Working from the inside out: a case study of Mackay Safe Community.

Mackay Whitsunday Safe Community (MWSC) was established in 2000 in response to high rates of injury observed in the region. MWSC assumed an ecological perspective, incorporating targeted safety promotion campaigns reinforced by supportive environments and policy. By involving the community in finding its own solutions, MWSC attempted to catalyze structural, social, and political changes that empowered the community and, ultimately, individuals within the community, to modify their environment and their behavior to reduce the risk of injury. A community network consisting of 118 members and an external support network of 50 members was established. A social network analysis conducted in 2000 and 2004 indicated that the network doubled its cohesiveness, thereby strengthening its ability to collaborate for mutual benefit. However, while MWSC was rich in social resources, human and financial resources were largely controlled by external agencies. The bridging and linking relationships that connected MWSC to its external support network were the social mechanism MWSC used to access the resources it required to run programs. These boundary-spanning relationships accessed an estimated 6.5 full-time equivalents of human resources and US$750,000 in 2004 that it used to deliver a suite of injury control and safety promotion activities, associated with a 33% reduction in injury deaths over the period 2002 to 2010. MWSC can only be understood in its ecological context. The productivity of MWSC was vulnerable to the changing policy priorities of external sponsoring agents and critically dependent on the advocacy skills of its leaders.