The community safety approach in Falun, Sweden. What makes it work?

Abstract

After five years of an injury prevention program in action, we found the injury rates to be markedly reduced. The objectives of this study are to describe the program and to evaluate its different parts, looking for possible dose-response relationships. The prevention program in Falun (population 55,000), Sweden was organized in five different committees under the leadership of an executive group. Five different categories of injury cases were registered. The prevention efforts were based primarily on active intervention through the provision of information, supervision, education and training. Passive intervention through tangible environmental changes was only minimal. The injury reduction was most pronounced in the categories of work and school accidents. Injury rates were reduced significantly more for males than for females. These differences were not caused by different active prevention efforts. Outcome data gave the unexpected result that groups considered to have given a lower“dose of prevention exposure” suggested a more pronounced injury reduction than groups exposed to a markedly“higher dose”. When using a quantitative definition of“dose of prevention exposure” we found a few indications of a dose-response relationship but were otherwise unable to demonstrate any such relationships clearly. The effects of the program seemed, on the other hand, to be most pronounced in groups of the population with established“upper risk level” rates according to the baseline data. The community safety approach may also provide“spin-off effects on groups not actively targeted and reinforce historical trends. These findings suggest that an analysis of possible dose-response relationships should be of a more qualitative character and that greater advantage must be taken of the significant role played by the mass media in creating a general awareness of injury risks.