Henry Kempe, a Denver pediatrician, realized in the 1960s that some of the children and infants who came to his hospital with severe injuries were being maltreated by their parents or caregivers. The bad news spread quickly round the world and bureaucratic agencies were set up in almost all developed countries to try to rescue children from such abuse.
Are these agencies successful in their efforts? This is the question that a long paper in a recent edition of The Lancet sets out to answer.
It is a formidably difficult question to answer for a number of reasons. Among them is the tendency for social problems to appear more common as agencies are set up to tackle them (few agencies ever dissolve themselves because the problem they were set up to tackle has been solved).
Moreover, the definition of the problem changes over time – usually in the direction of expansion. Child abuse started out as fractured legs and broken skulls, and has ended up as assaults on self-esteem.
To avoid definitional problems, the authors of the paper compared rates of violent death and non-accidental injury of children over time in several different countries or provinces: Sweden, 20 states of the U.S., England, Western Australia, New Zealand, and Manitoba, Canada. They took these measures because they reasoned that they were comparatively trustworthy and unsusceptible to diagnostic fashion.
They found that in most countries neither the death rate nor the rate of non-accidental injury had fallen; only the death rate in Sweden and Manitoba had fallen, but not the rates of non-accidental injury.