New York City’s window guard policy: four decades of success

Correspondence to Dr Amita Toprani, New York City Department of Health and Mental Hygiene, New York City, NY 10013, USA; [email protected]

Introduction

Falls from windows are an important cause of injury, disability and death among children. Window falls are of particular concern in urban areas with a high concentration of multistorey buildings because falls from three or more stories are more likely to result in severe injury or death.¹ From 1965 to 1969, >200 children in New York City (NYC) died due to falls.² In 1976, the Board of Health amended the NYC health code to mandate the installation of window guards in apartments housing young children.³ This action was associated with a 96% decrease in child window falls from 1978 to 1980. In this article, we review the history and evolution of NYC’s window guard rule and discuss aspects of the experience that may be instructive for public health practitioners.

Methods

We reviewed relevant NYC Health Department (hereafter, the Department) programme documents, correspondence, legislative records, legal decisions, peer-reviewed publications and newspaper articles to construct a comprehensive history of NYC’s window guard rule. Additionally, we conducted key informant interviews with window guard programme staff. We evaluated the impact of the rule and its successive modifications by reviewing the Department’s window fall surveillance data from 1969 to 2016.

Defining the problem

A study of 201 child fall deaths from 1965 to 1969 conducted by the Department’s Bureau of Vital Statistics showed that fall deaths were seasonally distributed, occurring mainly between May and September, and 123 (61%) of the deaths occurred due to falls from windows. A disproportionate number occurred in low-income neighbourhoods with poor housing quality in parts of the Bronx and Manhattan,² two of five boroughs of NYC. A study of 55 fatal and non-fatal child falls from >10 feet seen at a Bronx hospital between 1966 and 1968 showed that the majority of victims and all five fatalities were <4 years of age. More than half (55%) of all falls and all of the fatal falls occurred from windows.⁴

Pilot programme

In May 1972, Charlotte Spiegel, director of the Department’s Window Falls Prevention Programme, initiated a pilot programme with three major components: voluntary window fall reporting, a media and...