Traumatic injury is more prevalent in rural and remote settings globally. Large inequalities in the injury burden are found across rural and remote populations of most countries around the world, from the US and Australia to rural China and Bangladesh. Challenges in prevention include over-representation of marginalised populations, fewer preventative programs, implementation gaps and less well developed systems of care, particularly in resource poor settings. These unique challenges call for different approaches.

For decades injury practice and policy has concentrated on a public health approach that identifies burden and risk factors, and develops and implements cost effective programs. However, preventive programs need to incorporate the wide range of risk factors, both structural and individual that contribute to injury, in order to achieve change, and this is challenging to do in a context that focuses on injury as a vertical issue. There are complex interactions between environmental, organisational and personal factors which determine health outside of traditional ‘health’ services, and systems approaches recognise these, in addition to supporting the critical role of communities in bringing about change. Horizontal programs, that is, those that address systemic issues across disease groups and strengthen health systems maybe more likely to achieve success, especially in remote or resource poor settings where both preventive programs and health services are limited.

The sustainable development goals offer a new opportunity to shift our approach to both injury prevention and care by providing a mechanism to engage multiple stakeholders and work collaboratively. With major goals addressing road injury, universal health care, sustainable transport, disasters, and the rule of law amongst many other goals relevant to injury in rural and remote settings, there are major opportunities to develop cross-cutting programs that prevent injury and improve trauma care and rehabilitation, but also address multiple other conditions. This talk will focus on practical examples of such programs, with case studies from rural and remote settings in both high and low income countries.