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Busan Safe CommunityBrief description of communityBusan is a large metropolitan city with a population of 3.5 million people. It is the second largest city in South Korea.The population has been steadily declining since 2010 due to the relocation of its industrial base. While people of working age and their families have been reducing the number and proportion of senior citizens has been increasing.Figure 1: Population Busan Metropolitan City from 2010 to 2018Figure 2: Senior Citizen Population (> 65 yoa) Busan Metropolitan City from 2010 to 2018Busan Metropolitan is the upper-level of local government which consists of 16 local government organizations.Figure 3: Roles of Busan Metropolitan City / Gu, Gun DistrictsWhile there is some variation from city to city, Busan’s injury rates are comparable with the national average.Table One: Injury mortality rate major cities in South KoreaInjury mortality has steadily decreased in Busan over the period 2012 to 2917 (30% reduction) at a rate comparable to the overall reduction in Injury mortality in South Korea (31%)Figure Four: Injury mortality rate Busan 2010 to 2017Major causes of injury deaths include: suicide, road traffic injury, falls, drowning, homicide, poisoning and burnsFigure Five: Causes of Injury mortality Busan 2017Eights injury taskforces are co-ordinated by the Busan Metropolitan International Safe Community steering committeeSuicide prevention (57 member organisations)Traffic safety (13 member organisations)Fall prevention(35 member organisations)Violence prevention (29 member organisations)Disaster prevention & preparedness (33 member organisations)Tourism and Marine safety (14 member organisations) School safety (17 member organisations)Day to day operational support is provided by the Safe Community Task force team in collaboration with the Gu / Gun district management teamsFigure Six: Governance structure Busan Safe CommunityThe international Safe Community Research centre was established in 2012 to provide technical assistance, especially with regard to collecting and interpreting surveillance data, maintaining and promulgating expertise in best practice community safety promotionProgram has been running for 10 yearsProgram began in 2009Initial designation in 2014Re-certification in 2019Overall Impression CommentsWholistic understanding safety promotionWell described program goals and objectivesSound governance aiming to engage and empower population and build capacity for self determinationThe city has made substantial financial investments in community safety 2012 – 2016: $3.38M USD2017: $ 314,800 USD2018: $342,460 USDThere is extensive evidence of formalisation of policy. The government has passes 33 ordinances related to safety promotion, including the “Ordinance on the operation of Busan Metropolitan Community Safety promotion program” which ensures the long-term commitment to the program and it budgetingThe program publishes annual reportsBusan has been exceptionally active in the national and international safe community networks hosting the 7th international Asian Region Conference (20-14), providing a booth at the 9th Asian Safe Community conference (Atsugi 2018) and has sending representatives to a large number of international and regional safe community conference. There is a comprehensive injury surveillance system which is used to set priorities, plan programs and assess outcomesDemographics of target population well describedThere is a comprehensive injury prevention and safety promotion program covering all agers and genders, that is logically conceived and evaluations. The use of Haddon’s matrix to analyse the causes of different classes of injury was impressive. However, the notable issue missing in the application was workplace injury. There are programs targeting violence against women and children but no data about incidence was providedPrograms are evidence informedEvaluation is comprehensive and well-conceived.The international Safe Community Research Centre was established in 2012 to provide technical assistance, especially with regard to collecting and interpreting surveillance data, maintaining and promulgating expertise in best practice community safety promotionReflective practice and impact of quality improvement process on program design and modification well described Things that make the community safety program effectiveSound governance systemEngagement with stakeholdersComprehensive programs with comprehensive analysis of underlying causesEvidence informed programsReflective practice and good evidence of program revision as a result of evaluation and quality improvement systems Extensive engagement and contribution to the national and international safe community movementsExamples of good practiceThe formalisation of the International Safe Community Research Centre to assist with data analysis, the promotion and maintenance of best practice to ensure sustainability to expertise in the coalition. Suggestions to help the community get to the next stageCommunity engagement and capacity buildingYou emphasise this in your strategic goals. Rightly so. It is very important. But it is easier said than doneThe certifiers would be very interested in your reflections how you think this is actually going? What is working? What is not working? What can be done to make it better?If you can achieve this community buy-in is it a very powerful complimentary force to political buy-in. So much can be achieved when political buy in and community buy-in are focused committed and aligned. It is also you best defence against political disengagement.Program reachProgram reach is one of the key scientific principles underlying indicator 2 and a key determinant of whether or not the program is likely to achieve the desired population outcomesBusan Metropolitan is a large city covering 16 Gu & Gun Districts. While the metropolitan government sets the overall policy direction,to facilitate engagement at a community level much of the responsibility for program implementation is delegated to the districts, establishing multiple pilot projects for the various intervention domains at district level. In the short term this strategy promotes district and community ownership of the project, allows strategies to be trailed and refined before being rolled out at a metropolitan level To get to the next stage and achieve the goal of population injury reduction it will be necessary to focus on program reach (or program coverage to ensure the interventions are implemented with sufficient reach to achieve a population impactAn accurate understanding of the target population for each intervention, their needs, their risk profile, their injury vulnerabilities, their perception of injury risk and their motivation to reduce this risk are a critical consideration for the design of an intervention. This is referred to in clinical medicine as ICE Therapy – you always need to address the patients:IdeasConcernsExpectationsIf you don’t address the target populations “ICE” they are unlikely to adopt the desired to adopt the desired behaviours and attitudes promoted by your programKnowing the target population is also necessary to assess program reach (the proportion of the target population that is “covered” or “reached” by the intervention.Program reach is one of the key scientific principles underlying indicator 2 and a key determinant of whether or not the program is likely to achieve the desired population outcomesTo get to the next stage in program development and to ensure the program achieves the desired reduction in injury at a population level (program impact), it would be important to Busan to pay careful attention to the target population of each intervention and to optimising the reach of their programs regarding program impact, of which reach is an important determinant.Both program reach and program effectiveness are critical determinants of the population impact of a program. One potential reason the Safe Community Program is not achieving the desired population reduction in injury incidence, may be that program reach is insufficient to achieve this outcome.Provide leadership in the areas of violence against women and childrenFrom a 2015 survey conducted by the Korean Institute of Criminology on national random sample (4,000 people) in South Korea about incidence of intimate partner violence, 71.7% of female respondents felt the incidents of "being controlled" by a male partner, 36.6% felt psychological or emotional violence, 22.4% felt physical violence, 17.5% felt sexual violence, and 8.7% felt physical injury. prevalence of these issues, their causes and culturally appropriate remediate strategies are not well documented in the Republic of Korea or within the Korean Safe community movement. The certifiers believe Busan has the expertise, the commitment to wholistic safety promotion and hence the potential to provide welcome leadership on this issue in Korea. Given the increasing international literature on the physical, psychological, social and inter-generational trauma these issues cause throughout the world, we commend them for your careful consideration. Indicator 1: An infrastructure based on partnership and collaborations, governed by a cross- sector group that is responsible for safety promotion in their communityCommentsHistoryProgram started 2009First designated in 2014 Well described organisational structure (Figures Six – previous section) and stakeholder network structure & roles (Figure Seven)Figure Seven: Engagement with Key StakeholdersA wholistic understanding of community health and safety is formalised into city corporate plan. Well aligned with the UN Sustainable Development Goals.Figure Eight: Ecological Approach to Community Safety Busan CommunityWell described program goals and objectivesTable Two: Policy objective Busan Safe CommunityFigure Nine: Operational Plan Busan Safe CommunityAspiration to engage and empower population and build capacity for self determinationFigure Ten: Community Capacity Building, Empowerment and Capacity BuildingThe city has made substantial financial investments in community safety 2012 – 2016: $3.38M USD2017: $ 314,800 USD2018: $342,460 USDThere is extensive evidence of formalisation of policy. The government has passes 33 ordinances related to safety promotion, including the “Ordinance on the operation of Busan Metropolitan Community Safety promotion program” which ensures the long-term commitment to the program and it budgetingThe program publishes annual reports of injury statisticsFigure Eleven: Annual Report Busan Safe Community 2013 to 2017The program publishes annual reports of injury statisticsFigure Eleven: Annual Report Busan Safe Community 2013 to 2017Reflective practice and impact of quality improvement process on program design and modification well describedFigure Eleven: Quality Improvement Cycle Busan Safe CommunityTable Three: Reflective Practice – SWAT Busan Safe CommunityPoints of interest for the site visitCommunity engagement and capacity buildingYou emphasise this in your strategic goals. Rightly so. It is very important. But it is easier said than doneThe certifiers would be very interested in your reflections how you think this is actually going? What is working? What is not working? What can be done to make it better?Indicator 2: Long-term, sustainable programs covering genders and all ages, environments, and situationsDoes not meet certification standardsBorderlineGaps in program designEffective practice based on the application of guidelines and checklistsEffective evidence-informed local design of community safety programsLeadership promoting best practice in the safe community movementSignificant contribution to injury prevention and safety promotion internationally499849929210427142426035357314535974001397414457206777663873528357474572000211153850800347916597367X0X 1 2 3 4 5 6 7Why did you make this assessment? Busan Safe Community uses its surveillance system to identify priority issues in conjunction with community surveys and consultationsFigure Twelve: Priority setting Busan Safe CommunityBusan Safe Community identified a number of issues of high importance based on its surveillance system & community consultationTable Four: Leading causes of injury deaths Busan Safe CommunityTable Five: Leading causes of injury ambulance calls Busan Safe CommunityTable Six: Leading plaxe of injury ambulance calls Busan Safe CommunitySeven injury prevention and safety promotion task forces have been createdSuicide preventionTraffic safetyFall preventionViolence preventionDisaster prevention & preparednessMarine safetySchool safetyBusan Safe Community provided a comprehensive injury prevention and safety promotion programs covering all ages, genders, environmental and situations. A total of 438 programs across 16 Gu and Gin Districts.Gu & Gun pilot projectsTable Seven: Suicide Prevention Pilot ProgramsTable Eight: Traffic Injury Prevention Pilot ProgramsTable Nine: Fall Prevention Pilot ProgramsTable Ten: Violence and Crime Prevention Pilot ProgramsTable Eleven: Disaster Mitigation Pilot ProgramsTable Twelve: Leisure and Marine Safety Pilot ProgramsTable Thirteen: Traffic Injury Prevention Pilot ProgramsExtra evidence requiredNilPoints of interest for the site visitIn Table Four, poisoning is listed among the major injury issues identified. This is said to be addressed by the workplace safety program. Workplace injury is usually a common and serious source of injury throughout the world. The certifiers could wind no other evidence regarding your workplace injury programs. The certifiers would be very interested to hear about any programs Busan Safe Community operate in workplace health and safety. This would significantly improve our assessment of the comprehensiveness of your program.Suggestions to help Busan Safe Community get to the next stageProgram reach (also known as program coverage)Busan Metropolitan is a large city covering 16 Gu & Gun Districts. While the metropolitan government sets the overall policy direction,to facilitate engagement at a community level much of the responsibility for program implementation is delegated to the districts, establishing multiple pilot projects for the various intervention domains at district level. In the short term this strategy promotes district and community ownership of the project, allows strategies to be trailed and refined before being rolled out at a metropolitan level To get to the next stage and achieve the goal of population injury reduction it will be necessary to focus on program reach (or program coverage to ensure the interventions are implemented with sufficient reach and effectiveness to have a population impactProgram reach is one of the key scientific principles underlying indicator 2 and a key determinant of whether or not the program is likely to achieve the desired population outcomesThe various subpopulations for each intervention, or group of interventions are not described in the application.An accurate understanding of the target population for each intervention, their needs, their risk profile, their injury vulnerabilities, their perception of injury risk and their motivation to reduce this risk are a critical consideration for the design of an intervention. This is referred to in clinical medicine as ICE Therapy – you always need to address the patients:IdeasConcernsExpectationsIf you don’t address the target populations “ICE” they are unlikely to adopt the desired to adopt the desired behaviours and attitudes promoted by your programKnowing the target population is also necessary to assess program reach (the proportion of the target population that is “covered” or “reached” by the intervention.To get to the next stage in program development and to ensure the program achieves the desired reduction in injury at a population level (program impact), it would be important to Gwancheon to pay careful attention to the target population of each intervention and to optimising the reach of their programs regarding program impact, of which reach is an important determinant.209553966300Program ImpactEpidemiologist have a rule of thumb they use to assess potential program impactI = R x EProgram Impact = Reach x Effectiveness (Indicator 6) (Indicator 2) (Indicator 4 & 5)Reach = the proportion of the target population the program is delivered to (program reach is a core scientific principle underlying indicator 2)Effectiveness = the proportion of the population that achieve the desired outcome (indicator 4 & 5)It is worth spending a moment to understand how this formula works. The impact of a program is dependent on both reach and effectiveness.Imagine a program that is 100% effective, but is so intensive that it can only be delivered to a very small proportion of the target population (eg, 100 people out of a population of 100,000 – i.e 0.001% reach) then the impact will only be 0.001% (100% x 0.001% = 0.001%). Similarly, imagine a program that is delivered to every member of the target population (100% reach). If the program is not very effective and only one in a thousand people exposed the intervention achieve the desired outcome (0.001% effectiveness), the impact of the program will be 0.001%.Both reach and effectiveness are required for a safety promotion and injury prevention program to have an impact on population health and safety outcomeIndicator 3: Programs that target high-risk groups and environments, and programs that promote safety for vulnerable groupsCommentsThere are two approaches to risk assessment in safe communitiesRuling in issues based on your surveillance systemsRuling out issues that are so common throughout the world that they need to be ruled out by your surveillance systemA lot of the analysis in the designation application for Indicator 3 related to risk analysis of issues normally covered under Indictor 2 (Ruling in issues based on surveillance data) – risk shared by the general community – all ages and genders, environments and situations The application identified and described programs targeting the following high-risk groups as specified in the ISCCC guideline for Indicator 3Low income residentsMinority groups (especially with regard to workplace injuryVictims of intentional injury including self harm. Note self-harm is a different phenomenon to suicide, but they are related. Self-harm can also be a long term manifestation of psychological trauma, so it is related to intimate partner violence and also sexual and physical violence against children)Abused women and childrenSchool violence and bullyingPeople with mental illness, developmental delays or other disabilities Homeless People at risk due to religion, ethnicity or sexual preferencesThe application identified the following high-risk environmentsHigh risk sports (water sports)Natural disastersPublic facilities (school campuses, public facilities, senior citizen centres)Extra evidence requiredNilPoints of interest for the site visitFrom a 2015 survey conducted by the Korean Institute of Criminology on national random sample (4,000 people) in South Korea about incidence of intimate partner violence, 71.7% of females respondents felt the incidents of "being controlled" by a male partner, 36.6% felt psychological or emotional violence, 22.4% felt physical violence, 37.9% felt sexual harassment or misdemeanor, 17.5% felt sexual violence, and 8.7% felt physical injury. the high incidence and serious ramifications of violence against women throughout the world it would be important to provide some population estimates of their incidence in your community.The certifier would like to discuss the estimated incidence of interfamily violence against women in your community. Whether or not you believe these estimates are reliable. What are the barriers to reporting in your community? What are the services available to women at risk the estimated incidence of violence against children in your community. Whether or not you believe these estimates are reliable. What are the barriers to reporting in your community? What are the services available to children at risk Indicator 4: Programs that are based on the available evidenceCommentsThe central importance of evidence to ensure an effective safety promotion campaign, is highlighted by the fact that four of the seven International Safe Community indicators concern evidence that is required to be successful: indicator 5 (surveillance evidence – what is needed)indicator 4 (evidence about what works)indicator 6 (evidence about what has been achieved)indicator 7 (sharing evidence with others)Indicator four particularly concerns evidence about strategies that have been shown to work in injury prevent ion campaigns:Evidence about common types of injury and their causes?Evidence-based practice – evidence about what has worked under research conditionsPractice based evidence – evidence about what has worked in real world conditions such as a safe community programThe coalition has established formal relationships with a number of organisations that provide support and expertise:International Safe Community Certifying Centre (ISCCC)Korean Centre for Community Safety Promotion (Ajou University)International Safe Community Research Centre of Busan MetropolitanBusan Safe Community commissioned a number of community surveys and infrastructure audits to clarify the underlying causes of the problem identified by their surveillance system.Busan Safe Communities is very engaged with the International Safe Community Network. There is evidence of the incorporation of practice-based evidence from their networking. The International Safe Community Research Centre of Busan Metropolitan is based on a similar research establish in Dallas Texas, a comparable metropolitan city.Figure Thirteen: Accessing Evidence for the Design of Safety Promotion ProgramsExtra evidence requiredNilPoints of interest for the site visitThe Certifier would be interested to discuss the different types of evidence you used, why you chose it and how relevant is proved to be.To get to the next stageTo get to the next stage, describe the different types of evidence you used:How did you access this expertise or evidence?Why did you decide to use it? e.g:strength of evidence?relevance to you community?How well did it work? Why did it work?Why didn’t it work?What did you learn?What would you do differently next time around?What advice would you give to other communities trying to solve similar problems in the future?These reflections are themselves a valuable form of evidence to inform what you do in the future and to inform your safe community colleagues following in your footstepsAcademic citation is not required, but it is important to acknowledge the sources of the information you use.Finally, remember that sharing your observations and reflections on interventions that didn’t work, is just as important as sharing your successes. If you are trying hard enough, the certifiers expect that not everything you tried will work in the way you hoped. Share these experiences. This prevents other communities wasting time and effort on ineffective strategies. Indicator 5: Programs that document the frequency and causes of injuriesTable Forteen: Surveillance Data Sources Busan Safe CommunityTable Forteen: Surveillance Data Sources Busan Safe Community (cont’)Why did you make this assessment?Busan has a comprehensive injury surveillance system collating data from many different sources. The corner-stones of the data system are mortality data from Korean statistics and road mortality data from the Police service, crime data from the Police services and ambulance data from the Korean Fire service, supplemented by community surveys commissioned by the Safe Community Program (see table eleven).The system is put to good use, to prioritise issues, identify at-risk citizens and environments, design interventions and evaluate outcomes (see figure four).Surveillance data is extensively cited through-out the reportExtra evidence requiredNilPoints of interest for the site visitThe certifiers would be interested to discuss with community members how understandable and useful they found the statistics provided by the injury surveillance systemStandardised data is useful for comparing injury rates in Busan with other Korean communities. On the other hand, standardised data is often more abstract from the community’s perspective. Absolute numerical data is easier to understand and often has more traction for community medial releases.When numbers population numbers are small (e.g. subcategories of injury mortality data) standardised number can be misleading. As an annual change in 1 or 2 injury deaths (well within the bounds of statistical variation) can seemingly produce large swings in standardised injury mortality rates. It is very easy to over-interpret data unless you are experienced in data interpretation. Indicator 6: Evaluation measures to assess their programs, processes and the effects of changeCommentsTable Fifteen: Types of Evaluation Busan Safe CommunityThe evaluation program is well conceived. Outcome evaluation: Key target indicators (death & injury data, financial loss)“(2) The result and effectiveness evaluation”Impact evaluation: Risk factor monitoring (Awareness, Behaviour, physical environment audits, Safety index)Note: Examples of impact evaluation were provided (Safety index, seat belt wearing drink driving etc) even though impact evaluation is not specifically mentioned in the table aboveImpact evaluation is an important interim evaluation strategy, as evidence of improvement in injury risk factors can be documented before population level reductions in injury can be achievedProcess evaluation (implementation, program management indicators)“(1) The suitability of the evidence based program”“(2) The progress of the evaluation”“(3) The structural evaluation”Tables were provided documenting comprehensive evaluation proposals for the District level pilot programsOutcome evaluation: Injury mortality has steadily decreased in Busan over the period 2012 to 2917 (30% reduction) at a rate comparable to the overall reduction in Injury mortality in South Korea (31%)Table Sixteen: Injury Death Rates 2009 to 2017Table Seventeen: Injury Death Rates by cause 2009 to 2017Table Eighteen: Injury Requiring transport to hospital Rates by cause2011 to 2017Table Nineteen: Injury Requiring transport to hospital Rates by cause2011 to 2017Table Twenty: Estimated Financial loss due to injury to 2017Table Twenty one: Safety Index 2015 to 2017 (note higher scores are better)Extra evidence requiredNilPoints of interest for the site visitThe certifier is looking forward to discussing your results with you during the site visit seminar. How you believe you are progressing? Major learnings from the last 5 years? What you plan to change over the next 5-year period? What advice would you give to other communities following in your footsteps? Indicator 7: On-going participation in national and international Safe Communities networksCommentsBusan has been exceptionally active in the national and international safe community networks hosting the 7th international Asian Region Conference (20-14), providing a booth at the 9th Asian Safe Community conference (Atsugi 2018) and has sending representatives to a large number of international and regional safe community conference.Table Twenty two: Busan Safe Community engagement with International Safe Community NetworkTable Twenty three Busan Safe Community engagement with International Safe Community Network (cont’)Extra evidence requirednilPoints of interest for the site visitnil ................
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