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. 2009 Jul 8;2009(3):CD004445.
doi: 10.1002/14651858.CD004445.pub3.

The 'WHO Safe Communities' model for the prevention of injury in whole populations

Anneliese Spinks  1 , Cathy Turner, Jim Nixon, Roderick J McClure
Affiliations

The 'WHO Safe Communities' model for the prevention of injury in whole populations

Anneliese Spinks et al. Cochrane Database Syst Rev. .

Abstract

Background: The World Health Organization (WHO) 'safe communities' approach to injury prevention has been embraced around the world as a model for co-ordinating community efforts to enhance safety and reduce injury. Approximately 150 communities throughout the world have formal 'Safe Communities' designation. It is of public health interest to determine to what degree the model is successful, and whether it reduces injury rates. This Cochrane Review is an update of a previous published version.

Objectives: To determine the effectiveness of the WHO Safe Communities model to prevent injury in whole populations.

Search strategy: Our search included CENTRAL, MEDLINE and EMBASE, PsycINFO, ISI Web of Science: Social Sciences Citation Index (SSCI) and ZETOC. We handsearched selected journals and contacted key people from each WHO Safe Community. The last search was December 2008.

Selection criteria: Two authors independently screened studies for inclusion. Included studies were those conducted within a WHO Safe Community that reported changes in population injury rates within the community compared to a control community.

Data collection and analysis: Two authors independently extracted data. Meta-analysis was not appropriate due to the heterogeneity of the included studies.

Main results: We included evaluations for 21 communities from five countries in two geographical regions in the world: Austria, Sweden and Norway, and Australia and New Zealand. Although positive results were reported for some communities, there was no consistent relationship between being a WHO designated Safe Community and subsequent changes in observed injury rates.

Authors' conclusions: There is marked inconsistency in the results of the studies included in this systematic review. While the frequency of injury in some study communities did reduce following their designation as a WHO Safe Community, there remains insufficient evidence from which to draw definitive conclusions regarding the effectiveness of the model.The lack of consistency in results may be due to the heterogeneity of the approaches to implementing the model, varying efficacy of activities and strategies, varying intensity of implementation and methodological limitations in evaluations. While all communities included in the review fulfilled the WHO Safe Community criteria, these criteria were too general to prescribe a standardised programme of activity or evaluation methodology.Adequate documentation describing how various Safe Communities implemented the model was limited, making it unclear which factors affected success. Where a reduction in injury rates was not reported, lack of information makes it difficult to distinguish whether this was due to problems with the model or with the way in which it was implemented.

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Conflict of interest statement

One of the authors of this review (Rod McClure) was involved in the evaluation of the intervention activities that were conducted in Mount Isa and Mackay and is an author on the evaluation report included as a reference for that study.

Comment in

References

References to studies included in this review

Falkoping, Sweden {published data only}
    1. Svanstrom L, Schelp L, Ekman R, Lindstrom A. Falkoping, Sweden, ten years after: still a safe community?. International Journal for Consumer Safety 1996;3:1‐7.
Falun, Sweden {published data only}
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Harstad, Norway {published data only}
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    1. Ytterstad B, Smith GS, Coggan CA. Harstad injury prevention study: prevention of burns in young children by community based intervention. Injury Prevention 1998;4:176‐80. - PMC - PubMed
Lidkoping, Sweden {published data only}
    1. Svanstrom L, Ekman R, Schelp L, Lindstrom A. The Lidkoping Accident Prevention Programme ‐ a community approach to preventing childhood injuries in Sweden. Injury Prevention 1995;1:169‐72. - PMC - PubMed
Motala, Sweden {published data only}
    1. Lindqvist K, Timpka T, Karlsson N. Impact of social standing on injury prevention in a World Health Organization Safe Community ‐ intervention outcome by household employment contract. International Journal of Epidemiology 2004;33:605‐11. - PubMed
    1. Lindqvist K, Timpka T, Schelp L. Evaluation of an inter‐organizational prevention program against injuries among the elderly in a WHO Safe Community. Public Health 2001;115:308‐16. - PubMed
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    1. Lindqvist K, Timpka T, Schelp L, Risto O. Evaluation of a child safety program based on the WHO Safe Community model. Injury Prevention 2002;8:23‐6. - PMC - PubMed
Mt Isa, Mackay, Australia {published and unpublished data}
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New Plymouth, NZ {published data only}
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Shire of Bulla, Australia {published data only}
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Skaraborg County, Sw {published data only}
    1. Leon AP, Svanstrom L, Welander G, Schelp L, Santesson P, Ekman R. Differences in child injury hospitalizations in Sweden: the use of time‐trend analysis to compare various community injury‐prevention approaches. Scandinavian Journal of Public Health 2007;35:623‐30. - PubMed
Sweden (14 communities) {published data only}
    1. Nilsen P, Ekman R, Stark Ekman D, Ryen L, Lindqvist K. Effectiveness of community‐based injury prevention long‐term injury rate levels, changes, and trends for 14 Swedish WHO‐designated Safe Communities. Accident Analysis and Prevention 2007;39:267‐73. - PubMed
Vorarlberg, Austria {published and unpublished data}
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Waitakere, New Zealand {published data only}
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References to studies excluded from this review

Boras, Swedem {published data only}
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Boulogne‐Billancourt, Fr {published data only}
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Dallas, USA {published data only}
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Falkoping, Sweden (exc) {published data only}
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Fort McMurray, USA {published data only}
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Harstad, Norway (exc) {published data only}
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    1. Ytterstad B. The Harstad injury prevention study: the characteristics and distribution of fractures amongst elders ‐ an eight year study. International Journal of Circumpolar Health 1999;58:84‐95. - PubMed
    1. Ytterstad B. The Harstad injury prevention study: the epidemiology of sports injuries. An 8‐year study. British Journal of Sports Medicine 1996;30:64‐8. - PMC - PubMed
    1. Ytterstad B, Sogaard, AJ. The Harstad Injury Prevention Study: prevention of burns in small children by a community‐based intervention. Burns 1995;21:259‐66. - PubMed
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Illawarra, Australia {published data only}
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LaTrobe, Australia {published data only}
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    1. Day L, Ozanne‐Smith J, Cassell E, McGrath A. Latrobe Valley Better Health Project: evaluation of the injury prevention program 1992‐1996. Monash University Accident Research Centre 1997; Vol. Report #114.
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Lidkoping, Sweden (exc) {published data only}
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Motala, Sweden (exc) {published data only}
    1. Lindqvist K, Lindholm L. A cost‐benefit analysis of the community‐based injury prevention programme in Motala, Sweden ‐ a WHO Safe Community. Public Health 2001;115:317‐22. - PubMed
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    1. Nolen S, Lindqvist K. A local bicycle helmet 'law' in a Swedish municipality ‐ the effects on helmet use. Injury Control and Safety Promotion 2004;11:39‐46. - PubMed
Ngati Porou, New Zealand {published data only}
    1. Brewin M, Coggan C. Evaluation of the Ngati Porou Community Injury Prevention Project. Ethnicity and Health 2004;9:5‐15. - PubMed
Penarth, Wales {published data only}
    1. Kemp A, Gibbs N, Vafidis G, Sibert J. Safe Child Penarth: experience with a Safe Community strategy for preventing injuries to children. Injury Prevention 1998;4:63‐8. - PMC - PubMed
Rangiora & Kawerau, NZ {published data only}
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Shire of Bulla, Aus (exc) {published data only}
    1. Ozanne‐Smith J, Sherrard J, Brumen I, Vulcan P. Community based injury prevention evaluation report ‐ Shire of Bulla Safe Living Program. Monash University Accident Research Centre 1997; Vol. Report #66.
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Skaraborg County (exc) {published data only}
    1. Ekman R, Schelp L, Welander G, Svanstrom L. Can a combination of local, regional and national information substantially increase bicycle‐helmet wearing and reduce injuries? Experiences from Sweden. Accident Analysis and Prevention 1997;29:321‐8. - PubMed
    1. Ekman R, Welander G. The results of 10 years' experience with the Skaraborg bicycle helmet program in Sweden. International Journal for Consumer and Product Safety 1998;5:23‐39.
    1. Ekman R, Welander G, Svanstrom L, Schelp L. Long‐term effects of legislation and local promotion of child restraint use in motor vehicles in Sweden. Accident Analysis and Prevention 2001;33:793‐7. - PubMed
Thinh Liet & Co Nhue, Vie {published data only}
    1. Chuan LH, Svanstrom L, Ekman R, Lieu DH, Cu NO, Dahlgren G, et al. Development of a national injury prevention/safe community programme in Vietnam. Health Promotion International 2001;16:47‐54. - PubMed
Turanganui‐a‐kiwa, NZ {published data only}
    1. Brewin M, Coggan C. Evaluation of a New Zealand indigenous community injury prevention project. Injury Control and Safety Promotion 2002;9:83‐8. - PubMed
Vaeroy, Norway {published data only}
    1. Tellness G. An evaluation of an injury prevention campaign in Norway. Family Practice 1985;2:91‐3. - PubMed
Waitakere, NZ (exc) {published data only}
    1. Harre N, Coveney A. School‐based scalds prevention: reaching children and their families. Health Education Research 2000;15:191‐202. - PubMed

Additional references

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Sznajder 2002
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References to other published versions of this review

Spinks 2005
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