The Swedish National Safety Promotion Program.

Injuries are a global public health problem, causing about three and a half million deaths each year. ' In Sweden, despite major advances, injury remains the most common cause ofdeath in children, adolescents, and young adults. About 3000 people die from unintentional injuries each year in Sweden and about 160 000 are hospitalised. Injuries account for 4 125 560 days of hospitalisation2 and are responsible for about 900 000 medical consultations annually. In addition, there is the toll of intentional injuries to be considered. Each year 140 people die due to acts of violence, and each day six or seven are admitted to hospital as a consequence of assault.2 Although over the last 10 years injury mortality in Sweden has decreased by 10%,3 in 1990 the societal costs of injuries were roughly equivalent to 4%O of the Swedish gross national product.4 The Swedish Health and Medical Services Act of 1983 urges the health services to become more involved, not only in disease prevention but also in safety promotion. The first 'Health for all' program covering all areas and all levels of injury prevention and safety promotion was established in 1986.5 In its initial phase, it focused on intersectoral cooperation and the participation of diverse governmental organisations. This report describes the further development of the program in the context of the National Institute of Public Health established in 1992. The institute's function is to promote health and prevent disease. It works at the national level by adopting strategic measures to stimulate and support public health efforts. The National Safety Promotion Program (NSPP) at the National Institute of Public Health, is a nationwide network with many branches. It is based on 'Strategies for a safe Sweden', prepared in 1990/1 by a coordinating committee representing many authorities and organisations involved in injury prevention. The NSPP relies on intersectoral collaboration at local, county, and national level, and on cooperation between authorities, scientific institutions, and local practitioners. It requires the participation of politicians, civil servants, researchers, representatives of non-governmental organisations, and local public health workers. Its primary objective is to create a national network with branches at all levels and in all environments. Its other objectives are: * To develop local safety work * To extend intersectoral collaboration at local, regional, and national levels * To increase public awareness of injury risks and hazardous environments * To reduce injuries with special emphasis on certain risk groups and environments * To increase knowledge of what is being done to prevent injuries due to violence and what should be done in the future. The program is expected to initiate and implement national strategies by: * Monitoring and analysing the magnitude of the problem and causal patterns * Publishing timely reports for local communities * Developing an 'ABC of safety', comprising information on safety legislation and regulations * Promoting the use of bicycle helmets * Developing a 'risk hotline' to enable the general public to report environmental hazards and dangerous products * Analysing the role of non-governmental organisations * Promoting research, especially on injuries among the elderly * Organising conferences, seminars, and postgraduate courses * Monitoring current prevention projects and initiating new, local projects. Safety promotion requires a permanent organisation and collaboration between different levels of society (central, regional, and local), between different areas of activity, and between researchers and practitioners. One issue of particular relevance is how experiments and projects can be linked to, and transformed into, long term activities. Another task of the NSPP is to provide support for safety promotion. This involves creating networks, disseminating models and examples, formulating problems, putting these problems on the agenda, and moulding public opinion. In Sweden, many societal sectors have lengthy experience of safety promotion but there is a need for coordinated action. Thus, at the national level, two intersectoral groups form part of the network: one dealing with unintentional injuries, the other with injuries related to violence. A news bulletin with topical information is published periodically. One of the specific features of the program is building up skills among involved personnel. There is a need for better training and education at all levels. A masters course in public health on injury epidemiology and safety promotion was created in collaboration with the Karolinska Institute. To support this, a textbook has been compiled and courses held for health inspectors, health planning officers, and students at medial faculties. There have been, and will continue to be, regular meetings with people working in the network. Training National Institute of Public Health, Stockholm, and the Karolinska Institute, Department ofPublic Health Sciences, Division of Social Medicine, Stockholm, Sweden L Schelp L Svanstrom