A herd of pre-schoolers rushes out of kindergarten into the playground for their morning break. Some head for the swings, others for the sandbox or play chase. The hot Israeli sun blazes down but, sheltered by large shades across much of the yard, the children hardly notice. Meanwhile over at the local school, their older siblings are being taught about road safety and the use of bicycle helmets. When they eventually run out to play in the schoolyard, they too are sheltered from the burning sun. As the youngsters race around at their games, a group of pensioners is engaged in more gentle exercise. Nine elderly men and women sit on sturdy chairs in a semicircle, stretching first their arms, then their legs as their physiotherapist smilingly urges them to reach out as far as they can. These diverse residents are unwitting participants in the successful project for the World Health Organization to recognize the city of Ra'anana as the Middle East's first designated Safe Community. "We are honored to be the first Safe Community in Israel," new Ra'anana mayor Nahum Hofri said at the official award ceremony on September 27. WHO representative Dr. Joon Pil Cho, head of the Emergency Medicine Department at Ajou University Hospital in Suwon, South Korea, said he saw no irony in designating a city as "safe" in a country where terrorist attacks take place with alarming frequency. "A Safe Community doesn't mean a place where people aren't injured for any reason," said Cho. "It means having active, substantive programs to reduce injuries, morbidity and mortality, and to promote safety in the community." The Safe Communities project began in Sweden in the 1980s. To be accepted, cities or towns must have an active program to reduce the risks of injury to residents. Ra'anana, with a population of 75,000, adopted the project under former mayor Ze'ev Bielski in 1999 and now becomes the 88th city in the world to receive the title, alongside cities in Australia, New Zealand, Canada, South Africa, China, South Korea, the US (Dallas and Anchorage), and several European countries. Major activities in Ra'anana included removing safety hazards from the city's kindergartens and schools; promoting the use of car seats and teaching parents how to install them properly; giving driver education to teenagers; and introducing exercise classes to prevent falls among the elderly. Ra'anana city councilor and deputy mayor Dr. Tzipi Dolfin headed the project. "This project is not just about giving advice and raising awareness. It is about taking action. Everything we do is monitored and evaluated to see the results," said Dolfin. According to project researcher and consultant Sharon Goldman, the first thing done was a survey of emergency room admissions at Meir Hospital in Kfar Saba, with the aim of identifying high-risk groups. Some 395 Ra'anana residents were treated at the hospital's emergency ward between June and September 2000. Of children aged up to 14, more than half had suffered falls. Similarly, more than half those aged over 60 were injured in falls. In the 15-to-29 age group, the leading cause of injury was car accidents. Once the problem areas were identified, the city began introducing programs to reduce the injury rates. "The biggest program was fall prevention among the elderly," said Goldman. Some 410 Ra'anana residents over 60 are registered in the program, at no cost to them. Their homes were assessed; in 95 percent, some repairs were carried out to remove hazards. The residents also received a kit containing an anti-slip bath mat, handrails for the bathroom, a nightlight, and a flashlight. In addition, the city began running special balance training exercise classes to prevent falls. The classes, run by a physiotherapist, are held at the Day Care Center for the Elderly on Rehov Ha'hagana. Almost 200 elderly people were monitored for six months under the project. "About 85 percent of those in training for six months improved their balance or stayed stable, which at their age is considered an improvement," Goldman said. The next target was the city's kindergartens. In all of Ra'anana's 80 kindergartens, dangerous equipment was removed; outdoor sunshades erected; door stops and plastic door protectors installed to prevent small fingers from being caught; hot water faucets removed from the children's bathrooms; and the traditional hot water urns in the staff room for tea and coffee were replaced by electric kettles with short cords. In addition, the children were given basic road safety lessons. In another aspect of the project, the city collected information on traffic accidents and found large numbers of crashes on Rehov Weizman (26%), Rehov Ahuza (26%), and the industrial area (14%). Infrastructure improvements were enacted to reduce these numbers. The city also launched a major campaign to promote the proper use of car seats for children, with a new unit initiated at Meir Hospital to instruct parents how to install car seats. "We found that 50 percent of children in Ra'anana who should be in seats or boosters were not in the proper seats," Dolfin said. She added that future efforts would focus on enforcing this law. In addition, teenagers were being educated on responsible driving. The project coordinators also dealt with schools and public playgrounds. Equipment was checked and sunshades installed. In some public playgrounds, the traditional sand was replaced with rubber matting. In schools, children were taught road safety and given street maps showing the safest routes to school. There was also a bicycle helmet promotion campaign in which schools sold helmets at discounted prices. One Ra'anana school, the Shaked elementary school in the Lev Ha'park area, has been designated a WHO Safe School following a year-long campaign. The school has many of the safety measures of other schools, with an additional focus on health and sport. WHO member Max Vosskuhler, one of two WHO representatives visiting Israel to present Ra'anana with the Safe Community designation and the Shaked school with its Safe School certificate, noted that the importance of health and safety cannot be overrated as a promoter of academic excellence. "When children are healthy and safe, their academic levels go up," he said.