1. 1 IT ALL STARTED IN FALKÖPING, SWEDEN SAFE COMMUNITIES – GLOBAL THINKING AND LOCAL ACTION FOR SAFETY Leif Svanström WHO Collaborating Centre on Community Safety Promotion KI and HiS

2. 2 Pioneered by Professor Ragnar Berfenstam (1953-5), Sweden became the first country to attack the problem of injury in a scientifically based manner. He and his group were also the first to organize prevention involving all levels and through policy making.

3. 3 This time I have chosen to describe the development of the Safe Community movement from the point of view of some evaluated and scientifically reported findings. Almost 40 years will be described in different steps; It all started here in Falköping 1975 and will never end!

4. 4 Community Safety Promotion = Safe Communities 1975- the policy plans for local action in Skaraborg County

5. 5 Skaraborg County Council Olycksfall (Accidents) Kerstin Svanström Leif Svanström

6. 6 Skaraborg County Council Accident Prevention in a Municipality (Chosing Falköping as an intervention community and Lidköping as a control) Mats Nyström Lennart Ström Kerstin Svanström Leif Svanström

7. 7 The intervention was based on an "all ages – both sexes – all environments – all situations"

8. 8 Falköping Eight step program (Schelp L.) 1Epidemiologic mapping of injuries 2Choice of risk group/ -environment 3Intersectoral lead group + task force groups 4Joint planning (Mayor the Chair) 5Running the program 6Evaluation 7Modifications of program 8Disseminations of experiences

9. 9 Falköping 2 - 2 1/2 years program showed decrease of injuries: Total rate23% (from 113/1 000 inh:s) In traffic 28 % At home 27 % At work28 % Pre-school-age 45 % Other areas 1 % Control areaNo change

10. 10 Swedish Academic theses (dissertations) Falköping Bjarne Jansson, Bo Jacobsson, Marianne de Loês, Lothar Schelp Lidköping Robert Ekman, Glenn Welander Motala Kent Lindquist

11. 11 The first step towards a global movement – a Swedish network based on local action

12. 12 Lidköping ( Ekman, R. (1996) five intervention elements: surveillance, provision of information, training, supervision, and environmental improvements. Children1983- 1991 Boys -2,4% per year Girls -2,1% per year Elderly1987-92 Women -6,6%per year Men -5,4% per year

13. 13 Motala, Sweden Principal investigator: Kent Lindquist -13% total (119-106/1000 inv) Traffic almost 1/2 Costs decreased from 116 to 96 million SEK

14. 14 Falun, Sweden Principal investigator: Bo Bjerre Program showed decrease during 1989-94 by -24% total (9% in control area) Femoral fractures decreased by 6.3%, but were unchanged in the control area.

15. 15 Swedens National Board of Health and Welfare established a national program led by Guldbrand Skjönberg Principal manager Lothar Schelp Disappeared around 2000

16. 16 The second step towards a global movement – international dissemination

17. 17

18. 18 VAEROY, NORWAY 1982-83 30% Reduction 1982-9058% Reduction

19. 19

20. 20 Harstad, Norway Principal investigator Borge Ytterstad: -27% traffic injury rate, (increase in the control city of Trondheim) - 53% burn injury rate, ( increase in the control area). - 26% fall fractures in private homes

21. 21 Australia Jeffs, D., Illawarra area of New South Wales, found a reduction of 14% in hospital admissions during 1987-1991 Day, L.M., et al. Latrobe Valley program, found the injury rate by - 27%. Ozanne- Smith, J., et al. (2002) reported on Shire of Bulla, injury hazard reduction on the roads, in schools, and, slightly, in the home.Ozanne- Smith, J

22. 22 New Zealand From Waitakere Municipality Coogan, C., et al. (2000, 2003) reported on three-year process and outcome evaluations. With a quasi-experimental design, they demonstrated significant reductions in rates of Waitakere child injury hospitalisations, while comparison communities showed an increase

23. 23 Austria In Vorarlberg,Furian, G., & Rein, F. (2005), reported on a Safe Community model implemented in fourteen municipalities, and showed an injury decline of 19%. During 1993-2009, the number of hospital days in Austria increased by 10%, whereas in Vorarlberg Province they decreased by almost 20% (Furian, G., 2012).

24. 24 In the USA a number of evaluations have been done- the most published from Dallas, Texas.

25. 25 Step 3. Low- and middle-income countries and the Safe Communities movement

26. 26 Low- and middle-income countries suffer disproportionately from reduced life expectancy. 3/4 in low- and middle- income countries die before the age of 70, compared with 40% in high-income countries; injuries are a major cause of death under the age of 45.

27. 27 China and India account for more than one- third of all injury mortality in the world. At least 800,000 people in China die from injury each year; 50 million non-fatal injuries occur, of which 2.3 million lead to disability. There is an overwhelming problem of injuries in low- and middle-income countries and a lack of public health research.

28. 28 Do we need quasi-experimental design evaluations as a measure of success?

29. 29 Safe Community development is obviously successful as a policy development. The idea that a local community – village, municipality, county, city – can address its own problems using available resources is appealing. Seven so-called indicators - mainly process-oriented, can be used as a measure.

30. 30 Do we need national programmes or support? YES – we Do!

31. 31 Step 4 Enlisting the help of more international centres and the decentralisation of quality control

32. 32 School of Public Health = Safe Communities Vietnam

33. 33 School of Public Health = Safe Communities Thi Tran Lang

34. 34 School of Public Health = Safe Communities Thi Tran Lang Safe Waters

35. 35 School of Public Health = Safe Communities Vietnam Safe Schools

36. 36 School of Public Health = Safe Communities Vietnam Safe Traffic

37. 37 School of Public Health = Safe Communities Vietnam Safe Homes

38. 38 School of Public Health = Safe Communities Vietnam Safe Homes ??

39. 39 School of Public Health = Safe Communities Shanghai, China Safe City??

40. 40 School of Public Health = Safe Communities Shanghai, China Safe School

41. 41 School of Public Health = Safe Communities Shanghai, China Safe Food

42. 42 School of Public Health = Safe Communities Shanghai, China Safe Waters

43. 43 School of Public Health = Safe Communities Shanghai, China Counselling, conflict resolution

44. 44 School of Public Health = Safe Communities Shanghai, China Tai Chi as falls prevention

45. 45 School of Public Health = Safe Communities Shanghai, China Safe children/Safe stairs

46. 46 Jeju, Sydkorea Safe rescue services

47. 47 Hong Kong, China Application from a municipality

48. 48 Hong Kong, China

49. 49 Hong Kong, China Safe Hospitals

50. 50 Henk Harberts, A S C F Applications for Support Centres & Certifying Centres

51. 51 WHO Collaborating Centre on Community Safety Promotion at Karolinska Institutet Department of Public Health Sciences Division of Social Medicine

52. 52 Www.ki.se/csp http://www.ki.se/csp/ Www.ki.se/csp http://www.ki.se/csp/ pdf/Publications/version_20 120414.pdf leif.svanstrom@ki.se moa.sundstrom@ki.se leif.svanstrom@ki.se

53. 53

54. 54 Lidköping created the logo & flag, but it All started in Falköping Thanks for inviting us here for this Conference Two decades after the first International Safe Comm Conference 1991 (Mexico next – 2013) This is why we do it still: