Big killers overshadow a simple one – injury

by Professor Rod McClure

The Australian Bureau of Statistics Causes of Death data for 2010 paints an interesting picture of how the lives of 150,000 Australians ended that year.  The four top ranked conditions that killed Australians in 2010 were Heart disease (45, 499 deaths), Cancer (43,293) , Lung disease (11,954) and Injuries (8,925)

Because the community fragments the public health problem of injury into small separate categories,  – falls, skateboard accidents, snake bites etc – In contrast to the way we clump cancers, heart and lung disease into single issue conditions, we trivialise the significant health and economic impact of a condition that causes the death of almost 9,000 Australians each year. 

Earlier this month (December) the British medical journal, The Lancet, released its Global Burden on Health report. Like the Bureau of Statistics Report it is an extraordinary snapshot of what is making people sick and killing them – in over 180 countries, including Australia.

The Lancet report revealed that every day almost 16,000 people die from injuries. They drown, they get killed on the road, die at work, self harm or die during sport and leisure activities. Every day, many times that number are seriously injured, do not die, but suffer ongoing disability. 

In twenty years since the first Global Burden of Disease report was published by The Lancet in 1990 the global burden of road crash injury has increased 33 per cent, climbing from 12 to 10 place in the world ranking. Suicide has increased 24 per cent moving from 19 to 18 place, while falls has increased 37 per cent  moving from 22 to 19 place.  Not only are these increases dramatic but if considered collectively the “all injuries” group ranks alongside the equivalent collective category of “All cardiovascular/circulatory disease” as the leading non-communicable disease contributors to the global burden (substantially ahead, in terms of morbidity, than the “all cancer”, “all respiratory”, “all mental health”, and “all metabolic“ disease groups).

In Australia in 2010 there were 45,499 death from cardiovascular disease and 43,293 deaths from cancer.  Last year the federal government allocated over $133 million over four years to the newly created Australian Preventive Health Agency to promote health and reduce health risk and inequalities, and to initiate actions to promote health across the entire Australian community. The focus of the agency is currently restricted to tobacco, obesity and alcohol related diseases.

Among Australians younger than 44 years of age, injury is the leading cause of death.  A 2003 Access Economics study found that there are $1.3 trillion, yes trillion, of potential health gains to be made from reducing injuries. What has been the Australian response?

Injury is the only Australian National Health Priority Area without a high-profile focus for the promotion of evidence-based solutions. Injury has been entirely omitted from the Australian Government’s Preventive Health Strategy. This gap in national informed advocacy; coordinated, multi-disciplinary action; and the effective deployment of finite resources are contributing to the growing human and financial costs resulting from preventable injuries in all settings.

Australia has an excellent track record in creating focused, coordinated approaches to health problems: witness the response to HIV/AIDS and the reduction in cancer related deaths due to smoking. But we have failed to both recognise and address the health burden of injury.

The major public health problem that is injury has been rendered invisible through fragmentation of the problem into multiple, small, settings-based sub categories. An adequate response to the problem has been rendered impotent by the dissipation of the responsibility for the issue away from health and onto individuals and uncoordinated small groups with little capacity achieve social change.

Falls, crashes overdoses, violence, burns, drowning, and indeed all injuries across all settings, have one thing in common ; they all caused by a simple - and preventable - transfer of energy . While we continue to think of injury as a fragmented health issue, we are unlikely to halt its rapid rise up the Global Burden of Disease “Hit List”. While we continue to trivialise injury by shifting responsibility for addressing components of the problem to “other people” we are not going to save lives and build futures. 

Australia has led the way in preventative health before. What is urgently needed is a national commitment to addressing the problem of all-cause injury - for those 9,000 Australians each year who do not need to die, and many times more who do not need to live the rest of their life with disability. 

Professor Rod McClure is Director of the Monash Injury Research Institute.

This article originally appeared in the National Times.