Injury related morbidity and mortality in rural areas
Injuries, including those that result in death or permanent damage to health, are more common in rural, regional and remote Australia than in metropolitan areas.
This article examines the major forms of injury related morbidity and mortality in rural areas (focusing on the agricultural sector), what has and is being done to address them and how injury rates have changed in recent years.
Rates of injury related morbidity and mortality.
According to the Australian Bureau of Statistics, in 2008, long-term health conditions due to injury were 30 per cent more likely in non-metropolitan Australians than in those who lived in major cities. This is probably due to greater participation in agriculture, forestry, mining and other physically demanding industries, but also to higher rates of motor vehicle accidents.
In New South Wales, between 2000 and 2005, the annual rate of injury requiring hospitalisation was 2482 per 100 000 for rural residents
and 1755 per 100 000 for urban residents. Injury mortality rates were 48.1 versus 33.2 per 100 000 – 1.5 times higher for rural residents.
Rural residents had higher mortality rates than metropolitan residents for injuries related to machinery (4.84 times higher), firearms (4.20), being struck by/struck against animals or objects (3.52), fire and burns (2.08), natural and environmental factors (1.91), motor vehicle crashes (1.88), interpersonal violence (1.58), suffocation (1.51) and self-harm (1.36) injuries. Rural Australians also had higher rates of hospital admission for all factors except drowning.
Motor vehicle accidents.
As noted in a previous article on the rural–urban health gap, Australians living in non-metropolitan areas in 2008 were three times more likely to die following a motor vehicle accident than those living in major cities. Probable reasons include more car travel, higher average speeds on rural roads, poorer road conditions and longer waiting times for emergency services after an accident.
Other causes of injury.
Other fatal mechanisms such as fire and burns, and natural and environmental factors are almost twice as likely to involve rural Australians. For injuries requiring hospitalisation, interpersonal violence, fire and burns, machinery and electric currents affect rural residents at twice the rate of their urban counterparts. As is the case for motor vehicle accidents, the higher mortality and morbidity rates associated with natural and environmental factors and machinery are due to rural Australians’ greater exposure to these mechanisms.
Although the proportion of people engaged directly in agriculture in Australia has declined dramatically over the past century (14 per cent in 1901, three per cent in 2009), agricultural activities continue to result in substantial and disproportionate numbers of injuries that cause disability and death. According to WorkSafe, agriculture employs just 3 per cent of Victorian workers but accounts for almost 30 per cent of workplace fatalities. In an interview published in the Age on 8 July, Worksafe’s Marnie Williams said ‘Farmers are far more likely to die at work than any other Victorian workers’.
Seven agricultural workplace deaths had occurred in Victoria by the end of June 2016 – a major increase on recent years. Vehicle-related accidents are the major contributors to farm fatalities, and most involve tractors and quad bikes.
In the final decades of the 20th century, tractor incidents were responsible for most of the farming fatalities in Victoria (72% over 1985–96), mostly due to roll-overs (61%). Run-overs (12%) and entrapment in moving parts (11%) were other contributors to tractor fatalities in this period.
A total of 131 tractor-related fatalities occurred in Victoria (8.1 per year) between 1985 and 2010, of which 55 were the result of roll-overs.
In November 1998, state legislation mandated that all new tractors manufactured or imported since 1981 should have roll-over protective structures (ROPS) installed.Installation of ROPS was encouraged with rebate programs and information and education campaigns.
According to Dr Christopher Jones and Professor Joan Ozanne-Smith of Monash University, a significant decline in roll-over fatalities of about 7 per cent per annum occurred over the period 1985–2010.Interestingly, statistical analysis fails to show that the mandatory installation legislation significantly reduced the roll-over fatality rate – probably because widespread communication encouraged many farmers to install ROPS before 1988, diluting the directly attributable
effect to below the threshold of statistical detection.
Inevitably, tractor-related fatalities continue to occur, sometimes due to incidents other than rollovers. Nevertheless, in most years following mandatory ROPS installation legislation, the tractor roll-over fatality rate in Victoria has been zero or one per year.
Four-wheeled motor vehicles known as quad bikes are very popular, low-cost light ‘workhorses’ on Australian farms. An estimated 220 000 quad bikes were in use in Australia in 2012, 80 per cent of them in the agricultural sector.
Quad bikes are now the leading cause of death in Australian agriculture, about half of them as a result of roll-overs. Between 2001 and 2012 < sector, more than 160 people died in quad bike accidents on Australian farms (13 times the annual rate in 1989–92); simultaneously, as noted above, the rate of tractor-related deaths declined.
Two people died in quad bike accidents on Victorian farms in the first half of 2016, most recently a farmer in his sixties at Pomborneit East, near Colac.
In response to the recent deaths and injuries resulting from quad bike accidents, in late July 2016 the State Government announced that new rebates of up to $1200 will be available for Victorian farmers. Moreover, WorkSafe Victoria is expected to begin requiring the installation of roll-over protection devices on quad bikes used on work sites in early to mid-2017.
Agricultural injury research in western Victoria.
Researchers and clinicians from Deakin University, Monash University and the National Centre for Farmer Health are collaborating on a project called Farm-related major trauma in Victoria and both the long-term and immediate impact on recovery. With funding from Western Alliance, Professor Daryl Pedler and colleagues are measuring the social, mental and physical effects of farm-based major trauma. Their aim is to gain insight into the barriers that prevent farmers from returning to a pre-injury lifestyle and to identify ways to overcome them.