Summary of road safety among Indigenous peoples
Introduction
There are around 1,700 road deaths and over 22,000 serious injuries in Australia each year [1]. This means that every 22 minutes someone is killed or seriously injured on Australia’s roads. Road crashes cost each Australian over $750 per year and cost the community over $41 million every day.
Within the Australian population, Indigenous people are 3.5 times more likely to die from a road accident than are non-Indigenous people [2].
Impact of road injury
Road injury impacts on the community at multiple levels. Apart from the direct physical effects of road injury, which is reflected in mortality and morbidity data, there are also the psychological effects of a road accident, as families have to try and cope with the death or disability of a family member involved in a road crash [1]. This has a large impact in terms of emotional and also financial stress.
Other factors that are affected by the road injury toll are: lost labour; medical costs; quality of life; legal costs; workplace disruption; long-term care; vehicle repairs; travel delays; and insurance administration [1].
There has been a lack of research in the area of Indigenous road safety until quite recently. Quantification of the road injury problem in the Indigenous population has been difficult because of poor reporting of crashes and the complexity of ensuring the identification of Indigenous people in the various data collections [2].The Indigenous numbers and ratios quoted in this section have not been adjusted for the likely under-identification of Indigenous people, such as in deaths registrations. Based on the estimated completeness of identification, the actual numbers of deaths and ratios, for example, could be up to 30% higher [3].
Mortality
Motor-vehicle crashes, including car, motorcycle, and bus
crashes together with incidents involving pedestrians are
the leading causes of death from injury for Indigenous males
and females (see Table 1).
Table 1 Numbers of Indigenous deaths from injury and
standardised mortality ratios*, by sex, for WA, SA, and NT
(1997–2001)
Cause of injury
|
Males |
Females |
||
Number |
SMR* |
Number |
SMR* | |
Land transport |
172 |
3.3 |
78 |
6.7 |
Motor-vehicle crashes |
90 |
2.3 |
35 |
3.8 |
Pedestrians |
62 |
8.0 |
33 |
32.5 |
Other land transport |
20 |
4.4 |
10 |
0.1 |
All injury |
531 |
3.2 |
243 |
6.4 |
Source: [3], derived from
data from the AIHW mortality database
*The SMRs (standardised mortality ratios) have been calculated
by dividing the numbers of Indigenous deaths for each sex
by the numbers expected from the rates for non-Indigenous
people of the same sex.
For more info on standardisation and SMRs, click here.
The most striking feature of the death information is the much greater contribution of pedestrian deaths among Indigenous people than among non-Indigenous people: the numbers of Indigenous pedestrian deaths in Western Australia, South Australia, and the Northern Territory in 1997–2001 were eight times the number expected for males and almost 33 times the number expected for females. (The numbers expected were derived from the corresponding age-specific rates for the non-Indigenous population.)
Death rates from motor-vehicle crashes and incidents involving pedestrians were higher for Indigenous people than for non-Indigenous people in every age group (see Table 2). The greatest differences were for middle-aged adult pedestrians; for this group, the rates for Indigenous people were up to 33 times those for non-Indigenous people [3].
Table 2 Age-specific death rates* for motor-vehicle crashes and pedestrian deaths, by Indigenous status, and rate ratios,** for WA, SA, and NT (1997–2001)
| Age group | Motor-vehicle crashes | Pedestrian incidents | ||||
| Indigenous rate | Non-Indigenous rate | Rate ratio | Indigenous rate | Non-Indigenous rate | Rate ratio | |
| 0-4 | 6.7 |
1.3 |
5.3 |
12.3 |
1.6 |
7.6 |
| 5-14 | 8.7 |
1.4 |
6.4 |
2.3 |
1.3 |
1.8 |
| 15-24 | 28.1 |
18.3 |
1.5 |
14.0 |
2.1 |
6.6 |
| 25-34 | 20.5 |
11.3 |
1.8 |
14.5 |
1.5 |
9.5 |
| 35-44 | 25.6 |
7.9 |
3.3 |
35.4 |
1.1 |
32.7 |
| 45-54 | 25.2 |
5.5 |
4.6 |
23.1 |
1.2 |
19.3 |
| 55-64 | 23.9 |
6.7 |
3.6 |
12.0 |
0.9 |
14.0 |
| 65-74 | 16.1 |
8.2 |
2.0 |
8.0 |
3.1 |
2.6 |
| 75+ | 18.2 |
8.4 |
2.2 |
13.7 |
1.9 |
7.2 |
| Average | 19.2 |
7.7 |
2.5 |
15.0 |
1.6 |
11.3 |
Source: Derived from data provided by the
AIHW National Mortality Database and ABS low-series population
projections
*Rates are per 100,000 population
**The ‘rate ratio’ is the Indigenous rate divided
by the non-Indigenous rate.
As well as the very much higher contribution of pedestrian deaths, greater proportions of Indigenous people than non-Indigenous people die from crashes where only one vehicle is involved (such as roll-overs) [4].
Hospitalisation
The most recent publication with detailed information relating to Indigenous hospitalisation is one evaluating data for 1999-2000 [5]. In that period, 858 Indigenous males and 394 Indigenous females were hospitalised as a result of land transport injury. (As the identification of Indigenous people in hospital data is considered acceptable only in WA, SA and the NT, Australia-wide data underestimate the true impact of road injury hospitalisations on the Indigenous population, probably by around 25%).
As well as under-reporting of Indigenous road crash hospitalisations, information about crashes that resulted in hospital admissions is very sparse. For example, an investigation of 551 hospital admissions in South Australia in 1989-1996 found that for 22% of admissions it could not be determined whether the patient was the driver or passenger, and for 200 admissions the crash type (loss of control, collision with heavy transport vehicle) could not be identified [6].
In much earlier research – of data for 1991-92 – Indigenous people were 2.7 times more likely than non-Indigenous people to be injured as pedestrians, and 1.9 times more likely to be injured as motor vehicle passengers [7]. On the other hand, Indigenous people were less likely to be hospitalised as motor vehicle drivers or motorcyclists.
Factors contributing to road injury
Various reasons have been suggested for the overall differences between Indigenous and non-Indigenous people in road injuries. For a start, higher proportions of Indigenous than non-Indigenous people live in remote or rural areas, where environmental risk factors are greater than in urban areas. It has also been suggested that ‘differences in lifestyle and culture in Indigenous persons may exacerbate existing risks by reducing the appropriateness of current safety education programs’ [8].
Brice [9] argued that the analysis of road injuries involving Indigenous people needs to go much deeper than the usual identification of proximate factors (for instance, seat belt use and intoxication). Brice attributed the consistently large proportion of Indigenous road injury deaths in South Australia to ‘significant social disturbance at the root of individual incidents’, with ‘road trauma among Aboriginal and Torres Strait Islander people … as much a feature of class or social disadvantage as of culture or, for example, of popular notions of poor driving in sub-standard vehicles’ [9].
The following sections summarise a variety of factors contributing to road injury, grouped according to whether they are human, environmental or vehicle factors. A separate section summarises post-crash factors.
Human factors
Based on an analysis of research attempting to identify the causal factors behind the over-involvement of Indigenous people in road trauma, a recent report identified non-compliance with road laws (such as drink driving, non-wearing of seatbelts or restraints, overcrowding and illegal seating positions in vehicles, inappropriate speed, particular in rural areas) and carelessness about general road safety practices (especially by intoxicated pedestrians) as the major human factors involved [2].
A large proportion of Indigenous road crashes was characterised by alcohol involvement [2]. This applies particularly to fatal single-vehicle roll-over incidents and pedestrian fatalities.
A larger proportion of Indigenous people than non-Indigenous people dying from road injury had not used protective devices, such as helmets and seatbelts [2]. In particular, Indigenous children were more likely to be a serious casualty in a crash because of not wearing a seatbelt [6].
Not much research has been done into the role of driving offences, but the available data suggest that Indigenous people are over-represented, in particular in unlicensed driving. In Western Australia in 1999, for example, the most frequent reason for imprisonment was driving offences, with 53% of those imprisoned identified as being Indigenous [2]. The two most common offences were drink driving and unlicensed driving. Analysis of the NSW prison population in 1999 gave similar results [10].
Environmental factors
Approximately 70% of Indigenous people live in non-metropolitan areas and are consequently exposed to environmental risk factors specific to rural and remote Australia [8]. These include: greater distances travelled (and consequently greater exposure to the risk of a road crash); higher speed limits; poorer road quality; unsealed roads; increased diversity in types of vehicles; and delays in retrieval and accessing medical treatment and rehabilitation [11]. There is a lower risk of collisions with other vehicles, but there is a higher risk of collision with livestock and wildlife [12]. Police enforcement of speed limits, alcohol use and seatbelt wearing is less on rural roads than in urban areas [1]. These factors can contribute to more motor-vehicle crashes and deaths. But, even when these factors are taken into account, it is likely that the risks of serious road injury are greater for Indigenous than for non-Indigenous people.
Vehicle factors
The contribution of vehicle factors to the incidence and severity of Indigenous road crashes is not clear, even though vehicle choices and defects appear to have a large effect on rural and remote road trauma [2]. The lower socio-economic status of Indigenous people, including those living in rural or remote areas, suggests the possession of older vehicles. Lower socio-economic status may also cause a lower level of maintenance on vehicles, which is amplified in rural and remote areas from roads that are of poorer condition than in urban areas [2].
Post-crash risk factors
Largely because of the greater distances, emergency responses are slower and retrieval times longer in rural and remote areas [12]. As well, there is some evidence suggesting that Indigenous people in rural areas are reluctant to use organised health care services even when these are available [2]. Factors contributing to this include cost, lack of insurance coverage, travel distance, transportation problems, difficulty in taking time off work, traditional values, reduced referrals, and a lack of knowledge about the potential benefits of specialised medical care. A number of historical and cultural factors influence the beliefs and perceptions Indigenous persons hold about health and injury treatment. This also has an influence on the reluctance to use organised health care services.
Prevention and management in Indigenous road safety
The development of road injury prevention projects and programs depends on a solid understanding of the various factors contributing to road injuries. Reflecting the diversity of disciplines and backgrounds involved in injury prevention, including road injury prevention, approaches investigating these factors range from the traditional epidemiological single-risk-factor approach to broad sociological methods [3].
Generally, recent approaches stress the importance of using a capacity-building process when working with Indigenous communities, and of embracing Indigenous perspectives on health and injury [2].
Most community-based Indigenous road safety programs have focused on alcohol abuse in order to reduce the number of alcohol-related road crashes. There is, however, not much information available on the impact on road trauma of the minimisation of alcohol use [2, 9].
Interventions designed to increase compliance with restraint use or open-load legislation have been minimal until recently. Moreover, the majority of Indigenous road safety programs have not been informed by local Indigenous knowledge or systematic research with Indigenous groups [2]. These factors have contributed to the relative ineffectiveness of Indigenous road safety strategies and policies.
Despite rural populations being over-represented in road transport related crashes, not many road safety policies and interventions have targeted rural and remote populations and problems [12]. For the most part, this is due to the widespread distribution of the rural population, making some of the interventions used in urban areas less relevant. Furthermore, the cost of conducting research and implementing strategies in rural areas is significantly higher [12].
Policies and strategies
In November 2000, Australia adopted the National Road Safety Strategy, which provides a framework for coordinating and complementing the road safety initiatives of the various levels of government – Federal, State/Territory and local governments – and of others capable of influencing road safety outcomes [1]. The aim of the strategy was to reduce the annual number of road deaths by 40%, from 9.3 per 100,000 population in 1999 to no more than 5.6 in 2010.
The Australian Transport Safety Bureau develops Road Safety Action Plans on a biennial basis – these set out specific measures available to achieve the objectives of the Strategy [1]. The action plans are reviewed at the end of each two-year period.
Road safety strategy and policy measures are mainly driven by the States, Territories and local government, which conduct their own road safety programs. The role of the Australian Government and its agencies includes funding major road programs and the treatment of black spots; regulating new vehicle standards; research; compilation and analysis of national statistics; and facilitating the sharing of ideas and information among stakeholders [13].
The National Road Safety Strategy 2001-2010 [14] recognises road safety for Indigenous people as a particular issue of concern. The National Road Safety Action Plan for 2005 and 2006 [15] calls for an approach based on local consultation and action, facilitated by information-sharing and cooperation among jurisdictions, to identify and implement locally relevant initiatives to improve road safety outcomes for Indigenous people. These local initiatives will complement broader road safety measures in the Action Plan that will improve road safety for all Australians, including Indigenous people [13].
The Australian Transport Safety Bureau, with assistance from the Northern Territory Department of Infrastructure and Planning, organised and chaired the third Indigenous road safety forum in Alice Springs in September 2004 [13]. The forum aimed to enhance and build on existing strategies and initiatives relevant to Indigenous road safety and to provide a resource-sharing and networking opportunity to help empower communities to implement practical solutions to Indigenous road safety problems.
The delegates attending this forum comprised key stakeholders in Indigenous road safety from Federal, State and Territory transport, health, safety, corrective services and sport and cultural affairs agencies, including the Alice Springs Indigenous Coordination Centre, police, driver training schools, motorist associations, community organisations, local government and local Indigenous elders [13]. The forum covered a range of topics, including communication techniques, availability of statistics, government, police and community educational programs and other countermeasures, injury prevention plans by the health sector, a whole-of-government approach for Indigenous Coordination Centres, local government countermeasures, licensing programs and development of a national Internet-based information-sharing program dedicated to Indigenous road safety.
The forum confirmed the messages from previous forums that, although national statistical data on Indigenous road safety is seriously incomplete, the available data indicate that the Indigenous road fatality rate is much higher than the non-Indigenous rate. The issues that were identified as requiring national attention were:
- inconsistent and incomplete statistical data on Indigenous fatality and injury rates;
- low levels of licensed driving;
- low seat belt wearing rates among Indigenous drivers and passengers;
- unsafe consumption of alcohol by Indigenous drivers and pedestrians;
- need to share information on Indigenous road safety among key government bodies and stakeholders;
- need to involve local communities when developing countermeasure programs; and
- inadequate road infrastructure.
A working group of stakeholders met at the conclusion of the forum to analyse the issues raised and recommended a list of eleven actions. These actions are to be monitored through a twice-yearly teleconference of the working group and at the next forum [13].
Concluding comments
To minimise the impact of road injuries in the Indigenous community, effective prevention and management programs are essential. To be successful, these programs need strong leadership and excellent coordination and collaboration between different government sectors and between different levels of government. The transportation sector (the sector with direct responsibility for road safety) will need to work closely with (at least) the police, local government, and the health sector [3].
The development and implementation of effective road safety programs will require a level of intersectoral and intergovernmental cooperation and collaboration not commonly seen in Australia. Of course, even the best intersectoral and intergovernmental cooperation will not be effective unless the Indigenous community plays a key role in the development and implementation of strategies and initiatives addressing Indigenous road injury. A model for this role, vital at all levels—national, regional, and local – is provided in the Agreement on Aboriginal and Torres Strait Islander Health, which facilitates joint planning between governments and Indigenous organisations in the area of Indigenous health.
Cooperation between governments, sectors, and Indigenous communities will need to be supported by adequate funding for comprehensive road safety strategies and improvements to the road safety workforce. These requirements are, of course, common to many areas of Indigenous health and wellbeing [3].
References
1 Australian Transport Safety Bureau (2004) Road safety in Australia: a publication commemorating World Health Day 2004. Canberra: Australian Transport Safety Bureau
2 Macaulay J, Thomas R, Mabbot N, Styles T, Edmonston C, Sheehan M, Schonfeld C (2003) Australian Indigenous road safety: contract report. (Report no. RC2321-September 2003) Vermont South, Victoria: ARRB Transport Research
3 Thomson N, Brooks J (2003) Injury. In: Thomson N, ed. Health of Indigenous Australians. Melbourne: Oxford University Press:442-466
4 Cercarelli L (1999) Road crash hospitalisations and deaths in Western Australia involving aboriginal and non-aboriginal people, 1988 to 1996. Perth: Department of Public Health, The University of Western Australia
5 Lehoczky S, Isaacs J, Grayson N, Hargreaves J (2002) Hospital statistics: Aboriginal and Torres Strait Islander Australians, 1999-2000. (ABS catalogue no. 4711.0 AIHW catalogue no. IHW-9) Canberra: Australian Bureau of Statistics and Australian Institute of Health and Welfare
6 Tiong FCK (1997) Involvement of South Australian Aboriginal people in road traffic crashes 1989-1996. Adelaide: Transport South Australia
7 Moller J, Dolinis J, Cripps R (1996) Aboriginal and Torres Strait Islander Peoples: Injury-related hospitalisations 1991/92. Canberra: Australian Institute of Health and Welfare, National Injury Surveillance Unit
8 Cercarelli R, Ryan AG, Knuiman MW, Donovan RJ (2000) Road safety issues in remote Aboriginal communities in Western Australia. Accident Analysis and Prevention;32(6):845-848
9 Brice GA (2000) Australian Indigenous road safety: a critical review and research report, with special reference to South Australia, other Indigenous populations, and countermeasures to reduce road trauma. Adelaide: A report to the Aboriginal Health Council of South Australia & Transport SA supported by the Safety Strategy, Transport SA Urban Planning & the Arts
10 New South Wales Bureau of Crime Statistics (1999) Report on the NSW Government's implementation of the recommendations of the Royal Commission into Aboriginal deaths in custody. Sydney: NSW Government, Legislation and Policy Division
11 Harrison J, Miller E, Weeramanthri T, Wakerman J, Barnes T (2001) Information sources for injury prevention among Indigenous Australians: status and prospects for improvements. (Injury research and statistics series no. 8) Canberra: Australian Institute of Health and Welfare
12 Veitch C, Sheehan M, Turner R, Siskind V, Pashen D (2005) The economic, medical and social costs of road traffic crashes in rural north Queensland: a 5-year multi-phase study. Paper presented at the 8th National Rural Health Conference 10-13 March 2005, Alice Springs
13 Australian Transport Safety Bureau (2004) Summary of outcomes from 2004 Indigenous Road Safety Forum. Retrieved 04/04/05 from http://www.atsb.gov.au/road/nrss/indigenous.cfm
14 Australian Transport Council (2000) National Road Safety Strategy 2001-2010. Canberra: Australian Transport Safety Bureau
15 Australian Transport Council (2004) National Road Safety Action Plan: 2005 and 2006. Canberra: Australian Transport Safety Bureau
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