and 71% for use of child restraints.ConclusionsMany countries need to further strengthen their road safety legislation and enforcement in order to protect their populations, improve road user behaviour and reduce the number of crashes. Much can be gained from improving the safety of vehicles, having better road infrastructure and promoting sustainable physically active forms of mobility as alternatives to car use. Concerted policy efforts with systems approaches are needed to protect all road users in the Region.

Healthy Ageing is an important focus of the European Healthy Cities Network and has been supported by WHO since 2003 as a key strategic topic, since 2010 in cooperation with the Global Network of Age-friendly Cities and Communities. Based on the methodology of realist evaluation, this article synthesizes qualitative evidence from 33 structured case studies (CS) from 32 WHO European Healthy Cities, 72 annual reports from Network cities and 71 quantitative responses to a General Evaluation Questionnaire. City cases are assigned to three clusters containing the eight domains of an age-friendly city proposed by WHO's Global Age-friendly City Guide published in 2007. The analysis of city's practice and efforts in this article takes stock of how cities have developed the institutional prerequisites and processes necessary for implementing age-friendly strategies, programmes and projects. A content analysis of the CS maps activities across age-friendly domains and illustrates how cities contribute to improving the social and physical environments of older people and enhance the health and social services provided by municipalities and their partners.

BackgroundPast research has consistently identified children with out-of-home care (OHC) experience as a high-risk group for premature mortality. While many have argued that educational success is a key factor in reducing these individuals’ excessive death risks, empirical evidence has hitherto been limited. The aim of the current study was therefore to examine the potentially mitigating role of educational success in the association between OHC experience and premature mortality.MethodsDrawing on a Stockholm cohort born in 1953 (n=15 117), we analysed the associations among placement in OHC (ages 0–12), school performance (ages 13, 16 and 19) and premature all-cause mortality (ages 20–56) by means of Cox and Laplace regression analyses.ResultsThe Cox regression models confirmed the increased risk of premature mortality among individuals with OHC experience. Unadjusted Laplace regression models showed that, based on median survival time, these children died more than a decade before their majority population peers. However, among individuals who performed well at school, that is, those who scored above-average marks at the age of 16 (grade 9) and at the age of 19 (grade 12), the risks of premature mortality did not significantly differ between the two groups.ConclusionEducational success seems to mitigate the increased risks of premature death among children with OHC experience.