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Know: Overview

What is an injury?

Injury (or harm) usually means physical harm to a person’s body caused by intentional or unintentional exchange of energy between people or people and objects. Injury occurs because of an event or incident, is often immediate / short term or because of continual stress.1

An injury can be unintentional (like a fall) or intentional (like violence). Injury covers a range of areas, such as:

  • burns and scalds
  • drowning
  • falls
  • poisoning
  • road trauma
  • suicide and self-harm
  • violence

Accidents are often perceived as both unpredictable and unpreventable. In contrast, injury can result from events that are predictable and preventable.1 Since 1979 the International Classification of Diseases system has categorized injury in a miscellaneous group “injury, poisoning and certain other consequences of external causes” rather than labeling injury as an “accident”.1

Why is injury a serious public health concern?

The burden that injury places on the health care system, through disability and premature death makes injury a serious public health issue.

Injury was;

  • the fourth highest cause of death in Western Australia between 2007 and 20111
  • the fourth most common specific cause of hospitalisation in Western Australia between 2008 and 20122
  • ranked third as a specific cause of death for males in Western Australia between 2008 and 20122
  • more prevalent amongst individuals living in regional and remote areas3.

Injury affects Australians of all ages and population groups. Some injury areas are common across all age groups, such as injuries resulting from road trauma, which is among the top three causes of injury hospitalisations and fatality for people of all ages in WA.1 However the leading injury related cause of hospitalisation changes across the lifespan, as shown in Table 1. Between 2008 and 2012 in WA, Falls had the highest incidence of hospitalisations for people aged over 65 years, while individuals aged zero to four had the highest incidence of drowning.1

Table 1: Injury area and age group with the highest incidence of hospitalisations4

Injury Area

Age Group

Burns and Scalds 0 – 4 years
Drowning 0 – 4 years
Falls 65+ years
Poisoning 25 – 44 years
Road Trauma 25 – 44 years
Self-harm and Suicide 25 – 44 years
Violence 25 – 44 years

The rates of injury from violence, falls, drowning, burns and scalds, suicide, poisoning and road trauma are higher for Aboriginal People in WA compared to non-Aboriginal People, as shown in Table 2.2

Table 2: Aboriginal People hospitalisations due to injury4

Injury Area

Percentage of hospitalisations for Aboriginal People(a)

Burns and Scalds 16.6%
Drowning 6%
Falls 5.5%
Poisoning 8.4%
Road Trauma 7%
Self-harm and Suicide 9.9%
Violence 42%

(a) In Western Australia Aboriginal People make up 3.8% of the population

The impact that injury has on all Western Australians reinforces the importance of focusing on the preventable and predictable nature of injury and the need to make injury prevention a priority. Also the wide range of health areas within injury contributes to the need for an integrated approach to injury prevention by a range of health sectors.1

How does injury differ from disease?

There are common characteristics between disease and illness, however there are also factors that differentiate the two, as summarised in Table 3. Disease (generally though not always) happens over a longer period of time, whereas injury generally results in an immediate impact on the individual.1

Injury can result from unintentional and intentional actions, while in comparison acquiring a disease on purpose is extremely rare.1

Disease is caused by pathology (e.g. hormonal imbalances like in diabetes / non-communicable diseases, or infections like with communicable diseases).1 Illness is the feelings that might come with a disease. Feelings like pain, fatigue, weakness, discomfort, distress, confusion, or dysfunction.1 Due to the pathological connections to disease some diseases can be prevented through vaccination, in comparison susceptibility to injury is universal.1

Mental illness and chronic disability, although these may be eventual consequences of physical injury, are excluded by the above explanations.

Table 3: Characteristics of injury and disease1

Injury

Disease

Generally results in an immediate impact Occurs over a long period of time
Results from unintentional or intentional actions Rare to acquire a disease on purpose
Caused by pathology

What is the difference between safety and injury?

Safe’ and ‘injury’ can be described as being on a continuum, with safe being the optimal and an injury being the least optimal. This continuum is similar to the health and disease continuum.

Both safety and health are fundamental rights.6 Just as health is a broader concept than disease, safety is a much broader concept than injury.

Similarly to disease, injury, harm and violence are the undesirable outcomes.

What is safety?

Safety is ‘a state in which hazards and conditions leading to physical, psychological or material harm are controlled in order to preserve the health and well-being of individuals and the community’.1 In addition to the absence of intentional or unintentional injuries, safety must also lead to a perception of being sheltered from danger.1

Due to this a safe state includes two dimensions: objective and subjective.

Objectively safety can be assessed by measuring the number of injuries or behavioural and environmental factual parameters, such as the traffic-related deaths recorded in a community, the proportion of drivers reported to be under the influence of alcohol and the number of collisions at a dangerous road intersection.5

Subjective safety is evaluated according to the feeling of being out of danger or the safety of the population.5 Gathering data to assess safety subjectively can be achieved through a range of consultation methods including discussion groups, surveys and forums.

Some argue that both dimensions can influence each other and therefore should be considered together.2

What are safety promotion, injury prevention and injury management?

Safety promotion, injury prevention and injury management are processes along a continuum. This continuum is similar to the health promotion, disease prevention and disease management continuum and the prevention continuum (primary, secondary and tertiary).

For more information on this topic see Learn: Overview

Resources

Injury prevention in Western Australia by Denise Sullivan, Director Chronic Disease Prevention, Department of Health WA.

Australian Burden of Disease Study: Impact and causes of illness and deaths in Australia 2011, Australian Institute of Health and Welfare.

Specific disease burden in Western Australia 2011 Injury Fact sheet, Department of Health WA.

Providing Aeromedical Care to Indigenous Communities, Royal Flying Doctor Service

References

1Guohau, L., & Baker, C. (2012). Injury Research: Theories, Methods, and Approaches. New York: Springer Science & Business Media.
2Health Tracks Reporting. (2015). Epidemiology Branch, WA Department of Health. Perth: Department of Health, Western Australia.
3Department of Health Western Australia (2014). WA Death Registrations which includes data from the WA Register of Births Marriages and Deaths and Australian Bureau of Statistics. Personal Communication.
4Department of Health, Western Australia (2015). Specific Health Condition Analysis: Accidental drowning, submersion, threats to breathing hospitalisations by external cause (injury and poisoning) – Western Australia State.
5Maurice, P., Lavoie, M., Laflamme, L., Svanstrom, L., Romer, C. & Anderson, R. (2001). Safety and safety promotion: definitions for operational developments. Injury Control and Safety Promotion, 8(4). Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.123.8552&rep=rep1&type=pdf
6World Health Organisation. (1998). Safety and Safety Promotion: Conceptual and Operational Aspects. Retrieved from http://www.inspq.qc.ca/pdf/publications/150_SecurityPromotion.pdf