The 'WHO Safe Communities' model for the prevention of injury in whole populations

  • Conclusions changed
  • Review
  • Intervention




The World Health Organization (WHO) 'safe communities' approach to injury prevention has been embraced around the world as a model for co-ordinating community efforts to enhance safety and reduce injury. Approximately 150 communities throughout the world have formal 'Safe Communities' designation. It is of public health interest to determine to what degree the model is successful, and whether it reduces injury rates. This Cochrane Review is an update of a previous published version.


To determine the effectiveness of the WHO Safe Communities model to prevent injury in whole populations.

Search methods

Our search included CENTRAL, MEDLINE and EMBASE, PsycINFO, ISI Web of Science: Social Sciences Citation Index (SSCI) and ZETOC. We handsearched selected journals and contacted key people from each WHO Safe Community. The last search was December 2008.

Selection criteria

Two authors independently screened studies for inclusion. Included studies were those conducted within a WHO Safe Community that reported changes in population injury rates within the community compared to a control community.

Data collection and analysis

Two authors independently extracted data. Meta-analysis was not appropriate due to the heterogeneity of the included studies.

Main results

We included evaluations for 21 communities from five countries in two geographical regions in the world: Austria, Sweden and Norway, and Australia and New Zealand. Although positive results were reported for some communities, there was no consistent relationship between being a WHO designated Safe Community and subsequent changes in observed injury rates.

Authors' conclusions

There is marked inconsistency in the results of the studies included in this systematic review. While the frequency of injury in some study communities did reduce following their designation as a WHO Safe Community, there remains insufficient evidence from which to draw definitive conclusions regarding the effectiveness of the model.

The lack of consistency in results may be due to the heterogeneity of the approaches to implementing the model, varying efficacy of activities and strategies, varying intensity of implementation and methodological limitations in evaluations. While all communities included in the review fulfilled the WHO Safe Community criteria, these criteria were too general to prescribe a standardised programme of activity or evaluation methodology.

Adequate documentation describing how various Safe Communities implemented the model was limited, making it unclear which factors affected success. Where a reduction in injury rates was not reported, lack of information makes it difficult to distinguish whether this was due to problems with the model or with the way in which it was implemented.




世界衛生組織(World Health Organization (WHO))用來預防受傷的“安全社區”方法已被全世界提倡,作為共同整合社區力量以增加安全性並減少受傷的模式。全世界將近有150個社區有正式的“安全社區”名稱。公共衛生關心的是哪一種等級的模式是成功的,以及是否因此而減少受傷率。這篇考科藍回顧更新了先前已發表的文章。




我們檢索包括CENTRAL,MEDLINE及EMBASE,PsycINFO,ISI Web of Science:Social Sciences Citation Index (SSCI)及ZETOC。我們人工檢索特定的期刊並連絡每個WHO安全社區的主要人員。最近的檢索是在2008年12月。











此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

The 'WHO Safe Communities' model for the prevention of injury in whole populations

The World Health Organization (WHO) Manifesto for Safe Communities states that "All human beings have an equal right to health and safety". The emphasis of the Safe Communities approach is on collaboration, partnership and community capacity building to reduce the incidence of injury and promote injury-reducing behaviours. Approximately 150 communities throughout the world have been designated as 'Safe Communities', in countries as diverse as Sweden, Australia, China, South Africa and the Czech Republic. Programmes target high-risk groups or environments and promote safety for vulnerable groups. They range from bicycle helmet promotion in Sweden to anti-violence programmes in South Africa, traffic safety initiatives in South Korea and indigenous community injury prevention programmes in New Zealand.

The review authors identified that only 21 of the Safe Communities have been the subject of controlled injury outcome evaluations. These communities are from two geographical regions: the European countries of Austria, Sweden and Norway and the Pacific nations of Australia and New Zealand, both of which have relative economic wealth, higher health standards and lower injury rates than many other parts of the world. Although positive injury rate reductions were reported for some communities, the overall results varied substantially and overall do not provide a clear answer to the question of whether the adoption of the Safe Communities model leads to a significant reduction in injury. Limited information is available about how the programmes were implemented, their impact on injury risk factors and sustainability. There were also substantial methodology limitations associated with most of the included evaluations. No evaluations were available from other parts of the world, particularly those with lower economic and health standards.

Laienverständliche Zusammenfassung

Das "WHO Sichere Gemeinden" Modell zur Verhinderung von Verletzung in gesamten Populationen

Im Manifest der Weltgesundheitsorganisation (WHO) für Sichere Gemeinden heißt es, dass "alle Menschen das gleiche Recht auf Gesundheit und Sicherheit haben." Der Schwerpunkt des Konzeptes für sichere Gemeinden liegt auf Zusammenarbeit, Partnerschaft und Aufbau von Kapazitäten in den Gemeinden, um die Inzidenz von Verletzung zu vermindern und verletzungsminderndes Verhalten zu fördern. Rund 150 Gemeinden weltweit wurden als "Sichere Gemeinden" bezeichnet, in so unterschiedlichen Ländern wie Schweden, Australien, China, Südafrika und der Tschechischen Republik. Programme visieren besonders gefährdete Gruppen oder Umgebungen an und fördern die Sicherheit für gefährdete Gruppen. Sie reichen von der Förderung von Fahrradhelmen in Schweden bis hin zu Anti-Gewalt-Programmen in Südafrika, Verkehrssicherheitsinitiativen in Südkorea und Programmen zur Verhinderung der Verletzung von indigenen Gemeinden in Neuseeland.

Die Review-Autoren identifizierten, dass nur 21 der sicheren Gemeinden Gegenstand kontrollierter Beurteilungen mit dem Endpunkt Verletzung waren. Diese Gemeinden stammen von zwei geographischen Regionen: den europäischen Ländern Österreich, Schweden und Norwegen und den pazifischen Nationen Australien und Neuseeland, beide mit relativem wirtschaftlichen Wohlstand, höheren Gesundheitsstandards und niedrigeren Verletzungsraten im Vergleich zu vielen anderen Teilen der Welt. Obwohl für manche Gemeinden positive Verminderungen der Verletzungsrate berichtet wurden, variierten die Gesamtergebnisse erheblich und geben insgesamt keine klare Antwort auf die Frage, ob die Annahme des Modells der sicheren Gemeinden zu einer signifikanten Verminderung an Verletzungen führt. Eingeschränkte Informationen sind verfügbar darüber, wie die Programme umgesetzt wurden, über ihren Einfluss auf Risikofaktoren für Verletzungen und Nachhaltigkeit. Es waren auch erhebliche methodische Einschränkungen mit den meisten der eingeschlossenen Beurteilungen assoziiert. Es waren keine Beurteilungen von anderen Teilen der Welt verfügbar, insbesondere von denen mit niedrigeren wirtschaftlichen - und Gesundheitsstandards.

Anmerkungen zur Übersetzung

C. Zollbrecht, freigegeben durch Cochrane Deutschland.