In search of risk and safety cultures : empirical and theoretical considerations in the settings of northern and western Europe

There has been an increasing interest in determinants of public health at societal level. These factors have often been of a socio-economic nature, whereas culture has attracted less attention. The aim of this dissertation is to analyze, operationalize, and empirically explore the potentials of the concept of culture in macro- level injury research. The dissertation is built upon five different papers. The empirical papers investigate the scope available for employing culture as an analytic tool in macro-level studies. The investigation was performed stepwise.

The first step (Paper I) was to analyze differences in injury mortality between the Nordic countries, taking the debatable comparative statistical validity of official injury data into account. Differences in validity between the Nordic countries were found mostly in three categories: accidental falls, poisonings, and suicides. At the second step (Paper II), the long-term trends and patterns in mortality underlying the differences found in Paper I were analyzed according to whether or not any differences were found to be stable over time. A distinction was made between injuries with a social genesis and those with an environmental cause. The third step (Paper III) was to investigate how different structural factors associate with injuries in a broader selection of European countries. It was shown that injuries with primarily an environmental genesis( traffic fatalities chosen as example), show a different pattern from those with primarily a social genesis( suicides chosen as example). It was also possible to detect patterning among the structural variables. GNP and religion appear to be more important in relation to injury than alcohol consumption and unemployment. At the fourth step (Paper IV), indicators of culture in the form of human values were examined in the same way as the structural variables. It was found that values on uncertainty avoidance, freedom, and the importance of religion, and also the kinds of injuries that predominate in any one country, are clearly patterned.

In the theoretical work (Paper V) it is suggested that culture might be viewed as an "umbrella" concept that operates at collective, national or group level. Culture in itself is immaterial, but its expressions can be both material and immaterial. The immaterial part consists of thoughts and ideas, and might be operationalized through values, i.e. people's guiding principles. The relation of culture to injury runs via both safety culture and risk culture. The two cultures should be regarded as complementary variables. Risk culture is about a collective tendency to undertake potentially hazardous activities/operations. Such a tendency is built upon values and is demonstrated in actions. In the same way, safety culture is concerned with a collective readiness to control potential hazards, i.e. the extent to which safety measures are taken. The two facets of culture interact with socioeconomic factors, as mediators between historical past and present. In conclusion, it was found that it is possible to make comparisons between nations, provided data validity is considered. Culture can be operationalized by human values. A theoretical distinction is suggested between risk culture and safety culture.

List of scientific papers

I. Melinder KA, Andersson R (1998). Differences in injury mortality between the Nordic countries--with special reference to differences in coding practices. Scand J Soc Med. 26(3):190-197.
https://pubmed.ncbi.nlm.nih.gov/9768449

II. Melinder KA, Andersson R (2000). Stable and dynamic differences in injury mortality between the Nordic countries. What do they say about inherent national characteristics with regard to risk? Scand J Public Health. 28(1):16-22.
https://pubmed.ncbi.nlm.nih.gov/10817310

III. Melinder KA, Andersson R (2000). The impact of structural factors on the injury rate in different European countries. Eur J Public Health. [Accepted]
https://pubmed.ncbi.nlm.nih.gov/11582611

IV. Melinder KA, Andersson R (2000). Human values and injury mortality among European nations - Are there any significant patterns? [Submitted]

V. Melinder KA, Andersson R (2000). A culture-oriented approach to injury- towards a conceptual and analytic framework. [Submitted]