Effectiveness of the 'WHO Safe Communities' model to prevent injury in whole populations: a Cochrane Systematic Review Anneliese Spinks, Rod McClure, Cathy Turner, Jim Nixon

Rationale – Why a WHO Safe Communities Systematic Review? WHO Safe Communities formally initiated in 1989 At least 80 communities world-wide have been designated, with many more under preparation

Rationale – cont. Given the global interest and effort being afforded the Safe Community concept, it is of public health interest to determine to what degree the model is successful, i.e. Are injury rates reduced in the communities to which it is applied?

Web-accessed database of peer-reviewed systematic reviews Entails a rigorous methodology that provides a framework for high quality assessment of interventions

Objectives To conduct a Cochrane Systematic review to determine the effectiveness of the 'Safe Communities' model to prevent injury in whole populations, or targeted sub-groups of populations.

Searching for Evidence – Inclusion Criteria 1.Designated WHO Safe Community 2.Appropriate control community 3.Objective injury outcomes 4.Original data

Studies Located 61 studies written about Safe Communities 41 reported intervention outcomes 16 met the inclusion criteria 8 Individual Safe Communities

Included communities - Scandinavia Falkoping Falun Lidkoping Motala Harstad

Included communities - Australasia La Trobe Shire of Bulla Waitakere

Summary of Results Mainly “positive” 11 studies (4 communities) report significant decrease in injuries compared to control communities 2 studies report ‘no change’ while injury rates in control areas rose 1 study reports no overall change but decrease in pediatric sub-group 2 studies report no significant effect

Community / /96 Community 2 Limitations to Validity Arbitrary base-line / follow-up periods (particularly for those of short duration in small communities)

Limitations to Validity cont. Reliance on administrative databases to ascertain injury rates Not always taking pre-existing trends into account Publication bias Only small number of communities evaluated to date

Conclusions Cochrane methodology provides a framework to evaluate the Safe Communities Model There is evidence that Safe Communities model does reduce injuries in whole populations Not many communities have been formally evaluated Limitations in evaluation methodology

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