Technical Paper 3:
Preventing Alcohol-related harm in Australia: a window of opportunity
5.3 - Challenges in implementation
Australia’s international score card in the area of alcohol policy appears to be quite impressive, as the reviews mentioned above testify, and many would argue that incremental policy change, rather than radical approaches, is the most appropriate way to proceed. However, some have cautioned against taking comfort in this approach because of the ‘cultural inertia’ surrounding alcohol policy in Australia, which can be a formidable barrier to meaningful policy changes. ‘Drinking forms part of the Australian legend, and there is good precedent in Australian history to suggest that a radical alcohol reform agenda could provoke community backlash – beware the ‘wowser’ label’. An example of radical policy change that has been successful is the introduction of random breath testing, thanks in part to the accompanying social marketing campaigns that have highlighted both the seriousness of the problem and the effectiveness of the policy response. The level of public support in Australia for new alcohol policy interventions and/or the extension of existing interventions is encouraging in some areas (see Fig. 14); for example, the level of public support for measures known to be effective, such as the strict monitoring of late-night licensed premises (75%), is relatively high. While support for measures such as increasing tax on alcohol to pay for health, education and the treatment of alcohol-related problems is relatively lower (41%), it is a reasonably sufficient base of public support on which to build through public education and social marketing about the rationale and potential benefits of such a measure.
Figure 14. Support for alcohol measures, proportion of the population aged 14+ years, Australia, 2007
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There are some specific challenges that go beyond public understanding and attitudes. These have been raised throughout this paper and include:
- National Competition Policy, as it relates to liquor licensing systems, regulating alcohol prices and restricting alcohol promotions
- The division of responsibilities between levels of governments for key alcohol policy areas and the historic complexity in achieving coordinated action
- The economic and political importance, and thus influence, of the alcohol beverage and related industries.
These challenges arise in the context of broad, community-wide changes in the nature of work, education and social connectedness, and occur at a time when:
- Alcohol sponsorship of sporting and cultural activities has replaced and is now prominent in many areas previously occupied by the tobacco industry.
- Alcohol consumption is symbolically associated with positive and pleasurable life in portrayals of Australia’s history and culture, including the ongoing promotion of alcohol as a necessary ingredient of entertainment, celebration and all ‘rite of passage’ life course transitions.
- The ‘menu’ of psychoactive and performance-enhancing substances is increasing in scope and complexity within a society that is encouraged to focus on pleasure and performance, and where alcohol is seen, comparatively, as the ‘known’ commodity and thus ‘unchallengeable’ (or at least acceptable).
- The debate regarding the positive health benefits of small doses of alcohol makes forthright messages for social marketing purposes awkward and less memorable, and where compromise is extracted in every effort to implement effective alcohol harm prevention measures.
- Intoxicated behaviour is regarded by many community members as ‘normal’ and by many young people as desirable.
- The significantly lower life expectancy of Indigenous people is intrinsically linked to layered aetiology, including historic and structural issues, social and service exclusion, patterns of alcohol consumption, where there is great sensitivity to progressing evidence-based approaches in some communities and where the consequent immobilisation and inaction from the broader society is the most ready response. There is a parallel dilemma of too much too fast, and the possibility of even greater broad dysfunction if not managed carefully.
- ‘Consumer’ is a complex concept in this field. It can include both alcohol consumers (who generally seek liberal access to their favoured drug) and service users who are very often extremely reluctant to seek ‘help’. Those who experience the ‘second-hand’ effects of harmful consumption of alcohol are a somewhat untapped group (including parents, who are the most identifiable group, but extending well beyond this sub-category).
- The extent and level of detail of data available precludes the evaluation of the outcomes of the incremental and planned changes to the levers that influence alcohol-consumption patterns, and patterns of related harm over the past decades, and similarly make effective modelling or assessment of the likely impact of future directed changes incomplete and thus less reliable.
- While there are few well-qualified specialists, there are many middle-managing health and welfare personnel implementing interventions that they sometimes have little faith in, and the concomitant low expectations of success with patients or clients can be self-fulfilling. In this context there is now good evidence of what works and we know that treatment, for example, can be successful. Although many will agree with this statement, few in the responding industry seem to believe it or lack the skills to utilise the most effective means to achieve it.
- The views of community members tend to be closer to the alcohol beverage industries’ preferred preventative approaches, such as advocating for measures including school-based alcohol education, the responsible service of alcohol training, parent support and information, and education programs for specific target populations on fetal alcohol effects.