The Safe Community Model - from a local program in Sweden to a Worldwide Network Study visit from China 1 June 2009 Moa Sundström WHO Collaborating Centre on Community Safety Promotion Karolinska Institutet Stockholm, Sweden 2009

Background The magnitude of the problem Every year 6 million people die because of injuries. The prognosis is that injuries related to, particularly: - road traffic injuries, - interpersonal violence, - war - self–inflicted injuries will increase dramatically by the year 2020.

Road traffic injuries are the leading cause of injury related deaths worldwide. Road traffic related death account for 25 %.

Injuries by region 90 % of the world’s deaths from injuries occur in Low- and Middle-income countries. Injuries by gender and age group Young people between years account for almost 50% of the world’s injury-related mortality. Globally, injury mortality among men is twice as high as among women. In some regions mortality rate for suicide and burns in females are as high as or even higher than in males. (WHO 2002 Injury Chart book)

Behind this figures there are great suffering and big economic problems for the families and society. There are solutions, Injuries don’t just happen, most are predictable and preventable. “Vision Zero” And our vision shall be that no one shall die or be seriously injured. (This vision was adopted by the Swedish Parliament for traffic injuries )

The Safe Community Model - as a Strategy From theory to practice WHO had a theory to improve the prevention work for injuries by focusing on the local community - community participation -where the local community is identifying their own problems. Instead of each sector working separate on the national level, like traffic, work, water, and so on.

Sweden had already developed a model for safety promotion at mid The Safe Community program The initiator of this program was Professor Leif Svanström, now head of the WHO Collaborating Centre on Community Safety Promotion at the Karolinska Institutet The Safe Community Model Started in Sweden

From National Programs to Local Municipality The background was that safety promotion work in Sweden had been very successful in the areas of traffic and occupational safety. 70 % the injuries were however home related – but no organized work As a consequence of this the Community oriented safety promotion program was established in Sweden.

Falköping Program 1975 an intervention area was selected: Falköping municipality (30,0000 inhabitants) and a control area Lidköping municipality with similar municipality structure.

Falköping Program Already after 2,5 years’ program work showed decrease by 28% of Traffic injuries 27 % of Home related injuries 28 % of Occupational injuries 45 % of Pre-school injuries There is no other health promotion program that can show results within such a short period.

Implementation of a Safe Community Program Key Factors (1) The involvement of the local political leadership is necessary, to get a sustainable program.

Key Factors (2) A working group established of: local politicians from the municipality the health sector civil servants from the municipality Representatives from: Police Enterprise Industry Religious leader Sports organisation Pensioners organisation etc. NGO’s

Key Factors (3) Injury Surveillance The injury problem differs from country to country and from community to community. Local data is necessary, which can be from: - Hospital, -Health Care Centre - School Health Care, - Dental Care - Police – Insurance company - Household survey

Key Factors (4) Community Diagnose To make an analyse of the community’s injury problem, by mapping the: - causes - frequencies - when and where and - how the injuries happened - free text (narrative about what happened).

Key Factors (5) A project leader is necessary (preferably fulltime) The program shall include prevention of human injuries caused by: - accidents - violence - suicide, etc. - prevention of the consequences (human injuries) related to Natural Disaster The program shall cover all areas: - home - traffic - occupational - sport, leisure - school, etc.

The program shall cover all age groups: Children: 0-4, 5-14 Years Adolescence: Adults:30-44; Elderly: 60+ Involve the local people in the community for reporting dangerous situations, places and products. Involve Mass media.

Strategies (1) Environmental changes, by reconstruction of dangerous crossroads to roundabouts. Urban planning for safety, separate traffic from children, pedestrians.

Strategies (2) Build in safety in newly constructed buildings, ex: child safe windows, safe stairs. Separate traffic from pedestrian. Product Design Through the surveillance you can get information about dangerous products and use this information as feed back to the constructors, manufactures, designers etc.

Strategies (3) Education Programs (A) Home visits to all parents with newly borne children by Health Centre personnel. Safety information about risks for the child for that specific age, at each time at the visit at the Child Health Centre.

Education Programs (B) Immigrants Specific attention to immigrants (some groups may have a higher risk for injuries). Checklists, in many languages.

Education Programs (C) Children- traffic education by the - teachers, the police. In Sweden a bicycle law was introduced for children up to 15 years (1 January 2005.) Pensioners – information by the Read Cross, safety bag with safety devices.

Strategies (4) Law Enforcement Both community action and Law enforcements are necessary to reach goals. Bottom-up and Top-down approach As an example in Victoria, Australia, less than 5% bicyclists wore helmets but when the law was introduced (1991) the use raised to 83%, which resulted in 70 % less head injuries.

In the Ph.D. Thesis from Johan Lund, Norway is reported “Analysis of 332 interventions revealed that attitude modification measures used alone (leaflets, Mass Media) seemed to produce little effect, the effect increased when communication was personal and interactive. Structural measures (environmental changes, law and regulation) showed stronger positive effects. The strongest positive effect was a combination of prevention measures” (Safe Communities model)

Speed Control Speed kills. Introduce 30 km/hour in densely populated areas (where encounters with un- protected road users are possible). The majority (95%) will survive if they are hit by a motor vehicle with 30 km/hour speed. This speed regulation was introduced in: Graz City in Austria (1992) and Årdal in Norway and Stockholm, Sweden 2005 and many other places.

Safe Community Network World wide a number of Demonstration projects have been established (157 programs from ). Differ in size from million inhabitants. By fulfilling the 6 Indicators: Which includes programmes including safety promotion, injury-, violence-, and suicide prevention, and prevention of the consequences (human injuries) related to Natural Disaster covering all age groups, gender and areas and is part of and international network of sustained accredited programs. Application for Membership is administrated by the WHO CC at the Karolinska Institutet in Stockholm and the Certifying Centres.

The Safe Communities Network Designated Members Norway Alvdal Bergen Fredrikstad Harstad Høyanger Klepp Kvam Larvik Os Rakkestad Sogn &Fjordane Ski Spydeberg Stovner Trondheim Vågå Årdal Sweden Arjeplog Borås Falköping Falun Katrineholm Krokom Lidköping Ludvika Mariestad Motala Nacka Skövde Smedjebacken Staffanstorp Tidaholm Töreboda Uddevalla Denmark Horsens Finland Hyvinkää Kouvola Estonia Rapla Netherlands Rotterdam Austria Vorarlberg Poland Tarnowskie Góry Serbia Backi Petrovac Czech Republic Kromeriz Bosnia (B&H) Konjic Iran Arsenjan Bardaskan District 22 Kashmar Israel Raanana South Africa Eldorado Park Broadlands Park & Nomzamo South Korea Jeju Suwon Songpa Wonju Vietnam Cam Thuy Da Trach Dong Tien Duc Chinh Hoa Long Lang Co Loc Sonh Xuan Dinh China Dongzhimen Financial Sub-district Hong'qiao Huamu Jianwai Jing Ge Zhuang Jing’an Kangjian Lu’an Maizidian Qianjiaying Wangjing Yayuncun Youth Park Yuetan Alishan (Province of Taiwan) Dungshr (Province of Taiwan) Fongbin (Province of Taiwan) Neihu (Province of Taiwan) Shihkang (Province of Taiwan) Shoufeng (Province of Taiwan) Zhongzheng (Province of Taiwan) Kwai Tsing (Hong Kong) Sham Shui Po (Hong Kong) Tuen Mun (Hong Kong) Tai Po (Hong Kong) Tung Chung (Hong Kong) Tsuen Wan (Hong Kong) Japan Kameoka Australia Cairns Denmark Hume City Latrobe Mackay/Whitsunday Manly Melbourne Mosman Mount Isa Noarlunga Northcott Palmerston Pittwater Ryde Townsville Warringah New Zealand Christchurch New Plymouth North Shore Porirua Taurange Waimakariri Waitakere Wellington Whangarei Canada Brampton Brockville Calgary Wood Buffalo Rainy River Sault Ste. Marie USA Anchorage Dallas Itasca Omaha Springfield Peru San Borja Chile Peñaflor

15 Safe Communities in Mainland China Beijing Dongzhimen Financial Sub-district Jianwai Wangjing Yuetan Shanghai Hong'qiao Huamu Jing’an Kangjian Chaoyang District Maizidian Yayuncun Hebei Province, Jing Ge Zhuang, Kailuan Huaiyin District, Youth Park, Jinan City Shanxi Province, Lu’an Fengnan District, Qianjiaying, Kailuan

Safe Communities in China Province of Taiwan 1. Alishan 2. Dungshr 3. Fongbin 4. Neihu 5. Shihkang 6. Shoufeng 7. Zhongzheng

Safe Communities in China Hong Kong 1. Kwai Tsing 2. Sham Shui Po 3. Tuen Mun 4. Tai Po 5. Tung Chung 6. Tsuen Wan

Affiliate Safe Community Support Centre in China China Occupational Safety & Health Association (COSHA), Beijing Zhang Baoming, President Safety and Health Council, Hong Kong TANG Wah Shing, Executive Director Chair, Asia Safe Community Network – est Pending: Taiwanese Community Safety Promotion Center. Lu Pai Ph.D.

The Affiliate Safe Community Support Centres (ASCSC) and The Safe Community Certifying Centres (SCCC) Sweden Swedish Association for Safe Communities (SCCC) Czech Rebublic Centre for Injury Prevention (ASCSC) Uganda Injury Control Center (ASCSC) South Africa Centre for Peace Action (ASCSC) (SCCC) Canada Safe Communities Canada (SCCC) USA National Safety Council (ASCSC) Peaceful Resources Center (ASCSC) Injury Prevention Research Center (ASCSC) Colombia Instituto CISALVA (SCCC) China China Occupational Safety & Health Association (ASCSC) Occupational Safety and Health Council, Hong Kong (ASCSC) South Korea Center for Injury Prevention and Community Safety Promotion (ASCSC) (SCCC) Bangladesh Centre for Injury Prevention and Research (ASCSC) Australia Royal Children´s Hospital Safety Centre (ASCSC) Australian Safe Communities Foundation (SCCC) New Zealand Safe Communities Foundation (ASCSC) (SCCC) These Affiliate Centres are supporting the WHO CC in the development of the Safe Communities Program and providing advice and assistance in the field of injury prevention and safety promotion to the communities in their country and internationally. The Certifying Centres also take care of the certifying function of the WHO CC.

Safe Schools Certifying Centres Czech Rebublic Centre for Injury Prevention USA Peaceful Resources Center China Occupational Safety and Health Council, Hong Kong Taiwanese Community Safety Promotion Center ( Oct 09) South Korea Center for Injury Prevention and Community Safety Promotion Australia Australian Safe Communities Foundation New Zealand Safe Communities Foundation These Safe Schools Certifying Centres are supporting the WHO CC in the development of the International Safe Schools Program and providing advice and assistance in the field of injury prevention and safety promotion to the Schools in their country and internationally. The Certifying Centres also take care of the certifying function of the schools.

International Safe Schools Network Members Sweden Källby Gård Helhetskola Poland Tarnowskie Góry Serbia Jan Čajak Czech Republic Zachar Záchladní Slovan Elementary School Israel Shaked School China, Province of Taiwan Taipei Cheng De Primary School Nan-Hu Elementary School Tamkang University Zhi-Shan Junior High School Chiayi Chiapei Elementary School Chueiyang Primary School Giaopang Primary School Lan Tan Elementary School Singan Elementary School Yu-Ren Elementary School Tungshih Elementary School Nan-ao Shiang Dong Ao Elementary School Fongbin Primary School Kang Le Elementary School Hualein National Senior High School Korea Jung Ja Elementary School New Zealand Woodend School Cosgrove School Murrays Bay School Murrays Bay Intermediate Red Hill Primary School Papamoa School USA Porter E lementary School Thailand Suan Bua SchoolJeju Saint Johns International School

Development from Different Sectors The Safe Community activities have been developed through different sectors, ex: in Sweden, through the Health Care Sector, by the MD who meets the consequences of the accidents. Harstad, Norway

In Canada and China, Hong Kong the program has been developed through the Occupational Sector. Fort McMurray in Canada through the oil plant - occupational injuries - leisure time injuries For this reason the program was expanded to cover the whole community.

The leading cause of death related injuries in China are - Self-inflicted injuries - Road traffic injuries - Drowning Yuetan, Bijing Telephone hotline Counselling services Life Clinic attendants

A Leading Cause of the Global Burden of Disease

Global Road Traffic Injury Mortality The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO All rights reserved No data 29.2– – – –16.1 Mortality rate (per )

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO All rights reserved Global Drowning Mortality No data 9.3– – – –1.8 Mortality rate (per )

To Implement a Program We at the Karolinska Institutet, can provide you with knowledge. Education in Safety Promotion on Master level by Internet training or in Stockholm, and courses on Ph.D level.

Information is available at our web page Attend conferences! Yearly there are International and Regional Safe Communities conferences. 18th International Safe Communities Conference August 2009, Cali, Colombia 5th Asian Regional Conference on Safe Communities Safety, Health, Harmony October 2009, Beijing, China

We suggest you to visit some of the programmes, which is the best way to learn. Network Members are listed at our web page.

Remember You are expert on your culture for developing Safe Communities in Your region. The work has always to continue, as the society is constantly changing and influencing the injuries, like new products, economical and political changes and so on. We need your help for the further development of the Safe Communities model. Thank you for your attention!