Plenary 2: Achievement of Safe Communities over the decades: from Lidköping to …….." By Prof. Koustuv Dalal, SWEDEN

1. Achievement of Safe
Communities over the decades:
from Lidköping to …………..
Koustuv Dalal, PhD
Professor in Public Health Science (Health Economist)
Chair: International Safe Hospital
Director, Centre for Injury Prevention and Safety Promotion
Örebro University, Sweden
Academic Editor, PLOS ONE
koustuv.dalal@oru.se

2. Safe Communities around the world
Safe Communities year-wise
Evaluation
Outcome evaluation
Economic evaluation
What have we done?
What can we scientifically think?
What can we socially -economically think?
Do we need any more safe community?

3. Safe Communities
1. Australia
2. Austria
3. Bosnia and Herzegovina
4. Canada
5. Chile
6. China
7. Taiwan
8. China, Hong-Kong
9. Croatia
10. Czech Republic
11. Denmark
12. Estonia
13. Finland
14. Germany
15. Iran (Islamic Republic of)
16. Ireland
Safe Communities
17. Israel
18. Japan
19. Mexico
20. New Zealand
21. Norway
22. Peru
23. Poland
24. Republic of Korea
25. Serbia
26. South Africa
27. Sweden
28. Thailand
29. Turkey
30. United Kingdom
31. United States of America
32. Viet Nam

5. http://isccc.global/

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starting year 1989 till 2015

7. EVALUATION DOMAINS
Policy
Science Practice
Planning &
Evaluation

8. Evaluation
has
two
arms:
1. Data
gathering
2. Contextualizing
results

9. TYPES OF EVALUATIONS
Process evaluation
Qualitative evaluation
Formative evaluation
Evaluation Research
Program evaluation
Outcome
Economic

10. Program Evaluation:“Program evaluation is the
use of social research procedures to systematically
investigate the effectiveness of … programs.”
(Rossi, Freeman and Lipsey)
Also called impact, dissemination, and summative evaluation
Assumes efficacy has been confirmed by evaluation research
Concerned with both internal and external validity

11. Program evaluation typically involves
assessment of one or more of the five program
domains:
1. The need for the program
2. Design of the program
3. Program implementation and service delivery
4. Program impact or outcomes
5. Program efficiency

12. Outcome evaluation:
Gauges the extent to which a program produces the intended
improvements it addresses
Addresses effectiveness, goal attainment and unintended
outcomes
Is critical in quality improvement
Outcomes can be initial, intermediate or longer-term
Outcomes can be measured at the patient-, provider-,
organization or system level.

13. Why economic evaluation?
Injuries, illnesses are significant economic burden
=> Established need for economic analysis
Provides framework for comparison of
intervention options and effectiveness
Adds a transparency to decision making process

14. Economic Evaluations (EE) put values
Motivating a re-allocation of resources
Cost-effectiveness or cost-benefit
Economic Analysis is used to test economic theories and to predict
changes made in response to resource re-allocation
EE: Applied analytic methods to:
Identify,
Measure,
Value, and
Compare

15. Health
Economic
evaluation
“The
comparative
analysis
of
alternative
courses
of
action
in
terms
of
both
their
costs
and
consequences”
Related to social choice
Choice
A
B
Is A
better than,
as good as,
or worse than
B?
All
Economic
Evaluation:
assessment
of
both
use
of
resources
&
health
benefits
of
the
Health
Care
Program
] Optimum
use
of
scarce
resources

16. What have we done?
Evaluated all
SC reports
SC scientific articles
To know what Safe Communities have done (outcome)
To know what Safe Community Certifiers have done (process)
To know what Safe Community Program ( The World
Health Organization initiated program) has delivered by
economic point of view

17. The evaluation was conducted independently
being loyal to science
being loyal to research profession
So the evaluation is actual representation of ‘facts and
figures’ without any bias
as this evaluation is subject to anonymous review for
high-impact scientific publication for future reference

18. Output
Inputs
Productivity

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Designation: starting year 1989 till 2015

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Re-Designation: 2002 - 2015

21. SC reports
Effectiveness of Safe Communities
Overall injury reduction†: 22 - 33%
Minor injuries 41%
Use of bed-days due to injuries reduced by 39%
Health care treatments due to injuries reduced by 15%
Childhood injuries reduced significantly
Elderly injuries reduced
† could not test significance yet

22. Several scientific publications (>150)
RTI
Elderly
Child injury
Violence
……………….
More than 20 PhDs

23. SC program
Cost effectiveness
1.3 million USD intervention cost
2.7 million USD SAVINGS of societal costs
Cost-benefit ratio 1 : 10

24. Injury frequencies reduced
Significant difference between reports at
intra-country &
inter-countries
Lack of consistencies
reporting
inter-system evaluation (certification process)
Heterogenous approach of the system
Methodological inconsistencies

25. Global macro social factors
National / Regional macro social factors
Community
Friends RelativesHOST
Agent / vehicle
H o m E
Neighborhood
National / Regional Physical environment
Global physical environment
Social
env.
Physical
env.Lense
Telescope
Forward looking: intervention, determinant, injury=> outcome in a life stage
Previous
Generation
Childhood
Adult
Next
Generation
Older
age
Adolescent
Fetal
development Adolescent
Fetal
development
Fetal
development
Fetal
develop-
ment
Next
Generation
Hosking et al, 2011
Lense-Telescope
Model
Backward looking: injury prevention in a life stage

26. Economies of Scale and Economies of Scope
Economies of scale exist when average cost is declining.
Important to distinguish between long-run vs. short-run
Short-run economies of scale:
affect operating decisions and
relevant to post-entry stage
Long-run economies of scale:
impact whole structure
only relevant in the pre-entry stage.
Economies of scope: cost savings associated with a broadening of
scope of activities (e.g. multi-country).
Economies of scope arise from “complementarities” in the mechanism of
production or distribution of Safe Community services

27. Economies of scope for SC:
Excess capacity utilization (grossly missing)
Utilization of specific and dedicated networking
through carefully planned publicity (lacking)
Deliverable of ‘safe Community’ brand identity
(why society should buy it?)
SC should implicitly focus on
leveraging core competencies
competing on capabilities
mobilizing resource, human

28. when Safe Community program is in transition phase we
should be very CAREFUL to choose between short-run and
long-run goals
We should consider and re-consider whole SC structure to
emphasise on
either pre-entry level
or post-entry level
Can we emphasise on both?

29. Safe Communities are
Successful to reduce injuries
Effective in both Social and Economic perspectives
Remember the Cost : Benefit ratio = 1: 10

30. Do we have any other social program(WHO initiated) that provides such cost benefit?
No

31. Do we care for our children as future of our society?
Do we care for our money?
Do we like to be cost-effective?
YES

32. SC gives us
evidence-based injury prevention
community level safety promotion
Cost-effectiveness (all most 50% savings in cost)
Cost-benefit = 1: 10
Lens -Telescope model:
what are we providing for next generation?

33. Is it just a WHO logo we should think for?
Is it: “just you thinking of ‘you and your bragging -business’?
OR
Is it: “we think for our society and do our best to build up
sustainable Safe Communities”?
Is it: “we create a safer community for our next generation”?

34. Thanks for your valuable time!