Technical Paper 3:
Preventing Alcohol-related harm in Australia: a window of opportunity
5.2 - The best mix of interventions
While some interventions are more effective than others, there is no single strategy that can offer a ‘quick fix’ or ‘silver bullet’ to the prevention of harmful consumption of alcohol. The review undertaken by Babor et al. (2003)[13] concludes that an integrated approach is required that includes a combination of the strategies that are known to be effective and suitable for the particular context in which they are to be implemented. The NDRI emphasises[36] that it is important to consider the quality, rather than the quantity, of interventions. For example, ‘a single targeted restriction (for example, hotel closing at midnight) may be more effective than an entire suite of half-heartedly implemented, watered-down or ill-considered restrictions’.[36] Importantly, choosing high-quality interventions does not mean choosing the most expensive. In fact, many of the most effective strategies are the cheapest.
A recent analysis of studies into the cost effectiveness of various alcohol-prevention measures found that there are very substantial differences in costs and effects, both between interventions and between world regions. See Table 10.[99] Random breath testing (due to the need for regular sobriety checkpoints administered by police) and brief advice in primary care (the intervention itself, plus costs associated with training) are the most costly interventions to achieve equivalent savings in years of health, expressed as disability-adjusted life years (DALYs) With regard to taxation, cost effectiveness appears to depend in part on the efficiency of the tax system and the degree of anti-drinking sentiment. In the Americas and Europe, where like Australia, the prevalence of heavy drinking is high, taxation was the most effective and cost-efficient strategy. However, by contrast, tax is actually least effective and least efficient in South East Asia, where low rates of heavy drinking appear to favour more targeted approaches such as random breath testing and brief physician advice.[99]
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Table 10: Cost-effectiveness (average cost per DALY) of interventions for reducing the burden of alcohol in three WHO sub-regions (at different levels of economic development)
| Intervention | Americas | Europe | South East Asia |
|---|---|---|---|
| Brief physician advice | 776 | 2,612 | 856 |
| Random breath testing | 1,919 | 2,741 | 701 |
| Excise tax (current) | 364 | 370 | 5,420 |
| Excise tax (current + 20%) | 326 | 321 | 7,414 |
| Excise tax (current + 50%) | 297 | 287 | 9,418 |
| Reduced retail access | 484 | 1,208 | 1,406 |
| Comprehensive ad ban | 536 | 660 | 1,807 |
Source: Chisholm et al. (2006)[99]
A more recent, Australian-based study has identified the interventions for which strong Australian or international evidence exists as to their potential benefits, and has attempted to evaluate these benefits in terms of the reduction in the social costs of alcohol-related harm it would be possible to achieve.[100] Interventions identified as being effective and for which benefits are quantifiable, include:- Higher alcohol taxation, including differential tax rates on forms of alcohol that are particularly subject to abuse
- Partial or complete bans on the advertising and promotion of alcohol
- Measures to reduce drink driving: more intensive enforcement of random breath testing and lowering the legal blood alcohol concentration (BAC) level
- Brief interventions by primary care physicians to reduce hazardous alcohol consumption.