Injury of Aboriginal and Torres Strait Islander people due to transport 2003–04 to 2007–08

1. Injury of Aboriginal and Torres Strait Islander people due to transport2003–04 to 2007–08 James Harrison Geoff Henley Australian Institute of Health and Welfare National Injury Surveillance Unit

2. Overview of the report • The report • Biennial report funded by Dept. Infrastructure & Transport • Third edition released today. Available from www.aihw.gov.au • Also published before the 2006 and 2008 Forums • The only regular national statistical report on Indigenous road injury (or injury in general). • Similarities to previous release • Same data sources (deaths; hospital admissions) • Similar themes: • Comparison of Indigenous Australians with rest of population • Age, sex, remoteness, road user type, vehicle type, time trends • Produced by the AIHW National Injury Surveillance Unit • Differences • Previous editions were restricted to Qld, NT, WA & SA. This edition also includes NSW & Victoria • More recent data – but not as recent as was planned • The ABS has not yet released a data file for deaths registered in 2008

3. Context Injury is a major cause of death and serious injury among Indigenous Australians Leading causes of health burden, Indigenous Australians and total population, 2003 Vos et al., 2007

4. Context Injury is a major cause of death and serious injury among Indigenous Australians 12% of total health burden Leading causes of health burden, Indigenous Australians and total population, 2003 Vos et al., 2007

5. Context Transport-related injury is the second greatest cause of injury burden among Indigenous Australians, after suicide. As it is for Australians overall Injury burden, Indigenous Australians 2003 Vos et al., 2007

6. Overview of findings 1. Transport injury rates are higher for Indigenous Australians than for others • Death rate: more than twice as high • Hospitalised rate: about 20% higher c 85/y (c 75 traffic) c 1500/y (c 1000 traffic)

7. Overview of findings 1. Transport injury rates are higher for Indigenous Australians than for others • Death rate: more than twice as high • Hospitalised rate: about 20% higher Hence, transport injury contributes to the ‘gap’.

8. Overview of findings 2. Transport injury rates are higher for Indigenous Australians than for others • Death rate: more than twice as high • Hospitalised rate: about 20% higher Hence, transport injury contributes to the ‘gap’. Unfortunately, trends do not show narrowing.

9. Overview of findings 3. Remoteness of place of residence is an important point of difference • Rates of transport injury rise with remoteness of residence for all Australians Serious injury - traffic

10. Overview of findings 3. Remoteness of place of residence is an important point of difference • A much larger proportion of Indigenous Australians than others live in remote areas

11. Overview of findings 3. Remoteness of place of residence is an important point of difference • Rates rise with remoteness for all Australians • A larger proportion of Indigenous Australians than others live in more remote areas • So remote place of residence is associated with much of the higher rates for Indigenous Australians

12. Overview of findings 4. Transport injury rates for Indigenous Australians are relatively high in middle age Fatal injury Serious injury

13. Overview of findings • Injured Indigenous Australians are more likely pedestrians or passengers • Less likely motorcyclists, but… Fatal injury Serious injury

14. Overview of findings 6. Trends in road user groups …rates of motorcyclist cases are rising, among Indigenous Australians as well as others. Other Indigenous

15. Limitations • Data quality • Indigenous identification remains a problem • Imperfect everywhere, for deaths and hospital data and for all topics • Generally best for the NT • Doubt over future use of Victorian mortality data • But it’s what we have!! • Slowness of data release • Awaiting ABS data on deaths registered in 2008 • Lack of comparison data • Little or no data on Indigenous licensing, travel patterns, etc.

16. Summary of statistics • Compared to the overall population, Indigenous Australians have: • Higher rates of road death (x 2 to 3) • It is a high-ranked cause of health burden • A smaller elevation of serious injury (x 1.2 to 1.5) • A different pattern of place of occurrence • Much higher proportion in remote zones (reflects population) • A different pattern of road user status • More pedestrian, passenger. Less motorcyclist – but rising. • The fine print • Numerous limitations of the data, but: • Higher risk than general population • Enough differences to warrant separate attention

17. Wider picture: (road) Safety • Road safety is important, but… • …there is more to Indigenous people’s safety than road safety • Other high-ranked causes of health burden for Indigenous people • Suicide & self-inflicted injury • Homicide and violence • High incarceration rate... etc.

18. (road) Safety & Mobility • Strong needs to travel • Family obligations, work, health services, etc. • Options vary with place, circumstances • e.g. less public transport (or none) in rural & remote areas than in inner city • Remoteness: distance, speed, road surface, etc • Travel need + poor options => ?? • Don’t travel (miss doctor or court; no job; social pressure cooker; sleep rough; etc.) • Travel anyway (unlicensed; hitch-hike; uncertain connections; etc.)

19. Other initiatives • Aboriginal People Travelling Well Qualitative information & action research • APTW report released at previous Forum • Progress since then • new Community Report Yvonne Helps, David Moodie, Gail Warman Published by The Lowitja Institute • Further attention has been given to some issues raised Driver licensing was the subject of a recommendation to the SA Premier by Thinker in Residence Professor Ilona Kickbush. Responses are in progress. • There is potential to build on this foundation See Yvonne Helps for further information.

20. (road) Safety, mobility & licences • There is more to driver licences than road safety Kickbusch, 2007

21. Other initiatives • Road safety and Aboriginal people • ARC Discovery Grant project (2011-2013) • Led by Rebecca Ivers (George Institute) • …an in-depth examination of factors underlying the high involvement in road crashes by Aboriginal people in Australia. Using mixed methods in six communities across NSW and South Australia it will inform development of new programs aimed at closing the gap in this important area. • Knowledge, attitudes and behaviour on licensing and other matters relevant to transport safety • Data collection at and in cooperation with Aboriginal Controlled Health Services

22. Summary • Indigenous road injury warrants attention • High enough risk; sufficiently distinct • Current data give broad view, but lack detail • Nb factors associated with remoteness • Take a broad view (APTW, Kickbusch, Safe Systems, etc.) • Size and interconnectedness of problems • Understanding (e.g. why drive without a licence?) • Avenues for interventions • Cost/benefit of interventions (e.g. more driver licensing might improve road safety and also reduce imprisonment and remove a barrier to employment) • Look for ‘entry points’ that lends themselves to action

23. www.aihw.gov.au/publications www.nisu.flinders.edu.au/publications james.harrison@flinders.edu.au