What does it mean to be a safe community?
Dr. Trevor Hancock
23 July 2017
When people talk about the qualities of a healthy community, one of them is that it be safe. But what ‘safe’ means depends in part on who you are, as well as where you are from and what threat or harm we are considering. Indeed, safety isn’t just about physical harm, but perceptions of fear and insecurity – as anyone who has ever walked down a dark lonely road at night knows only too well. And war, of course, is an intensely dangerous situation for any community, but not one I am considering here.
Some groups in society feel less safe – and are less safe – than others; women, Indigenous people, people of colour, youth, seniors, people who are LGBTQ and others experience different sorts of risk, and thus creating a safe community is a complicated task.
In the late 1980’s, when I was helping the European Region of the World Health Organisation (WHO) develop the Healthy Cities program, they were also developing a Safe Cities program. While it never made sense to me that they would develop these as two separate programs, what I found interesting, coming from North America, was that Safe Cities in Europe was focused mainly on injury prevention, not safety in the sense of protection from crime and violence.
This points to one of the challenges in creating a ‘Safe Community’ initiative; what threat are we discussing and seeking to prevent? In public health we tend to think of safety in terms of its opposite – harm – and the physical consequences of harm, namely injuries. Normally we classify injuries as either intentional or unintentional.
Intentional injuries include both violence (“the infliction of fatal or non-fatal injuries by another person, by any means, with intent to kill or injure”) and self-harm, which includes both attempted and completed suicide. Unintentional injuries, not surprisingly, are defined as “not purposely inflicted, either by the person or anyone else”, according to the BC Injury Research and Prevention Unit (BCIRPU). These are what we usually call accidents, although that term is often avoided these days, since many ‘accidents’ are due to human error of some form and thus not truly accidental.
When we think about a safe community, only too often our thoughts turn to keeping us safe from crime and violence. But we would be mistaken to put most of our efforts there, because in fact most of the injuries that we experience are not due to violence but come from unintentional and self-inflicted injury.
The BCIRPU reports that in the five year period 2010 to 2014 the four leading causes of death due to injury in BC were, in order, falls, suicide, unintentional poisoning and transport-related deaths. Between them, they accounted for almost 9 in 10 deaths due to injury. Of these, three are considered unintentional and accounted for more than 6 in 10 deaths, while suicide accounted for almost one quarter of all injury deaths; homicide was a distant fifth, with only 2 percent of all injury deaths.
Injuries don’t only kill, of course, they result in disability ranging from minor and brief to severe and lifelong, and often result in hospitalisation. Falls are by far the most common cause of hospitalisation for injury, accounting for 46 percent in 2013 – 14, with transport-related injuries a distant second (11 percent) and attempted suicide third (5.5 percent); assault, which is intentional, comes in 7th at just 2.7 percent.
Injuries are not only very expensive in human terms, they also exact a high economic cost. A 2015 BCIRPU report found that in 2010, injuries cost BC $3.7 billion, or more than $800 per person, of which health care costs were $2.2 billion – more than $500 per person or $2000 for a family of four. Again, unintentional injuries account for most of the costs – 84 percent in 2010.
So from the perspective of safe communities in BC, as in Europe, the primary focus should be on the prevention of unintentional injuries, particularly falls, transport related crashes and accidental poisoning. Of these, injuries due to falls are the number one priority. So in my next three columns, I will look at three different aspects of a safe community; preventing unintentional injury, violence and self-harm.
© Trevor Hancock, 2017