26 World Health • 49th Yeor, No. 2, Morch-Aprill996
Promoting community safety
Leif Svanstrom
&Moa Sundstrom
A
t least three and a half million deaths due to injuries caused by accidents, poisoning and violence are reported each year around the world.Among children and young adults, injuries are the number one cause of death, and a major cause of dis- ability and suffering.
During this century struc- tural changes like urbaniza- tion, industrialization and increasing motor traffic have made injuries a major public health problem.
participation by local organizations. It was able to show a 27-28% reduc- tion of injuries in the trans- port, home and industrial safety areas by 1981. In the areas without surveillance there was no decline. The ideas behind the
programme, based on information, education, supervision and environ- mental control, were taken up by communities in several other countries, such as Australia, Canada, Denmark, France, New Zealand, Norway and the United Kingdom. At the same time, similar pro- grammes were being devel- oped in countries like Indonesia and Thailand.
Injury control has pri- marily been tackled sector by sector: transport safety authorities have established their solutions, industrial safety theirs and so on.
However, we still do not have control over safety.
This was evident to WHO's
How to protect children from burns. The municipality of Falkoping in Sweden started an iniury control programme that has since been adopted in many countries.
The one in Thailand started with an initiative taken by the National Injury Prevention
Programme at the beginning of the 1980s and has been fully stated in WHO's General Programme of Work for 1990-1995 and 1996-2001, as well as in the Manifesto for Safe Communities of 1989. The
Manifesto was the result of work by 500 delegates from 50 countries during the First World Conference of Accident and Injury Prevention, held in Stockholm 1989 and sponsored by WHO.
Much of the success of local safety work resulted from
programmes pioneered in Norway, Sweden and Thailand, which were able to reduce the number of injuries by between 30% and 50%. As far as we know, the first programme of this kind was developed in the municipal- ity ofFalkoping, Sweden. Injury surveillance started there in 197 8 and the programme was based on inter- sectoral cooperation and voluntary
Disillusionment and feelings of being a loser may lead to destructive behaviour, criminality, gang-building, violence and abuse. If we do not understand and tackle this problem today, we will receive a rude awakening tomorrow.
Promoting healthy, non-violent communities in cities may be one of the most important contributions to the health of future generations.
Board of Public Health which stimulated the Primary Health Care organization of each village to encourage popular participation in health and safety matters. Local village committees in some areas judged injuries to be the number one problem and ran safety promotion campaigns. In the village of Wang Khoi, the schools developed safety education, farmers tried to make two- wheeler tractors safer, and everyone took action to prevent poisoning by pesticides.
11
Safe Community" models
Could such different cultural condi- tions as are found in the rural parts of Thailand and the wealthy areas of Scandinavia really be compared? In May-June 1991, a group of20 dele- gates analysed the two programmes during a five-week travelling semi-
World Health • 49th Year, No. 2, March-April1996 27
A safe playground developed by the Novaio nation in the USA.
The Navaio Safety Program achieved success by taking cultural factors into account.
Farmers in Thailand are taking action to reduce the risk of insecticide poisoning.
nar and found that the components were essentially the same. However, the structure and organization of different societies need to be taken into account when choosing strate- gies for introducing Safe Community models. Some societies favour a local model of decision-making and are easier to approach than others where formal action is limited by official approval. In the latter case it may be necessary to have national approval before action can be taken at the local level.
"Various models are proposed for the Safe Community rather than one model", but all "contain an element of community involvement and participation", Ms Irene Graham from the Safe Castelmilk programme in Glasgow, Scotland, told the Third International Safe Community Conference in Harstad, Norway.
Professor Dinesh Mohan from the Indian Institute of Technology stresses that it is not possible simply to transfer Safe Community guide- lines from northern Europe to less industrialized countries, because of the different stages in technical development and democratization.
A seminar hosted by the Navajo Nation in the USA in 1993 empha- sized that, just as the community is the owner of its problems, so the community should also be the owner of its development activities, like safety promotion. Experts can coor- dinate and support the programmes but the actual work and initiatives must come from the members- as is
done in the Navajo Safe Community programme, whose success has underlined that safety promotion must take the specific cultural fea- tures into account.
The Indian tribes, like indigenous groups in many other situations, were driven away from their country during the nineteenth century, and were thus threatened with the loss of their cultural structure, their lan- guage and their philosophy of life.
During the seminar, questions such as the following were asked: "What does lack of cultural respect and understanding mean to people?
What happens to people when they become refugees in their own coun- try? What happens to parents when they find themselves unable to give their children good advice for the future? What happens to children when they realize that what they learn from their parents is of no help to them in school or daily life?"
A rude awakening?
Losing one's cultural identity can be like opening the gate to destructive behaviour. We now see huge prob- lems of alcoholism, criminality, domestic violence and alcohol- related transport injuries among the population. Disillusionment and feelings of being losers may domi- nate, which may also lead to destruc- tive behaviour, criminality,
gang-building, violence and abuse.
If we do not understand and tackle
this problem today, we will receive a rude awakening tomorrow.
The challenges faced by less industrialized countries in safety promotion differ from those of indus- trialized countries, but everywhere, health and safety beliefs are an inte- gral part of life, culture, history and religion. As a result, elements from all settings should be used for the further development of the Safe Community movement and of WHO's Safe Community programme. The programme in- volves more than 30 countries and has 14 official demonstration com- munities. It is coordinated by the WHO Collaborating Centre on Community Safety Promotion at the Karolinska Institute in Sweden.
WHO-sponsored International Safe Community Conferences are orga- nized each year. Three-week travel- ling seminars are also held, and The Safe Community News is the Centre's channel for spreading information.
•
Professor Leif Svansfrom and Or Moo Sundstrom
are with the WHO Collaborating Centre on Community Safety Promotion, of the Karolinska lnsfifufe, Department of International Health and Social Medicine, S-172 83 Sundbyberg, Sweden. For further information contact
Or Sundstrom, fox: 46 898 6367, tel. 46 8629 05 08.
