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Injury surveillance: unrealistic expectations of safe communities
  1. John Langley,
  2. Jean Simpson
  1. Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand
  1. Professor J Langley, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 913, Otago, New Zealand; john.langley{at}

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Designation as a World Health Organization (WHO) Safe Community (SC) is based on local capacity to meet six criteria. Criterion 4 states that communities must have: “Programmes that document the frequency and causes of injuries” ( This is typically interpreted as information that pertains directly to their community.

The reasons for doing so have been summarised by Nilsen et al1:

“Community-based injury prevention programmes need local IS [injury surveillance] to identify and characterize unique community injury problems, to develop tailored prevention strategies and to evaluate the effectiveness of local programme interventions”. In addition: “Local data can play an important role in motivating local action by increasing the community feeling of ownership and accountability for the mitigation of the injury problem” (p36).

It is important to note the evaluation need mentioned by Nilsen, since criterion 5 for designation as an SC requires: “Evaluation measures to assess programmes, processes and effects of changes” (

The review of Nilsen et al1 of 25 WHO SCs in Scandinavian and 16 Canadian Safe Community Foundation programmes reported that many of these programmes experienced significant difficulties accessing local injury data and few utilise these data effectively. In our evaluation of two small SCs, we noted similar difficulties.2 Nilsen et al1 recommend that, given the limited resources of most SCs, the situation be addressed by a greatly expanded supportive role of the coordinating or affiliate support centres of the two networks. They suggest “…the local programmes or the centres could collect IS data with the centres supporting analysis and interpretation with involvement of collaborating injury prevention researchers” (p41).

In this commentary, we demonstrate that expectations of SCs in terms of local surveillance systems are unrealistic. Our commentary is structured as follows:

  • Characterising problems and tailoring interventions

  • Evaluation

  • Local data motivate local …

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  • Contributors: Both authors contributed to conceptualisation of this commentary. JL developed the first draft. JS contributed to the revision of various subsequent drafts. JL is the guarantor.

  • Competing interests: None.