Provinces with strong evidence-based injury prevention policies have fewer child and youth hospitalizations and deaths from road-traffic-related causes.

By  Liraz Fridman, Postdoctoral Research Fellow, Hospital for Sick Children/Alberta Children’s Hospital Research Institute

In 2012, the European Child Safety Alliance published comparative reports that examined the burden of injuries over time in 31 European countries ( In Canada, no such report existed that looked at the trends in childhood injuries over time and related them to evidence-based best practices.

Researchers at York University and University of British Columbia in collaboration with the Canadian Collaborating Centres for Injury Prevention (CCCIP) and Parachute Canada wanted to examine whether or not there were differences among provinces on hospitalizations and deaths from road-traffic-related causes including occupants, cyclists, and pedestrians. We also wanted to determine which policies and legislation such as distracted driving, booster seats, bicycle helmets, graduated driver licensing (GDL), and pedestrian safety were implemented across the country. In March 2018, the Canadian Child Safety Report Card was published in Injury Prevention.This is the first interprovincial report that ranks Canadian provinces on a number of child and youth injury indicators, including hospitalizations, deaths, and evidence-based safety policies (Fridman et al., 2018).

While road traffic safety policies differ across Canada, some policies are beginning to be standardized among provinces. For instance, booster seat legislation is found in all provinces except for Alberta. Our Canadian Child Safety Report Card ranked these booster seat legislations based on if they included age, weight, and height stipulations alongside public education, incentive programs, non-compliance penalties, and driver responsibility. Ontario, British Columbia, Nova Scotia, and Prince Edward Island had the highest booster seat legislation scores, but generally Canada is doing fairly well on mandating the use of child safety seats for children under the age of nine years. Our study also showed a 40-per-cent decrease in occupant- related hospitalizations over time. This demonstrates that strong evidence-based policies may have a role in decreasing road traffic related injuries for child occupants. 

Pedestrian safety findings

The good news is that we found hospitalizations for injuries from road-traffic-related causes has decreased in Canada by one third over the period of study (2006-2012). However, while all of the sub-causes showed a declining rate over time, the smallest decline was for pedestrian-related injuries.

In the past, studies have found that child pedestrians are seven times more likely to be hospitalized for an injury in neighbourhoods that have an average speed limit of 50 km/hour compared to 30 km/h (Desapriya et al., 2011). Despite the fact that lower speed limits are associated with fewer injuries, there are still differences in pedestrian safety laws across Canada.

Our study evaluated the quality of pedestrian safety laws by examining which stipulations were required in each province including: speed limits in residential and school zones; double fines in residential and school zones; and provisions for “pedestrian only” zones, which are areas that are set apart within a highway for the exclusive use of pedestrians.

This law was difficult to assess on a provincial level as differences typically occur between municipalities. Given the importance of speed as a risk factor for childhood injuries, we gave provinces a better ranking when their pedestrian safety laws including speed limits in residential and school zones of less than 50 km/h. Ontario was the only province that scored “excellent” on their pedestrian safety laws.

Toronto is Ontario’s largest city, comprising 22 per cent of the province’s population. The first emphasis area in Toronto’s Vision Zero Road Safety Plan is pedestrians. One key safety measure that is highlighted in this plan is reducing speed limits on roadways. Policies related to pedestrian safety should involve designing safer routes to school which can include built environment changes such as sidewalk design and traffic calming.

We know that injuries are a multifactorial problem but we also know that evidence-based policies targeted at reducing childhood injuries from road-traffic-related causes have been proven to work. For instance, a Cochrane Systematic Review concluded that stronger graduated driver licensing programs result in a larger reduction in fatalities from motor vehicle crashes in young drivers (Russell et al., 2011). Given there are still inconsistencies among road traffic policies across the country, especially those targeted at child pedestrians who are a group of vulnerable road users, future preventive efforts should focus on harmonizing evidence-based policies that reflect best practices in Canada.

One limitation to our study was that we could not consider contextual factors other than policy/legislation that may have affected the provincial injury rate over time such as population density, demographic makeup, access to health care, and changes to the built environment. However, we did find that, generally, provinces that have a number of strong evidence-based injury prevention policies also had fewer child and youth hospitalizations and deaths from road-traffic related causes.

Transport-related injuries among children and youth have been decreasing in Canada over time, however differences between provinces in road traffic safety policies and legislation remain. Harmonizing best practices, including reducing speed limits to decrease the risk of injuries to pedestrians and cyclists is one step towards a safer road environment.


Desapriya E, Sones M, Ramanzin T, et al. Injury prevention in child death review: child pedestrian fatalities. Inj Prev 2011;17 Suppl 1:i4–i9. Available at:

Fridman L, Fraser-Thomas JL, Pike I, et al. Canadian Child Safety Report Card: a comparison of injury prevention practices across provinces. Inj Prev 2018; 0 1-6. doi: 10.1136/injuryprev-2018-042745. Available at:

Russell K, Vandermeer B, Hartling L. Graduated driver licensing for reducing motor vehicle crashes among young drivers (A Cochrane Database of Systematic Reviews). 2011 (10). Available at: