Community Safety Promotion Networks: From Metaphor to Methodology

Dale William Hanson (dale.hanson@jcu.edu.au)
School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University
July, 2007
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Dr Dale Hanson graduated from Flinders University of South Australia in 1982, initially pursuing a career in Family Medicine, and subsequently in Emergency Medicine. Since 1986 he has been working as Staff Emergency Physician at Mackay Base Hospital, in regional Queensland. Concerned at the high rate of injury in the region, he developed an interest in injury research, safety promotion, and social network analysis, completing his Masters Degree in Public Health and Tropical Medicine in 2000 and subsequently his Doctorate in Public Health at James Cook University in 2007. He was awarded a university medial for his doctoral dissertation by James Cook University.
 

Abstract

Injuries are preventable. However, discrepancy between academic, practitioner, community and political perceptions of injury causation remain an important barrier to mounting an effective response. This thesis proposes the “injury iceberg”, a unifying cognitive framework designed to facilitate productive dialogue between the academic, professional and community groups required to design and implement effective community based safety promotion interventions. The individual is, metaphorically speaking, the “tip of the iceberg,” just one part of a complex ecological system. While they may be the most visible part of this system, important determinants of behaviour and environmental risk are “hidden below the waterline.”
While this comprehensive, wholistic model of safety promotion offers many opportunities to address a community’s injury problem, it also poses special challenges. The dynamic, multi-causal, multi-level nature of community safety means it is resistant to interventions designed by a single profession or agency. Promoting safety requires a multifaceted, comprehensive response.
Networks have been advocated as an effective response to the complex problems that plague modern society. Health practitioners, researchers, administrators and politicians have embraced the network metaphor. By networking, sharing knowledge, expertise and resources, it is argued that communities can be empowered to generate the critical mass of expertise, resources and activity required to promote their own health and safety.
Mackay Whitsunday Safe Communities was launched in February 2000 in response to excess injury morbidity observed in the region. The Mackay Injury Surveillance Network reported 35,211 injury presentations to regional Emergency Departments over the three year period from the 1st of January 1998 to the 31st of December 2000. An age standardised rate of 126 per 1,000 for males, 2.0 times that observed in South Brisbane, and 64 per 1,000 for females, 1.7 times that observed in South Brisbane.
In keeping with contemporary wisdom Mackay Whitsunday Safe Communities formed a collaborative network to address the communities’ injury problem. This thesis used Social Network Analysis to evaluate the structure and function of the Mackay Whitsunday Safe Communities Social Network.
Social network analysis proved a powerful tool, providing diagrammatic representation of the social structure and quantifying important changes in the structure and function of community safety promotion network and its external support network. Since the network was established the number of relationships doubled from 500 to 1002, the relational distance separating network members decreased (average distance reduced from 3.9 to 2.7) and cohesiveness of the network increased (density increased from 0.022 to 0.036). There was increased tendency for group formation (clustering coefficient increased from 0.30 to 0.50) and a more centralised structure (centralisation index increased from 18% to 43%). Mackay Whitsunday Safe Communities had clearly succeeded in developing cohesive social capital – the ability to collaborate for mutual benefit.
However, social network analysis also provided compelling evidence that a small number of well-connected social entrepreneurs played an important facilitative role in network activities. Whether measured in terms of direct social influence, efficiency of communication, or brokering potential, six actors were disproportionately influential, maintaining 44% of all relationships and brokering 52% of in-kind, 54% of human and 66% of financial investments made in the network. They provided an important social conduit for the transfer of information, expertise and resources within the system.
In 2004 the network accessed an estimated 6.5 FTE of staff time and $0.9 million dollars. However, resources were largely accessed from, and controlled by, an external support network. The entrepreneurial bridging relationships that unite network members around a cause and facilitate access to the in-kind, human, financial and social resources necessary to maintain network productivity are therefore critical to ensure the sustainability of community safety promotion networks.
This network analysis identified that two types of social capital were necessary to develop and sustain a productive community safety promotion network: cohesive social capital and entrepreneurial social capital. The development of stronger, dense relationships (cohesive social capital) meant that Mackay Whitsunday Safe Communities was better positioned to co-operate for mutual benefit and thereby promote safe standards of community conduct and a safe physical environment. However, to develop this state and facilitate a sustainable resource base to maintain it, the entrepreneurial social capital of key network facilitators appeared to be critical component of network function.
It is encouraging to note that over the four year period since the launch of MWSC in February 2000 age standardised emergency department injury presentations to Mackay Base Hospital have reduced from 76 per 1,000 in 2000 to 68 per 1,000 in 2004, a 12% reduction. Injury now constitutes 21% of ED caseload rather than 25%. Over the same period Mackay experienced a 5% reduction in age standardised injury separations relative to the Queensland. However because of the multi-causal nature of injury and local service utilization and data issues it is not possible at this time to attribute this reduction to MWSC. Further research is required.



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