Assessment 1: Injury, Social Determinants, and Health Outcomes Report

This report, focusing on injury and its prevention, examines the relationship between social determinants of health and the epidemiology of injury across different populations, specifically comparing Indigenous and non-Indigenous Australians and Maori people in New Zealand. It explores environmental, social, and individual factors influencing injury risk, emphasizing the impact of social determinants such as education, employment, housing, and access to healthcare. The report highlights disparities in injury burden, hospitalization rates, and access to healthcare services between Indigenous and non-Indigenous populations. It discusses the importance of understanding these determinants to develop effective injury prevention strategies, considering factors like history of colonization and socioeconomic status. The analysis reveals higher injury rates among Indigenous populations, particularly in specific age groups, and underscores the need for targeted interventions to address these disparities and improve health outcomes. The report concludes with a call for the development of appropriate policies and practices to prevent injury within these communities.

Assessment
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Contents
PART A...........................................................................................................................................3
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Analysis the relationship between the social determinants of health and the epidemiology of
the disease in each population................................................................................................3
Compare and contrast of burden of injuries experienced by Indigenous and non-Indigenous
Australians and Maori people of New Zealand......................................................................5
CONCLUSION................................................................................................................................7
PART B............................................................................................................................................8
INTRODUCTION...........................................................................................................................8
MAIN BODY...................................................................................................................................8
Literature to determine a local area where injury is prevalent...............................................8
Current strategy used to address injury issue in Australia...................................................10
Importance of Capacity building, Collaboration, and Sustainability in success of the strategy
..............................................................................................................................................11
CONCLUSION..............................................................................................................................12
REFERENCES..............................................................................................................................13
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PART A
INTRODUCTION
Injury is defined as a physical trauma or damage caused to body to external force. It may be
caused through weapons, falls, accidents, hits and other causes. Injury is the major trauma which
has the potential to cause disability for long term or death. It is very necessary to prevent the
injury being happen (Ananthakrishnan, Kaplan, and Ng, (2020). Injury prevention is stated as the
element of safety as well as public health. Its main goal is to enhance the health of people
through preventing injuries and thus, improves life quality. The Australian National Health
priority area considered in this report is injury and injury prevention. The report covers compare
and contrast of disease burden experience by indigenous and non-indigenous Australians and
Maori people of New Zealand. Apart from this, relationship between social determinants of
Health and epidemiology of injury in population is discussed in the report.
MAIN BODY
Analysis the relationship between the social determinants of health and the epidemiology of the
disease in each population
The approach to public health for injury prevention is to examine the determinants of
injury. These are the factors that increase in lower down the risk of occurrence of injury. The
factors that have optimistic influence are known as protective factors and the factors that have
adverse influence are called risk factors. The injury determinants combined to impact health and
safety of people and communities, thus different determinants of injury at many levels might be
considered to effectively target interventions (Vakayil, and et. al., (2020). The determinants to
injury includes environmental factors, social factors including cultural, economic and political
determinants and individual and behavioural characteristics of person. The social determinants of
injury are referred as the conditions where people are born, live, grow, work, and other set of
forces that shaping the daily life conditions. It involves development agenda, political systems,
economic policies, social policies and social norms. The extent to which a person obtained
education, kind of work an individual does and the money a person earns can influence the
health of a person (Parikh, and et. al., (2020). Some of the social determinants which influence
the health of people includes history of colonisation includes history of colonisation,
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employment and job security, housing access and security, education and literacy levels, gender,
race, disability, food security involving quantity and quality of food, working conditions, social
inclusion, access to social services like unemployment support, housing support and child care,
social enrichment etc. The factor like social exclusion contributes highly to lower down the
feelings of self-worth and leads individual towards depression that acts as a risk factor for self-
harm (Koh, Sun, and Hsiao, (2020).
Apart from the social factors, there are some environmental factors also that contributes to
injury. These factors are proximally linked to social determinants and impact one another. It
involves surroundings where people live, play, work and grow. In rural areas, unsealed roads can
maximize the risk of road crashes. In addition to the social and environmental factors, some
individual and behavioural determinants of injury also there. This includes coping skills of
people, attitudes, knowledge and beliefs regarding injury and risk taking behaviour and choices.
The behavioural determinants are linked to the actions of an individual that they take each day
which either decrease the injury risk or increase the injury risk. It is also very necessary to
consider the non-modifiable and physiological determinants of injury while developing the
interventions (Cohen, and et. al., (2017). These determinants include genetics, gender and age.
Not utilising appropriate mobility devices when needed is the behavioural factor that maximize
injury risk due to falls. Proper understanding of the influences of causes of injury and addressing
its determinant is the primary approach to reduce the inequalities in Australian indigenous and
non-indigenous people. Some individuals have poor health on the basis of the genetics, the job
they do and the choices they make. These factors outcomes in health inequality which are the
differences in health status of people.
The resources which assist in enhancing the quality of life can have impact on outcomes of
health of population. The resources that enhance life quality can have impact on life of an
individual. Proper access to healthcare and availability of resources is very necessary so as to
ensure that the daily needs of the population can be mitigate and they have proper social support,
access to healthcare services, job Opportunities, good education etc. The epidemiology of injury
is highly impacted by all these social determinants of health and injury (Lee, and et. al., (2017).
Lack of attention to these factors is the key reason to behavioural change in the people and
results into injury. This determinants of injury have been associated with increased incidence,
prevalence and burden of injury and impact on the health of indigenous and non-indigenous
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people of Australia. If people are not able to get access to healthcare services on time, then they
are not able to get proper treatment for the injury and results into prolonged disability or death.
Social support depends indirect influence on control of injury which is mediated by the process
of access to care. The health of an individual is influenced by the complex factors exists in the
social environment and are viewed as main influencers of population health outcomes. Social
determinants are the key factors behind prevalence of injury (Zha, (2019). For the health care
organisations and government of Australia, it is very necessary to develop appropriate policies
and practices in order to prevent injury among indigenous and non-indigenous community of
nation.
The injury has been defined as main cause of morbidity in the population. The burden
related to injury in terms of treatment cost, lost potential, rehabilitation and disability are
substantial. According to a study, peaks in happening of injury related traumas are seen in
adolescence as well as their etiologies are obvious priorities for research. The social risk factors
are the potential injury determinants. The increasing attention has been render to social economic
status effects on health. The economic gap between the poor and rich people is widening
continuously and the people who are financially deprived might be embedded in hazardous
social context (Glymour, and Bibbins-Domingo, (2019). The lifestyle of the people that includes
engagement in truancy, substance use etc. leads them towards increased risk of injury. Then non
indigenous people in the Australia has high risk of injury in comparison to indigenous people.
The main causes of injury and death includes interpersonal violence, transport crashes, falls,
poisoning etc.
Compare and contrast of burden of injuries experienced by Indigenous and non-Indigenous
Australians and Maori people of New Zealand
Similar to most of the indigenous people all over the world, Maori people of New Zealand
or the indigenous people have marked with consistent health disparities in comparison to non-
indigenous people of New Zealand. The Maori people who are aged 15 to 64 years have high
hospitalization rate (1788 per 100000 in comparison to 1104.5 per 100000) and mortality
because of unintentional injury (14.80 per 100000 in comparison to 18.7 per 100000). In around
31% of disabled Maori adults, the main reason of their disability is injury (Amelang, and Bauer,
(2019). Despite of large disparities between Non Maori and Maori people. The information
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regarding outcomes following broad range of types of injury and severities will contribute to
determine opportunities to decline such disparities. For the no fault injury compensation scheme
in New Zealand, the accident compensation corporation responsible and administer support for
rehabilitation, treatment as well as compensation for lost earnings. In spite of high injury
disability rates and mortality rate mention above, Maori people in New Zealand have low
accessibility to Accident Compensation Corporation services in comparison to Non Maori
people. It depicts the general situation where ethnic minorities and indigenous individuals often
have low access as well as utilisation rate of services associated with health care. In the total
population of New Zealand, the Maori people represent 14.6% and only 11.6 % of total accident
compensation corporation claims between year 2004 and 2009 were from Maori people
(Indigenous injury outcomes, 2013). These individuals also have disproportionately low rates of
vocational and social rehabilitation services, with around 6.6 % of these claims being from
Maori. Due to lack of information regarding accident compensation corporation entitlements,
Maori people may encounter barriers to the access of services.
On the other hand, over the period of 5 years, around 115021 hospitalisation of indigenous
individuals were determined as being an outcome of injury. In comparison to female, more
indigenous males were hospitalized due to injury. Because of injury, age standardised
hospitalization rate was higher among indigenous Australian people as compared to non-
indigenous people. Among the indigenous females, the hospitalisation rate because of injury
were twice as compared to non-indigenous females. It has been examined in each of the five
years that the hospitalization rate because of injury among indigenous people raised than number
of non-indigenous individuals (Suen, and et. al., (2019).
Figure 1: Hospitalisations due to injury, by sex and Indigenous status, Australia, 2011–16
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Figure 2: Number of hospitalisations due to injury, by year and Indigenous status, Australia,
The hospitalization rate because of injury of indigenous females and males raised over a
period. The same rise wasn't seen for Australian non indigenous people. The highest injury rate
over the period were for Australian indigenous female and male is the recent year 2016 - 2017,
i.e., 3659 and 4144 cases per 100000 people (Fos, Fine, & Zï, (2018). In indigenous Australian
people, the large proportion of cases happen at the age of 25 - 44 for women (40%) and men
(36%). In comparison with non-indigenous counterparts, the hospitalization distribution because
of injury was different for indigenous females and males. For men, the injury cases proportion
among people with younger age groups was very high in Australian indigenous people. At the
age of 25 to 44 years, the injury proportion among males (36%) was around it was 8 percent high
in comparison to non-indigenous men. Contrasting to this, for indigenous man, the injury cases
proportion among men who are aged 65+ was 3% as compared to 20% for Australian non-
indigenous males (Hospitalised injury among Aboriginal and Torres Strait Islander people,
2016). In case of indigenous females, the differentiations were more pronounced. Around 40% of
hospitalizations because of injury happening among women in the age of 25 to 44 years
compared with 16% among the women belongs to non-indigenous community. The injury cases
proportion among Australian indigenous women who aged 65+ was 5 percent only compared
with 44% among the women belongs to non-indigenous community (Singal, & El-Serag, (2015).
CONCLUSION
As per the above discussion, it has been concluded that Injury is the physical trauma caused
to body because of external force. There are various social determinants of injury including
education and literacy levels, housing access and security, food security, working conditions,
social enrichment, history of colonisation etc. All these factors contribute to increased risk of
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injury among the people. Epidemiology of injury and social determinants of injury are linked
with each other. The hospitalization rate due to injury of indigenous males and females increases
over the time. In comparison to non-indigenous people of Australia, the indigenous people are at
more risk of injury in the Australia.
PART B
INTRODUCTION
The healthcare practices are related to the way to determine, gather, evaluate and
disseminate information and execute appropriate practices assistant improving the health
outcomes of patient or population group and contribute to their wellbeing. The prevelence of
injury has been recognised as the key cause of morbidity and mortality in Australian indigenous
and non-indigenous people (Sanders Jr, and et. al., (2015). This project covers the information
about prevalence of injury in Australian indigenous and non-indigenous people along with the
current strategy which is utilised by the government and other institutions of Australia to reduce
the occurrence of injury. In addition to this, the significance of collaboration, sustainability and
capacity building in relation to success of strategy in preventing injury is included in the report.
MAIN BODY
Literature to determine a local area where injury is prevalent
Injury is one of the major contributor to morbidity, permanent disability and mortality in
Australia. Falls has been shown to be the leading causes of disability, death and injury globally
for the individuals who are 65 years of age and above residing in the community. It has been
found for a study that around 30% of older individual’s experience one fall at least each year.
Hip fracture is the most common severe fall injury for older people followed by head injury. In
case of severe fall injury, recovery can be the process, with individuals potentially never
regaining their complete functional ability and maximize the risk of being moved into services
associated with residential care (Faron, Ledeboer, & Buchan, (2016). Those individuals who
have suffered from hip fracture are three times more possibly to be functionally dependent and
have greater risk of death. With maximizing life expectancy, falls is the growing health issue for
the people who are old. The injuries associated with fall have the potential to be the main health
priority for indigenous population aged over 65 years. It has been found from a study that the
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onset of different health conditions related to aging in indigenous population like cardiovascular
disease, diabetes complication etc. These conditions have been depicted to maximize the risk of
an individual of falling and sustaining a fall associated injury. Although, there are many fall
prevention interventions known which are effective in minimising the falls in general
community, it is not clear that to what extent these intervention programs are accepted by
Australian indigenous people. The structure, content and delivery mode of programs for
indigenous individuals is known to be distinct from mainstream programmes (Bhopal, (2016).
In year 2011, it is accounted for around 8.8 percent of total disease burden in Australia and
was one of the leading cause of burden in the country. On the basis of self-reported data, 4.3
million Australian people living with disability happened due to poisoning or injury. In year
2014 - 2015, injury was identified as a reason of over 12600 deaths in the country - 8.1% of all
deaths. The injury death rates were high for women and men aged 65+. In this age group, 60% of
female and 42% of male injury deaths happened. The age standardized injury death rates in year
2014 - 2015 was around 48% per 100000 populations. Since 2004 - 2005, this rate has remained
steady, following a decline from 55 per 100000 people in 1999 - 2000. In comparison to females,
the death rates were high in males in every age group. The common causes of deaths to injury
were transport crashes (11 percent), suicide (23%) and falls (37%). Though, differences were
there in leading cause of injury for females and males. Falls were the main cause for females and
suicide were the main cause for males (Neuhauser, (2016). The age standardized injury death
rates for aboriginal and Torres strait islander individuals were double the rate for Australian non-
indigenous people. With the increasing remoteness, the rate of injury death maximized from
approx. 43 deaths per 100000 people in cities to around 88 deaths in remote areas.
According to a study, indigenous people are injured because of similar types of extrinsic
causes as Australian non indigenous people. However, indigenous individuals experience high
injury rates. The top 3 causes for indigenous people of injury falls, exposure and assaults. For
non-indigenous Individuals, the causes include transport crashes (12%), exposure to inanimate
mechanical forces (14%) and falls (41%). The main cause of hospitalization indigenous people
due to injury was falls (981 cases per 100000 people) followed by exposure to inanimate
mechanical forces (430) and assaults (875) (Prince, and et. al., (2015).
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Current strategy used to address injury issue in Australia
In order to prevent the injury, the Australian government develop a strategy include
National Injury Prevention Strategy, 2020 - 2030. This strategy aims to develop National
focus on injuries as well as their prevention. It takes wider approach to injury as well as aims to
address intentional and unintentional injuries across all the population groups and ages.
Currently, this strategy is being developed and recognised that injury is the main cause of death
in people aged 1 - 44 years. The strategy helps in demonstrating the success in some areas like
reducing road trauma. Apart from this, the national injury prevention strategy is assistive in
preventing intentional and unintentional injuries. As Australia has ageing population, there is a
requirement for focused action on injury. In order to lead the development as well as writing of
the strategy, the George Institute for Global Health has been engaged by the Australian
government department of health (Xu, and et. al., (2015). The George Institute has partnered
with Monash University, Australian injury prevention network and Ngarruwan Ngadju first
people health and wellbeing research centre to develop the strategy. It has been informed through
advice of various experts from expert advisory group. In March 2019, a face-to-face stakeholder
consultation round were held across Australia in order to discuss the draft strategy.
The stakeholder consultation was held with main organisations from August to October in
year 2019. In early 2020, the feedback from federal government was sought and has informed
current version of strategy. The strategy adopts the holistic view of health of aboriginal and
Torres strait islander. Injury is not just the physical harm caused due to extrinsic event, but
cultural, emotional and spiritual aspects of harm. It means that the prevention of injury must
emphasize not only on minimising hospital bed days or deaths but, also the emotional wellbeing
as well as safety of people and the whole community (National Injury Prevention Strategy,
2020). The national injury prevention strategy addresses widest definition of injuries - The
spiritual, physical, cultural as well as community cost of injuries. The strategy addresses self-
harm and self-inflicted injury like suicide, intentional injury like violence and non-intentional
injuries like road traffic, drowning, poisoning, sport injuries, falls and burns. It must be noted
that many of these kinds of injuries can also be the outcome of intended harm.
There are six principles that underpins the strategy and must be at forefront in planning and
executing the actions and objectives of strategy (Vakayil, and et. al., (2020). These principles
include principal of evidence-based according to which the strategy execution addresses priority
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areas by data-driven as well as evidence based action (Chou, & et. al., (2020). The principle of
equity provides equitable access to education, information, environments, policies and programs
which product and minimise risk of injury. The third principal is principle of engagement in
which engage, empower and enable the communities to core design and execute programs and
impact policies which are in keeping with local community’s priorities. The coordination
principle ensures that the efforts are coordinated among the partner agencies along with unified
leadership and clear lines of responsibility. The resourcing principle emphasize on target funding
as well as the action to minimise burden of injury by determining priority areas for action that
are attainable, modifiable and acceptable. The sixth principal of strategy is principle of
responsibility which ensures that each lead agency stay accountable to that particular action and
adopt clear plan for communication with all partners as well as articulate deliverables (Forouhi,
& Wareham, (2019).
Importance of Capacity building, Collaboration, and Sustainability in success of the strategy
Collaboration: it is significant in terms of preventing and treating injury as it helps in make
sure that all the Health Care professionals and practitioners work together with government and
organisations and share significant responsibilities in order to provide appropriate care services
to the people. It helps in taking effective decisions that assist in reducing the issue of injury and
ensuring its prevention in an appropriate way (Ananthakrishnan, Kaplan, and Ng, (2020). In
relation to current strategy, an effective collaboration with various health care organisations
(public and private) and government is very necessary in order to ensures proper direction and
motivation of people to direct them towards lifestyle modification and reducing the incidence of
injury.
Capacity Building- It is basically related to maximising the potential, skills as well as
knowledge of an individual, communities and organisation so as to effectively sustain the
activities and lifestyle associated with health and wellbeing thus, plays a significant role in
success of the National Injury Prevention Strategy. In relation to the current strategy related to
eliminate unintentional and intentional strategy, capacity building act as significant aspect for its
success as well as leads it to ensures better transformation of information and data and
generation of knowledge and skills in people as well as individuals regarding the need and
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significance of lifestyle modification for preventing and avoiding risk of injury (Koh, Sun, and
Hsiao, (2020).
Sustainability- This aspect is related to accomplishment and delivery of high quality as well
as improved way of delivering quality care to the people without exhausting or affecting natural
resources that causing any kind of severe ecological damage. It is very much necessary to ensure
adoption of sustainable ways to deliver appropriate care and support services to the people who
are injured. It is also necessary that at the time of executing national injury prevention strategy,
the government must ensure to adopt sustainable ways as it plays an important role in its
successful execution through motivating and guiding individuals towards more good long living
habits (Glymour, and Bibbins-Domingo, (2019).
CONCLUSION
As per the above discussion, it has been concluded that Injury is the main contributor to
morbidity, mortality and permanent disability. In Australia, the presence of injury is high among
Australian indigenous people. Falls has been seen as the main cause of disability and death
among older people who are aged over 65 years. Australia is accounted for approximately 8.8 %
of total disease burden. People are injured due to the same types of external causes as non-
indigenous people. The national injury prevention strategy helps in preventing all types of injury
whether it is intentional, unintentional or self-harm or self-inflicted injury. Capacity building,
collaboration and sustainability are the significant aspects that contribute in the success of the
strategy in preventing injury among Australian indigenous and non-indigenous people.
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REFERENCES
Books and Journals
Ananthakrishnan, A.N., Kaplan, G.G. & Ng, S.C., (2020). Changing Global Epidemiology of
Inflammatory Bowel Diseases: Sustaining Health Care Delivery Into the 21st Century.
Clinical Gastroenterology and Hepatology, 18(6), pp.1252-1260.
Vakayil, V. & et. al., (2020). Epidemiological trends of surgical admissions to the intensive care
unit in the United States. Journal of Trauma and Acute Care Surgery, 89(2), pp.279-288.
Parikh, R.V. & et. al., (2020). Community-based epidemiology of hospitalized acute kidney
injury. Pediatrics, 146(3).
Koh, Y.Y., Sun, C.C. & Hsiao, C.H., (2020). Epidemiology and the Estimated Burden of
Microbial Keratitis on the Health Care System in Taiwan: A 14-Year Population-Based
Study. American Journal of Ophthalmology.
Cohen, A.T.& et. al., (2017). Epidemiology of first and recurrent venous thromboembolism in
patients with active cancer. Thrombosis and haemostasis, 26(01), pp.57-65.
Lee, D.J. & et. al., (2017). Recent changes in prostate cancer screening practices and
epidemiology. The Journal of urology, 198(6), pp.1230-1240.
Zha, P., (2019). Social Epidemiology. In Social Pathways to Health Vulnerability (pp. 159-180).
Springer, Cham.
Glymour, M.M. & Bibbins-Domingo, K., (2019). The future of observational epidemiology:
improving data and design to align with population health. American journal of
epidemiology, 188(5), pp.836-839.
Amelang, K. & Bauer, S., (2019). Following the Algorithm: How epidemiological risk-scores do
accountability. Social studies of science, 49(4), pp.476-502.
Suen, J.J. & et. al., (2019), February. Translating public health practices: community-based
approaches for addressing hearing health care disparities. In Seminars in hearing (Vol.
40, No. 01, pp. 037-048). Thieme Medical Publishers.
Fos, P. J., Fine, D. J., & Zï, M. A. (2018). Managerial epidemiology for health care
organizations. John Wiley & Sons.
Singal, A. G., & El-Serag, H. B. (2015). Hepatocellular carcinoma from epidemiology to
prevention: translating knowledge into practice. Clinical gastroenterology and
hepatology, 13(12), 2140-2151.
Sanders Jr, T. L., and et. al., (2015). The epidemiology and health care burden of tennis elbow: a
population-based study. The American journal of sports medicine, 43(5), 1066-1071.
Faron, M. L., Ledeboer, N. A., & Buchan, B. W. (2016). Resistance mechanisms, epidemiology,
and approaches to screening for vancomycin-resistant Enterococcus in the health care
setting. Journal of clinical microbiology, 54(10), 2436-2447.
Bhopal, R. S. (2016). Concepts of epidemiology: integrating the ideas, theories, principles, and
methods of epidemiology. Oxford University Press.
Neuhauser, H. K. (2016). The epidemiology of dizziness and vertigo. In Handbook of clinical
neurology (Vol. 137, pp. 67-82). Elsevier.
Prince, M. J., and et. al., (2015). The burden of disease in older people and implications for
health policy and practice. The Lancet, 385(9967), 549-562.
Xu, X., and et. al., (2015). Epidemiology and clinical correlates of AKI in Chinese hospitalized
adults. Clinical Journal of the American Society of Nephrology, 10(9), 1510-1518.
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Chou, R., and et. al., (2020). Epidemiology of and risk factors for coronavirus infection in health
care workers: a living rapid review. Annals of internal medicine.
Forouhi, N. G., & Wareham, N. J. (2019). Epidemiology of diabetes. Medicine, 47(1), 22-27.
Online
Indigenous injury outcomes: life satisfaction among injured Māori in New Zealand three months
after injury, 2013. [Online]. Available through:
<https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-11-120>
Hospitalised injury among Aboriginal and Torres Strait Islander people, 2016. [Online].
Available through: <https://www.aihw.gov.au/getmedia/89ae4b17-ad35-42da-958f-
5c48ee209cf3/aihw-injcat-198.pdf.aspx?inline=true>
National Injury Prevention Strategy, 2020. [Online]. Available through:
<https://consultations.health.gov.au/population-health-and-sport-division/national-injury-
prevention-strategy_/>
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