Last drinks: regulating alcohol to prevent non-communicable diseases

Focussing on ‘harmful’ alcohol use means attention is diverted from reducing alcohol intake across the population. Visit Greenwich

Non-communicable diseases – Paula O'Brien looks at the what The Lancet NCD Action Group and the NCD Alliance name as one of the [priority interventions](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(\11)60393-0/fulltext) for mitigating the impact of NCDs: reduction in hazardous alcohol intake.

The Australian government has taken a tough stance against the tobacco industry and its deadly products. But despite the known harms of alcohol, it’s been slow to confront the nation’s drinking habit.

The government has a bill before Parliament mandating plain packaging of tobacco products as the latest of a series of steps to control tobacco consumption.

It has taken this action because tobacco is recognised as one of the leading causes of preventable death.

What about alcohol?

Like tobacco, alcohol is also a key risk factor for non-communicable diseases (NCDs), such as cardiovascular disease, cancer, diabetes and chronic lung disease.

What’s more, alcohol is the cause of many injuries and mental disorders, as well as social costs such as absenteeism from work and property damage.

In Australia alone, the total annual cost of alcohol misuse is estimated at $36 billion.

Yet, the government has done very little to deal with alcohol as a cause of disease and injury.

So what should it be doing?

This is an important question, as Australia and other countries gather this week at the United Nations in New York to decide what steps they need to take to prevent and control the four non-communicable diseases.

Countries have been moved to make this global effort because 68% of all deaths in 2008 were due to one of these four non-communicable diseases.

The draft declaration for the UN meeting states tackling the “harmful use of alcohol” must be a priority.

But talking about “harmful” alcohol consumption might throw Australia off course in its efforts to address alcohol as a risk factor for non-communicable diseases.

First, it suggests some alcohol use is not harmful even though there’s evidence this isn’t correct.

Cancer Council Australia maintains “any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption.”

If we accept this assessment of alcohol’s impact, it may mean we start to take a tougher approach to regulating alcohol.

We might start to think about alcohol as being much more similar to tobacco – in terms of its inherent potential to cause harm – than the alcohol industry would like us to believe.

Second, the notion of harmful alcohol use suggests that Australia should introduce programs focussing on people who drink in a harmful way, such as binge drinkers or alcoholics.

Programs giving attention to these sub-groups are important, but just as important are efforts to bring down the level of alcohol consumption across the whole population.

This is a challenging idea for many in a country like Australia, where food and alcohol go hand-in-hand at most social gatherings. And where people who abstain or who drink very little are often seen as “wowsers”.

Possible measures

If the real goal is to reduce alcohol consumption, then Australia should act to better regulate alcohol in three respects: pricing, warnings, and retailing.

These, and other areas for action, were identified by the National Preventative Health Taskforce as the way to create “a safer drinking culture for Australia”.

The pricing of alcohol clearly affects consumption patterns. When the Northern Territory imposed a levy on cask wine in the 1990s, quarterly per capita consumption of cask wine per person aged 15 years and over fell from 0.73 litres to 0.49 litres.

The tax system can be used to price alcohol to change the way we drink but Australia’s current taxation regime for alcoholic products is both complicated and flawed.

The system needs to be reformed to include: a minimum price for all alcoholic products (to prevent bargain basement discounting by retailers) and a tax based on volume of alcohol (so that high-alcohol products like wine don’t cost substantially less than low-alcohol beers).

Warnings are not currently required on alcoholic beverage containers or packaging in Australia. Alcohol is also largely exempt from basic nutrition and ingredient labelling requirements that apply to other foods.

Text and picture warnings, tested for their impact and rotated on a regular basis so consumers don’t become immune to their messages, can shape people’s knowledge, awareness, use and perceptions about alcohol.

The government is considering whether to introduce this style of mandatory warning regime. It should take this step and not opt for industry self-regulation.

But it’s not just the Federal government that has a role to play in reducing Australians’ alcohol consumption.

State governments are responsible for liquor licensing laws that regulate retailers of alcohol, such as bars, pubs, and cafes.

There are problems with under-enforcement of these laws in some states and territories. And many licensees are not meeting their obligations under the laws, such as not to serve persons who are intoxicated, because there are no real consequences for failing to comply.

Another problem is that previous changes to these laws have seen a proliferation in the number of licensed venues in many states.

In Victoria, this change was said to promise a more sophisticated, European-style drinking culture.

Rather, it’s now understood that increased availability of alcohol – more venues, longer opening hours – is connected with more alcohol-related problems.

Leading the way

Australia should make changes to the regulation of alcohol – in pricing, labelling and retailing – as a way of tackling at least this primary risk factor for non-communicable diseases.

And as a wealthy country, it should also look at what it can contribute to international efforts to combat non-communicable diseases – the greatest burden of deaths from non-communicable diseases is felt in poor- and middle-income countries.

Providing technical and financial assistance to such countries is one way to assist. At the very least, Australia should not stand in the way of evidence-based public health measures other countries want to introduce.

The United Nations meeting on non-communicable diseases this week will hopefully give Australia a push to take more decisive and effective action to deal with alcohol as a major cause of non-communicable diseases and other health problems.

This is the second part of our non-communicable diseases series. To read the other instalments, follow the links here:

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