Injury includes damage to health due to such events as transport-related accidents, falls, drowning and near-drowning, suicide and intentional self-harm, homicide and interpersonal violence, fire, burns and scalds, poisoning (from pharmaceuticals and other substances), sports-related accidents, incidents occurring in workplaces and on farms, and from other causes.

Size of the problem

• Injuries were responsible for one-tenth of the total Victorian burden in men in 1996 (31,099 DALYs)

• The female burden was less than half of this at 12,829 DALYs

• About three-quarters of the burden caused by injury is due to mortality

• In men, the picture is dominated in equal proportions by suicide and road traffic accidents, which together account for over half the male burden attributable to injuries

• In women, the picture is dominated in almost equal proportions by traffic accidents, suicide and falls which together account for two-thirds of the overall female burden

• In 1996 in Victoria, injuries caused 1,567 deaths (1,094 males and 473 females) resulting in 30,568 Years of Life Lost (YLL)

Historical trends

• There has been a significant decline in injury mortality in Victoria and Australia over the last 30 years

• Injury continues to account for 5-6% of all deaths

• The road injury death rate declined rapidly after 1970

• Overall suicide rates in the general population in Australia have been fluctuating at around 20 per 100,000 population for males, and 5 per 100,000 population for females since the 1920s, except for a drop during World War II attributed to social factors

International comparisons

• Australia ranks in the middle of other OECD countries in total deaths resulting from injury and poisoning, with France, Switzerland and the USA highest, while Italy, UK and the Netherlands have the lowest rates

• The potential for improvement is demonstrated by the injury death rate in the Netherlands (about 26 per 100,000 persons) compared with Australia (57 per 100,000) in 1988-92

Projections

• Overall death rate for injury and poisoning is projected to continue to decline

• The rank order of the burden of unintentional injuries in 2016 compared to 1996 is expected to rise from 9th to 6th in males and from 10th to 7th in females

• Such projections must be taken with caution, since expectations of a continued drop in road traffic deaths may prove too optimistic, while the number of deaths caused by heroin overdose in recent years has fluctuated enough as to make future trends uncertain

Special populations

Special populations for prevention of injury and poisoning are:

• Children:
  Numbers of cases of burns and poisoning are particularly high in the 0-5 year age group, whereas injuries sustained from pedal cycling or motor vehicle passenger accidents are significant in the 5-14 year age group, although reductions have been occurring over time

• Young males:
  Each year in Australia over 1,600 young males aged 15-29 years die and more than 60,000 are hospitalised, the single largest cause being transport-related accidents, with suicide the second most common cause of death in the 15-24 year age group

• Indigenous Australians:
  Australian death rate ratios for Indigenous compared with non-Indigenous populations remain high (3.4:1 for males and 3.0:1 for females), and do not appear to be improving significantly

• Older age groups
  Falls in older people is an important issue in injury prevention

• 'Other remote' areas:
  Death rate ratio in 'other remote areas' compared to Victoria overall is more than 1.9:1 for both males and females; farm safety is an important issue

Evidence-based interventions

There are many examples of extremely effective injury and poisoning prevention activities in Victoria e.g.

• Bicycle helmet promotions in Australia began in Victoria in the early 1980s. Compulsory helmet wearing laws were first introduced in Australia in Victoria in 1990 with a concomitant reduction in bicycle-related head injuries (by 48% in the first year and by 78% in the second year)

Known effective strategies requiring continued action:

• Smoke detectors

• Sports policies regarding known effective protective gear

• Playground equipment safety standard and regulations

• Speed/red light cameras

Strategies which merit further evaluation:

• Accords with licensed premises

• Responsible serving of alcohol programs

• Risk management of baby walkers

• Falls prevention in older people (e.g. medication management, gentle exercise, hip protectors, nursing home performance agreements)

• Limiting availability of methods of suicide/self-harm (e.g. guns, barbiturates, detoxifying natural gas)

Injury risk factors

1. Downstream (biomedical/physiological)
   • excess weight
   • osteoporosis
   • poor eyesight
   • certain types of medication
     (related to frequency and severity of falls in the elderly)
2. Midstream
   • Behavioural: alcohol misuse; illicit drug use
   • Demographic/socio-economic:
   • Low SES; Indigenous; CALD; Rural/remote residence
3. Upstream (physical/social environmental conditions; broader determinants of health)
   • Social capital
   • Civic engagement
   • Income inequality
   • Government policies

Reference