Technical Paper 3:
Preventing Alcohol-related harm in Australia: a window of opportunity
5.1 - The state of alcohol policy in Australia
A recent report by the WHO warns that ‘the difference between good and bad alcohol policy is not an abstraction, but very often a matter of life and death’.(13) Nonetheless, it is acknowledged internationally that ‘alcohol policy is often the product of competing interests, values and ideologies’, and hence is not always based entirely on scientific evidence.(13) More specifically, the cultural significance of alcohol in many societies, along with its economic importance and the political influence wielded by the global and domestic alcohol beverage industries, create a hostile environment for public health polices, especially those aimed at reducing consumption overall as a way of preventing and reducing alcohol-related harm.
While we can see that it is politically necessary to have ‘collaborative and cohesive’ alcohol policy where all interested parties are included, this poses significant impediments to the implementation of the most effective preventative interventions. Notwithstanding this, Australia has been assessed as being comparatively progressive and among the best in the world in terms of evidence-based alcohol policy.(93) In a recent commentary on national alcohol control policies in 18 countries, Babor and Winstanley (94) report that ‘contrary to the generally pessimistic reports about alcohol policies, the case of Australia provides cause for optimism’. This assessment probably speaks to the relative low level of well-integrated policies globally, rather than an opportunity for complacency in Australia.
Stockwell (2004:(42)) has judged that while there are ‘some significant disappointments’, there are also ‘some wonderful examples of successful Australian public policies around alcohol from the past two decades’. Among the population-wide strategies that have been successful in reducing alcohol-related harm in Australia, Stockwell highlights taxation and drink-driving legislation/enforcement. For high-risk groups, the compulsory fortification of bakers flour with thiamine and liquor licensing restrictions in some Indigenous communities are considered as successes. Among the strategies not likely to have been effective, Stockwell points to the dissemination of national drinking guidelines, the introduction of standard drink labelling on alcohol containers, and efforts to encourage GPs to deliver brief interventions and advice about low-risk drinking. Stockwell also underlines some significant ‘setbacks’ in Australian alcohol policy, such as the relaxation of liquor licensing laws, which has led to the proliferation of outlets in many Australian jurisdictions; changes to the tax rate on wine, which has encouraged the production and harmful consumption of cheap wine; and, since 1997, the inability of states and territories in Australia to collect levies on the sale of alcohol products.
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The recent review of alcohol policies in 30 OECD nations rated Australia as fifth overall, behind Norway (1st), Poland, Iceland and Sweden.(93) The study rated the state of alcohol policy in each of the 30 countries by creating a composite score based on the extent to which the country had adopted polices in various policy domains such as the physical availability of alcohol, prices, drinking context, alcohol advertising and road safety.
The study also examined the relationship between each country’s score and per capita alcohol consumption, and found a strong negative correlation that implied a decrease in consumption of 1 litre of alcohol per year for each 10-point increase in the score. In other words, as alcohol policies increased in strength (i.e. effectiveness), alcohol consumption decreased.
Since the late 1980s, Australia has adopted several national strategies to tackle the harmful consumption of alcohol. Australia’s first national alcohol strategy was completed in 1989 (95) followed by subsequent inerations in 1996, (96) 2001, (97) and most recently in 2006.(6) If the success of these strategies is to be measured on the basis of any change in rates of overall per capita drinking, rates of adult binge drinking, rates of underage drinking, and outcomes such as hospitalisations and crime, then these strategies appear to have had only modest success. One Australian commentator has said that ‘while these documents provide the basis for a coherent and legitimate national approach to alcohol there has been poor follow-through on implementation’.(98) A recent summary of the state of alcohol policy in Australia reported that ‘what is needed now is not so much an understanding of what works, but an appreciation of how to make it work in the various contexts in which it is implemented’(43) (emphasis added). Essentially, even the most effective strategies in the world will not be effective if they are not properly implemented as intended.