lecture 36: the role of public policy in managing harm from alcohol

Question 1

What is policy?

Answer 1

• a course or principle of action, adopted or proposed by a government, party, business, or individual - Australian concise oxford dictionary
• the term is used in many different ways but there are some central features common to all good policy:
  
  • it states matters of principle
  • it is focused on action, stating what is to be done and by whom
  • it is an authorative statement, made by person or body with power to do so

Question 2

What is an example of good public policy?

Answer 2

• it is estimated that 46,000 people haven’t died
• and 600,000 people haven’t been seriously injured due to prevention of RTA

Question 3

What has been the effect of public policy re: tobacco?

Answer 3

• national tobacco campaign launched in 1998
• male lung cancer rates/100,000 today are as low as they were in 1963
• death rates for heart disease now as low as they were immediately post WW2

Question 4

What are essential elements for behaviour change?

Answer 4

• evidence
• legislation and regulation (advertising, promotion, sponsorship)
• pricing and taxation
• community mobilization, understanding, support
• communications - social marketing/ counter advertising

Question 5

What is the lifetime risk of death per 100 male drinkers (NAG)/

Answer 5

• depends on number of standard drinks and frequency of consumption
• e.g. someone who drinks 8 standard drinks everyday has lifetime risk of 10 in 100
• but 1 standard drink everyday has risk of 0/1 in 100

Question 6

What is the lifetime risk of hospitalisation through alcohol related injury per 100 male drinkers?

Answer 6

Question 7

Australia: a nation built on alcohol?

Answer 7

• Milton Lewis, authour of The Rum State says heavy drinking was an established cultural norm in the UK and was transported to Australia at the time of its colonisation
• this happened at a time of the gin epidemics that devastated communities in Britain - “per capita consumption of gin was astonishingly high”
• Ross Fitzgerald, the author of Under the Influence says Australia “was from the outset launched on a sea of spirits”
• once in australia, these heavy drinking norms or traditions contributed significantly to the destruction of indigenous culture
• at the same time heavy drinking became enshrined within various rituals of male solidarity

Question 8

What were two drinking practices established that exist today?

Answer 8

• ‘shouting’ - in which each person in turn buys a round of drinks for the whole group
• the other is ‘work and bust’ - a prolonged drunken spree following a long period of hard work in the bush- an early term for our contemporary notion of binge drinking

Question 9

What other factors were at play?

Answer 9

• for a time spirits were used in barter and convicts were part-paid in rum
• in this way rum became a currency of the colony - hence the term ‘ a rum state’
• the control of alcohol gave enormous political power
• and alcohol has been reported to be involved in the only miltary coup in Australia - the Rum rebellion in 1808

Question 10

What have been different social meanings of alcohol over the years?

Answer 10

• in australia and elsewhere wine, brandy, beer and stout have been seen as good dietary supplements for invalids
• alcohol was once seen as a good healthy food
• nursing mothers were encouraged to drink stout because there was a popular belief that it would help with the production of breast milk
• so over time alcohol has been used as a beverage, a food, a medicine and a psychoactive drug
• as milton lewis says it has been consumed as a sacrament, a toast, a fortifier, a sedative, a thirst-quencher, and a symbol of sophistication

Question 11

What were the temperance organisations?

Answer 11

• sprang up in early 18th century, active in Australian colonies from 1830s
• they intially advocated moderation, but would eventually demand prohibition
• they were affiliated with Christian churches, and in some ways were a reaction by the middle classes to an upsurfe in lower-class drinking of spirits, due to more industrialised production of distilled spirits - the feat of the working class being more dangerous when it is drunk
• the highpoint of Temperance came during WW1, with the imposition of 18:00 closing time, which in turn led to the 6 o’clock swill
• consumptuon went down dramatically across english speaking world, to a low point of 2-3 litres per head per year in the early 1930s, largely due to the depression

Question 12

What happened post World War II?

Answer 12

• there was a backlash against the anti-alcohol movement
• drinking rates began to climb again along with the growing prosperity and cultural shifts such as the changing role of women, shaped the way we drank
• ‘civilised’ drinking became the norm - drinking with food, and in moderation
• wine became a much more popular drink by the 1960s and australia invented the wine cask
• there may be however, many wine lovers who refuse to countenance the notion of “civilised” and “wine cask” existing in the same sentence

Question 13

What significant change occurred in Victoria in 1986 with the Niewenhausen report?

Answer 13

here is an extract from Epicure in the Age in 2006, 20 years after the report:

• before his reforms, Victorian-era wowserism ruled
• hotels had a monopoly on serving alcohol and restaurants wanting a liquor licence had to submit a lengthy, expensive, cumbersome and paternalistic application process
• Nieuwenhuysen, then an economist at Melbourne University, had a vision of European-style liberalisation, of civilised drinking and freedom of choice

Question 14

What is the overall per capita consumption in Australia?

Answer 14

• in 2010
• australia’s total per capita consumption of alcohol (PCC) has been increasing significantly over time because of a gradual increase in the alcohol content and market share of wine and is now at one of its highest points since 1991-92

Question 15

What is the lifetime risk of death from alcohol-related disease?

Answer 15

• per 100 drinkers, by number of standard drinks per occasion, Australia 2002

Question 16

What are problems in Australia?

Answer 16

• the proportion of young Victorians consuming 20 or more standard drinks on at least one occasion per year has increased from 26% in 2002 to 42% in 2009
• one in four hospitalisations of young people aged 15-24 years occurs because of alcohol misuse (national health and medical research council; victorian drug and alcohol prevention council)
• the doubling of Victoria alcohol-attributable hospitalisations from 12,000 in 1995/96 to 23,000 in 2004/05 was the largest of all Australian jurisdictions (National drug research institute)
• three-quarters of Australians are negatively affected by someone else’s drinking, with 70,000 victims of alcohol-related assault, including 24,000 victims of domestic violence
• in victoria a third of substantiated child abuse cases involved alcohol

Question 17

What happened with Big Booze and the alcopops tax?

Answer 17

• “Alcopop Tax Failure - Unfair. Unworkable. Dishonest. The time has come to vote it down”
• the alcohol industry tried to label the tax a failure
• however, alcohol sales figures showed that RTD sales fell by more than 30 per cent in the 2008-09 financial year, and declined further in 2009-10
• although sales of other spirits increased, the rise accounted for less than half the decrease in RTD sales, with a net effect of a 1.5 per cent reduction in all alcohol apparently consume in 2008-09 and a further reduction the following year

Question 18

What is alcohol advertising?

Answer 18

• along with deregulation we have had rapid increases in advertising and promotion
• ad new 25 march 2005
  
  • alcoholic beverages
  • “a strong performing category in 2004, finishing 16.3% ahead of 2003, after a 15.7% growth over 2002”
• below the line forms such as word-of-mouth campaigns called buzz marketing, mumble campaigns, give-aways, ‘guerilla’ marketing and ‘roach’ baiting

Question 19

What is the growth in liquor licenses in victoria?

Answer 19

• ~3000 in 1986
• almost 18,000 in 2006

Question 20

What causes the big problems?

Answer 20

• high density of outlets
• large size of venue
• extended opening hours
• aggressive promotions

Question 21

What is seen in victorian male secondary school student rates of risky.high risk drinking?

Answer 21

• 20 years of data show increasing

Question 22

What are determinants, behaviours and outcomes of alcohol-related harm?

Answer 22

• modifiable determinants:
  
  • cultural place and availability
    
    • price
    • outlet locations
    • opening hours
    • minimum purchase age
    • service practices
    • law enforcement
    • promotion
    • social norms and values
• target behaviours
  
  • drinking to intoxication (BAC more than 0.08)
  • long term heavy drinking
• outcomes
  
  • public safety and amenity
    
    • violence
    • property damage
    • anti-social behaviour
    • perceptions of safety
  • short term (acute) health impacts
    
    • road injuries
    • assaults
    • drowning
    • suicides
    • falls
    • fire/smoke injuries
    • sexually transmitted infections
  • long term (chronic) health impacts:
    
    • cancers
    • cirrhosis of liver
    • dependence
    • mental illness

Question 23

What are the policy options?

Answer 23

• prohibition versus harm minimisation
• regulation versus industry self-regulation
• public health education: changing the culture of drinking in Australia
• school education
• other interventions, including market interventions e.g. pricing taxation

Question 24

What are features of legislation and regulation (advertising, promotion, sponsorship)?

Answer 24

• harmonise liquor control regulations:
  
  • outlet opening times, outlet density
  • accreditation requirements prior to the issuing of a liquor licence
  • late-night and other high-risk outlets
  • responsible serving of alcohol (RSA) and training model
  • optimal levels of enforcement of drink-drinking laws
  • intelligence-led, outlet-focused systems of policing and enforcement
  • annual review of liquor licences as part of annual licence renewal process +
  • demerit points penalty systems for licensees who breach liquor control laws
• i.e. taking the granting, owning, managing, and enforcement of liquor licenses far more seriously
• in a stage approach phase out alcohol promotioms from times and placements which have high exposure to young people aged up to 25 years
• the phasing out sponsorship of sport and cultural events, e.g. live sport broadcasts

Question 25

What are features of pricing and taxation?

Answer 25

• a rationalised tax and excise regime for alcohol
• develop the public interest case for minimum (floor) price of alcohol to discourage harmful consumption and promote safer consumption

Question 26

What are features of community mobilisation, understanding, support and communications (e.g. social marketing /counter advertising)?

Answer 26

• comprehensive, sustained national social marketing and public awareness strategy
• help build a national consensus on safer alcohol consumption
• raise awareness and understanding of NHMRC alcohol guidelines
• de-normalise intoxication
• raise awareness of the longer term risks and harmful consequences of excessive alcohol consumption

Question 27

What do other areas covered in the Strategy include?

Answer 27

• primary health care network of alcohol-related referall services and programmes
• increase access to health services for indigenous people
• locally developed initiatives in indigenous communities
• multi-site trial of alcohol diversion programmes
• protect the health and safety of children and adolescent brain development
• promote informed community discussion about the appropriate age for young people to begin drinking
• support parents in managing alcohol issues at all stages of children’s development
• improve systems of alcohol data collection
• develop a set of essential indicators on alcohol consumption, health and social impacts

Question 28

What is the (un)holy union?

Answer 28

• manufacturers
• retailers
• advertisers
• media
• sports, arts, and community associations

Question 29

What is confronting the alcohol and hotel industry?

Answer 29

• can you change culture? can you redefine risk and responsibility within cultural contexts?
• how powerful is the drinks industry and how far are they prepared to change?
• can the goverment balance the books (the cost-benefit of price-leverage)?
• how far can the law regulate industry and behaviour
• gamechanger.org.au