Name of the Community: Nacka
Country: Sweden
Number of inhabitants: 75,000
Programme start: 1993
"WHO-designation" year: 2000
Info address on the world wide web: www.nacka.se/skadeforebygga
Info address on the world-wide web for the community as a whole: www.nacka.se

For the age groups:

Children 0-14 years:

Conversations about accident risks at child health-care centres, which reach out to virtually all new parents. The work of the child health-care centres has been developed through a child-safety package, a waiting-room exhibition, a video film about child safety, and the selling of bicycle safety helmets.

The municipality certifies preschools as "Safe and Secure". To obtain such certification, a number of safety criteria have to be met. By the Year 2000, 20 preschools and 36 family child day-care centres had fulfilled the criteria. Checklists for both preschools and family day-care centres have been produced to aid certification work.

The public dental-care service informs parents of one-year-olds about injury risks, and distributes a so-called "injury card" providing information about what to do when a tooth is knocked out. The card is re-issued on dental visits when children are three years old.

Youth 15-24 years:
"Reversing the trend" is a social crime-prevention programme aimed at young people via schools, hobby and sports associations, and youth recreation centres. The work, the extent of which is unique to Nacka, communicates knowledge and methods concerning basic values, and promotes a broad health-promoting perspective on working with children and young people. A network of parents’ associations contributes to the project.

Attention is drawn to sports injuries among young people in collaboration with sports associations.

Adults 25-64 years:
Priority is given to efforts to prevent sports injuries.

The elderly 65+ years:
Home visits are made by district nurses for health conversation with 70-year-olds living in their own residences. Going through and talking about injury risks and how to prevent them is an important element. A guidebook and special counselling and demonstration material are used as aids for the conversations. A brochure called "Safer Everyday Living" has been produced by the intersectoral group working on injury prevention among the elderly and the disabled.

The home:
Attention is paid to injury risks in the home, and their prevention through home visits to people in their 70s.

Increasing attention is being paid to planning of the physical environment within the municipality. Public-health and injury-prevention issues are integrated into the municipality’s overall town plan and are highlighted in the detailed plans. Development work on descriptions of health consequences is in progress.

Traffic:
Work on traffic safety is being pursued on the basis of the "Zero Vision", whose ultimate target is that no-one shall be killed or seriously injured on the roads. Responsibility for action rests on the municipality’s four area boards. The initiatives of local citizens for improvements are supported and strongly encouraged.

"Traffic safety rounds", i.e. systematic inspections of traffic areas, have been performed on a district basis within the municipality. Representatives of many sectors with the local community, including road-maintenance workers, the police, house-owners’ associations and schools, participate and jointly document the hazards. Action proposals are made and priorities set, and are then presented by officers of the municipality to the political authority responsible.

The submunicipal district of Älta has run a pilot project involving increased participation of local citizens in traffic-safety work.

Statistics on road accidents are presented and discussed on a regular basis at major public events in Nacka’s submunicipal districts.

During 1999 and 2000 a speed limit of 30 km/h was introduced on most local streets in three of the submunicipal districts.

Work:
There is a network of companies/employing organisations within the frame of Agenda 21. Work so far has focused primarily on environmental issues. No overall safety-promotion activities have yet been performed. However, in that the network exists, the prerequisites for running long-term safety-promoting activities are now met.

The municipality and a number of companies in Nacka have run a bicycle-promotion project. The aim of the project is to persuade participants to cycle rather than take the car. In turn, this would provide benefits in the forms of improved health and less negative environmental impact. Use of bicycle helmets and reporting of safety hazards are some of the elements in the project.

Schools:
Certification of preschools, according to a model developed in Nacka itself, has been ongoing since 1998. The ones that meet requirements are given the quality award "Nacka – A Safe One". The criteria are that:

• injury-prevention work forms a part of everyday activities;
• routines are developed and established so that hazardous situations are removed;
• routines are developed and established for the cases where an accident occurs or a child is exposed to violence;
• all near-accidents and injuries are reported;
• child-safety rounds (systematic safety inspections) are performed once a term;
• there is an action plan for safety work that shows the preschool’s own control system, responsibility and authority.

Certification is valid for 1½ years. For the award to be retained it must be demonstrated by action that the criteria are met and that safety work has improved.

As an element in developing the internal-control activities of schools within the work-environment arena, Nacka Municipality and Sweden’s National Institute for Working Life have jointly produced material called "School Environment 2000". Efficient work-environment activities can favour the development work of a school as a whole. School Environment 2000 has been produced to facilitate and enable diverse efforts to interact so as to form a cohesive whole. Educational goals and a healthy work environment are at the centre, Several subareas within School Environment 2000 reinforce injury-prevention and safety-promotion work.

The School Health Service is running a program for all compulsory-school grades (1 to 9) to teach emergency heart and lung resuscitation. At Grade 6, the risks of dental injuries, including during sporting activities, is taken up by the National Dental Health Service. An injury card is distributed. Information about the risks of tobacco is a main theme running through all compulsory-school grades.

Sports:
A project has been started in the sporting arena with the purposes of strengthening awareness of and affecting attitudes to safety matters, and of effecting improvements to environments where sports associations run their activities. A possible way forward is to introduce certification of "Safe Sports" associations according to the pattern established for preschools. A pilot study has been performed, and a questionnaire distributed to local associations. Further, a description of how such certification might be introduced has been prepared.

Leisure:
See above.

There is a municipal crime-prevention programme, which is also an element in work to promote safety and prevent injuries during leisure time.

Miscellaneous:
"Nacka Dialogue" offers a way for local residents to communicate with the municipality. The Dialogue also operates as a telephone "Risk Hotline". Anyone can ring in to report injury risks and dangers in the environment. Thereafter, the municipality ensures that attention is drawn to the person/body concerned about the risk/defect in question. The municipality follows up to ensure that counter-measures are taken When the telephone is not manned, it is possible to leave a message on an answering service. Reports can also be made via e-mail.

Violence prevention (intentional injuries):
"Reversing the trend" is a social crime-prevention programme primarily aimed at young people but also at hobby and sports associations, and youth recreation centres. The aims of the project are to communicate knowledge and methods concerning basic values, and adopt a salutogenic perspective on working with children and young people

A crime-prevention programme has been initiated in collaboration with the police. It is based on the Swedish Government’s national crime-prevention programme. The national programme has been broken down and translated into a community crime-prevention project. There is a strategy for how crime-prevention work shall be pursued. The overall goals are to reduce crime and increase security in Nacka.

Suicide prevention (self-inflicted injuries):
Suicide and violence are prioritised areas, but work has not yet been systematised.

Programmes aimed at high-risk groups:
On the basis of injury registration, the injury panorama has been described. In the light of surveillance, children and the elderly (as high-risk groups), and also the area of sports injuries have been prioritised.

Surveillance of injuries:

Nacka Hospital: 1993 – 1995
Söder Hospital: 1997 –
Nacka Primary Care: 1993 –
Dental Health Service: 1993 –
School Health Service: 1993 –

Registration is not comprehensive since there are clinics available where injuries are not recorded. No analysis of missing cases has been conducted, but one can count on a substantial number.

Numbers per year

All cases recorded:
1993: 2,191 (11 months)
1994: 2,468
1995: 2,401 (approx. 9 months)
Söder Hospital:
1997 – 1998: 1,221 (12 months)
1999: 1,938
Primary care and dental health service:
2000: 407 (9 months)

Population base:
1993: 67,300
1995: 70,165
1997: 72,230
1998: 73,029
1999: 73,976
2000: 75,000

Start year: 1993

Publications (scientific): None

Produced information material, pamphlets:

• Brochure "Injury Prevention Programme program";
• Brochure "Safer Everyday Living";
• Seasonal pamphlet "A Safe Preschool";
• Information material about "Risk Hotline".
  

Staff
Number: 1
Working hours: full-time
Permanent: 1
Temporary: 0

Organisation: Injury-prevention work is integrated into the regular activities of local government (at both municipal and county level). The work is led by politically composed boards and agencies, and groups of officials with representation from both the municipality and county-run health services. One strategy adopted is, so far as possible, to develop injury-prevention work though existing networks and organisations. Examples of organisations where such collaboration takes place include "Welfare Nacka" (between the municipality’s social services, social insurance office, and the health region), "The Consulting Group" (an organ for political cooperation between the municipality and the health region) and "The Injury Prevention Network in Stockholm County" (a contact organisation for health-planning officers in Greater Stockholm).

Specific intersectoral leadership group: An intersectoral public-health group is responsible for the coordination of injury-prevention work. The group includes representatives from the municipality and county council, including the dental service. Since great emphasis has been placed on injury registration and surveillance, there is very close collaboration in this area. There is also a special intersectoral reference group for the target group, the elderly and the disabled.

General public health/health-promotion group: See above

International commitments:
Health Protection Conference in Tartu, Estonia (1995).

The municipality has established collaboration with several countries, including Russia and the Baltic states. The issues concerned include the environment, and Agenda 21 and public health (including injury prevention).

Nacka Municipality takes part actively in environmental and public-health work run within The Union of Baltic Cities. This network encompasses around 90 towns or cities in the Baltic area.

Study visits

Within the frame of the international exchange of experiences of the "Safe Community" organisation and the Karolinska Institutet with its WHO Collaborating Centre on Community Promotion, the municipality has received study visitors from the USA, France and Asia.

Participation in the International Injury Prevention and Control Conference

Atlanta 1993

Host to Safe Community conference

Not so far, but Nacka Municipality is host to Sweden’s Seventh National Injury Prevention Conference (Year 2000)

Hosting "Travelling Seminars":
2001

For further information, please contact:

Elisabeth Skoog
Public Health Officer
Nacka kommun
SE-131 81 Nacka, Sweden
Phone: +46 8 718 93 79
Fax: +46 8 718 94 54
elisabeth.skoog@nacka.se