Abstract
Road trauma is a significant health problem in rural and remote regions of Australia, particularly for Indigenous communities. This study aims to identify and compare the circumstances leading to (proximal causation) and social determinants of (distal causation) crashes of Indigenous and non-Indigenous people in these regions and their relation to remoteness. This is a topic seriously under-researched in Australia. Modelled on an earlier study, 229 persons injured in crashes were recruited from local health facilities in rural and remote North Queensland and interviewed, mainly by telephone, according to a fixed protocol which included a detailed narrative of the circumstances of the crash. A qualitative analysis of these narratives identified several core themes, further explored statistically in this sample, supplemented by participants in the earlier study with compatible questionnaire data, designed to determine which factors were more closely associated with Indigenous status and which with remoteness. Indigenous participants were less often vehicle controllers, more likely to have recently been a drink driver or passenger thereof; to be unemployed, unlicensed, distracted or fatigued before the crash, alcohol dependent and have lower perceived social, but not personal, locus of control in a traffic crash than non-Indigenous persons. Differences between Indigenous and non-Indigenous participants are largely ascribable to hardship and transport disadvantage due to lack of access to licensing and associated limitations on employment opportunities. Based on these findings, a number of policy recommendations relating to educational, enforcement and engineering issues have been made.
Highlights
Road trauma resulting from vehicular crashes has been a longstanding cause of death and injury in rural areas of Australia and, like other causes of injury, the risk increases with remoteness [1].This, and the sequelae of such trauma, places a significant burden on health services in rural areas which tend to be under-resourced in terms of health care personnel, specialised skills and capacity [2]
Recruitment into the supplementary sample was facilitated through two hospitals and 31 local health facilities, resulting in 80 Indigenous and 149 non-Indigenous participants
While many of the familiar risk factors for road crashes and associated injuries—alcohol use, speeding, non-use of restraints, fatigue and distraction—were common to both Indigenous and non-Indigenous groups, they tended to be more prevalent among Indigenous crashes and more prevalent for both groups in remote areas
Summary
Road trauma resulting from vehicular crashes has been a longstanding cause of death and injury in rural areas of Australia and, like other causes of injury, the risk increases with remoteness [1]. This, and the sequelae of such trauma, places a significant burden on health services in rural areas which tend to be under-resourced in terms of health care personnel, specialised skills and capacity [2]. An issue that remains understudied and uncertain is the relative contribution of rural factors including road characteristics and related personal driving styles to high levels of crashes or are these characteristics more likely to be experienced in a remote region? Res. Public Health 2020, 17, 1467; doi:10.3390/ijerph17051467 www.mdpi.com/journal/ijerph
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