The injury iceberg: an ecological approach to planning sustainable community safety interventions.

ISSUE ADDRESSED A systematic ecological framework in which to design sustainable, community-based, safety promotion interventions is presented. METHOD A literature review was undertaken of English-language articles addressing the topics of 'ecological injury prevention or safety promotion', 'ecological health promotion', 'sustainable economic, health or ecological systems' and 'steady state', with 143 articles retrieved and reviewed. RESULTS Injury prevention is a biomedical construct, in which injury is perceived to be a physical event resulting from the sudden release of environmental energy producing tissue damage in an individual. This reductionist perspective overlooks the importance of psychological and sociological determinants of injury. Safety has physical, psychological and sociological dimensions. It is inherently an ecological concept. Interventions aiming to achieve long-term improvements in community safety must seek to develop sustainable safety promoting characteristics within the target community. CONCLUSION To reduce a community's risk of injury and sustain this lowered risk, the community 'ecological system' must have access to the resources necessary to maintain the desired outcome and the ability to mobilise these resources.