Future Directions for Injury Prevention in New Zealand
Every year in New Zealand many people have an injury that causes them pain and suffering. For example, each year about 1.7 million of us will have an injury that’s serious enough for an ACC claim to be made.
An injury often also affects our families and friends, and results in costs to our workplaces and communities. A recent report estimates the total social and economic costs of injury for New Zealand as being $9.67 billion per annum. 1
1. O’Dea, D. and Wren, J. (2010). Cost of Injury in New Zealand and Methods for Prioritising Resources, prepared for NZIPS. Accident Compensation Corporation, Wellington, New Zealand. February 2010.
We know most injuries are preventable. Therefore, it makes sense to support injury prevention activities and reduce the number of injuries occurring and their severity. It also makes sense to check from time to time that what we’re doing is working and that we’re focusing on what’s important.
The New Zealand Injury Prevent Strategy (the Strategy) was launched in 2003, with implementation beginning in 2004. During 2009 the Strategy underwent a five year evaluation. The purpose of this evaluation was to:
- review the high-level achievements that have resulted from the implementation of the NZIPS;
- assess the country’s injury prevention performance to date;
- identify emerging injury issues;
- identify areas of progress and barriers to optimal performance;
- recommend changes to simplify and streamline the governance structure;
- identify potential new approaches to achieve cost-effective injury reductions.
The findings and recommendations from the evaluation have been valuable for setting the future direction of the Strategy. The key recommendations were presented to the Injury Prevention Ministerial Committee and Cabinet for their approval. Following are the confirmed recommendations:
- New Zealand Injury Prevention Strategy (NZIPS) is continued, with ACC (through the NZIPS Secretariat) having an increased focus, and being responsible for driving the Strategy’s performance and improving accountability from other lead agencies, and efficiencies from other injury prevention groups;
- The Strategy’s governance be streamlined through improved role clarity and accountability;
- Measurable high-level targets, where appropriate, or effective interventions, are identified and reported within individual priority areas;
- Statistics New Zealand continues to advance work on improving the availability and timeliness of data, through their mandated role of Injury Information Manager;/li>
- NZIPS Secretariat’s role includes the implementation of a more robust monitoring and reporting role and the promotion of the focus areas with a particular emphasis on child injury and alcohol-related harm;
- Chief Executives of the six lead agencies (Ministry of Justice, the Ministry of Social Development, Ministry of Health, ACC, the Ministry of Transport, and the Department of Labour) be held responsible for outcomes in their priority areas and attend the annual Chief Executives’ Forum and the IPMC to report on the outcomes for the strategies;
- Stakeholder Reference Group is retained and will meet annually, but is no longer appointed through the Cabinet Appointments and Honours process but nominated by the Senior Officials’ Group and approved by the Associate Minister for ACC;
- Intended focus of the NZIPS Secretariat over the next 12 months is on measurable results, clear accountability and active collaboration;
- Associate Minister to identify by September 2010, which agencies will be responsible for the critical focus areas of child injury and alcohol-related injury.
Structure of the evaluation
The NZIPS evaluation has drawn on findings from five separate work streams, each with an associated report 2. Each of these reports can be found here.
The final report details:
- findings from a study looking into social and economic costs of injury in New Zealand;
- a snapshot of progress across the six injury priority areas and key challenges;
- description of the key achievements for the NZIPS, and barriers to progress;
- information on government expenditure on injury prevention;
- proposed changes to the governance arrangements and potential new approaches for the NZIPS.
Report 1: Evaluation of the New Zealand Injury Prevention Strategy: Stakeholder Interviews (Litmus Consulting), October 2009
Report 2: Review of the Functional Relationship and Structures (Martin Jenkins Consulting), February 2010.
Report 3: Evaluation of the New Zealand Injury Prevention Strategy: Summary of Findings from Regional Workshops and Submissions (NZIPS Secretariat), November 2009.
Report 4: Cost of Injury in New Zealand and Methods for Prioritising Resources (NZIPS Secretariat), February 2010.
Report 5: Estimating Government Expenditure in Injury Prevention (NZIPS Secretariat), February 2010.
Key achievements identified in the evaluation
The evaluation reported that there is general acceptance and awareness that injury is a significant issue in New Zealand, and that the presence of the Strategy has paved the way for an improved, shared focus on the issue.
The evaluation noted the following benefits attributed to the Strategy:
- increased engagement between agencies (at national and regional levels) in relation to individual agency initiatives with injury prevention outcomes;
- the introduction of some priority area strategies that might not otherwise have emerged (such as suicide across all ages, drowning and falls);
- a contribution to some tangible outcomes (such as regulatory change in, for example, the prohibition of caustic dishwashing powders, the development of an all-age suicide strategy, and more designated safe communities);
- some shifts in focus (such as the Ministry of Transport putting more emphasis on reducing serious injuries rather than just reducing fatalities);
- providing a rationale and legitimacy for community injury prevention activities and enabling NGOs to link their programmes to the Strategy outcomes, leading to increased credibility, recognition and potential funding.
Injury prevention performance to date
The evaluation used the NZIPS serious injury outcome indicators, which were developed in 2005, and provide trends for fatalities and serious injuries over time. The indicators are based on the concept of “threat to life” and are mainly derived from the New Zealand Health Information System mortality and National Minimum Dataset hospitalisation data.
The use of these indicators, commissioned by the NZIPS Secretariat, is the first time that lead agencies have agreed to use the same data indicators when reporting on injury. This has been another success of the NZIPS.
Overall, injury fatalities have decreased in recent years. While there has been a downward trend in the rates of motor vehicle and drowning-related fatalities, for all other areas the injury fatality rate has remained relatively stable.
In contrast to fatalities, there has been a steady increase in the rate of serious, non-fatal injuries 3 . This increase is most noticeable for the period since 2005. The recent upward trend in serious injury and other hospitalisations is likely to be due to a range of factors, these are detailed on page 14 of the evaluation report.
Emerging injury issues
The evaluation identified two emerging injury issues. The first is alcohol-related harm. It is clear that alcohol is a contributing factor to injury in almost all settings. At high levels of consumption, drinking has been shown to place a considerable cost burden on our communities. There are various government agencies involved in the prevention of alcohol-related harm, including the Alcohol Advisory Council of New Zealand (ALAC), the Ministry of Justice with its Drivers of Crime work programme, and the Ministry of Health, but there is no specific leadership in addressing alcohol as a causal factor for injury.
Similarly children were also identified as a group requiring special focus. Children under five years of age are vulnerable members of our society and have the least ability to change their environment. Both in New Zealand and internationally, injury is a major health problem for this age group. Unfortunately, children under five are most susceptible to high levels of serious, non-fatal injury. 4. Page 23 of the evaluation report provides an overview of the child injury sector.
3. Serious, non-fatal injuries are events defined as having resulted in an admission to hospital that was associated with at least a 6% chance of death. Of all injury discharges from hospital (excluding re-admissions for the same event), approximately 13% have at least a 6% chance of death.
4.Data from ACC’s Injury Prevention Child Safety Under 5 portfolio.
Barriers to performance at a strategic level
The evaluation identified ten issues that hindered progress in the injury prevention sector. These are listed in full in section 5.6, starting on page 27, of the evaluation report.
Key recommendations were made to address six of the ten issues. These are: the need to strengthen the accountability structure across government; the limited priority for injury prevention which is not considered core business, even for lead agencies; a need for more specific goals and focus; more focus on issues common to agencies within the Strategy; cross-cutting issues require a focus within the strategy; and the insufficient dissemination of research and information.
Three of the other four issues identified are encompassed in the key recommendations. For example, the report highlights the need to focus more on the high rate of injury amongst Maori and that coordination and collaboration between agencies and community organisations requires improvement. These issues have been addressed with the introduction of common focus areas.
The remaining issue is the lack a natural injury prevention sector. It is believed that implementing the key recommendations will result in a stronger injury prevention sector.
The NZIPS Secretariat is working with its government and non-government partners to address the key recommendations arising from the evaluation and will continue to provide updates regarding this work.