Technical Paper 3:
Preventing Alcohol-related harm in Australia: a window of opportunity
3.3 - Health inequalities
There are variations in alcohol consumption across Australia and different impacts on specific high-risk population groups. Per capita alcohol consumption varies significantly between urban and rural areas, and between Australian states and territories. For instance, while the prevalence of drinking at short-term risky/high-risk levels at least monthly is 18.7% in New South Wales and 19.4% in Victoria, it is 28.4% in the Northern Territory. Alcohol consumption levels (and alcohol-attributable mortality and morbidity) are consistently found to be lower for people living within major cities when compared to outer regions. In 2004 it was estimated that the proportion of Australians who drank at risky/high-risk levels for short-term harm, residing in outer regional (24%) and remote/very remote (28%) locations was between 20% and 40% greater than for residents of major cities. The proportion of the population residing in outer regional and remote/very remote locations who drank at risky/high-risk levels for long-term harm were 11% and 16% respectively, compared to 9.5% in major cities. Not surprisingly, there are also geographic differences in the rates of alcohol-related harm in Australia. The Northern Territory has the highest rate of alcohol-attributable deaths and hospitalisations in the country.
Indigenous Australians are about twice as likely to abstain from alcohol as non-Indigenous Australians, but those who do drink may be up to six times more likely to drink at high-risk levels than non-Indigenous people. A survey estimated that 38% of Indigenous people aged 14 and over drank at risky/high-risk levels for acute harm, compared to 20% among non-Indigenous people; and that 23% drank at risky/high-risk levels for chronic harm, compared to about 10% of non-Indigenous people. However, a less recent, but better designed, Indigenous-specific survey of substance misuse found that about 58% of all Indigenous respondents drank at risky/high-risk levels. Among Indigenous people who live in remote parts of Australia, levels of alcohol consumption are particularly high.
In 2002–2003 the rate of hospital admission among Indigenous males for conditions related to high levels of alcohol use was between two and seven times greater than for non-Indigenous males. Such conditions include acute alcohol intoxication, alcoholic liver disease, harmful use and alcohol dependence. In addition, between 1999 and 2003 about 71% of Indigenous homicides occurred in situations where both the perpetrator and victim were drinking (as opposed to 19% of non-Indigenous homicides). Other studies have shown that the rates of death from wholly alcohol-caused conditions among residents of Western Australia, South Australia and the Northern Territory are almost eight times greater for Indigenous males than for non-Indigenous males and 16 times greater for Indigenous females than for other females. The level of alcohol-attributable death among young Indigenous Australians (15–24 years) has also been shown to be almost three times greater than for their non-Indigenous counterparts – with the divergence between the two populations apparently increasing in recent years.
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Rates of risky drinking in Australia peak amongst young people, and alcohol-related harm is substantial for both adolescents and young adults. Drinking contributes to the three leading causes of death among adolescents – unintentional injuries, homicide and suicide – along with risk-taking behaviour, unsafe sex choices, sexual coercion and alcohol overdose. A recent study of self-reported harm found that drinkers under the age of 15 years are much more likely than older drinkers to experience risky or antisocial behaviour connected with their drinking, and the rates are also somewhat elevated among drinkers aged 15–17 years. Furthermore, initiation of alcohol use at a young age may increase the likelihood of negative physical and mental health conditions, social problems and alcohol dependence. Regular drinking in adolescence is an important risk factor for the development of dependent and risky patterns of use in young adulthood. Childhood and adolescence are critical times for brain development and the brain is more sensitive to alcohol-induced damage during these times, while being less sensitive to cues that could moderate alcohol intake.
Like adolescents, young adults continue to be greater risk takers than older adults, but their decision-making skills remain undeveloped – factors that are reflected in the high levels of injuries sustained by this age group. Alcohol affects brain development in young people; thus, drinking, particularly ‘binge drinking’, at any time before brain development is complete (which is not until around 25 years of age) may adversely affect later brain function. In addition, young adults are also the adult age group most likely to take mood-altering drugs.
Trends in youth drinking are unclear, with neither school survey data (ASSADS) nor the National Drug Strategy Household Survey (NDSHS) demonstrating clear trends in drinking amongst adolescents or young adults in the last decade. While a recent examination of Victorian data relating to young people aged between 12 and 24 found no clear trend in rates of risky drinking, it revealed that rates of hospitalisation and presentation at emergency departments have increased dramatically over recent years. The study suggests that the relationship between survey-derived estimates of alcohol consumption and rates of alcohol-related harms is not as clear-cut as expected, and raises concerns about the sensitivity of population surveys in detecting changes in harmful drinking patterns.
Drinking can also lead to poorer outcomes for people who have a mental health condition, whether it is a high-prevalence condition such as depression or a low-prevalence condition such as schizophrenia.
There has been little analysis of the patterns of consumption and trends in alcohol-related dysfunction or harm in older people in Australia. Older people are more vulnerable to the effects of alcohol due to changes in their body composition, decreased metabolic capacity, the presence of co-morbid conditions and the medications that regulate these conditions. Older people express concern about reduced perceptions of safety associated with public place drinking. Women in the baby boomer age group, now aged in their 50s to 70s, are more likely than their parents to be alcohol consumers and it might be anticipated that this will produce an increase in alcohol-related morbidity in their older years, but this is yet to be documented.
Certain occupational groups are also known to regularly drink at risky/high-risk levels, especially tradespeople and unskilled workers, and those working in the hospitality, agricultural and mining industries.