Pric­ing, sup­ply re­duc­tion will cut al­co­hol abuse and vi­o­lence

The Weekend Australian - Travel - - Health - DONNA AH CHEE

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

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