The Manifesto for Safe Communities states that 'All human beings have an equal right to health and safety' (WHO Safe Communities). The Safe Communities concept was introduced to the world during the First World Conference on Accident and Injury Prevention held in Stockholm, Sweden in September 1989. It arose as the response to a successful community approach to the problem of injury that had been implemented as a pilot project in the Swedish municipality of Falkoping in 1974 (WHO 1999). This project demonstrated a 23% decrease in total population injury rates, following an intervention that focussed on specific injury related issues identified within the local community (Schelp 1987).

Since then, the Safe Communities approach has been embraced around the world as a model for coordinating community‐oriented efforts to enhance safety and reduce injury. The Safe Communities ideology engenders the notion that safety can be achieved through integrated, collaborative efforts that are implemented in a supportive social, cultural and political environment. Partnerships that unite various community members and groups are thus an essential component of the Safe Communities process. The official WHO Safe Communities Web site is available at http://www.phs.ki.se/csp/default.htm and describes the Safe Communities model in detail. This official site also provides details of all existing designated Safe Communities and Affiliate Safe Community Support Centres.

WHO Safe Community accreditation process

Communities are eligible for international recognition and accreditation through the World Health Organisation (WHO) if they meet the following six indicators (WHO Safe Communities):
1. an infrastructure based on partnership and collaborations, governed by a cross‐ sectional group that is responsible for safety promotion in their community
2. long‐term, sustainable programmes covering both genders and all ages, environments and situations
3. programmes that target high‐risk groups and environments, and programmes that promote safety for vulnerable groups
4. programmes that document the frequency and causes of injuries
5. evaluation measures to assess their programmes, processes and the effects of change
6. ongoing participation in national and international Safe Communities networks.

Initially communities were expected to meet 12 criteria, but this has since been amended to the above six indicators and there is now an evaluation component.

Since 1989, at least 78 communities throughout the world have been formally designated as 'Safe Communities', with populations ranging from 2,000 to 2,000,000. These communities exist in many culturally diverse countries that include Sweden, Australia, China, South Africa and the Czech Republic. Not only do these countries differ in culture and lifestyles, but also in many other aspects that affect the predominant causes, types and prevalence of injury, including climate, geography, and government. Accordingly, these communities each encounter their own unique issues and injury‐related problems that need to be addressed. In addition, they are equipped with varying levels of resources and infrastructure with which to tackle the injury problem. To further compound the issue, the political environments in which these communities exist, as well as the attitudes of community members towards safety initiatives, differ in many respects.

By definition, each Safe Community around the globe is an individual programme with its own challenges to overcome. Therefore, the specific injury prevention initiatives range from bicycle helmet promotion in Skaraborg County, Sweden; to violence programmes in Eldorado Park, South Africa; to traffic safety initiatives in Suwon, South Korea; and to indigenous community injury prevention programmes in Waitekere, New Zealand. The unifying element within these programmes is the emphasis on collaboration, partnership and community capacity building that is the core of the Safe Community model .

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, and whether its application does indeed reduce injury rates in the communities to which it is introduced. Due to the long‐term nature of the intervention, there are few published studies reporting injury rate outcomes and, amongst those published, there are conflicting findings. A Swedish study reported a significant reduction in injury risk, post versus pre‐intervention, of 26% for children in a WHO Safe Community, compared to a non‐significant reduction in injury risk of only 7% for children in a control community (Lindqvist 2002). However, an Australian study was unable to replicate these significant reductions (Ozanne‐Smith 2002). This systematic review will identify those studies conducted within WHO‐designated Safe Communities that have an evaluative component that includes a comparison with a control community, in order to determine the effectiveness of the Safe Communities model in preventing injury.