Abstract For the last 20 years injury prevention policy in Australia has been hampered by poor consultation practices, limited stakeholder involvement, inadequate allocation of resources, poor implementation, and an absence of performance measures. This paper describes the development of injury prevention policy in Australia from its beginnings in 1981 to the current day and considers what measures should be undertaken to create an effective platform for the reduction of the burden of injury in Australia. The National Injury Prevention and Safety Promotion Plan 2004–2014 , released in 2005, needs to be supported by a whole of government commitment to the reduction of injury. The Council of Australian Governments would be an ideal forum to monitor progress, supported by a cross-government Ministerial Council.
ABSTRACT
ObjectiveThis study aims to quantify 12-month morbidity attributable to traumatic injury using a population-based matched cohort in Australia.
ApproachA population-based matched cohort study of individuals ≥18 years using linked emergency department (ED) presentation, hospital separation and mortality records from three Australian states during 1 January 2008 to 31 December 2010. Injury admissions were identified using a principal diagnosis of injury (ICD-10-AM: S00-T75 or T79). The first injury-related hospital admission during 2009 was identified as the index injury admission and pre and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence at the date of the index injury admission of their matched counterpart. Comorbidities were identified using diagnosis classifications and a 1-year lookback period. Injury severity was estimated using the International Classification of Injury Severity Score (ICISS): minor (≥0.99), moderate (0.942-<0.99) and serious (<0.942).
Negative binomial and Poisson regression methods will be used to quantify associations between injury and counts of hospital admissions 12-month post-index injury health service use.
ResultsThere were 166,032 individuals injured in 2009 and admitted to hospital in New South Wales, South Australia or Queensland with a matched comparison. Males represented 57% of those injured, 30.1% were aged 18-34 years, 37.9% were aged 35-64 years, 32.1% were aged ≥65 years and 65.1% resided in an urban location. Comorbidities were more common in the injured cohort (χ² =9384.5, df (2), p<0.0001). The most common injuries were fall-related (38.4%) and as a result of road trauma (12.4%). The majority of injuries were minor (43.9%) or moderate (37.2%), with 18.9% serious injuries. Attributable risk and adjusted rate ratios for injured versus matched non-injured comparison will be presented for pre and post health service use controlling for key confounding characteristics.
ConclusionThrough the use of national data linkage, this study contributes to informing research efforts on better quantifying the attributable burden of injury-related disability in Australia.
ABSTRACTObjectivesTo examine the relationship between home risk and hospital treated injury in Australian children up to five years of age. ApproachWomen with children between two and four years of age enrolled in an Australian longitudinal birth cohort study, Environments for Healthy Living (EFHL) between 2009 and 2011, were invited to complete a Home Injury Prevention survey. A total home risk score (HRS) was calculated and linked to EFHL baseline demographic survey and perinatal data. The child's injury related state-wide hospital emergency department and admissions data was extracted from the child's date of birth until 31 December 2013. Multiple imputation methods were used to impute incomplete multivariate exposure factors. Zero-inflated poisson regression was used to estimate crude and adjusted rate ratios (RRs) between exposure (HRS quartiles) and outcome (count of injury related episodes of care) for child participants, accounting for individual person-years of exposure time.ResultsData from 566 child participants were included with outcomes data available for 97% of the cohort. Using data linkage of administrative health records with multiple survey data sources, we found an inverse relationship between home risk and child injury, with children living in homes with the least injury risk (based on the absence of hazardous structural features of the home and safe practices reported) having 1.90 times the injury rate of children living in high risk homes (95% CI 1.15-3.14). Whilst this appears counter-intuitive, families in the lowest risk homes were more likely to be socio-economically disadvantaged than families in the highest risk homes (more sole parents, lower maternal education levels, younger maternal age and lower income). After adjusting for demographic and socio-economic factors, the relationship between home risk and injury was no longer significant (p>0.05). Discussion and conclusionsThrough the use of comprehensive linkage of five years of state-wide administrative health data, combined with individual survey data methods, this study overcame the most significant threat to longitudinal research – loss to follow-up. Our results demonstrated that children in socio-economically deprived families have higher rates of injury, despite living in a physical environment that contains substantially fewer injury risks than their less deprived counterparts. These findings support continued efforts to implement societal-wide, long term policy and practice changes to address the socioeconomic differentials in child health outcomes.
Abstract Background There is a sound rationale for the population-based approach to falls injury prevention but there is currently insufficient evidence to advise governments and communities on how they can use population-based strategies to achieve desired reductions in the burden of falls-related injury. The aim of the study was to quantify the effectiveness of a streamlined (and thus potentially sustainable and cost-effective), population-based, multi-factorial falls injury prevention program for people over 60 years of age. Methods Population-based falls-prevention interventions were conducted at two geographically-defined and separate Australian sites: Wide Bay, Queensland, and Northern Rivers, NSW. Changes in the prevalence of key risk factors and changes in rates of injury outcomes within each community were compared before and after program implementation and changes in rates of injury outcomes in each community were also compared with the rates in their respective States. Results The interventions in neither community substantially decreased the rate of falls-related injury among people aged 60 years or older, although there was some evidence of reductions in occurrence of multiple falls reported by women. In addition, there was some indication of improvements in fall-related risk factors, but the magnitudes were generally modest. Conclusions The evidence suggests that low intensity population-based falls prevention programs may not be as effective as those that are intensively implemented.
For more than a decade, suicide rates in Australia have shown no improvement despite significant investment in reforms to support regionally driven initiatives. Further recommended reforms by the Productivity Commission call for Federal and State and Territory Government funding for mental health to be pooled and new Regional Commissioning Authorities established to take responsibility for efficient and effective allocation of 'taxpayer money.' This study explores the sufficiency of this recommendation in preventing ongoing policy resistance. A system dynamics model of pathways between psychological distress, the mental health care system, suicidal behaviour and their drivers was developed, tested, and validated for a large, geographically diverse region of New South Wales; the Hunter New England and Central Coast Primary Health Network (PHN). Multi-objective optimisation was used to explore potential discordance in the best-performing programs and initiatives (simulated from 2021 to 2031) across mental health outcomes between the two state-governed Local Health Districts (LHDs) and the federally governed PHN. Impacts on suicide deaths, mental health-related emergency department presentations, and service disengagement were explored. A combination of family psychoeducation, post-attempt aftercare, and safety planning, and social connectedness programs minimises the number of suicides across the PHN and in the Hunter New England LHD (13.5% reduction; 95% interval, 12.3–14.9%), and performs well in the Central Coast LHD (14.8% reduction, 13.5–16.3%), suggesting that aligned strategic decision making between the PHN and LHDs would deliver substantial impacts on suicide. Results also highlighted a marked trade-off between minimising suicide deaths versus minimising service disengagement. This is explained in part by the additional demand placed on services of intensive suicide prevention programs leading to increases in service disengagement as wait times for specialist community based mental health services and dissatisfaction with quality of care increases. Competing priorities between the PHN and LHDs (each seeking to optimise the different outcomes they are responsible for) can undermine the optimal impact of investments for suicide prevention. Systems modelling provides essential regional decision analysis infrastructure to facilitate coordinated federal and state investments for optimal impacts.
Objective: In 2020, we developed a public health decision‐support model for mitigating the spread of SARS‐CoV‐2 infections in Australia and New Zealand. Having demonstrated its capacity to describe disease progression patterns during both countries' first waves of infections, we describe its utilisation in Victoria in underpinning the State Government's then 'RoadMap to Reopening'. Methods: Key aspects of population demographics, disease, spatial and behavioural dynamics, as well as the mechanism, timing, and effect of non‐pharmaceutical public health policies responses on the transmission of SARS‐CoV‐2 in both countries were represented in an agent‐based model. We considered scenarios related to the imposition and removal of non‐pharmaceutical interventions on the estimated progression of SARS‐CoV‐2 infections. Results: Wave 1 results suggested elimination of community transmission of SARS‐CoV‐2 was possible in both countries given sustained public adherence to social restrictions beyond 60 days' duration. However, under scenarios of decaying adherence to restrictions, a second wave of infections (Wave 2) was predicted in Australia. In Victoria's second wave, we estimated in early September 2020 that a rolling 14‐day average of <5 new cases per day was achievable on or around 26 October. Victoria recorded a 14‐day rolling average of 4.6 cases per day on 25 October. Conclusions: Elimination of SARS‐CoV‐2 transmission represented in faithfully constructed agent‐based models can be replicated in the real world. Implications for public health: Agent‐based public health policy models can be helpful to support decision‐making in novel and complex unfolding public health crises.
Using a health impact assessment framework, we estimated the population health effects arising from alternative land-use and transport policy initiatives in six cities. Land-use changes were modelled to reflect a compact city in which land-use density and diversity were increased and distances to public transport were reduced to produce low motorised mobility, namely a modal shift from private motor vehicles to walking, cycling, and public transport. The modelled compact city scenario resulted in health gains for all cities (for diabetes, cardiovascular disease, and respiratory disease) with overall health gains of 420-826 disability-adjusted life-years (DALYs) per 100 000 population. However, for moderate to highly motorised cities, such as Melbourne, London, and Boston, the compact city scenario predicted a small increase in road trauma for cyclists and pedestrians (health loss of between 34 and 41 DALYs per 100 000 population). The findings suggest that government policies need to actively pursue land-use elements-particularly a focus towards compact cities-that support a modal shift away from private motor vehicles towards walking, cycling, and low-emission public transport. At the same time, these policies need to ensure the provision of safe walking and cycling infrastructure. The findings highlight the opportunities for policy makers to positively influence the overall health of city populations.
