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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: 
The George Institute for Global Health, University of Sydney
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): 
Priority: prevention of road injury. In 2010 injuries accounted for the greatest fatal burden in Aboriginal and Torres Strait Islander people, accounting for 21% of the total burden, mainly due to people dying of injuries early in life.[1] Injuries account for 14% of the total gap in fatal burden between Aboriginal and Torres Strait Islander people and the rest of the community, and are the leading cause of death in Aboriginal people aged 1-34 years.[1] Road injury deaths for Aboriginal and Torres Strait Islander people are at least 2-3 times the rate of the rest of the community.[2] For Aboriginal men, between 1999 and 2010, road deaths fluctuated between 35-40 deaths per 100,000 population,[2] similar or greater than rates in sub-Saharan Africa; the current national road fatality rate is 5.4 deaths per 100,000. To date there has been very little research on the underlying burden, risk factors and appropriate preventative interventions to prevent road crashes and injury in Aboriginal people. There are challenges in understanding the burden as Indigenous status is not well recorded in routinely collected data[3] and very little research capacity across road authorities, Indigenous peak bodies or research institutions to progress research in this field.
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): 
Injury Prevention and Control was endorsed by the Australian Health Ministers as a Priority Health Area in 1996, and the National Aboriginal and Torres Strait Islander Safety Promotion Strategy was developed to lead policy and action. The Strategy has not been updated and there is no current National Body responsible for its delivery. There is however reference to Indigenous road safety in the National Road Safety Strategy, and recognition of the need for implementation of evidence based programs. The now defunct National Road Safety Council (NRSC) also recognised the need for action on Indigenous road safety and commissioned a report on ways forward,[4] and funded an NT wide Indigenous driver licensing program.[5] NSW currently has a state wide strategy for Aboriginal road safety e.g. NSW Aboriginal Road Safety Action Plan 2014-2017, and other states including WA and NT have developed specific resources for the Aboriginal road safety. The Audit Office of NSW also has recently recognised the need for action on Indigenous driver licensing and made significant recommendations.[6]
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): 
Most road safety programs are implemented at a state level by road authorities and few are evidence based or evaluated for effectiveness. A TCR in large scale implementation trials of promising interventions would provide a unique opportunity to build on the limited research in this field to generate high level research evidence to help close the gap for a preventable condition. There is a critical need for research that funds research partnerships between research groups and Aboriginal peak bodies and community organisations to develop and implement innovative road safety programs. Particular areas of need include extension of driver licensing support programs, restraint programs, management of alcohol and drink driving, and novice driver safety. A TCR would generate research that leads to implementation of programs to reduce road crash injury and death, could contribute to significant reductions in this prominent contributor to the gap in Aboriginal and Torres Strait Islander health. The TCR could include opportunities for partnership grants as this would provide significant extra leverage for contribution from State road and health authorities, Indigenous peak bodies, insurance companies and NGOs.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Road injury is a highly burdensome, yet preventable condition for Aboriginal and Torres Strait Islander people. By developing better understanding of risk factors and population groups most at risk, and working with Aboriginal communities to develop targeted, culturally appropriate road injury prevention programs, for example to address restraint use, drink driving, and speed, a substantial number of lives could be saved. Research to harness development in technology to aid prevention programs, for example by mobile phone and social media, would also contribute to development of cost effective programs. Licensing programs help Aboriginal people gain and retain a driver licence, contributing to road safety outcomes and also enabling opportunities to access employment, education and health care, as well as reduced incarcerations.[7] Research that addresses inequalities in driver licensing, and road injury, will reduce the years of life lost by Aboriginal and Torres Strait Islander people, reduce the financial burden on the health care system and both financial and social costs to the community.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
1. AIHW 2015. Australian Burden of Disease Study: fatal burden of disease in Aboriginal and Torres Strait Islander people 2010. Canberra: AIHW. 2. AIHW 2015. Trends in injury deaths, Australia: 1999–00 to 2009–10. Canberra: AIHW. 3. Ivers R, et al. Collecting measures of Indigenous status in driver licensing data. Australian Epidemiologist 2012; 19.2: 9-10. 4. Ivers R, et al. Indigenous Road Safety: a report to the National Road Safety Council. NRSC, Canberra, October 2011. 5. Cullen P, et al. The program was the solution to the problem’: Process evaluation of a multi-site driver licensing program in remote communities. Journal of Transport & Health. (Epub July 25 2016). 6. Audit Office of NSW. New South Wales Auditor-General’s Report Performance Audit: Improving legal and safe driving among Aboriginal people. Audit Office of NSW, Sydney, 2013. 7. Ivers RQ, et al. 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. 8. Styles TO, Edmonston C (2006) Australian Indigenous road safety: 2005 update. Canberra: Australian Transport Safety Bureau. 9. Australian Transport Safety Bureau (2004) Summary of outcomes from 2004 Indigenous Road Safety Forum. ATSB, Canberra.

Page reviewed: 30 August, 2018