more_vertThis is the first national report on the 21 Better Cardiac Care measures for Aboriginal and Torres Strait Islander people. It shows that: the age-standardised death rate due to cardiac conditions for Indigenous people was 1.6 times that for non-Indigenous people; mortality from cardiac conditions for Indigenous Australians decreased by 41% between 1998 and 2012, while access to cardiac care has improved over time.
Preference: Indigenous Health
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Signs not good for flu season
The nation’s top medical officer has issued an urgent call for people, particularly vulnerable groups including pregnant women, the elderly and those with chronic illnesses, to get vaccinated against the flu amid signs the nation is headed for its worst season on record.
Official figures show that so far this year more than 14,124 have caught the flu – double the long-term average for the period – and a third higher than for the same time last year.
In a worrying sign that the flu season is gathering momentum, figures compiled through the National Notifiable Diseases Surveillance System show that in in just one month, from 5 June to 6 July, an extra 4911 laboratory-confirmed cases were reported, including almost 2000 in the first week of July.
Underlining the seriousness of the illness, the Health Department said it had so far been notified of 36 deaths associated with influenza since the beginning of the year, with the likelihood that number will rise sharply as the rate of infection accelerates.
Commonwealth Chief Medical Officer Professor Chris Baggoley specifically urged people considered to be at risk, including those aged 65 years and older, Indigenous Australians, pregnant women, and those with cardiac disease and chronic respiratory conditions and illnesses, to take advantage of the free vaccine provided by the Government.
“Flu is highly contagious and spreads easily from person to person, through the air, and on the hands,” Professor Baggoley said. “We need to get higher uptake [of the vaccine] among these groups.”
The Chief Medical Officer emphasised the importance of doctors and other health professionals in helping ensure people were vaccinated against the disease.
“Immunisation is still the best form of protection from influenza, and health care professionals play an essential role in ensuring high uptake,” he said.
The National Seasonal Influenza Immunisation Program began late this year because of a rare double strain change in the vaccine to cover two new strains of the virus – one of which caused havoc in the northern hemisphere.
In the US alone, around 100 children were reported to have died from the flu during the northern flu season, and there was also widespread illness among the elderly.
For the first time under the national immunisation program, Australians have access to single-dose vaccines covering the four most common flu viruses, including three quadrivalent formulations.
The World Health Organisation and the Australian Influenza Vaccine Committee have recommended that vaccines this year cover one existing and two new strains – the California H1N1-like virus that has been in circulation since 2010, the Switzerland H3N2-like virus and the Phuket 2013-like virus.
There have been claims that the delay to the vaccination program has contributed to the strong start to the flu season by leaving a large number of people unprotected, and Professor Robert Booy of the Influenza Specialist Group told the Herald Sun fewer people had been vaccinated that “we would have liked”.
But Health Minister Sussan Ley said the Government was ahead of where it was last year in acquiring vaccine doses.
Ms Ley said that so far in 2015 4.5 million doses had been bought under the National Immunisation Program, 200,000 more than were distributed in 2014.
She did not say how many of these doses had been administered.
Ms Ley said the flu season usually peaked in August and September which, given that it usually takes around three weeks following vaccination to develop immunity, meant people needed to get themselves vaccinated as soon as possible.
Promisingly, early figures suggest vaccinations are helping to reduce the number and severity of infections.
The pilot Flu Tracking surveillance system, a joint University of Newcastle, Hunter New England Area Health Service and Hunter Medical Research initiative that collects data from a weekly online survey, has so far identified only low levels of influenza infection.
But it found that 3.4 per cent of those not vaccinated against the flu suffered fevers and coughs, and 2.1 per cent had to take time off work, while among those vaccinated, 2.7 per cent had coughs and fevers and 1.6 per cent reported having to take sick leave.
The results underline calls from AMA Vice President Dr Stephen Parnis for people, particularly elderly and vulnerable patients and health professionals, to make sure they are vaccinated against the flu.
Dr Parnis said it was important for doctors, nurses and other health workers to get the flu vaccine, for the sake of their own health as well as that of their patients.
Adrian Rollins
Spatial variation in Aboriginal and Torres Strait Islander people’s access to primary health care
The report shows that overall, Australian Government funded Indigenous-specific primary health-care services appear to be well positioned relative to the geographic distribution of Aboriginal and Torres Strait Islander people and to the distribution of other GP services. However, there are a number of areas where Aboriginal and Torres Strait Islander people have very limited access to both Indigenous-specific services and GP services in general.
Deadly hitchhiker threat to young
Researchers have warned of the risk of measles outbreaks among infants, adolescents and young adults because of gaps in the nation’s immunisation coverage against the potentially deadly disease.
While the World Health Organisation has declared Australia measles-free, infectious disease experts have cautioned parents and health authorities that they need to remain vigilant about maintaining high rates of vaccination because of the vulnerability of young people no longer exposed to wild versions of the infection.
A study in the Health Department’s latest Communicable Diseases Intelligence report found the incidence of measles plummeted following the commencement of mass vaccination programs in the 1980s and 1990s, and was now at a level “consistent with elimination of indigenous measles in the country”.
Since the last big outbreak in the early 1990s, when almost 10,000 people caught the disease and four died, the rate of infection has plunged. Between 2000 and 2011, 990 cases were notified but none were fatal.
However, although the disease is no longer considered to be endemic, it is still being brought into the country by people travelling from regions where it is common, raising the risk of infection for vulnerable groups, particularly the very young.
Children are not eligible for their first measles vaccine until they are 12 months, and national figures for 2000 to 2011 show the incidence of the disease was highest in this age group, reaching a peak of 3.8 per 100,000 in 2011.
Next most vulnerable were children aged between one and four years, followed by adolescents aged 10 to 19 years and young adults aged 20 to 34 years.
The authors of the study, who were from the Health Department, the National Centre for Immunisation Research and Surveillance and the Australian National University, speculated that infants could be particularly vulnerable because of a decline in maternal antibodies in women with vaccine-acquired immunity.
“It has been postulated that because measles is becoming rare, the lack of natural boosting thorough exposure to wild virus in both vaccinated women and women with past infection has consequently resulted in infants becoming more susceptible,” they wrote. “It is therefore important…that timely vaccine uptake among infants occurs at the recommended 12 months of age.”
They also highlighted gaps in coverage caused by the staggered introduction of mass vaccination programs in the 1980s and 1990s.
In particular, they noted that those born between 1968 and 1982 were “particularly susceptible as low vaccine coverage existed when they were infants and circulation of wild virus was becoming less common”. In addition, people in this age group missed out on a second round of vaccinations for adolescents carried out between 1994 and 1998, while a 2001 immunisation campaign aimed at reaching many of them had only limited success.
The researchers said there was a risk of under- or un-vaccinated young adults catching the disease while travelling overseas, and urged greater efforts to assess their immunity before they left the country.
“As most outbreak in Australia begin with an importation of measles from an endemic country, it is essential that measles immunity status be assessed when patients attend clinics to receive vaccinations for international travel,” they said, citing research showing that just 4 per cent of travellers who attended hospital within two years of returning from abroad were vaccinated against measles, mumps and rubella.
“Clearly, age-specific vulnerability of populations exist[s], even though measles is so rare in Australia and, consequently, this may lead to outbreaks in these populations,” the authors said. “Hence, there is an ongoing need to improve vaccine uptake in vulnerable populations.”
Adrian Rollins
‘Cracking good’ team supports life of service
A rural GP with a “cracking good” health team and a life-long fascination with the life of birds is among AMA members recognised in the 2015 Queen’s Birthday honours.
Dr David Hollands who, with his wife Margaret, has lived and worked in the east Victorian town of Orbost more than 50 years, was awarded a Medal of the Order of Australia for his many decades of service to his community, as well as his enormous contribution to ornithology.
In an interview with his local newspaper, the East Gippsland News, Dr Hollands recalled how, when he and his wife first arrived in Orbost not long after migrating from Britain, local doctors were expected to do “almost everything”, from delivering babies and stitching up cuts to dealing with major trauma cases.
“There was nothing like the air ambulance or helicopter evacuations,” he told the East Gippsland News. “People expected that the local doctor would cope with almost everything.”
Dr Hollands was among 20 GPs, specialists, researchers and educators recognised for their significant contributions to the health of the community and their services to medicine in the Queen’s Birthday Honours List.
AMA President Professor Brian Owler said the diversity and breadth of the accomplishments cited in the awards were testament to the significant contribution to the community made by medical practitioners every day.
Among the recipients is South Australian GP Dr Anh-Tuan Ngo, who had been a doctor in the South Vietnamese army and came to Australia as a refugee with his family in 1984. Since arriving in Australia, Dr Ngo has worked tirelessly, not only to look after his patients, but to serve the local Vietnamese community and support other veterans of the Vietnam War.
Another to be made a Member of the Order of Australia was Victorian GP Dr Barry Christopher who, in addition to his work as a doctor, campaigned for decades to advance Indigenous rights.
In the late 1950s Dr Christopher became President of the Victorian Council for Aboriginal Rights, and was a founding member of the Federal Council for the Advancement of Aborigines and Torres Strait Islanders.
Dr Hollands’ experience is indicative of how important is the role performed by many doctors in their community.
Working in an area that included 35 saw mills as well as major interstate roads, Dr Hollands and his wife – also a doctor – saw plenty of horrific accidents.
“Industrial health and safety was non-existent and alcoholism was absolutely rife – people would arrive at work on Monday still half pickled. So we had an enormous amount of trauma,” he said, adding that the number and severity of road accidents they attended were “just incredible”.
He recounted how 35 people were injured when a tourist bus overturned late at night, and he and another doctor worked for 48 hours straight at the Orbost Hospital, “non-stop setting fractures and sticking tubes in chests and sewing people up”.
Asked about his award, he said that although receiving it was “very nice”, much was due to a “cracking good team”, including his wife, two other doctors and devoted and capable nursing and surgery staff.
In addition to his medical work, Dr Hollands has also been recognised for his enormous contribution to the study of birds.
He told the East Gippsland News of his life-long fascination with ornithology, and his is the author of numerous books including Owls, Frogmouths and Nightjars of Australia, Owls – Journeys Around the World, and Kingfishers and Kookaburras.
“I’ve been a fanatical birder since about eight, so I’m getting an award for something I really love doing,” Dr Hollands said.
Professor Owler said Dr Hollands, Dr Ngo and Dr Christopher were examples of the major contribution made by many AMA members to aspects of life well beyond medicine, and were deserved recipients of Queen’s Birthday Honours.
Adrian Rollins
Data sharing in Indigenous health research: guidelines needed
We need to share data to enable efficient and timely research
Data sharing maximises the value of collected data, minimises duplicative data collection, and promotes follow-up studies of secondary research questions using existing data.1 The importance of data sharing in advancing health is becoming increasingly recognised. The funders of health research around the world, including the National Health and Medical Research Council (NHMRC), have endorsed the call to increase the availability to the scientific community of public health research data from the research projects that they fund.2,3 Recently, cohort profiles and data source profiles have increasingly been published to facilitate data sharing.4,5 From the publications using the shared data, we have learned that data sharing increases the productivity of both original data collectors and subsequent data users.4
Why the urgent need?
Health data linkage, such as that done in Western Australia and the Northern Territory, has made it possible for researchers to use administrative data for Indigenous health research. However, there are no national guidelines for sharing de-identified data that are specifically collected from Indigenous communities for publicly funded individual research projects. With limited research funding, expertise and access to study participants for data collection for Indigenous health research, data sharing is urgently needed for three reasons.
Cost savings
First, the cost of collecting population-based data from Indigenous communities is generally much higher than that for the general Australian population because of a relatively small Indigenous population scattered throughout communities across a vast geographic area. With limited research funding, a relatively small group of Indigenous health researchers is trying to tackle a large number of health issues among heterogeneous communities. Therefore, unnecessary duplication in data collection from Indigenous communities could be avoided through data sharing and would provide savings in terms of the limited research resources.
Ethical obligations
Second, in addition to our obligation to protect the privacy and dignity of Indigenous patients who have provided personal information, we have an ethical obligation to maximise public health benefits to Indigenous community members. Since a single research project is generally funded for up to 5 years, and most of those years are allocated to data collection, original data collectors often do not have sufficient time and capacity to analyse and disseminate all the data collected within such a time frame.
Replicating findings
Third, replicability is one of the fundamental tenets of the scientific process. Public health researchers can only report fractional and selective findings of a research project. Due to the scarcity of comparable data in Indigenous health research, the chances for the findings from such data to be independently scrutinised are often lower than those from non-Indigenous health research. In addition, the complexity of the widely used multivariable statistical techniques for adjusting for potential confounders makes it even more difficult to reproduce published findings without access to the original data.
Barriers to data sharing
We face a challenging task due to barriers to data sharing in public health research.6 For original data collectors, possible reasons for not sharing include: ethics of data sharing; fear of being scooped; inadequate levels of recognition of the original data collectors; and lack of time, data-sharing standards, and financial, technical and infrastructure support.7–9
In terms of ethics, sharing health data that contain personal information in Australia should legally adhere to two sets of NHMRC guidelines approved under section 95 and section 95A of the Privacy Act 1998 (Cwlth). Although personal information data are generally collected in most original projects, often only de-identified data are used at the data sharing stage, and de-identified information is not “personal information” protected under the Privacy Act. There is no legislation and there are no guidelines to specifically regulate and guide the sharing of such de-identified data.
According to the NHMRC funding rules 2015, the NHMRC “encourages researchers to share and deposit research data arising from NHMRC supported research projects through an open access database.”10 Original collectors are still reluctant to share the de-identified data, some with the perceived fear of being scooped by others using their data before they can. This fear is perhaps unfounded because of the increased productivity that is enabled by data sharing.4 The lack of recognition of the original data collectors’ contribution may also discourage them from sharing. It is a common perception that those who make their research data available to others receive inadequate levels of recognition, in terms of funding decisions, career advancement and assessment of research performance.11,12
The priorities
Obtaining valuable data from Indigenous communities, particularly remote communities, requires the ongoing commitment and hard work of original data collectors. Their contribution to research outputs should be adequately recognised by funding agencies, journals and research institutions. Appropriate resources, including technical and financial support, should also be allocated for sharing de-identified data. Importantly, legislation and guidelines are needed to make the sharing de-identified data a routine practice.
Celebrating 10 years of collaboration: the Australian Indigenous Doctors’ Association and Medical Deans Australia and New Zealand
Closing the gap by growing the Aboriginal and Torres Strait Islander medical workforce
This year marks the 10th anniversary of the collaboration between the Australian Indigenous Doctors’ Association (AIDA), the professional association for Aboriginal and Torres Strait Islander doctors and medical students,1 and Medical Deans Australia and New Zealand (Medical Deans), the peak body representing professional entry-level medical education, training and research in Australia and New Zealand.2 In October 2005, AIDA and Medical Deans established an inaugural collaboration agreement formalising our shared commitment to achieving health equality for Aboriginal and Torres Strait Islander people, with a focus on growing the Indigenous medical workforce.
Over the past 10 years, AIDA and Medical Deans have reaffirmed this strong and sustained commitment to achieving our shared objectives through three successive collaboration agreements. Notable milestones have been achieved since 2005, including:
- a growth in the Aboriginal and Torres Strait Islander medical student cohort;
- co-auspicing of the biennial Leaders in Indigenous Medical Education (LIME) Connection, which brings together a range of key health and medical education stakeholders to share innovative approaches in Indigenous medical education;3
- implementation of the Capacity Building for Indigenous Medical Academic Leadership Project to support more Aboriginal and Torres Strait Islander people becoming medical academic leaders;4 and
- the National Medical Education Review,5 which highlighted best practice for Australian medical schools in implementing the Indigenous Health Curriculum Framework.6
While all our achievements are significant, we are particularly pleased with the marked growth in the number of Aboriginal and Torres Strait Islander medical students. In 2005, Aboriginal and Torres Strait Islander medical students represented just 0.8% of first-year domestic enrolments. In 2011, this increased substantially to 2.5%, reaching population parity for the first time. In 2014, a record number of about 30 Indigenous medical students completed their degrees, and three universities celebrated their first Aboriginal and Torres Strait Islander medical graduates. These achievements reflect the importance of partnership in supporting Aboriginal and Torres Strait Islander medical students along the education and training pathway, to contribute to a growth in the Indigenous medical workforce.
Although there has been real progress in growing Aboriginal and Torres Strait Islander doctor and medical student numbers, there is still much work to be done in this area, particularly in regards to strengthening recruitment and retention. We envision a future where Aboriginal and Torres Strait Islander doctors and medical students reach a critical mass in the Australian medical workforce; and one in which all doctors are trained to deliver equitable, accessible, high-quality and culturally safe services to Aboriginal and Torres Strait Islander people.
The success of the AIDA and Medical Deans partnership has provided the impetus for similar arrangements to be developed across the medical education and training continuum, such as AIDA’s collaboration agreements with the Committee of Presidents of Medical Colleges and the Confederation of Postgraduate Medical Education Councils. Our achievements have been recognised in Australia and internationally, through presentations on our successes at forums such as the Pacific Region Indigenous Doctors’ Congress (PRIDoC) Conference. PRIDoC provides a culturally safe environment for health and medical professionals of the Pacific region to share and promote culturally safe research and clinical practices for Indigenous peoples.7
The current AIDA–Medical Deans collaboration agreement is due to expire at the end of 2015.8 To ensure that our partnership continues, AIDA and Medical Deans are in the process of developing a new collaboration agreement for 2016–2018. We anticipate launching the new collaboration agreement around the time of the 6th biennial LIME Connection, which will be held in Townsville on 11–13 August 2015. The development of the new AIDA–Medical Deans collaboration agreement is timely, as it coincides with the theme of AIDA’s 2015 conference — “Collaborate, communicate and celebrate” — which will be held in Adelaide on 16–19 September 2015.
We look forward to extending our partnership to continue our work in growing the Indigenous medical workforce and improving health and life outcomes for Aboriginal and Torres Strait Islander people.
The link between health and wellbeing and constitutional recognition
The Lowitja Institute is Australia’s national institute for Aboriginal and Torres Strait Islander health research. It is an Aboriginal and Torres Strait Islander organisation, named in honour of its patron Dr Lowitja O’Donoghue, AC, CBE, DSG. The Institute was established in 2010, emerging from a 14-year history of cooperative research centres.
The Lowitja Institute has led an initiative called Recognise Health, which promotes understanding of the important link between health and wellbeing and constitutional recognition of Aboriginal and Torres Strait Islander people. The initiative has brought together a coalition of 125 leading non-government organisations across the Australian health system in support of constitutional recognition. These organisations have signed the following statement (https://www.lowitja.org.au/recognisehealth/statement).
We call on all Australians to support recognition of Aboriginal and Torres Strait Islander peoples in the Australian Constitution.
We look forward to a time when all Aboriginal & Torres Strait Islander people can fully participate in all that Australia has to offer, enjoying respect for our country’s first cultures and leadership, and the dignity and benefits of long healthy lives.
Australia’s First Peoples continue to die far earlier and experience a higher burden of disease and disability than other Australians. This is a result of long term economic disadvantage and social exclusion, among other factors. Constitutional recognition would provide a strong foundation for working together towards better health and social wellbeing in the hearts, minds and lives of all Australians.
Recognise Health was launched at Parliament House in Canberra on 5 March 2015, with parliamentarians, medical and health leaders and community representatives present, in a strong show of commitment to the initiative.
The Australian Constitution, the main law that guides the operation of the Commonwealth of Australia, took effect in 1901. At that point in time, Aboriginal and Torres Strait Islander people had lived on this land for thousands of generations, keeping alive the world’s oldest living continuous cultures. However, Australia’s founding document does not recognise this first chapter of our national story.
Following the 2012 report of the Expert Panel on Constitutional Recognition of Indigenous Australians, all major political parties declared their support for recognition. Subsequently, the Prime Minister announced that the government intends to work towards a referendum. For the referendum to pass, the people of Australia need to understand and support the case for change, and there needs to be strong leadership from across the political spectrum, business and community sectors, and, of course, by Aboriginal and Torres Strait Islander leaders. Part of the work required for a successful referendum is to engage key community organisations — such as health organisations — in the national dialogue, thereby engaging their membership and the broader public to support the referendum.
Recognition of Aboriginal and Torres Strait Islander people would acknowledge their powerful sense of identity, pride, history and belonging to this land. It would promote opportunities for full participation in all that Australia has to offer and would be a significant step towards equity between Indigenous and non-Indigenous Australia.
Recognition, participation and equity would, in turn, have profound positive consequences for wellbeing, and therefore health. There is significant evidence from health research to indicate that being connected to the wider community, having a strong identity and feeling socially supported all have significant positive impacts on health.
The role of social and economic factors in determining health status is well understood; health does not exist within a vacuum. It is intricately connected to education, employment, housing, and more. Cultural factors also have a profound impact. Having a strong sense of identity and pride — individually and communally — has a supportive, protective and healing influence. Unfortunately, how we experience the great benefits of modern medical science has become disconnected from cultural, community, social and economic contexts.
As Aboriginal singer and performer Archie Roach stated at the launch of Recognise Health: “I really believe that being recognised within the Constitution has a lot to do with how we feel about ourselves, that we are worthy and we can be proud of my people” (http://www.recognise.org.au/blogs/ourstory).
The Institute has worked closely with Recognise (http://www.recognise.org.au), the people’s movement to recognise Aboriginal and Torres Strait Islander people in the Australian Constitution, on this initiative. More information, including a short film featuring five health leaders, is available at https://www.lowitja.org.au/recognisehealth.
Non-admitted patient care 2013–14: Australian hospital statistics
In 2013–14, about 46 million occasions of service were provided for non-admitted patients by 558 public hospitals, including:-6 million occasions of service for emergency care -18 million for outpatient care -22 million for other non-admitted patient care. For the first time, information is also included about the patient’s age and sex, their Indigenous status, how the service was delivered and how it was funded.
Open speeds on Northern Territory roads: not so fast
Road safety should remain a public health priority not a political issue
Annual road deaths in Australia have decreased from 7.9 to 5.2 per 100 000 population in the period from 2004 to 2013 (Box).1 In contrast to the national figures, the Northern Territory has recorded a mean of 21.8 deaths per 100 000 over the same period.
There are many possible factors contributing to this large discrepancy. Among NT road users, alcohol usage is high and seatbelt usage is low.2 Additionally, NT roads are almost invariably single lane and unseparated, many are unsealed, they are subject to the extremes of weather and are also exposed to wandering livestock and wildlife. Consequently, NT roads have attracted the lowest of Australian Road Assessment Program safety ratings, with over half having one and two stars out of five.3 The NT is unique in many ways and these differences threaten the survival of road accident victims. Road traffic is light and, as a consequence of this, victims may not be found for many hours after an accident. Hospitals and retrieval assets are sparse, resulting in prehospital times of many hours. The “golden hour” of trauma — that window immediately after injury when medical intervention can be life-saving — seldom exists for Territorians in remote areas.
Indigenous Australians comprise nearly 30% of the NT population, and most of these people live in remote areas. The risk of road trauma is magnified in these remote communities, as cultural and linguistic differences are a barrier for driver licensing and training and there is a paucity of public transport, and yet there are frequent cultural demands for short-notice mass transport.4
Changing policy with changing governments
Before 2007, there was no speed limit on most NT highways, and drivers were free to travel at whatever speed they felt comfortable with. In 2007, in response to the high road toll, the NT Government introduced speed limits of 130 km/h on the four main highways and 110 km/h on other rural roads.5 Since then, differing political, professional and public opinions have been discussed frequently in the NT media. These speed limits were reconsidered in 2012, and the NT government made an election promise to conduct a review on the feasibility of reintroducing open speeds.6 The government commissioned reports from road safety experts, but this information remains cabinet-in-confidence. In February 2014, the NT Government reintroduced open speeds for a 200 km section of the Stuart Highway on a trial basis,7 despite voiced concerns from medical, policing and road safety groups. The response from the current NT Government to these concerns is to cite the role of fatigue, to emphasise the roles of alcohol and seatbelts, to deny that speed is a major factor in many crashes and to promote individual driver responsibility.7
Vehicular speed and crash risk
The relationship between speed and a motor vehicle collision goes beyond the kinetic energy released being proportional to the product of mass and velocity squared. Researchers have developed several formulas to describe the multifactorial nature of road accidents, involving multiple variables; however, in each of these models, speed remains a decisive factor. An increase in vehicular speed increases crash risk either exponentially or to a power ratio.8 Modelling has suggested that the greater the difference in speed between two vehicles, the greater the crash risk for both the slower and the faster vehicle.8 The implications of a mix of open speed and speed-restricted vehicles, such as towing vehicles, heavy vehicles and probationary drivers, are obvious. Further, Australian and international case–control studies have shown that reducing posted speed limits by 10 km/h on rural roads decreases crash risk by 20%–25%. Multiple examples of this are included in the National Road Safety Strategy 2011–2020.9
What seems to be lacking in this debate is a dispassionate examination of the available evidence. Allowing individual motorists to drive to conditions seems optimistic and discounts that there will always be a cohort of inexperienced drivers. This policy seems to place blame on individual motorists, overlooking the conditions that increase the risks of fatal crashes. Higher vehicle speeds are promoted by lobby groups as a solution to reducing fatigue. While combating fatigue is important in improving road safety, swapping one risk factor for another is not the solution. Campaigns to combat drink driving and poor rates of seatbelt use are appropriate, but road safety is a package, and a vital element of the package is missing.
The small numbers involved make statistical interpretation difficult. The Australian road deaths database shows a decrease in fatalities of 3.4 per year on those NT roads with speed limits of 110 km/h and above after the abolition of open speeds (mean deaths: 2000–2006, 31.1 per year; 2007–2014, 27.7 per year).10 For every road death in Australia, 23 other people are hospitalised as a result of a road crash,9 which amplifies the potential societal benefit of any reduction in speed limit. Other legislative measures, infrastructure and trauma system improvements are likely to have contributed to this reduction, but attempting to minimise the role of speed in crash risk would seem unwise.
The Northern Territory needs a stronger road safety package
Trauma is too often considered an accident when it should be considered a preventable disease. We understand the causes and effects and we know, to an extent, how to prevent this trauma from occurring. Every crash is multifactorial, and alcohol and seatbelt use should remain a focus of a strong road safety package. However, allowing unlimited speed on major highways sends the wrong message to the NT population, especially when they are already three times more likely to die on the roads than people living in other parts of Australia, and at a rate that is equivalent to that in many low- and middle-income countries.11 The available evidence in the literature suggests that the piecemeal reintroduction of open speeds on the highways of the NT will eventually result in an increased number of fatalities and serious injuries. The NT Government should strengthen its road safety package and tailor it to the unique needs of its population, not abandon components due to popular demand. A comment from scientist Richard Feynman on the interplay between science and politics resonates here:
For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.
Comparison of annual road deaths per 100 000 population in the Northern Territory with the national total, 2004–2013*
* Data from: Bureau of Infrastructure, Transport and Regional Economics. Road deaths Australia: 2013 statistical summary.1