The community safety approach in Falun, Sweden — is it possible to characterise the most effective prevention endeavours and how long-lasting are the results?

Abstract

The safe community concept was put into practice in order to reduce the number of unintentional injuries occurring in the Falun municipality. A community-based injury prevention programme was initiated in 1989 and has been gradually built up since that time. The prevention endeavours were based primarily on active intervention strategies through the provision of information, supervision, education and training. After 5 years of an active intervention programme, a significant effect was found as regards the injury rates for both outpatients as well as patients discharged from hospitals. The objectives of this study were: to examine whether the character of the prevention endeavours was a determining factor on the outcome (recorded as in-patient injury cases); to evaluate the effects of this programme, which is still in practice, compared to long-term historical trends; and to draw comparisons with other community-based programmes. A category of ‘most targeted risks’ was identified as being different with respect to how the injury mechanisms involved were targeted through the programme activities. The development within the injury rates for this group, comprised predominantly of injuries caused by falls at the same level, was significantly different than those for the groups categorized as ‘less targeted’ and ‘non-targeted’. The general effect of the programme appeared to be a neutralization of an otherwise upward trend in the injury rates. A particular effect was demonstrated in the number of fall injuries, including femoral fractures. It was also noted that there was still a reduction in injuries after 7 years. However, it was possible to surmise a waning effect during the last 2 years of the programme while still in progress. This observation suggests that a community-based injury prevention programme must be continuously renewed and reinforced.