Pricing, supply reduction will cut alcohol abuse and violence
THE major barrier to addressing excessive levels of alcohol consumption and harms in Aboriginal communities is not a lack of desire by Aboriginal people, but the lack of willingness of policy makers to implement measures that we know work in reducing the supply and availability of alcohol. Such measures are not generally popular, or for obvious reasons supported by the alcohol industry.
As Australia’s internationally renowned alcohol policy researcher professor Robin Room says, ‘‘ what’s popular doesn’t work, and what works isn’t popular’’.
The most effective strategies include increasing the price of alcohol, especially cheap bulk alcohol, reducing take-away trading hours and reducing the density of alcohol outlets.
Why is it that decision makers continue to favour strategies that are known not to work, such as alcohol education or legislating to stop drinking in particular locations? Meanwhile, the advertising, promotion and availability of alcohol use targeting young people by the alcohol industry continues all but unchecked. Alcohol treatment and rehabilitation services by themselves are never going to be sufficient to address the excessive alcohol consumption in Aboriginal communities. It is time for policy makers to do what is needed, not what is popular with the community or the alcohol industry.
As the deputy director of the local Aboriginal health service, I can attest that there have been immediate health and social benefits for the whole community, especially Aboriginal people, since October last year when Alice Springs introduced restrictions on the supply of alcohol. Since cheap bulk alcohol was removed from the market for the first four hours of takeaway trading, along with other restrictions, we have seen a 10 per cent reduction in alcohol consumption and a consequent reduction in harms such as assaults and alcohol-caused hospital admissions. As predicted by research, the heaviest drinkers are now shifting to beer because this is the cheapest form of alcohol left on the market, and this is less harmful.
However, the community in general doesn’t like paying more for commodities, and in this sense alcohol is just another commodity. In spite of this, restricting the supply of alcohol using a minimum-price benchmark (which sets an agreed minimum price for all alcohol products) is potentially a more popular approach than using volumetric taxation (which sets taxation levels based on the actual volume of alcohol in each product) — because the former approach only affects the price of cheap, poorer-quality alcohol rather than higher-quality alcohol products.
The harm in any alcoholic beverage is due to the price per standard drink of pure alcohol it contains. So spirits, at 40 per cent alcohol by volume, are considered much less harmful than cask wine — at 9.5 per cent alcohol by volume — because the pure alcohol in a bottle of spirits sells at about three times the price per standard drink when compared to a cask of cheap wine. The alcohol industry already knows that price is the principal driver of consumption, but now the general public should understand that if it wants to see reductions in alcohol-caused harms, then it needs to demand policy makers use price as a lever.
Total take-away trading hours are also vitally important. The more hours, the more harm. A study just published in the August edition of the UK-based Emergency Medicine Journal (2007;24:532) has shown the extent to which England’s introduction of 24/7 takeaway alcohol sales has further increased harm at a large central London hospital. This adds to the wide array of international evidence that shows a direct relationship between the increasing liberalisation of take-away sales and harms.
The introduction of one take-away alcoholfree day per week was shown to be effective in Tenant Creek in the Northern Territory, and this is a measure that should be introduced in other Aboriginal communities and towns where there is a substantial alcohol problem.
To maximise the effectiveness of this approach all the normal Centrelink payments should be made on this day as well — and this is now administratively possible due to electronic payments. Take-away hours on other days should also be reduced. This should be combined with reducing the amount of takeaway alcohol licences given in any location.
These types of supply reduction measures are not popular with many who gain financially from alcohol sales, because they impact on their profits. They reduce consumption and therefore reduce the profits from alcohol sales. They are also initially not popular with the general community, but there is evidence to suggest that this is partly due to the misinformation about what actually works.
Many people in the general community believe that alcohol education works, and that this — along with better treatment services — is all that is needed without anyone having to be inconvenienced by restricting alcohol availability. If only this were true.
There is also the mistaken belief that reducing supply equates to prohibition and that it will prompt heavy drinkers to shift to more harmful drugs. As long as there is still ready access to alcohol, this does not occur. People keep drinking, but in a less harmful way; this is the goal of supply reduction.
Supply reduction measures are the most effective way to deal with the very high levels of alcohol consumption in many Aboriginal communities, and are also the key missing link in the current policy response. We cannot afford to wait any longer before these types of measures are broadly applied. Over time supply reduction becomes popular because it works and it is seen to create safer, healthier communities for everyone. Donna Ah Chee is deputy director of Congress in Alice Springs and a member of the National Indigenous Drug & Alcohol Committee