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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

This submission reflects the views of
Organisation Name: 
Transport and Road Safety (TARS) Research, UNSW
Personal Details
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
Injury is in fact the leading cause of death for Aboriginal and Torres Strait Islander (herein “Aboriginal”) but is often overlooked among competing priorities in illness and disease. Suicide and transport injury are the leading causes of mortality. At Transport and Road Safety (TARS) Research at UNSW, we particularly focus on road injury and therefore this is the focus of this submission. Road safety is a significant health challenge for Aboriginal people for which only "guesstimated' data are usually available to try to identify priorities and contributing factors to road casualties for improved countermeasure development and post-crash response. The research literature is limited. Primary sources are government commissioned reports and policy documents, in addition to only a small number of peer-reviewed papers. In particular, there is a paucity of research aiming to identify key risk factors for road injuries or to evaluate interventions to reduce them, despite the implementation of a range of local and jurisdictional initiatives. There is a dire need for high-quality, representative research, both fundamental research, such as understanding exposures to road risks, and applied research, particularly evaluations of program effectiveness, efficacy and sustainability.
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
The Australian Transport Council’s (2011) National Road Safety Strategy 2011-2020 identifies Indigenous road users as a particularly vulnerable and high-risk group and particularly acknowledges the need for “Increased access of Indigenous people to graduated licensing and vehicles with higher safety ratings” and includes as an immediate priority to “Develop and implement programs to increase the opportunities for driving practice for disadvantaged learner drivers, particularly in Indigenous communities.” All states and territories endorsed the national strategy and have local strategies also reiterating need for specific initiatives to improve Aboriginal road safety. In NSW a separate strategy was specifically developed [Transport for NSW (2014). NSW Aboriginal Road Safety Action Plan. NSW Government: Sydney NSW: http://roadsafety.transport.nsw.gov.au/downloads/aboriginal-road-safety-plan.pdf.] A 2015 progress report suggests that there has been limited effort on improving access to safe vehicles and while some effort has been made to improve licensing rates in some remote areas in Australia, this fails to recognise road safety as an issue for all Aboriginal people including those in urban areas. Moreover, there are many other issues and fundamental research questions that are worthy of investigation. [National Road Safety Strategy 2011-2020: Implementation Status Report (2015): http://roadsafety.gov.au/performance/files/NRSS_Implementation_report_Nov2015.pdf.]
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
Current estimates are that Aboriginal people are three times more likely to die and 30% more likely to be seriously injured from road crashes than non-Aboriginal people; with a 2.3 times higher risk of dying as a driver, 5.8 times as a passenger, and 5.2 times as a pedestrian. Unlicensed driving, seatbelt non-use, alcohol use, speeding and fatigue are likely behavioural contributors, suggesting efforts to address these generally are not reaching or resonating with Aboriginal people. Overcrowding of (the limited vehicles available, generally of poor quality) also likely contributes. Moreover, the proportion of people killed on our roads increases sharply with increasing remoteness, and Aboriginal people comprise the vast majority of people living in remote areas. However, these disparities exist even in urban areas. Aboriginal people can face substantial barriers to licensing and roadworthy vehicles, including lack of identification documents, literacy, language and cultural barriers, particularly in remote areas where licensing services are limited, and lack of suitable supervisors or vehicles to achieve the high logbook hours required in many jurisdictions. Licensing is important not only for employment and education, but can also be critical for Aboriginal people to access health services and daily needs, including shopping and social mobility needs.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
The last detailed estimate of the cost of road crashes to Australia reached a figure of $27b per annum. This was a 2009 report based on 2006 dollars. [Australian Bureau of Infrastructure, Transport and Regional Economics (2009). Cost of road crashes in Australia 2006 - Report 118. Canberra: https://bitre.gov.au/publications/2010/report_118.aspx).] At minimum, it is estimated that Aboriginal people comprise 10% of all road deaths and 5% of all serious injuries, based on rudimentary calculations only for the National Road Safety Strategy 2011-2020 (notably despite comprising <3% of the Australian population). Therefore, while the cost of Aboriginal casualties was not specifically estimated, they can be determined to cost multiple millions to the Australian economy and contribute to a considerable burden on the health system. Indigenous status is not routinely collected at the time of driver licensing throughout Australia, with NSW an only recent exception. Making such identifications at the time of crash is fraught with complications. In its latest report on Aboriginal road injury, the Australian Institute for Health and Welfare suggested “acceptable” mortality data records of Aboriginal status were only available from WA , SA, QLD and NT, but included recent data from NSW, and VIC with “some caution”.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
AIHW: Henley G & Harrison JE 2013. Injury of Aboriginal and Torres Strait Islander people due to transport, 2005-06 to 2009-10. Injury research and statistics series 85/Cat INJCAT 161. Canberra (http://www.aihw.gov.au/publication-detail/?id=60129543939). Ivers RQ, Hunter K, Clapham K, Helps Y, Senserrick T, Byrne J, Martiniuk A, Daniels J, Harrison JE. Driver licensing: descriptive epidemiology of a social determinant of Aboriginal and Torres Strait Islander health. Australian and New Zealand Journal of Public Health, 2016;40(4):377-82.. Ivers R, Clapham K, Senserrick T, Harrison J. Collecting measures of Indigenous status in driver licencing data. Australasian Epidemiologist, 2012;19(2):9-10. Senserrick T, Hinchcliff R, Ivers R, Martiniuk A, Boufous S, Clapham K. Aboriginal injury prevention projects: a review. Report to NSW Department of Health. The George Institute for Global Health, Sydney; 2010. (https://www.saxinstitute.org.au/wp-content/uploads/19_Senserrick-et-al-Aboriginal-injury-prevention-projects.pdf) Boufous S, Ivers R, Senserrick T, Martiniuk A, Clapham K. Underlying causes and effects of injury in Australian Aboriginal populations: a review. Report to NSW Department of Health. The George Institute for Global Health, Sydney; 2010. (https://www.saxinstitute.org.au/wp-content/uploads/14_Boufous-et-al.-FINAL-FOR-PUBLICATION.pdf) Martiniuk A, Ivers R, Senserrick T, Boufous S, Clapham K. Effective and inclusive intervention research with Aboriginal populations. Report to NSW Department of Health. The George Institute for Global Health, Sydney; 2010. (http://www.health.nsw.gov.au/research/Documents/07_effective-intervention-research-in-aboriginal-populations.pdf)

Page reviewed: 30 August, 2018