Australian Aboriginal and Torres Strait Islander Peoples are the traditional owners of the land in Australia and hold a rich culture of traditional knowledge and beliefs that give insight into a history that stretches over 65,000 years. Aboriginal and Torres Strait Islander People is a broad term that encompasses over 250 different language groups that are spread across the land.
As of 2016, Aboriginal and Torres Strait Islander Peoples make up an estimated 3.1% of the total Western Australian population. Although only a small proportion of the population, Aboriginal Peoples made up 8.9% of hospitalisations due to injury between July 2006 and June 2015.3 To ensure that the rich historical knowledge and culture of these Peoples can continue, the health of the population should be fostered with a holistic approach to injury prevention and the incidence of injuries within this priority population need to be reduced.
Definition of Injury
Injury Injury is the intentional or unintentional harm to a person resulting from contact with an object, substance or another person. This can be the results of excessive energy or the sudden absence of vital elements, such as oxygen; and mental harm, suffering, damage, impairment or dysfunction caused to a person as a direct results of some action, perceived threat or failure to act by some individual.1
Impact of injury on Aboriginal and Torres Strait Islander peoples in Western Australia
What are the leading injury areas for Aboriginal and Torres Strait Islander peoples in WA?
In Western Australia between July 2011 and June 2015, the leading causes of injury hospitalisations to Aboriginal peoples were assault (30% of injury hospitalisations), falls (17%), complications due to medical and surgical care (13%), exposure to inanimate mechanical forces (11%) and transport (8%).2
How prevalent is injury among Aboriginal and Torres Strait Islander peoples in WA?
In Western Australia between 2006 and 2015, 831 Aboriginal peoples died due to injury, contributing to 18.6% of all Aboriginal peoples fatalities.3
In Western Australia between July 2006 and June 2015;
- 49,751 Aboriginal peoples were hospitalised due to injury
- 53% of Aboriginal peoples hospitalised were male
- Aboriginal peoples aged 25-44 experienced the highest rate of injury hospitalisations.3
Aboriginal peoples made up 3.1% of the population in WA, however Aboriginal peoples made up 8.9% of hospitalisations due to injury between July 2006 and June 2015.3
Impact on health system
Aboriginal and Torres Strait Islander peoples accounted for 7.7% of injury costs in WA in 2012, despite only making up 3.6% of the WA population.4 The total lifetime cost of injury to Aboriginal and Torres Strait Islander peoples in WA in 2012 cost an estimated $742 million due to health care costs, longterm care needs, loss in paid productivity and quality of life lost.4
In WA in 2015, there were 14,848 bed days occupied by Aboriginal peoples due to injury costing an estimated $34,118,831.3
In WA from July 2004 to June 2015, there was an 11% increase in the age-standardised hospitalisation rate for injury to Aboriginal and Torres Strait Islander Australians, from 448 per 1,000 in 2004-05 to 471 per 1,000 in 2014-15.2 During this same time period the non-Aboriginal hospitalisation rate increased by 16%, however the rates were considerably lower at 296 and 339 per 1,000 non-Aboriginal population.2
Determinants of injury for Aboriginal and Torres Strait Islander peoples
Despite a large amount of theory and discussion around injuries to Aboriginal and Torres Strait Islander peoples there has been minimal rigorous studies conducted to identify the risk factors for injury to Aboriginal and Torres Strait Islander peoples and measure the impact of these risk factors.5,6 However studies which have examined the risk factors for injury in Aboriginal and Torres Strait Islander peoples have identified similar factors to the overall risk factors for injury including; alcohol consumption, low socioeconomic status and remote geographical location.5-7
Low socioeconomic status
Research indicates that low socio-economic status is associated with an increased risk of injury.8,9 In WA in 2016, the median weekly income for Aboriginal and Torres Strait Islander peoples aged 15 years and over was $398, compared to the WA State median of $724.10 A lower median weekly income can heighten Aboriginal and Torres Strait Islander people’s injury risk due to increased poverty-related stressors, poorer housing conditions, low health literacy, lower working conditions, and reduced access to medical care.8,11
Aboriginal and Torres Strait Islander peoples are inequitably affected by racism, which can influence injury risk through reduced access to healthcare, long-term psychological stress, prejudice, mental health, alcohol consumption and substance abuse.2 Results from the 2014-15 National Aboriginal and Torres Strait Islander Social Survey indicate that 37% of Western Australian Aboriginal and Torres Strait Islander peoples felt they had been unfairly treated at least once in the previous 12 months because they were Aboriginal and/or Torres Strait Islander.33
Racial discrimination towards Aboriginal and Torres Strait Islander peoples has directly resulted in violent incidents, increasing the rate of assault hospitalisations and fatalities across Australia.2,12 Racism has been attributed to lower levels of education, employment and living conditions, all of which have been associated with higher levels of injury risk.6,11,12
Environmental, Community and Organisational Determinants
In Australia between 2014 and 2015, the hospitalisation rate for Aboriginal and Torres Strait Islander peoples increased with remoteness from 38 per 1,000 in major cities to 74 per 1,000 in remote and very remote areas.13 This is attributed to limited access to prevention, treatment and rehabilitation services, poor environmental conditions, and occupations with a higher injury risk.7
Behavioural and Individual Determinants
Due to the impact alcohol has on risk-taking behaviour and psychomotor performance, even at moderate doses, the volume of alcohol consumed and the pattern of drinking overtime can influence injury risk.14 In WA from 2000 to 2008, alcohol contributed to over 22% of all Aboriginal and Torres Strait Islander peoples injury hospitalisations, which was twice the rate of non-Aboriginal and Torres Strait Islander peoples.15 Due to the influence of alcohol consumption on injury risk, higher rates of alcohol consumption among Aboriginal and Torres Strait Islander peoples can influence the rate of injury particularly violence, suicide, falls and transport injuries.15
Leading injury areas for Aboriginal and Torres Strait Islander peoples in Western Australia
Suicide and self harm
In 2016, the rate of suicide among Aboriginal and Torres Strait Islander peoples in WA was 43.9 per 100,000 people compared to 12.2 per 100,000 in non-Aboriginal people.16 This was ranked as the third leading cause of death among Aboriginal and Torres Strait Islander peoples (47 fatalities).16 The suicide fatality rate is even higher in regional areas of WA, with research indicating it is one of the highest fatality rates in the world for Indigenous peoples, at 74 persons per 100,000 people annually.17
Aboriginal and Torres Strait Islander peoples in WA were hospitalised due to intentional self-harm at a rate of 3.0 per 1,000 people, which was lower than the National Aboriginal and Torres Strait Islander peoples rate of 3.2 hospitalisations per 1,000 people, between July 2013 to June 2015.2
Higher rates of suicide and self-harm to Aboriginal and Torres Strait Islander peoples compared to non-Aboriginal Australians has been attributed to social factors associated with colonisation, policies that enabled racial discrimination, and the breakdown of culture including; social isolation18, socioeconomic disadvantage18,19, limited access to culturally appropriate services5,19, transgenerational trauma5, alcohol misuse19, regional residency19, violence19,20 and poor mental and physical health.18 As a protective factor, Aboriginal and Torres Strait Islander culture and community has shown to be a large influence in preventing suicide and self-harm, this includes strong family bonds and community connectivity.21
The Aboriginal and Torres Strait Islander population in WA experienced higher transportation hospitalisations (4.2 per 1,000 people) compared to the National Aboriginal and Torres Strait Islander peoples population (3.6 per 1,000 people) from July 2013 to June 2015.12 In 2016, land transport was the sixth highest cause of fatality for Aboriginal and Torres Strait Islander peoples (23 fatalities), compared to non-Aboriginal people ranked twenty first.16 Contributing factors associated with higher rates of transport mortality for Aboriginal and Torres Strait Islander peoples include speeding5, unsurfaced roads5, long travel distances5, lower seatbelt use22 and driving in vehicles with lower safety standards.22
From July 2013 to June 2015, the national rate of Aboriginal and Torres Strait Islander peoples were hospitalised due to assault was 8.9 per 1,000 people, which is considerably lower than the WA rate for Aboriginal and Torres Strait Islander peoples of 17.7 hospitalisations per 1,000 people.2 In WA, 48 Aboriginal people died as a result of assault between 2009 and 2013 (30.8% of all WA fatalities due to assault).3 Risk factors for family and community violence in the Aboriginal and Torres Strait Islander population include; family hardships5, trauma due to colonisation, separation from traditional culture, previous experiences of violence, low socio-economic status, poor physical and mental health, high levels of alcohol misuse and illicit drug use.23 However many elements of Aboriginal culture can be protective factors against violence including strong; social connection, family structures, trust, self-esteem and resilience.24
In WA, 48 Aboriginal and Torres Strait Islander peoples died as a result of assault between 2009 and 2013 (30.8% of all WA fatalities were due to assault).3 The National rate of Aboriginal and Torres Strait Islander peoples hospitalised due to assault was 8.9 per 1,000 people, in July 2013 to June 2015, which is considerably lower than the WA rate of 17.7 hospitalisations per 1,000 Aboriginal and Torres Strait Islander peoples.2 Risk factors for family and community violence in the Aboriginal and Torres Strait Islander population include; family hardships5, trauma due to colonisation, separation from traditional culture, previous experiences of violence, low socio-economic status, poor physical and mental health, high levels of alcohol misuse and illicit drug use.2 However many elements of Aboriginal and Torres Strait Islander culture can be protective against violence, including strong social connection and integrated family structures, as well as high levels of trust, self-esteem and resilience.24
Injury risk factors for Aboriginal and Torres Strait Islander peoples, including social isolation, a lack of culturally appropriate services and separation from culture, point to the urgent need to address the social and economic disadvantage to improve the social, emotional, cultural well-being and prevent injury to Aboriginal and Torres Strait Islander peoples. Interventions aiming to address injury prevention requires consultation, involvement and support from local Aboriginal and Torres Strait Islander communities throughout the development and implementation of strategies.20,24 This is to ensure culturally appropriate activities and the acknowledgement of persistent and underlying inequalities.20
Legislation, Policies, Standards and Codes of Practice
In Western Australia there are a range of legislations which directly and indirectly contribute towards injury prevention by supporting the maintenance of safe environments and promoting safe behaviours.
Western Australian example
Key injury prevention legislations in WA which contribute to injury prevention include the; Domestic and Family Violence Protection Act 2012, Firearm Act 1973, Western Australian Road Traffic Act 1975, The Poisons Prevention Act 1964 and Building Regulations 2012 (particularly around smoke alarms and pool fencing).
Policies, which make a commitment to focusing on reducing risky health behaviours, and other factors, that contribute to leading injury areas for Aboriginal and Torres Strait Islander peoples, have the potential to reduce the prevalence of injury amongst Aboriginal and Torres Strait Islander peoples. In 2008 voluntary restrictions were placed on the availability of alcohol in the Goldfields town of Norseman. These included limiting red and white wine purchases (one five litre case), other non-fortified wine (one four litre case) and port wine (one two litre cask) per person per day. Research regarding these restrictions indicates that between 2004 and 2014 there was a significant reduction in the rate of domestic violence and assaults among Aboriginal and Torres Strait Islander peoples.25
Western Australian examples
The WA Aboriginal Health and Wellbeing Framework 2015-2030 includes alcohol and other drug use, mental health, injury, suicide prevention, family violence as “risk factors and other health related influencing factors that require addressing”. For example the framework lists encouraging adolescents to reduce their alcohol and drug use a key factor towards supporting adolescents healthy behaviour choices.26
The National Road Safety Strategy 2011-2020 highlights implementing programs addressing the road safety needs of Aboriginal and Torres Strait Islander communities as a step for the first three years of the strategy. This included the implementation of programs to increase opportunities for driving practice and the delivery of local culturally appropriate Aboriginal and Torres Strait Islander peoples community education campaigns to promote key road safety messages.27
Environmental, Community and Organisational Initiatives
When developing campaigns for Aboriginal and Torres Strait Islander peoples, it is essential to involve the local community in the planning, implementation and evaluation of the campaign.20
Western Australian examples
As part of the Road Safety Commissions ‘Grow Up’ drink driving campaign, two Television Commercials were developed and rolled out in the north-west of WA to provide road safety messages in a culturally acceptable format to local Aboriginal people in the north-west of WA.
The WA Office of Road Safety “Project .05” focused on four main elements (education, enforcement, environment and evaluation) to target 17-39 year old non-Aboriginal and Aboriginal peoples in Port Hedland and Newman. Evaluation of “Project .05” supports that a coordinated, comprehensive and community-based intervention can reduce high risk alcohol consumption and alcohol-related transport injuries.28
Group and Individual Initiatives
Through education programs, at-risk individuals can increase their knowledge of the injury area and public awareness of the injury area can also be raised.4
Western Australian example
Aiming to reduce the high suicide rate among Aboriginal and Torres Strait Islander youth in the Kimberley, the Alive and Kicking Goals projects peer education workshops, one-on-one mentoring and counselling services are led by Aboriginal peoples.20 Results from the 12 month pilot indicate that through the Alive and Kicking Goals project peer educators learnt practical skills in suicide awareness and prevention.29
Research findings regarding a respectful relationships education program for teenagers, LOVE BiTES, has indicated significant and positive effects on Aboriginal and Torres Strait Islander participants attitudes towards domestic violence and gender relations. This program has actively involved participants in creative works, worked in partnership with Aboriginal and Torres Strait Islander services, utilised local language and facilitators with cultural knowledge.24
Injury Prevention Projects
Given the range of injury areas affecting Aboriginal and Torres Strait Islander peoples there are a number of injury prevention projects developed to be culturally appropriate and inclusive for Aboriginal and Torres Strait Islander peoples.4
Western Australian examples
To encourage safe aquatic participation, Royal Life Saving WA, through their Remote Aboriginal Swimming Pools Project, provides recreation and swimming programs to six remote communities. Research reported that participants noted that the swimming and water safety lessons were effective in teaching local school children how to swim.32
Developed for Aboriginal families and communities in WA the “Fire safety in your home” resource, produced by the Department of Fire and Emergency Services with assistance from the Jacaranda Community Centre, provides information on how to prevent fires and how to escape from a house fire. The resource includes Aboriginal artwork, local Aboriginal community members and a lots of visuals throughout.
A violence prevention peer-mentor program in Sydney has created a safe place for Aboriginal women to become community advocates against violence by holding their meetings in spaces which are welcoming to Aboriginal women and encouraging participants to share a meal together at the end of the each meeting.30
Cultural programs for youth
Cultural factors have been identified as a contributing factor to the higher risk of injury for Aboriginal and Torres Strait Islander peoples. Due to the importance of acknowledging and understanding cultural history in re-establishing strong healthy communities, by focusing on cultural elements such as identify, and social and emotional wellbeing some programs have the potential to reduce the risk of injury to Aboriginal and Torres Strait Islander peoples.20
Western Australian examples
Since commencing in 2000, the Kimberly Aboriginal Law and Culture Centre’s Yiriman Project has enabled young people to go on trips to country with elders. During these trips the young people are immersed in stories, song and knowledge about their cultural heritage, helping to build the participants confidence and self-worth.13
The Yiriman Project in Fitzroy Crossing provides an opportunity for young people to go walking on country. During this time participants attention is not on unhealthy choices and behaviours, such as alcohol consumption and violence.20
Key stakeholders in Western Australia
1. National Public Health Partnership. The National Injury Prevention and Safety Promotion Plan: 2004-2014. Canberra: Commonwealth of Australia; 2005 Jul. Report No.: 3738 (JN 9220).
2. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework 2017 report: Western Australia. Canberra: AIHW; 2017.
3. Data generated using HealthTracks Reporting, by the Epidemiology Branch, WA Department of Health in collaboration with the Cooperative Research Centre for Spatial Information (CRC-SI), April 2018.
4. Hendrie D, Miller T, Randall S, Brameld K, Moorin R. Incidence and costs of injury in WA 2012. Perth: Chronic Disease Prevention Directorate Department of Health WA; 2016.
5. Boufous S, Ivers R, Senserrick T, Martiniuk A. Underlying causes and effects of injury in Australian Aboriginal populations: a rapid review. Wollongong, NSW: University of Wollongong; 2010.
6. Clapham K, Senserrick T, Ivers R, Lyford M, Stevenson M. Understanding the extent and impact of Indigenous road trauma. Injury. 2008 Dec 1;39:S19–23.
7. Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011 [Internet]. Canberra, ACT: Australian Institute of Health and Welfare; 2016 [cited 2017 Apr 7]. Available from: https://www.aihw.gov.au/getmedia/e31976fc-adcc-4612-bd08-e54fd2f3303c/19667-bod7-atsi-2011.pdf.aspx?inline=true
8. Kruithof N, de Jongh MAC, de Munter L, Lansink KWW, Polinder S. The effect of socio-economic status on non-fatal outcome after injury: A systematic review. Injury [Internet]. 2016; Available from: //www.sciencedirect.com/science/article/pii/S002013831730013X
9. Blas E, Kurup AS, World Health Organization, editors. Equity, social determinants, and public health programmes. Geneva, Switzerland: World Health Organization; 2010. 291 p.
10. Australian Bureau of Statistics. Census Quickstats Western Australian, People: employment, viewed 3 January 2018 [Internet]. 2016. Available from: http://www.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/5
11. Laflamme L. Explaining socio-economic differences in injury risks. Inj Control Saf Promot. 2001 Sep 1;8(3):149–53.
12. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report [Internet]. Canberra: AHMAC; 2017. Available from: http://www.dpmc.gov.au/sites/default/files/publications/2017-health-performance-framework-report.pdf
13. Australia, Steering Committee for the Review of Government Service Provision, Productivity Commission. Overcoming Indigenous disadvantage key indicators 2016: report [Internet]. Melbourne, Vic.: Productivity Commission; 2016 [cited 2017 Feb 7]. Available from: http://www.pc.gov.au/research/ongoing/overcoming-indigenous-disadvantage/2016
14. Macdonald S, Greer A, Bubacher JR, Cherpitel C, Stockwell T, Zeisser C. Chapter 19: Alcohol consumption and injury. In: Alcohol [Internet]. Oxford: Oxford University Press; 2013. Available from: ProQuest Ebook Central
15. Ballestas T, Xiao J, McEvoy S, Somerford P. The Epidemiology of Injury In Western Australia, 2000 – 2008. Perth: Department of Health WA; 2011.
16. Australian Bureau of Statistics. Underlying causes of death, Leading causes by Aboriginal and Torres Strait Islander status and Sex, WA, 2016 [Internet]. 2017. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02016?OpenDocument
17. McHugh C, Campbell A, Chapman M, Balaratnasingam S. Increasing Indigenous self-harm and suicide in the Kimberley: an audit of the 2005–2014 data. Med J Aust. 2016 Jul 4;205(1):33.
18. Australian Government. Australian Government Response to: Before it’s too late: Report on the inquiry into early intervention programs aimed at reducing youth suicide. 2013.
19. Australian Government Department of Health and Ageing. Promoting Good Practice in Suicide Prevention – Activities Targeting Men [Internet]. Canberra: Australian Government Department of Health and Ageing; 2008. Available from: https://www.livingwell.org.au/wp-content/uploads/2012/11/MensSuicidePrevention_dev05.pdf
20. Dudgeon P, Milroy J, Calma T, Luxford Y, Ring I, Walker R, et al. Solutions that work what the evidence and our people tell us: Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project report [Internet]. Crawley, WA: School of Indigenous Studies, University of Western Australia; 2016 [cited 2017 Feb 7]. Available from: http://www.atsispep.sis.uwa.edu.au
21. Dudgeon P, Milroy H, Walker R, Telethon Institute for Child Health Research, Kulunga Research Network, University of Western Australia, et al. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2014.
22. Department of Health and Ageing. National Aboriginal and Torres Strait Islander Health Plan 2013-2023 [Internet]. Canberra, ACT: Dept. of Health and Ageing; 2013 [cited 2017 May 26]. Available from: http://www.health.gov.au/natsihp
23. Olsen A, Lovett R. Existing knowledge, practice and responses to violence against women in Australian Indigenous communities: Key findings and future directions [Internet]. New South Wales: Australia’s National Research Organisation for Women’s Safety Limited; 2015. Available from: http://www.thelookout.org.au/sites/default/files/ANROWS-Compasss-January-2016.pdf
24. Closing the Gap Clearinghouse (Australia), Australian Institute of Health and Welfare, Australian Institute of Family Studies. Family violence prevention programs in Indigenous communities [Internet]. Canberra, A.C.T.: Closing the Gap Clearinghouse; 2016 [cited 2018 Feb 5]. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129557831
25. Midford R, McKenzie J, Mayhead R. ‘It fits the needs of the community’: Long-term evaluation of the Norseman Voluntary Liquor Agreement [Internet]. Foundation for Alcohol Research and Education; 2016 Feb. Available from: http://www.fare.org.au/wp-content/uploads/research/Long-term-evaluation-of-the-Norseman-Voluntary-Liquor-Agreement-web.pdf
26. Department of Health, Government of Western Australia. WA Aboriginal Health and Wellbeing Framework 2015–2030 [Internet]. Western Australia: Department of Health; 2015. Available from: http://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Aboriginal%20health/PDF/12853_WA_Aboriginal_Health_and_Wellbeing_Framework.ashx
27. Australian Transport Council. National Road Safety Strategy 2011–2020 [Internet]. Sydney: Australian Transport Council; 2011. Available from: www.infrastructure.gov.au/roads/safety/national_road_safety_strategy/
28. AMR Interactive. Evaluation of the Port Hedland and Newman Community Alcohol Related Road Trauma Project ‘Project .05’ Final Report [Internet]. The Office of Road Safety; 2005 Oct. Available from: http://healthinfonet.ecu.edu.au/uploads/resources/2783_eval_pt_hedland.pdf
29. Tighe J, McKay K. Alive and Kicking Goals!: Preliminary findings from a Kimberley suicide prevention program. Adv Ment Health Maleny. 2012 Jun;10(3):240–5.
30. Rawsthorne M. ‘Helping Ourselves, Helping Each Other’: Lessons from the Aboriginal Women against Violence Project. Adv Soc Work Welf Educ. 2014 Aug;16(1):7–21.
31. Cullen P, Chevalier A, Hunter K, Gadsden T, Ivers R. ‘The program was the solution to the problem’: Process evaluation of a multi-site driver licensing program in remote communities. J Transp Health. 2017 Mar 1;4:81–9.
32. Royal Life Saving WA. The Photovoice Project. Remote Aboriginal Swimming Pool Research [Internet]. Available from: https://royallifesavingwa.com.au/your-community/facts-and-figures/water-safety-issues-research/remote-aboriginal-swimming-pools-project
33. Australian Bureau of Statistics. 2014-15 National Aboriginal and Torres Strait Islander Social
Survey (NATSISS) [Internet]. 2017. Available from: http:// www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4714.02014-15?OpenDocument