Key Public Health Questions
What is the issue?
How big is the issue?
Who is most affected by the issue?
What is surveillance?
This first stage of the Public Health Approach to Injury Prevention is surveillance and a key step in any injury prevention planning process. Surveillance is defined as “…the ongoing systematic collection, analysis, and interpretation of injury data, for use in planning, implementation and evaluation of prevention activities. Injury prevention programs use surveillance data to assess the need for new policies or programs and to evaluate the effectiveness of those that already exist.”1
This stage involves the collection, analysis and interpretation of information including data in order to:
- Understand the context
- Define the priority injury issue(s)
- Describe the extent to which the selected injury issue is a problem.
This stage can also be referred to as a “needs assessment” or a “situational analysis”.
This is only an overview. For a more detailed discussion of injury surveillance see:
Understand the context
Understanding the context involves identifying and describing aspects of the environment that will influence the planning, implementation and evaluation of an injury prevention initiative. Setting injury priorities will be influenced by a range of pressing influencers both internal to an organisation and external including1,2:
- Government factors such as legislation, policies and planning frameworks
- Agency factors such as capacity and capabilities of your agency or partner agencies
- Community factors such as concerns and characteristics of the community
- Evidence factors such as the magnitude of the problem
- Intervention factors such as the return on investment.
|Vision and mission
Capacity and capability
Available funding sources
Partners and stakeholders and
Access and equity
|Magnitude of issue
Impact of the issue
Return on investment
Direct and Indirect Costs
For example, the national and state policies can provide direction on which injury area to address. A number of government departments have outlined their priorities for injury prevention using community-level priority setting approaches. It is crucial however that the priorities you select are important for your community. We have listed a couple of key state-wide strategies that influence the work that is undertaken to reduce injury related harm in our community.
The Department of Health Western Australia Priorities
The Department of Health WA have set out their priorities for injury prevention. These are:
- Reduce road crashes and road trauma
- Prevent falls in older people
- Protect children from injury
- Improve water safety
- Reduce interpersonal violence
More information about these priorities can be located at:
Mental Health Commission Western Australia Priorities
The Mental Health Commission WA has set out priorities that are to:
- Prevent and reduce mental health problems, suicide and suicide attempts
- Prevent and reduce the adverse impacts of alcohol and other drugs
- Promote positive mental health
- Enable everyone to work together to encourage and support people who experience mental health, alcohol and other drug problems to stay in the community, out of hospital and live a satisfying, hopeful and contributing life.
More information about these priorities view:
However there is no single approach to understanding the context hence below is a selection of tools that can assist.
SWOT Analysis (Strengths, Weakness, Opportunities, Threats)
A SWOT analysis is a key tool to begin the process of understanding the context of a particular issue in injury prevention and the ability of your organisation to develop interventions in this area.
It is an “examination of an organisation’s internal strengths and weaknesses, its opportunities for growth and improvement, and the threats the external environment presents to its survival”.4
Discussing the strengths, weaknesses, opportunities and threats assists in determining where adjustments need to be made.
When conducting a SWOT analysis the following steps occur;4
- All key data is collected and evaluated
- The data is sorted into four categories – strengths, weaknesses, opportunities and threats
- A SWOT matrix is developed for each alternative that is under consideration
- Finally the SWOT analysis is used when making a decision on the best alternative for the organisations
It is important to note that despite the SWOT analysis being based on data and facts the conclusions that are made from the SWOT analysis opinions rather than data and facts.4
Click here to download the Know Injury – SWOT analysis template
A PESTLE analysis can be used to consider the context within which a specific change is occurring by reflecting on the factors influencing the organisation.5 PESTLE refers to the following influential factors;2
- Political – current political environment
- Environmental – current environmental issues
- Social – current social changes
- Technological – changing technology
- Legal – current legal status
- Economic – current financial and economic impacts
Click here to download the Know Injury – PESTLE analysis template
Define the priority injury issue(s)
Injuries are diverse; diverse in type, diverse in settings in which they occur and diverse in audiences that they affect. All agencies work within a finite set of resources, which means that we have to make tough decisions as to which injuries areas to focus on, that is which are our priorities, in order to achieve the best outcomes.
Defining priority injury issues can occur at two levels2: community-level and agency/program/project-level.
Priority setting at community-level
Because of the multitude of important issues that any given community faces, it is important to set priorities for what injury issues your agency or program will work on. Without this ‘fence’ around what is the focus and what is not, it will be very difficult to make any progress on any particular issue.
Priority setting at an agency, program or project-level
Once you have selected an injury issue (whether from a national or state policy, organisational strategic plan or based on community need) we then need more detail about the issue. To achieve this we need to:
- Identify the key questions to answer about the issue
- Identify data sources
- Describe the size of the injury issue
- Interpret the data
- Present the data.
Identify the key questions to be answered
To keep your planning on track, identify questions you need to answer about the selected issue. Key questions to help you plan include:
- Severity: How severe is the issue (i.e. how many deaths, hospitalisations)?
- Demographics: Whom does the issue affect? Is any group more at risk than another?
- Setting: Where does the issue affect them? Does it occur more in one location
- Timing: When does the issue affect the community? Is it seasonal?
- Impact: How does the issue affect the community? What is the impact of the issue? How does the community perceive the situation?
Click here to download a Know Injury – Key questions template.
Identify the data sources
Once you have decided on your questions, there are numerous data sources that can help inform your understanding of the issue. Information can be sourced from both quantitative data and/or qualitative data as well as from primary and secondary data sources.
Quantitative data are measures of values or counts and are expressed as numbers.2
Qualitative data are measures of ‘types’ and may be represented by a name, symbol, or a number code.10
Quantitative and qualitative are often combined to get a more in-depth picture of the issue and the community.
For a detailed explanation of these concepts view: Statistical Language – Quantitative and Qualitative Data.
Information can be sourced from both primary and secondary data sources.
Primary data is data that has been collected first-hand by a researcher or practitioners. The advantage of primary data sources is that you can tailor the questions to your specific purpose but it can be expensive to collect and analyse.
Secondary data is data that has already been collected by another a researcher or practitioners. The advantages of secondary data are that it is often readily available and inexpensive to obtain however because it was collected and analysed for another purpose it may require time to sort through what you need.
Both types of data can be sourced from a range of methods such as surveys, observations interviews and experiments.
Below provides a selection of sources of injury data – both quantitative and qualitative from secondary data sources. You may also be able to build partnerships with local agencies and develop data sharing arrangements.
For more details on methods of data collection see Learn – Determinants.
Each data source has its own strengths and weaknesses and it is best to speak directly with the agency hosting the data or the author to find out these limitations.
Epidemiology Branch, Department of Health WA
The WA Health Department Epidemiology Branch provides comprehensive data in a variety of formats including:
- Population health surveillance and monitoring information
- Health profiles
- Burden of disease measures
- Population based surveys
- Statistical advice and interpretation
- Evaluation of health interventions and health outcomes
- Mapping of infrastructure, health facilities and boundaries
- Spatial analysis
The branch is also able to provide epidemiological advice. For more information see: Epidemiology Branch
The approximate turnaround for returned data is two weeks, depending on requirements.
Australian Bureau of Statistics
The Australian Bureau of Statistics (ABS) mission is to “assist and encourage informed decision making, research and discussion within governments and the community, by leading a high quality, objective and responsive national statistical service”. Due to the large amount of data the bureau has, there is a useful search engine to find the data required.
The ABS website can be found here.
West Australian Police
The West Australian Police are a good source of data for injury as a result of interpersonal violence. The following link provides readily available reports on these statistics in WA by financial year. Note that these reports will also include crime statistics that may not be relevant to injury prevention practitioners. Reports can be found here.
The WA Poisons Information Centre
The WA Poisons Information Centre (WAPIC) collect data on poisonings separate to the Epidemiology Branch. While the Epidemiology Branch provide data on hospital presentations and deaths due to poisoning, the WAPIC collect data on phone calls made to the service that may not result in hospitalisation. This provides a more thorough overview of poisons in Western Australia; though note that the service does not have data on the outcome of the phone call.
The service collects data relating to circumstances of the poisoning, i.e. the date, who made the call, location of exposure, what the caller said the substance was and what the actual substance was, the time since exposure and the route of exposure, in addition to demographic data such as the age and gender of the person exposed.
The WAPIC can be contacted on 13 11 26 and found here.
Published Evidence and Research
Published evidence and research are value sources of secondary data; this can be in the form of peer-reviewed journal articles or grey literature (unpublished or not peer-reviewed academic literature) such as past program evaluations and reports. Local library resources such as newspaper archives may also be useful.
A selection of journals that contain valuable information to inform this stage are listed below.
The Australian and New Zealand Journal of Public Health is the Journal of the Public Health Association of Australia and is published six times a year, in February, April, June, August, October and December.
The Health Promotion Journal of Australia, an official publication of the Australian Health Promotion Association, aims to facilitate communication between researchers, practitioners and policymakers involved in health promotion activities.
Injury Prevention is an international peer review journal, offers the best in science, policy, and public health practice to reduce the burden of injury in all age groups around the world. The journal publishes original research, opinion, debate and special features on the prevention of unintentional, occupational and intentional (violence-related) injuries.
International Journal of Injury Control and Safety Promotion (ICSP) publish high quality original articles, reviews and short communications. The Journal will be of interest to researchers and practitioners in all fields of injury control, including prevention, acute care and rehabilitation.
Google Scholar is a freely accessible web search engine of scholarly literature across an array of publishing formats and disciplines.
Stakeholder and Community
Engagement Community engagement is an important element to any planning process. By talking to stakeholders and community members you can find out about the:
- Community’s needs and concerns
- Groups that are affected
- Main determinants of injuries
- The community’s openness to support to address the injury issue
- Other programs which have gone before
- Others working on this issue
This can be done through a number of formal and informal ways as outlined in Table 4.
Table 4: Engagement Methods
|Focus Groups||Community gathering|
|Clinical Records||Stories (written, spoken, pictures)|
Adapted from here.
For more details on community engagement methods see Learn – Determinants.
Describe the extent to which the selected injury issue is a problem
At this step we need to use the information and data sources obtained in the previous step to explore the magnitude of the problem. Topics to help explore the extent of the problem include:
- Severity of the injury
- Demographics of the community affected
- Setting and geography
Severity of the injury
Exploring the severity of an injury can provide valuable insights.
The most common forms of data used to understand the severity of an injury in a community are mortality (death/fatal injuries) and injuries resulting in hospitalisations. See the Know Section for data on each injury area.
Use this template Burden of Injury Measurements for details on a range of most common types of data required to measure the burden of injury.
However, there are limitations when gathering injury data. While mortality and hospitalisation data are powerful measures, they only comprise a fraction of the impact of injuries on a community – not all injuries require hospitalisation.1 This means that not all occurrences of an injury will be recorded and may mean that the data gathered is an underestimation.
The Injury Pyramid illustrates this limitation (Figure 1)2. At the bottom, there are injuries that are most difficult to measure, being those that are treated at home or not at all. Secondly, there are injuries that may require visits to primary care facilities, which can be measured but may not always be captured. Similarly, emergency department visits, hospitalisations and deaths being the easiest to measure are the most accurate measures available. This pyramid illustrates the difficulty in measuring the true impact of injury.
In addition to the severity of an injury, a host of cultural and economic factors can determine the level of treatment an injury victim receives.1 See the Learn Section – Determinants of Injuries for more information.
Figure 1: The Injury Pyramid
Demographics of the community affected
Demographic data is essential to determine whom the issue is affecting.
Common demographic breakdowns used are age, gender, Aboriginality, birthplace and language spoken at home. These breakdowns can be useful in figuring out, for example, which age groups in both males and females are most at risk of a certain injury type and what percentage of these statistics were Aboriginal people.
Age standardised rates or ASR’s are a direct standardisation using predetermined population data and are usually expressed per 1,000 or 100,000 person years. The rates allow for a comparison between population groups and different years for the same population group. This can be helpful when determining which locations have the highest needs as the frequency of the issue is not affected by the population of the geographical area.
See the Know Section for data on each injury area.
Setting and geography
Setting information is useful to understand where an injury is occurring. Setting can be broken down into the geographical location of where a death or hospitalisation occurs (e.g. metropolitan, rural), as well as the environmental setting (e.g. creek, pool, ocean for drownings) in which an injury can occur.
Common settings in which injuries occur include:
- Sport and Recreation
Common geographical areas for analysis include:
- State level
- Health Region
- Health District
- Local Government Area
- Metropolitan / Country
- Statistical Local Area
State: Useful for a broad overview of how an injury affects Western Australia as a whole and how Western Australia compares with other states.
Health Region: Regional data is useful for targeting specific programs towards areas where a particular injury has a higher incidence. Figure 2 shows the health regions of Western Australia.
Figure 2: Health Regions of WA
Health District: Health Regions can be broken down further into Health Districts. The eight Health Regions are divided into 25 Health Districts. The following table outlines how each region can be further divided. Table 1 outlines the Health Districts of Western Australia, as per their corresponding region.
Table 2: Health Districts of Western Australia by Health Region
|South East Coastal|
|Great Southern||Central Great Southern|
|Lower Great Southern|
Local Government Area: There are currently 139 local governments in Western Australia made up of a varying number of suburbs. Each local government website can be useful in ascertaining the boundaries of that area, this assists when accessing data for an entire area.
The Western Australian Local Government Association (WALGA) is the peak body for local government association’s and details of each can be accessed here.
Metropolitan/Country: This data is useful when comparing different injury data between the metropolitan and regional areas.
The Accessibility/Remoteness Index of Australia (ARIA) is a useful measure of remoteness of a community in Western Australia. This assigns a remoteness score to a community based on road distance and population number, designed to ascertain how restricted accessibility to goods, services and opportunities for social interaction are in that community. This score can be categorised one of five ways.1
Table 3: Accessibility/Remoteness Index of Australia (ARIA) Categories
|0 – 1.84||Highly accessible||Relatively unrestricted access.|
|1.85 – 3.51||Accessible||Some restrictions of accessibility of some goods, services and opportunities for social interaction.|
|3.52 – 5.80||Moderately accessible||Significantly restricted accessibility of goods, services and opportunities for social interaction.|
|5.80 – 9.08||Remote||Very restricted accessibility of goods, services and opportunities for social interaction.|
|9.09 – 12||Very remote||Very little accessibility of goods, services and opportunities for social interaction.|
Adapted from here.
Statistical Local Area: Statistical Local Areas are boundaries defined by the Australian Bureau of Statistics.12
Information relating to the timing of an injury is useful to understand when an injury is occurring. When considering the impact that time may have on an injury time can be broken down according to time of the day, day of the week, week, month and/or season. This will assist in determining when the injury is more prevalent as there may be peaks that occur due to the time, for example late at night, on the weekend, during holiday periods or during winter.
When considering the extent to which the injury is a problem it is important to factor in the impact that the injury has on all levels, not just on the individual. In most cases an injury occurs to one person; however the effect that the injury has extends beyond the individual who was injured. Injury places a strain on the healthcare system due to the high rate of hospitalisations and ongoing treatments that occur as a result of the injury.13 Following on from the injury it can place stress on the family, workplace and community in a number of ways depending on the level of the injury.
How to read and understand research by Dr Paola Chivers, Lecturer and Researcher, University of Notre Dame
The impact of injury on children 0-14 years by Scott Phillips, CEO, Kidsafe WA
The impact of injury on youth 15-24 years by Donna Quinn, Project Manager, Youth Affairs Council of WA
The impact of injury on adults 25-64 years by Kim Papalia, Road Safety Commissioner, Road Safety Commision WA
1Espitia-Hardeman. V., Paulozzi. L. (2005). Injury Surveillance Training Manual. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.
2Australian General Practice Network (2012). Preventive Health and Health Promotion – A Toolkit for Medicare Locals. Retrieved from http://www.fmpml.org.au/sites/all/sites/default/files/files/res_pophealth_Preventive-Health-and-Health-Promotion-Toolkit.pdf
3Victorian Healthcare Association. (2014). Population Health Planning Framework. Retrieved from http://www.vha.org.au/docs/population-health-planning-framework_analyse-the-planning-context.pdf
4Harrison, J. (2010). Essentials of Strategic Planning in Healthcare. Health Administration Press.
5Gillam, S., Yates, J., Badrinath, P. (2012). Essential Public Health: Theory and Practice. 2nd edition. Cambridge University Press.
6University of Kansas Community Health and Development Work Group. (2014). About the toolbox. Retrieved from http://ctb.ku.edu/en/about-the-tool-box
7Timmreck, T. (2003). Planning, Program Development, and Evaluation: A Handbook for Health Promotion, Aging, and Health Services. Jones & Bartlett Learning.
8Miller, R. (2012). Epidemiology for Health Promotion and Disease Prevention Professionals. Routledge Publishing.
9Department of Health, Victoria (2012). Integrated Health Promotion Resource Kit. Retrieved from http://docs.health.vic.gov.au/docs/doc/8196B97B654C907BCA257A7F001DF6E4/$FILE/integrated_health_promo.pdf
10ABS (2013). Statistical Language – Quantitative and Qualitative Data. Retrieved from http://www.abs.gov.au/websitedbs/a3121120.nsf/home/statistical+language+-+quantitative+and+qualitative+data
11World Health Organization. (2010). The injury pyramid. Retrieved from http://www.who.int/violence_injury_prevention/key_facts/VIP_key_fact_5.pdf
12Australian Bureau of Statistics. (2006). Australian standard geographical classification. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/bb8db737e2af84b8ca2571780015701e/
13Cripps, R. & Harrison, J. (2008). Injury as a chronic health issue in Australia. Retrieved from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442458807