tag:theconversation.com,2011:/us/topics/alcohol-policy-4992/articlesAlcohol policy – The Conversation2023-06-08T03:22:56Ztag:theconversation.com,2011:article/2069852023-06-08T03:22:56Z2023-06-08T03:22:56ZAustralia should follow Ireland’s lead and add stronger health warning labels to alcohol<figure><img src="https://images.theconversation.com/files/530553/original/file-20230607-15-bbcsrb.jpg?ixlib=rb-1.1.0&rect=8%2C172%2C5742%2C3656&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/beer-bottles-on-conveyor-belt-191643152">Shutterstock</a></span></figcaption></figure><p>From <a href="https://www.foodstandards.gov.au/industry/labelling/Documents/q-and-a-pwl-requirements-sep-2020.pdf">August 2023</a>, Australian beer, wine, spirits and pre-mixed drinks have to warn of the <a href="https://theconversation.com/australia-has-some-of-the-highest-rates-of-drinking-during-pregnancy-its-time-to-make-labelling-mandatory-142645">harms of drinking alcohol while pregnant</a>. But they don’t have to mention the other harms of alcohol for the wider population. </p>
<p>Ireland <a href="https://www.theguardian.com/world/2023/may/22/ireland-to-introduce-world-first-alcohol-health-labelling-policy">recently signed legislation</a> to introduce tougher alcohol warning labels, to warn about the risks of liver disease and fatal cancers from drinking alcohol. These will be in place from 2026. </p>
<p>Considering the ongoing efforts of the industry to undermine the introduction of <a href="https://www.sciencedirect.com/science/article/pii/S2214109X21005702">effective alcohol labelling</a> worldwide, the Irish example is an important victory for public health. </p>
<p>In Australia, it’s time to put consumer health and rights before commercial interests and warn people drinking and buying alcohol of the risks. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/trying-to-cut-back-on-alcohol-heres-what-works-179664">Trying to cut back on alcohol? Here's what works</a>
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</em>
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<h2>Educating consumers about the health risks</h2>
<p>Alcohol causes <a href="https://www.who.int/news-room/fact-sheets/detail/alcohol">more than 200 diseases, injuries and other health conditions</a>. </p>
<p>There is strong evidence that from the first drink, the risk of various cancers (of the breast, liver, colon, rectum, oropharynx, larynx and oesophagus) <a href="https://adf.org.au/insights/alcohol-cancer-risk/">increases</a>. This is <a href="https://www.cancervic.org.au/cancer-information/preventing-cancer/limit-alcohol/how-alcohol-causes-cancer">because</a>:</p>
<ul>
<li><p>ethanol (pure alcohol) and its toxic by-product acetaldehyde damages cells by binding with DNA, causing cells to replicate incorrectly</p></li>
<li><p>alcohol influences hormone levels, which can modify how cells grow and divide</p></li>
<li><p>direct tissue damage can occur, increasing the absorption of other cancer-causing substances.</p></li>
</ul>
<p>Alcohol use kills <a href="https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2021">more than four Australians</a> a day (the highest rate in the past decade) and results in <a href="https://ndri.curtin.edu.au/ndri/media/documents/publications/T302.pdf">A$182 million of avoidable costs</a> per day. </p>
<p>Yet only half of Australians know drinking alcohol <a href="https://adf.org.au/insights/alcohol-breast-cancer/">can cause cancer</a>. </p>
<p><a href="https://www.jsad.com/doi/10.15288/jsad.2020.81.249">Research shows</a> mandatory health labelling is an important way to increase awareness and should form part of a comprehensive <a href="https://fdslive.oup.com/www.oup.com/academic/pdf/openaccess/9780192844484.pdf">alcohol control strategy</a>. </p>
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<img alt="Person pours wine into a glass at a lunch" src="https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530732/original/file-20230607-17-hl3pvs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people are unaware of the link between alcohol and cancer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/making-sure-glasses-stay-full-shot-2151108503">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Countering industry influence</h2>
<p>The alcohol industry currently uses alcohol labels and packaging as a marketing and branding tool. Alcohol warning labels help counter these marketing messages.</p>
<p>Alcohol industry interests have so far succeeded in exempting alcoholic drinks from the usual <a href="https://fdslive.oup.com/www.oup.com/academic/pdf/openaccess/9780192844484.pdf">consumer information requirements</a>. Under the <a href="https://www.fao.org/fao-who-codexalimentarius/en/">international labelling guidelines</a>, all processed foods must have all ingredients listed on the label. But alcohol industry interests have so far succeeded in these rules <a href="https://movendi.ngo/wp-content/uploads/2021/08/Hepworth-et-al-2020.pdf">not being applied to alcoholic beverages</a>. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/no-more-than-10-standard-drinks-a-week-or-4-on-any-day-new-guidelines-urge-aussies-to-go-easy-on-the-booze-151595">No more than 10 standard drinks a week, or 4 on any day: new guidelines urge Aussies to go easy on the booze</a>
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<p>In Australia, the alcohol content and number of standard drinks must be <a href="https://www.foodstandards.gov.au/consumer/labelling/Pages/Labelling-of-alcoholic-beverages.aspx">listed on the product’s label</a>. However, there is no requirement, as for other foods and drinks, that ingredients (except for certain allergens such as milk or gluten) and nutritional information (energy, carbohydrates, and so on) be listed. </p>
<p>Aside from warnings to pregnant women to abstain from alcohol, there is no provision for consumer information about the risks of alcohol consumption on alcohol packaging. Yet such warnings are required for other hazardous substances taken into the body, such as tobacco.</p>
<h2>How Ireland is leading the charge</h2>
<p>Ireland is leading the world with its alcohol labelling. From 2026, drinks containing alcohol will have to inform consumers about the specific risks of liver disease and fatal cancers. </p>
<p>Labels will also have to notify buyers of the alcohol risks to pregnancy, the calorie content of the beverage, and the number of grams of alcohol it contains. </p>
<figure class="align-center ">
<img alt="People walk past a pub in Ireland" src="https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530734/original/file-20230607-16366-8nixs9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health warning labels will be mandatory in Ireland from 2026.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/dublin-ireland-july-11-2021-outdoor-2007076256">Shutterstock</a></span>
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</figure>
<p>The new labelling move <a href="https://www.cancer.ie/about-us/news/irish-cancer-society-statement-on-the-introduction-of-health-warning-labels-on-alcohol-products">demonstrates</a> the government has prioritised reducing alcohol-related disease and has widespread support. A recent <a href="https://academic.oup.com/eurpub/article/33/2/323/7067991">household survey</a> in Ireland found 81.9% of the more than 1,000 participants supported the introduction of health warning labels on alcohol.</p>
<h2>Barriers to overcome in Australia</h2>
<p>In 2020, in the face of intense pressure from industry groups, the Australian government decided on new labelling requirements for alcoholic beverages, but only to warn about the <a href="https://theconversation.com/australia-has-some-of-the-highest-rates-of-drinking-during-pregnancy-its-time-to-make-labelling-mandatory-142645">risks of drinking during pregnancy</a>. From a public health point of view, this was a mediocre compromise.</p>
<p>Australia is currently considering introducing energy content (kilojoule) labelling on alcoholic beverages. This would be a positive step and but it is as far as Australia seems willing to go for now. There are no plans for Australia to follow Ireland’s lead. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-reduce-harm-from-alcohol-we-need-indigenous-led-responses-204030">To reduce harm from alcohol, we need Indigenous-led responses</a>
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<p>Some countries seem to be <a href="https://www.ibec.ie/drinksireland/news-insights-and-events/news/2023/05/16/strong-international-opposition-to-irelands-alcohol-labelling-proposals">gearing up</a> to use the World Trade Organization’s processes to oppose Ireland’s new labels. </p>
<p>Australia <a href="https://pubmed.ncbi.nlm.nih.gov/22716074/">previously opposed</a> enhanced alcohol warning labels Thailand proposed, at the same time Australia was seeking international support for its tobacco plain packaging laws. This time, Australia should prioritise the public’s health over commercial interests and support Ireland’s alcohol warning messages in the World Trade Organization.</p><img src="https://counter.theconversation.com/content/206985/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In the last five years, Emmanuel Kuntsche has received funding from La Trobe University, the Australian Research Council, the Victorian Health Promotion Foundation, the University of Bayreuth Centre of International Excellence "Alexander von Humboldt", the Veski Foundation, the Foundation for Alcohol Research and Education, the Swiss National Science Foundation, Queensland Mental Health Commission, New South Wales Department of Family and Community Services, and the Netherlands Organisation for Scientific Research.</span></em></p><p class="fine-print"><em><span>Paula O'Brien has received funding from the University of Melbourne, the Foundation for Alcohol Research and Education, the Victorian Health Promotion Foundation, and the National Health and Medical Research Council. Paula is employed by the University of Melbourne and the Victorian Government, The views expressed here do not reflect those of either of her employers. </span></em></p><p class="fine-print"><em><span>Robin Room has received funding from the Australian Research Council; the NHMRC; the US National Institutes of Health; the Centre for Addiction and Mental Health in Ontario, Canada; Victoria, New South Wales and Western Australia state agencies; the World Health Organization; Stockholm University; La Trobe University; and the California Public Health Institute. </span></em></p>Ireland recently passed legislation to introduce clearer alcohol labels to warn about the risks of liver disease and fatal cancers from drinking alcohol. Australia should do the same.Emmanuel Kuntsche, Director of the Centre for Alcohol Policy Research, La Trobe UniversityPaula O'Brien, Associate Professor in Faculty of Law, The University of MelbourneRobin Room, Professor, Centre for Alcohol Policy Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2040302023-05-18T20:01:24Z2023-05-18T20:01:24ZTo reduce harm from alcohol, we need Indigenous-led responses<figure><img src="https://images.theconversation.com/files/526666/original/file-20230517-15-4kdxgg.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5149%2C3438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/loving-african-american-foster-care-parent-1653226690">Shutterstock</a></span></figcaption></figure><p>Alcohol management in Aboriginal and Torres Strait Islander communities has been a deeply divisive issue, as seen recently in Alice Springs in the Northern Territory. </p>
<p><a href="https://www.theguardian.com/australia-news/2023/feb/04/we-have-to-come-together-alcohol-bans-alone-wont-fix-alice-springs-problems">Indigenous leaders called for</a> and welcomed emergency restrictions on the sale of alcohol from January 24 2023. </p>
<p>This approach resulted in an immediate decrease in alcohol-related harms, including family violence and emergency department presentations. </p>
<p>But Elders in Alice Springs <a href="https://www.theguardian.com/australia-news/2023/feb/04/we-have-to-come-together-alcohol-bans-alone-wont-fix-alice-springs-problems">have warned</a> these restrictions “should not let governments off the hook” from addressing the underlying social determinants of alcohol-related harm. </p>
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<p>This reflects a long-standing community concern that prohibition alone does nothing to address issues such as intergenerational trauma, poverty, housing, education, unemployment, access to alternative activities, access to adequate health care and racism. </p>
<p>Critics of government-imposed alcohol management argue the allocation of resourcing is <a href="https://newsevents.med.unsw.edu.au/sites/default/files/newsevents/news/Drug%20Budgets%20Mono%2024%20FINAL.pdf">too strongly weighted</a> toward supply reduction – and especially law enforcement – with inadequate funding of demand-reduction and harm-reduction strategies. </p>
<p>Our commentary, published this week in the <a href="https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(23)00092-5/fulltext">Lancet Western Pacific Regional Health</a>, highlights the need for culturally responsive approaches to alcohol in remote communities. Reductions in alcohol use are linked with the strength of culture, empowerment and community. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/want-to-improve-the-nations-health-start-by-reducing-inequalities-and-improving-living-conditions-64434">Want to improve the nation's health? Start by reducing inequalities and improving living conditions</a>
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<h2>Incorporating Aboriginal culture</h2>
<p>Australia’s <a href="https://www.health.gov.au/sites/default/files/national-drug-strategy-2017-2026.pdf">National Drug Strategy</a> outlines three ways to address alcohol-related harm, by reducing:</p>
<ol>
<li><p>demand – preventing people taking up drinking or delaying starting, providing education, and offering treatment services</p></li>
<li><p>supply – reducing alcohol availability and greater policing </p></li>
<li><p>harm – encouraging responsible service of alcohol and providing services such as sobering-up shelters that reduce harm for people who are intoxicated. </p></li>
</ol>
<p>But development and implementation of these strategies has overlooked culturally responsive approaches to meet the needs of Aboriginal and Torres Strait Islander peoples. One such approach is the “interplay wellbeing framework”. </p>
<p>The <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-017-0563-5">interplay wellbeing framework</a> is based on Indigenous concepts of wellbeing and positions risky alcohol use in the context of systemic inequities across all the social determinants of health, including housing, education, employment and wealth. </p>
<p>Such approaches show how government and communities can work together in a shared and respectful space to progress the National Drug Strategy.</p>
<figure class="align-center ">
<img alt="Alice Springs town shot" src="https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526697/original/file-20230517-29-a10oqt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s important to look at risky drinking in the context of all the social determinants of health, including housing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/wide-image-alice-springs-nearby-hill-1655776171">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Non-drinkers and risky drinkers</h2>
<p>Overall, Indigenous Australians are <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/priority-populations/aboriginal-and-torres-strait-islander-people#Lifetime%20risk">more likely</a> to be non-drinkers (15.4%) compared to non-Indigenous people (7.9%). </p>
<p>But alcohol-related harm has been very destructive for many Indigenous communities. In 2018, alcohol <a href="https://www.aihw.gov.au/getmedia/1656f783-5d69-4c39-8521-9b42a59717d6/aihw-bod-32.pdf.aspx?inline=true">accounted for 10.5%</a> of the total burden of disease and injury for Indigenous Australians. This harm is preventable.</p>
<p>Risky levels of alcohol use for Indigenous Australians are often due to the ongoing <a href="https://link.springer.com/article/10.1007/s12546-016-9159-y">negative impacts of colonisation</a>. This includes intergenerational trauma, which manifests as <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/ajs4.109">poor psychological wellbeing</a> and is sometimes interlinked with risky alcohol consumption. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/life-changing-what-50-years-of-community-controlled-housing-at-yumba-meta-tells-us-about-home-and-health-203907">'Life changing' – what 50 years of community-controlled housing at Yumba-Meta tells us about home and health</a>
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<h2>How alcohol harms</h2>
<p>According to the <a href="https://www.health.gov.au/resources/publications/national-alcohol-strategy-2019-2028?language=en">National Alcohol Strategy 2019–2028</a>, many people who drink at risky levels don’t consider themselves as heavy drinkers. Nor do they identify alcohol use as a <a href="https://www.health.gov.au/sites/default/files/documents/2020/11/national-alcohol-strategy-2019-2028.pdf">cause of</a> cancer, heart disease, stroke, liver disease and gastrointestinal disorders. </p>
<p><a href="https://healthbulletin.org.au/wp-content/uploads/2018/02/Alcohol-Review-Bulletin-2018.pdf">Social harms</a> related to alcohol use include physical assaults, injuries, child neglect and abuse, suicidal thoughts, partner violence and crime. Lives are lost prematurely to family violence, homicide, suicide and accidents. </p>
<p>The costs of alcohol-related social harm are estimated at <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/impacts/economic-impacts">A$66.8 billion dollars</a> in Australia from 2017–2018.</p>
<h2>Alcohol industry is a barrier to reducing harms</h2>
<p>The alcohol industry uses <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998576/">excessive advertising</a> to promote alcohol as a safe product. The DrinkWise program, for instance, is <a href="https://journals.sagepub.com/doi/abs/10.1177/1329878X16651136">funded by the alcohol industry</a>. It seeks to <a href="https://www.tandfonline.com/doi/abs/10.1080/09581596.2010.529424">blame the consumer</a> as an irresponsible drinker. This reduces the need for the alcohol industry to take responsibility for its harmful product. </p>
<p>Harm-minimisation strategies need the genuine support of the alcohol industry if they are to effectively reduce alcohol use and respond to the impact of <a href="https://journals.sagepub.com/doi/10.1177/1077801217742756">serious injury, violence,</a> illness and disease related to alcohol use. </p>
<p>But to date, the alcohol industry has capitalised on the challenges communities face. It provides easy access <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440301/">alcohol outlets</a> in areas of lower socioeconomic status. This exploitative practice increases the risk of alcohol-related harm to people living in these areas.</p>
<figure class="align-center ">
<img alt="Alcohol shop shelves" src="https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526725/original/file-20230517-29-2g9fwb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The alcohol industry capitalises on the challenges of low socioeconomic communities.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/blurred-image-wine-shelves-display-supermarket-485979961">Shutterstock</a></span>
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<h2>Healing through culture</h2>
<p><a href="https://healingfoundation.org.au/app/uploads/2017/02/Aboriginal-and-Torres-Strait-Islander-Healing-Programs-A-Literature-Review.pdf">Indigenous-led approaches</a> to alcohol-related harm promote holistic wellbeing and draw on the healing qualities that Aboriginal culture offers. This is an effective way of alleviating intergenerational trauma and interrelated alcohol harm. </p>
<p>Community-level healing- and trauma-informed approaches can overcome barriers <a href="https://www.lowitja.org.au/content/Image/Lowitja_PJH_170521_D10.pdf">such as racism</a> that prevent people accessing health and social support systems. </p>
<p>However, they need to be adequately funded and resourced. Culturally responsive healing approaches need to be community-, evidence- and theory-informed and inclusive of both traditional healing and western methodologies.</p>
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<strong>
Read more:
<a href="https://theconversation.com/treatment-for-drug-and-alcohol-misuse-should-involve-families-and-communities-197536">Treatment for drug and alcohol misuse should involve families and communities</a>
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<h2>How the model can work</h2>
<p>The value of culture on Country has been demonstrated through a healing model of care for promoting effective rehabilitation. </p>
<p><a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-017-0135-0">Orana Haven Drug and Alcohol Residential Rehabilitation Service</a> is a three-month program that combines 12-step treatment with residential treatment facility focusing on:</p>
<ul>
<li>healing through culture and Country</li>
<li>emotional safety and relationships</li>
<li>strengthening life skills </li>
<li>improved wellbeing. </li>
</ul>
<p>Information collected <a href="https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-017-0135-0">through semi-structured interviews</a> found that embedding culture and being on Country enhanced participants’ feelings of connection, identity and spirituality.</p>
<h2>Indigenous leadership and self-determination</h2>
<p><a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00813-6">Culturally responsive approaches</a> require <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315252414-3/indigenist-research-aboriginal-australia-lester-irabinna-rigney">Indigenous leadership</a> and culture to counter the harms associated with alcohol use. </p>
<p>This ensures the healing process can privilege resistance, resilience, interpersonal relationships and strengths. Incorporating a holistic view of community and culture can facilitate mutually respectful collaboration and <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">self-determination</a> – and lead to sustained change. </p>
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<strong>
Read more:
<a href="https://theconversation.com/new-funds-will-tackle-indigenous-smoking-but-heres-what-else-we-know-works-for-quit-campaigns-205016">New funds will tackle Indigenous smoking. But here's what else we know works for quit campaigns</a>
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<img src="https://counter.theconversation.com/content/204030/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lorelle Holland receives funding from the National Health and Medical Research Council (NHMRC) Post Graduate Scholarship (PGS) and The Australian Academy of Science Douglas and Lola Douglas Scholarship in Medical Science. </span></em></p><p class="fine-print"><em><span>Andrew Smirnov, Natasha Reid, Nicole Hewlett, and Tylissa Elisara do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>For remote Indigenous communities, reductions in alcohol use are linked with the strength of culture, empowerment and community.Lorelle Holland, PhD Candidate, The University of QueenslandAndrew Smirnov, Senior Lecturer, The University of QueenslandNatasha Reid, Research Fellow, The University of QueenslandNicole Hewlett, Project Manager, The University of QueenslandTylissa Elisara, Senior Aboriginal and Torres Strait Islander Research Officer and Tutor, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2027312023-05-05T01:22:54Z2023-05-05T01:22:54ZAfter decades of trying, how can we deliver more effective alcohol regulation in the NT?<figure><img src="https://images.theconversation.com/files/524261/original/file-20230504-22-xyvydo.jpg?ixlib=rb-1.1.0&rect=5%2C29%2C3677%2C2691&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Kristen Gelineau/AP</span></span></figcaption></figure><p>The Northern Territory continues to report the <a href="https://nt.gov.au/wellbeing/health-conditions-treatments/alcohol-drugs-and-your-body/alcohol-and-your-health">highest levels of alcohol consumption</a> and harm in Australia, despite <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11957-5">decades of reform</a>. </p>
<p>As we’ve seen over the years, there’s been a concerning link between alcohol consumption and domestic violence, crime and antisocial behaviour. When federal laws restricting access to alcohol <a href="https://www.abc.net.au/news/2022-12-23/nt-chief-minister-blames-former-federal-government-alcohol-harm/101801900">lapsed</a> last year, it led to a surge in crime that <a href="https://nacchocommunique.com/wp-content/uploads/2022/05/Media-Release-CAAC-concerns-re-end-APAs-3.5.22.pdf">many had warned about</a>. The alcohol ban was <a href="https://www.nytimes.com/2023/03/12/world/australia/alice-springs-alcohol.html">swiftly reinstated</a>.</p>
<p>But NT-based and Indigenous communities have long argued that banning alcohol is only part of the solution to a complex problem. The challenge is to find a more long-term, sustainable solution to alcohol consumption that incorporates a mix of policy, legislative, industry and community strategies.</p>
<p>Here are three possible strategies for the NT:</p>
<h2>1) Controlling supply and distribution</h2>
<p>The simplest way governments can reduce alcohol-related harm is to <a href="https://www.cdc.gov/alcohol/fact-sheets/prevention.htm">decrease supply and access</a> to alcohol. </p>
<p>The NT has done this by regulating alcohol outlet availability and density in cities, limiting the hours and days when alcohol can be sold, and enhancing enforcement of laws restricting or banning alcohol. The <a href="https://www.abc.net.au/news/2021-04-30/dan-murphys-darwin-woolworths-nt/100105088">public anger over the planned opening of a Dan Murphy’s</a> near three dry communities in 2021 indicates that Territorians understand the link between supply and harm. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/just-ask-us-come-and-see-us-aboriginal-young-people-in-the-northern-territory-must-be-listened-to-not-punished-199297">'Just ask us, come and see us'. Aboriginal young people in the Northern Territory must be listened to, not punished</a>
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<p>There is also compelling evidence that restrictions on Good Friday and Christmas Day – which are common throughout Australia - are <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395915003497">associated with a decreased incidence of alcohol-related harm</a>. </p>
<p>In addition, the NT government has recently announced plans to buy back liquor licences, which <a href="https://fare.org.au/community-organisations-welcome-nt-governments-voluntary-buy-back-of-grocery-store-liquor-licences/">has been welcomed</a> by health, First Nations and other community groups. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1641285820161335296"}"></div></p>
<p>We can also learn from other countries how to take a more comprehensive approach. </p>
<p>In Norway, for instance, the government controls production and distribution through <a href="https://www.vinmonopolet.no/social-responsibility">a state-owned monopoly</a> called Vinmonopolet, which decides where outlets will be located, the hours of operation and stock. </p>
<p>These measures are combined with targeted and adequately resourced alcohol-related public health campaigns, such as a recent one aimed at <a href="https://www.vinmonopolet.no/content/om-oss/pressemelding/2021/langingskampanje">reducing the supply of alcohol to minors</a>.</p>
<h2>2) Changing purchasing and consuming behaviour</h2>
<p>The NT was the first jurisdiction to introduce a <a href="https://industry.nt.gov.au/publications/business/policies/floor-price">minimum unit pricing scheme</a>, a policy that sets a minimum price at which alcohol can be sold per unit of alcohol, <a href="https://industry.nt.gov.au/publications/business/policies/floor-price">currently at $1.30</a>. This has proven <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.13055">effective in reducing alcohol consumption</a> – especially for wine products.</p>
<p>However, <a href="https://www.sciencedirect.com/science/article/pii/S0277953621000228">recent research from the UK</a> shows that when higher-percentage alcohol products go on sale (which happens more frequently than for lower- or zero-percentage alcohol products), minimum unit pricing can be less effective. </p>
<p>More broadly, there have been calls to <a href="https://www.sciencedirect.com/science/article/abs/pii/S095539591500016X">increase regulations on retail alcohol outlets</a>. Currently, alcohol regulation is more extensive for hotels, pubs and clubs than retail outlets. </p>
<p>As a result, consumers may be motivated by the cheaper cost and reduced scrutiny when buying alcohol from a bottle shop. This dynamic can also facilitate risky patterns of consumption, such as <a href="https://link.springer.com/article/10.1007/s10865-014-9573-6">pre-drinking</a>.</p>
<p>Another way of changing behaviour is through health messaging. Most alcohol labelling is covered under Australia’s food standards code – <a href="https://www.legislation.gov.au/Details/F2020C00723">with a strong pregnancy focus</a>. </p>
<p>However, a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0276189">recently published study</a> found that using both words and images on health warning labels can better informs people about the health risks associated with alcohol (including cancer). This would be <a href="https://theconversation.com/cheers-to-health-warning-labels-for-alcoholic-drinks-2891">similar</a> to the warnings used on tobacco labels.</p>
<p>These enhanced warning labels also lead people to form stronger intentions to reduce consumption, compared to text or photograph warnings alone. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/alcohol-bans-and-law-and-order-responses-to-crime-in-alice-springs-havent-worked-in-the-past-and-wont-work-now-198427">Alcohol bans and law and order responses to crime in Alice Springs haven't worked in the past, and won't work now</a>
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</em>
</p>
<hr>
<h2>3) Empowering community-led approaches</h2>
<p>Another way governments and communities can manage alcohol-related harm is to promote drink-free activities and one-month alcohol abstinence campaigns, such as “dry July”. These types of campaigns have <a href="https://academic.oup.com/alcalc/article/55/4/433/5835641">lasting positive effects</a> on health, wellbeing and maintaining control over drinking. </p>
<p>Some Darwin locals have also formed a <a href="https://www.abc.net.au/news/2020-07-26/socially-sober-club-forms-amid-coronavirus-pandemic-in-darwin-nt/12425060">social sober club</a>, where socialisation without alcohol is emphasised.</p>
<p>However, such efforts often go against <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2020.1820491">entrenched drinking norms</a> in Australia. </p>
<p>And many people drink not for socialisation, but to cope with <a href="https://theconversation.com/coronavirus-its-tempting-to-drink-your-worries-away-but-there-are-healthier-ways-to-manage-stress-and-keep-your-drinking-in-check-134669?gclid=Cj0KCQjwla-hBhD7ARIsAM9tQKvwbCU3Wl__5Uk81SdSoNuN799TwQAFawcAB1FTF5bQtPQEhVhyTosaAqjmEALw_wcB">broader social problems and stressors</a>. Issues such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609661/">unemployment</a>, <a href="http://www.naaja.org.au/wp-content/uploads/2014/05/NAAJA-Alcohol-Review-Submission.pdf">housing stress</a> and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12448">mental health</a> are linked to alcohol use, which are <a href="https://www.sciencedirect.com/science/article/pii/S2468266721001596">especially relevant</a> in regional and remote areas in the NT. </p>
<p>Similarly, the continued effects of colonisation and intergenerational trauma experienced by First Nations people necessitate an approach that <a href="https://link.springer.com/article/10.1186/s12961-022-00813-6">emphasises the right to self-determination</a> in addressing alcohol-related issues. </p>
<p>We need to provide adequate resources and support to help communities alleviate these sources of stress and trauma, which will hopefully have an impact in reducing alcohol-related harm. </p>
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<h2>A way forward</h2>
<p>Ultimately, effective reform will require deep reflection on what alcohol means to us as individuals, and as a society. </p>
<p>In the NT, we need a <a href="https://theconversation.com/the-northern-territory-is-about-to-ease-alcohol-restrictions-but-more-consultation-from-first-nations-community-members-is-needed-first-184844">consultative, co-design process</a> that brings together the territory and Commonwealth governments, representatives from the alcohol industry, the alcohol rehabilitation community, tourism providers, pub owners and leaders from Indigenous communities. </p>
<p>By learning from the successes and failures elsewhere, we can deliver a tailored approach for the NT that will have a better chance of success in the long term.</p><img src="https://counter.theconversation.com/content/202731/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Restricting access to alcohol has proven successful, but it’s only part of the solution. There are other strategies that can lead to a longer-term, more sustainable approach.Elizabeth Crawford Spencer, Professor of Law, Charles Darwin UniversityGuzyal Hill, Senior Lecturer, Charles Darwin UniversityKim M Caudwell, Lecturer - Psychology | Chair, Researchers in Behavioural Addictions, Alcohol and Drugs (BAAD), Charles Darwin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1996732023-02-16T01:36:23Z2023-02-16T01:36:23ZFetal alcohol spectrum disorder is tragic but not new. How should fresh funding tackle it in the NT?<figure><img src="https://images.theconversation.com/files/510246/original/file-20230215-16-crz0to.jpg?ixlib=rb-1.1.0&rect=45%2C15%2C5051%2C3400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.au/detail/photo/pregnant-woman-holding-glass-of-red-wine-royalty-free-image/167457231?phrase=alcohol%20pregnancy&adppopup=true">Getty/Jamie Grill</a></span></figcaption></figure><p>In recent weeks, the Australian and Northern Territory governments <a href="https://theconversation.com/alcohol-bans-return-to-nt-indigenous-communities-with-250-million-federal-assistance-199258">announced</a> new funding to address the longstanding, much-publicised challenges facing Central Australia.</p>
<p>The promised A$250 million adds to an earlier commitment of $48 million and aims to tackle problems faced by residents in Alice Springs and Central Australia from many angles, including strategies to reduce alcohol-related violence, harms and crime. </p>
<p>Included is a <a href="https://cmc.nt.gov.au/news/2023/$298-million-landmark-package-for-central-australia">commitment</a> to “improve the response to fetal alcohol spectrum disorder (FASD) by the health and justice sectors”.</p>
<p>This is an important goal, but it is a big ask – the problems are complex and they are not new. FASD often goes undiagnosed and can cause severe and lifelong problems.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/alcohol-warning-labels-need-to-inform-women-of-the-true-harms-of-drinking-during-pregnancy-134049">Alcohol warning labels need to inform women of the true harms of drinking during pregnancy</a>
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<h2>The heart of many problems</h2>
<p>Alcohol is behind or has been linked to many of the current problems in Central Australia, including the recent wave of crime and violence. Some believe this <a href="https://www.sbs.com.au/news/article/a-crime-wave-has-sparked-emergency-measures-in-alice-springs-heres-whats-going-on/3qcqvrkip">followed the relaxation</a> in July 2022 of the <a href="https://www.dss.gov.au/sites/default/files/documents/09_2012/stronger-futures-booklet-jul2012.pdf">Stronger Futures</a> laws that limited access to alcohol in many NT communities for more than a decade. </p>
<p>In communities where alcohol use is high, a focus on <a href="https://www.cdc.gov/ncbddd/fasd/facts.html#:%7E:text=Fetal%20alcohol%20spectrum%20disorders%20(FASDs)%20are%20a%20group%20of%20conditions,a%20mix%20of%20these%20problems.">FASD</a> is warranted. In Alice Springs, communities are <a href="https://www.abc.net.au/news/2023-02-04/fasd-fetal-alcohol-aboriginal-youth-crime-alice-springs/101854566">calling for action</a>.</p>
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<h2>Alcohol and pregnancy</h2>
<p>FASD is a <a href="https://www.fasdhub.org.au/fasd-information/assessment-and-diagnosis/guide-to-diagnosis/">condition</a> that affects people exposed to alcohol before birth and causes problems with motor skills, behaviour or learning, or a mix of these. </p>
<p>FASD is a result of alcohol’s ability to cross the placenta, so maternal and fetal blood alcohol concentrations rapidly reach the same level. Prenatal exposure to alcohol may disrupt development of the brain (neurodevelopment) and other organs in the unborn child. People born with FASD can <a href="https://pubmed.ncbi.nlm.nih.gov/26777270/">have</a> severe neurodevelopmental problems that may be accompanied by birth defects and have lifelong ramifications. </p>
<p>Worldwide, rates of FASD in the general population are <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2649225">estimated</a> at 1–5%, but we lack data in the general Australian population. Internationally, several identifiable groups are at <a href="https://pubmed.ncbi.nlm.nih.gov/30831001/">high risk</a> of FASD – children in foster and adoptive care, in orphanages, mental health facilities, juvenile justice, and some Indigenous groups. </p>
<p>Consistent with these data, <a href="https://pubmed.ncbi.nlm.nih.gov/28499185/">high rates</a> of FASD have been recorded in remote Australia (one in five) and in <a href="https://bmjopen.bmj.com/content/8/2/e019605">juvenile detention</a> (one in three). </p>
<p>But FASD is not selective. It <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2649225">occurs</a> across all socioeconomic levels and racial groups in society. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/factcheck-qanda-does-australia-have-some-of-the-highest-rates-per-capita-of-fetal-alcohol-syndrome-in-the-world-57736">FactCheck Q&A: does Australia have some of the highest rates per capita of fetal alcohol syndrome in the world?</a>
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<h2>Often underdiagnosed</h2>
<p>Alcohol use in pregnancy is common throughout Australia. In cohort studies from our major cities, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3354-9">about 60%</a> of pregnant women report drinking alcohol – often before realising they are pregnant. A pattern of <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12232">high-risk drinking</a> is reported in some remote communities. However, the Australian household survey suggests more educated, more affluent mothers are <a href="https://ada.edu.au/national-drug-strategy-household-survey-2019-5/">more likely to drink</a> throughout their pregnancy.</p>
<p>FASD has significant <a href="https://pubmed.ncbi.nlm.nih.gov/31628757/">economic costs</a> – through its impact on health, education, out-of-home care and justice systems. However, its <a href="https://doi.org/10.1093/oxfordhb/9780199935291.013.78">social impacts</a> are immeasurable.</p>
<p>Children born with FASD are <a href="https://pubmed.ncbi.nlm.nih.gov/26777270/">often slow</a> to develop the social skills and language, motor skills and attention, academic skills and impulse control that would otherwise help them achieve at school and contribute in their community.</p>
<p>They may strive to keep up with their peers but are often easily led and may be unable to distinguish right from wrong. With <a href="https://learningwithfasd.org.au/classroom-strategies/">good support</a> at home and school, children with FASD can thrive. Without it, children and young people <a href="https://bmjopen.bmj.com/content/8/2/e019605">may</a> drop out of school and some fall into a pattern of crime. </p>
<p>It is telling that many incarcerated children and youth have <a href="https://bmjopen.bmj.com/content/8/2/e019605">never had</a> a thorough medical and psychosocial assessment, and many have undiagnosed FASD. So, their strengths and needs have too long gone unrecognised and they have missed opportunities for vital early treatment. </p>
<p>The challenges of FASD are <a href="https://edmontonfetalalcoholnetwork.files.wordpress.com/2018/12/fasd_2nd_ed-2018.pdf">compounded</a> by early-life trauma. We must revert from a punitive to a therapeutic approach for these vulnerable children.</p>
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<figcaption><span class="caption">Every moment matters in your pregnancy.</span></figcaption>
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<h2>The focus so far</h2>
<p>For more than a decade, the Australian government has partnered with clinicians, researchers and others and has made a major contribution to addressing FASD.</p>
<p>After two <a href="https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=spla/fasd/report.htm">national</a> <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/024357/toc_pdf/Effectiveapproachestoprevention,diagnosisandsupportforFetalAlcoholSpectrumDisorder.pdf;fileType=application%2Fpdf">inquiries</a>, we have a <a href="https://aodknowledgecentre.ecu.edu.au/healthinfonet/getContent.php?linkid=613544&title=National+Fetal+Alcohol+Spectrum+Disorder+%28FASD%29+Strategic+Action+Plan+2018-2028&contentid=35916_1">National Strategic Action Plan for FASD</a> and a national <a href="https://www.fasdhub.org.au/fasd-information/about-us/governance/">FASD Advisory Group</a> to monitor implementation of its recommendations. The <a href="https://www.fasdhub.org.au/fasd-information/assessment-and-diagnosis/guide-to-diagnosis/">Australian Guide to the Diagnosis of FASD</a> has bolstered clinicians’ skills, and the <a href="https://www.fasdhub.org.au">FASD Hub website</a> is a valuable resource. </p>
<p>Local resources for <a href="https://learningwithfasd.org.au/">primary</a> and <a href="https://www.nofasd.org.au/service-providers/education/through-different-eyes/">early childhood educators</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/13218719.2020.1780643?journalCode=tppl20">justice professionals</a>, funded <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/372-million-for-foetal-alcohol-spectrum-disorder-support-and-awarenes">multidisciplinary clinics</a>, the <a href="https://www.nofasd.org.au/contact-us/">National Organisation for FASD</a> website and helpline, a FASD <a href="https://fasdregistry.org.au/">registry</a> to monitor trends, and a vibrant <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1754.2003.00281.x">research network</a> have collectively raised awareness and improved diagnosis and support for people living with FASD and their families.</p>
<p>However, FASD is still inadequately managed within the health and justice sectors in remote regions, including the NT, which are overwhelmed by the needs. </p>
<h2>What the new funds could achieve</h2>
<p>We need a systematic approach to identify all children with developmental and learning vulnerability and offer them treatment at the earliest possible opportunity. In any such child, we need to consider FASD and explore whether there might be a history of prenatal alcohol exposure. </p>
<p>We must increase our screening and diagnostic capacity – not only in specialised services, but in the places of first contact with health services: primary care, midwifery and community paediatric practices, in remote regions.</p>
<p>We also need trained professionals, available locally, to assist families to join the National Disability Insurance Scheme. But there is also a need for <a href="https://theconversation.com/use-it-or-lose-it-getting-ndis-funding-is-only-half-the-battle-for-participants-188530">accessible services</a>, including <a href="https://cdn.shopify.com/s/files/1/1613/1919/files/MWRC_NDIS_Report_2021.pdf?v=1649468403">where remote families live</a>, so they can spend the support funds they are allocated.</p>
<p>The need for culturally appropriate and trauma-informed services to support people with FASD and their families goes without saying. Training of more Aboriginal and Torres Strait Islander health workers is essential.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1557667894296997888"}"></div></p>
<h2>Prioritise prevention</h2>
<p>Prevention efforts must be <a href="https://www.phrp.com.au/issues/march-2015-volume-25-issue-2/fetal-alcohol-spectrum-disorders-in-australia-the-future-is-prevention/">at the fore</a> in the effort to address FASD. We must <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-584">understand</a> that disadvantage and historic trauma, addiction, and partner drinking and violence are among the most <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.13330">common drivers</a> of alcohol use in pregnancy, and shift the blame away from women. In turn, the drivers of disadvantage – inadequate housing, education and vocational opportunities, transport and access to good-quality education and health care – must be addressed. Australians must also relinquish their tolerant attitudes to binge drinking. </p>
<p>From July 2023, <a href="https://www.foodstandards.gov.au/industry/labelling/Pages/pregnancy-warning-labels-downloadable-files.aspx">pregnancy warning labels</a> will feature on all Australian alcohol products. Importantly, Australia’s first public awareness campaign – <a href="https://everymomentmatters.org.au/about/">Every Moment Matters</a> – is currently being rolled out nationally. It includes resources for the public, women at risk, and health professionals. And the <a href="https://twitter.com/catgiorgi/status/1625706451481268224">Strong Born</a> resources will be launched next week for Aboriginal and Torres Strait families and service providers.</p>
<p>All these efforts must be underpinned by legislation and strategies proven to reduce alcohol harms. Although unpopular, we must continue to push for restrictions on advertising and promotion of alcohol, appropriate taxation and pricing, and limit-setting on the number and opening hours of liquor outlets, especially in our most vulnerable communities.</p><img src="https://counter.theconversation.com/content/199673/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Elliott receives grant funding from the NHMRC, MRFF, the Ian Potter Foundation, Healthway WA, the NDIS, the Australian Government, NSW Health. She is on a number of committees related FASD including government, NGO and academic committees. </span></em></p>Fetal alcohol spectrum disorder can cause problems with movement, behaviour or learning or a mix of these. In communities where alcohol use is high, a focus on FASD is warranted.Elizabeth Elliott, Professor of Paediatrics & Child Health and Director of the Australian Paediatric Surveillance Unit, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1983792023-01-25T22:41:55Z2023-01-25T22:41:55ZCanada’s new drinking guidelines don’t consider the social benefits of alcohol. But should they?<figure><img src="https://images.theconversation.com/files/506504/original/file-20230125-24-54hefc.jpg?ixlib=rb-1.1.0&rect=74%2C14%2C1793%2C1224&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many studies on alcohol and health do not consider the social context of drinking.</span> <span class="attribution"><span class="source">(Pixabay)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/canada-s-new-drinking-guidelines-don-t-consider-the-social-benefits-of-alcohol--but-should-they" width="100%" height="400"></iframe>
<p>This month, the Canadian Centre on Substance Use and Addiction issued <a href="https://ccsa.ca/canadas-guidance-alcohol-and-health">revised recommendations</a> for lower-risk alcohol consumption. The <a href="https://ccsa.ca/canadas-guidance-alcohol-and-health">new guidelines</a> state that no amount of alcohol is “safe” and that individuals should drink no more than two standard drinks per week in order to minimize their risk for chronic diseases, such as cancer. </p>
<p><a href="https://ccsa.ca/sites/default/files/2023-01/CCSA_Canadas_Guidance_on_Alcohol_and_Health_Final_Report_en.pdf">The report</a> also acknowledges the reality that 40 per cent of Canadians, aged 15 and older, drink more than six standard drinks per week – meaning that many of us exceed the new recommendations for low-risk alcohol consumption. </p>
<p>Given <a href="https://amp.theguardian.com/society/2018/sep/01/social-drinking-moderation-health-risks">the role that alcohol plays</a> in many of our lives, it’s of little surprise that people are reacting to these new recommendations with a fair <a href="https://www.cbc.ca/news/canada/london/ccsa-alcohol-guidelines-1.6716722">degree of skepticism</a>. At the heart of the <a href="https://www.ctvnews.ca/health/low-risk-alcohol-guidance-sparks-debate-as-drinkers-start-examining-habits-evidence-1.6242625">emerging debate</a> are two contradictory truths: </p>
<ol>
<li>The more alcohol you drink the greater risk you subject yourself to; and,</li>
<li>You can still have good reasons for drinking more than public health officials say you should.</li>
</ol>
<h2>Risk-taking isn’t always about risk</h2>
<p>As a social and behavioural epidemiologist, I have worked extensively to understand how people perceive risk, the factors that shape whether individuals engage in so-called “risky” behaviours, and how assessments of risk can create stigma for individuals who flout social norms. Much of my work has been focused on sexual and gender minorities, youth who use drugs and other marginalized populations. </p>
<p>I have learned that many of the behaviours that you or I might think of as “risky” are actually adaptive responses that help individuals meet their fundamental needs as human beings. </p>
<p>For example, people who engage in risky sexual behaviours describe <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376348/">feelings of intimacy and connection with their sexual partners</a>. Those who drink alcohol or use other drugs report that these substances help them unwind — making it easier to come out of their shell and <a href="https://doi.org/10.1111/add.15798">connect with friends and family</a>. </p>
<p>In other words, people derive benefit from these <a href="https://doi.org/10.1080/13669877.2017.1351465">stigmatized activities</a>.</p>
<h2>Considering the social benefits of alcohol</h2>
<p>For thousands of years, our ancestors have derived benefits from alcohol — whether those benefits be the added nutrition from being able to eat and metabolize <a href="https://doi.org/10.1073/pnas.1404167111">fermenting fruit from the forest floor</a> or its <a href="https://doi.org/10.1093/oso/9780198842460.001.0001">benefits</a> as a so-called “<a href="https://openprairie.sdstate.edu/discoursejournal/vol2/iss1/10/">social lubricant</a>.”</p>
<p>However, the authors of the new guidelines and the studies that underlie them <a href="https://www.theglobeandmail.com/canada/article-one-of-the-sociologists-behind-the-new-drinking-guidelines-explains/">often ignore these benefits</a> arguing that they are inconsequential to health. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/506506/original/file-20230125-16-pxtm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A large group of people around a table with food and drinks" src="https://images.theconversation.com/files/506506/original/file-20230125-16-pxtm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506506/original/file-20230125-16-pxtm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506506/original/file-20230125-16-pxtm4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506506/original/file-20230125-16-pxtm4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506506/original/file-20230125-16-pxtm4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506506/original/file-20230125-16-pxtm4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506506/original/file-20230125-16-pxtm4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Poor social health can be just as harmful as smoking, drinking, being obese, sedentary living and exposure to poor air quality.</span>
<span class="attribution"><span class="source">(Unsplash/Priscilla du Preez)</span></span>
</figcaption>
</figure>
<p>However, as the lead researcher on a <a href="https://casch.org/guidelines">national study</a> aiming to develop <a href="https://www.universityaffairs.ca/news/news-article/university-researchers-are-helping-to-create-a-canadian-guide-for-social-connection/">Canadian Social Connection Guidelines</a>, I would argue that the social benefits of alcohol use are fundamentally important to the development of public health guidelines for alcohol consumption. </p>
<p>Just as <a href="https://doi.org/10.17269%2Fs41997-020-00320-7">most people</a> do not know that alcohol increases your risk for cancer, <a href="https://pubmed.ncbi.nlm.nih.gov/29274614/">most of us also don’t realize</a> that <a href="https://pubmed.ncbi.nlm.nih.gov/24028260/">poor social health is just as, if not more, harmful than smoking, drinking, being obese, sedentary living and exposure to poor air quality</a>. </p>
<p>In fact, the list of diseases and conditions that have been <a href="https://doi.org/10.1371/journal.pmed.1000316">linked to social disconnection is expansive</a> and includes <a href="https://doi.org/10.1186/s12888-018-1736-5">depression and anxiety</a>, <a href="https://doi.org/10.1007/s00127-018-1482-5">psychotic disorders</a>, <a href="https://doi.org/10.1136/heartjnl-2015-308790">cardiovascular disease</a>, <a href="https://doi.org/10.1038/ncponc1134">cancer</a>, <a href="https://doi.org/10.1186/s12889-017-4948-6">diabetes</a>, <a href="https://doi.org/10.3233/jad-180439">neurocognitive impairments</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32415849/">poorer immune response</a>, <a href="https://doi.org/10.1016/j.neubiorev.2020.02.002">inflammation</a> and <a href="https://doi.org/10.1080/13607863.2018.1488942">poor metabolism</a>. </p>
<p>While decades of research have warned about the dangers of loneliness and social isolation, public health bodies have not fully embraced the need to <a href="https://doi.org/10.1056/NEJMp2208029">prioritize social connection</a>. </p>
<h2>Reconciling harms and benefits</h2>
<p>Reconciling <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713002/">the benefits and consequences of alcohol is certainly a challenge</a>. This is especially difficult given that many studies on alcohol risk fail to capture meaningful dimensions of social life. </p>
<p>For example, studies rarely account for <a href="https://doi.org/10.1177%2F0963721420969406">the social context of drinking</a> when measuring the impact of alcohol on poor health. Similarly, the fact that many <a href="https://doi.org/10.1016%2Fj.drugalcdep.2012.05.022">drinkers may have been exposed to high levels of second-hand smoke</a> has not been fully accounted for in estimating its health consequences. </p>
<p>Measuring these <a href="https://nationalpost.com/opinion/sabrina-maddeaux-two-drinks-a-week-new-guidelines-are-unsupported-and-puritanical-kill-joys">potential confounders</a> is especially important given that even if alcohol doubles or triples your risk for a given cancer, <a href="https://www.cbc.ca/news/canada/alcohol-risks-cancer-questions-1.6723092">the risk in the first place may have been extremely low</a>. Measuring very small changes in risk is hard. More and better studies are still needed.</p>
<figure class="align-center ">
<img alt="A man playing solitaire on a computer screen" src="https://images.theconversation.com/files/506507/original/file-20230125-24-ewgljl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506507/original/file-20230125-24-ewgljl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506507/original/file-20230125-24-ewgljl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506507/original/file-20230125-24-ewgljl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506507/original/file-20230125-24-ewgljl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506507/original/file-20230125-24-ewgljl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506507/original/file-20230125-24-ewgljl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our society also needs to do better in supporting campaigns that teach people the importance of social health and help them develop social skills, so they don’t need to rely on alcohol as a social lubricant.</span>
<span class="attribution"><span class="source">(Unsplash/Romina Mosquera)</span></span>
</figcaption>
</figure>
<p>These future studies must also account for the benefits of alcohol use. Within the context of the new guidelines, the report suggests that the potential harm from consuming even 14 drinks per week (which is well above the new two drinks per week threshold for low-risk alcohol use) appears to be very modest: less than a year of lost life expectancy, on average. </p>
<p>This is similar to the estimate calculated from <a href="https://doi.org/10.1016/S0140-6736(18)30134-X">a synthesis of 83 studies</a>, which found that those who drank seven to 14 drinks (100 to 200 grams) per week had shorter life expectancy by just six months, compared to those who drank zero to seven drinks (zero to 100 grams) per week. </p>
<p>Many of us may be willing to make these trade-offs in order to live a happier life overall. </p>
<p>Meanwhile, studies on the <a href="https://doi.org/10.1007/s40750-016-0058-4">functional benefits of alcohol on social health</a> have reported <a href="https://doi.org/10.1037/emo0000451">benefits from moderate drinking</a>. These benefits are likely due to alcohol’s promotion of <a href="https://doi.org/10.1038/srep25267">endorphins</a> — which play a key role in social bonding. </p>
<p>Considered along with a growing body of research that <a href="https://www.adultdevelopmentstudy.org/">emphasizes meaningful social connections as the most important determinant of happiness and well-being</a>, these studies suggest that we (at least those of us who feel a little more social after a drink or two) might benefit more from drinking alcohol than abstaining from it.</p>
<p>Of course, we certainly should find ways to reduce our alcohol consumption, perhaps by finding alternative social lubricants, including <a href="https://doi.org/10.3389/fpsyg.2019.02466">cannabis</a>. Our society also needs to do better in <a href="https://genwellproject.org/">supporting campaigns</a> that teach people the importance of social health and help them develop social skills, so they don’t need to rely on alcohol when a <a href="https://www.degruyter.com/document/doi/10.1515/humor-2015-0021/pdf">well-timed joke</a> might do just as much to break the ice.</p>
<h2>Moderation in all things</h2>
<p>In summary, I agree with the authors of the new alcohol guidelines that alcohol risk is best represented along a continuum: drinking two or fewer drinks per week creates negligible-to-low risk, drinking three to six drinks is moderately risky, and drinking more than six drinks puts you at higher risk for poor health. </p>
<p>However, these estimates must be considered alongside the other important determinants of our health and happiness. Truly, none of us can lead risk-free lives and most of us probably don’t want to anyway.</p><img src="https://counter.theconversation.com/content/198379/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kiffer George Card receives funding from Michael Smith Health Research BC, The Social Sciences and Humanities Research Council, and the Canadian Institutes of Health Research. He is affiliated with the Faculty of Health Sciences at Simon Fraser University, The GenWell Project, and The Canadian Alliance for Social Connection and Health.</span></em></p>Loneliness and social isolation are some of the strongest predictors of poor health. But many studies informing Canada’s new alcohol guidelines don’t consider social connection at all.Kiffer George Card, Assistant Professor in Health Sciences, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1888822022-08-24T23:02:34Z2022-08-24T23:02:34Z‘Oh well, wine o’clock’: what midlife women told us about drinking – and why it’s so hard to stop<figure><img src="https://images.theconversation.com/files/479498/original/file-20220816-18397-5ffk8h.jpg?ixlib=rb-1.1.0&rect=0%2C80%2C6720%2C4386&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/an-elderly-woman-drinking-wine-while-sitting-on-the-chair-8532492/">Karolina Grabowska/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Many of us enjoy a drink at the end of a stressful day. But for some, this is less of a discretionary treat and more of a nightly must-have.</p>
<p>While alcohol reduction campaigns ask us to check our relationship with alcohol, emphasising the role it can play in causing violence and disease, our research has found many Australian women view alcohol in a different way. Many don’t see alcohol as only a bad thing and have complex reasons for their relationships with alcohol. </p>
<p>We conducted 50 interviews with midlife women (45–64 years of age) from different social classes living in South Australia. All women had a relationship with alcohol but the nature of the relationship was really different according to their social class. </p>
<p>Our <a href="https://academic.oup.com/heapro/article-abstract/37/4/daac097/6674367?redirectedFrom=fulltext">study</a>, published today in the journal <a href="https://academic.oup.com/heapro/article-abstract/37/4/daac097/6674367?redirectedFrom=fulltext">Health Promotion International</a>, suggests the problem for public health lies in the circumstances that shape women’s lives and lead to a relationship with alcohol. </p>
<p>Public health messaging around alcohol harm reduction needs to be more nuanced, and tailored to women’s level of disadvantage and what support they can access. A message that hits home for middle class women won’t necessarily resonate for working class women.</p>
<p>Here are some key themes that emerged from our research.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/479501/original/file-20220816-1865-3wzntl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/479501/original/file-20220816-1865-3wzntl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479501/original/file-20220816-1865-3wzntl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479501/original/file-20220816-1865-3wzntl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479501/original/file-20220816-1865-3wzntl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479501/original/file-20220816-1865-3wzntl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479501/original/file-20220816-1865-3wzntl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479501/original/file-20220816-1865-3wzntl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public health messaging around alcohol harm reduction may need to be more nuanced.</span>
<span class="attribution"><span class="source">Photo by Arzu Cengiz on Unsplash.</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>For many midlife women, alcohol makes life better – or at least, liveable</h2>
<p>For all women we spoke to, drinking alcohol was perceived to reduce loneliness and isolation. They didn’t just drink alcohol, they had a “relationship” with alcohol.</p>
<p>Women often have many competing responsibilities (working, caring, domestic duties). Many described feeling invisible and unacknowledged. </p>
<p>One middle class woman noted alcohol could be “numbing”. Another said: </p>
<blockquote>
<p>[I drink] just on my own; doesn’t bother me. I don’t need to be sociable and I don’t necessarily drink when I’m out […] alcohol has always played a fairly large role.</p>
</blockquote>
<p>For working class women however, alcohol can provide a reliable stand-in support in the absence of anything else. As one woman said:</p>
<blockquote>
<p>Loneliness is definitely a factor for me, and I think it is for a lot of women. And I think once you start having a drink, it becomes a habitual […] I’d like to see more done in terms of the loneliness because I think it is a real thing.</p>
</blockquote>
<p>Another woman noted:</p>
<blockquote>
<p>I didn’t have anything – so in my life I have actually always had, like, a glass of wine. </p>
</blockquote>
<p>Women with the most privilege drank to celebrate their achievements and enjoy life within social networks of similar women. Many middle class women described drinking alcohol as a long-standing part of their lives – drinking for relaxation, empowerment or because they felt they deserved a reward. As one put it: </p>
<blockquote>
<p>It seems to be that ladies our age, all the ones I hang out with, are exactly the same as me. They say, “Oh well, wine o’clock.” […] I don’t need it, I don’t have to have a drink. I just choose to.</p>
</blockquote>
<p>Many described drinking as socially acceptable, normal, or even “expected” of them. One middle class woman described “girl’s nights out” where drinking is “what I’m supposed to do”.</p>
<p>But, women with less privilege described drinking alcohol, often alone, to make a difficult and isolated life more liveable. As one put it:</p>
<blockquote>
<p>It provides relief, even if for a couple of hours, to take that away, thinking, “Where the hell am I going to come up with A$1000 from?” OK, let me have a drink. Calm down. Think of this. To me, to remove that from women, you’re actually removing a part of their autonomy.</p>
</blockquote>
<p>Many working class women we interviewed thought of alcohol as a reliable friend that allowed them to cope with really difficult and sometimes intolerable lives. One remarked:</p>
<blockquote>
<p>How is that not a positive? […] I’m not going to cut something out that enhances my life so much.</p>
</blockquote>
<h2>‘Breaking up with alcohol’ can be hard to do</h2>
<p>All women have complex reasons for drinking, which can make it hard to “break up” with alcohol. </p>
<p>Middle class women wanted to change their drinking and sometimes regretted drinking, taking steps to moderate their alcohol. But many working class women felt they could not manage their consumption when they already felt so restricted by life’s difficulties and saw alcohol as the only way to cope.</p>
<p>Some working class women felt punished if their drinking was questioned, because alcohol served as a way to regain control.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/479545/original/file-20220817-15-jvcwcd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/479545/original/file-20220817-15-jvcwcd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479545/original/file-20220817-15-jvcwcd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479545/original/file-20220817-15-jvcwcd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479545/original/file-20220817-15-jvcwcd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479545/original/file-20220817-15-jvcwcd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479545/original/file-20220817-15-jvcwcd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479545/original/file-20220817-15-jvcwcd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our research shows society needs to pay more attention to the broader systemic issues underpinning women’s drinking.</span>
<span class="attribution"><span class="source">Photo by Matilda Wormwood/Pexels</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Clues for public health messaging</h2>
<p>A blunt public health message telling women “do not drink, it is bad for you” does not address the structural reasons women drink in the first place – seeking connection for middle class women and dealing with isolation and hardship for working class women.</p>
<p>The positive and negative roles alcohol plays in women’s lives would need to be replaced, if alcohol were reduced. Our research shows society needs to pay more attention to the broader systemic issues underpinning women’s drinking, particularly the general absence of support for women during midlife. This is especially so for working class women without the resources to access support and appropriate care.</p>
<p>Getting the support needed to reduce drinking can use up a lot of resources (including what we have, who and what we know). And many working class women would lose what they see as an important (and often only) coping mechanism. </p>
<p>The challenge for public health is to make reducing alcohol or becoming “sober curious” a reasonable, affordable and feasible option for all women.</p><img src="https://counter.theconversation.com/content/188882/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Belinda Lunnay receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Kristen Foley receives funding from the National Health and Medical Research Council of Australia for her doctoral scholarship which explores the social and commercial determinants of alcohol for Australian women in midlife. </span></em></p><p class="fine-print"><em><span>Paul Ward does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many of our interviewees didn’t see alcohol as only a bad thing and had complex reasons for their relationships with alcohol.Belinda Lunnay, Post-doctoral researcher in Public Health , Torrens University AustraliaKristen Foley, PhD Candidate, Torrens University AustraliaPaul Ward, Professor of Public Health, Torrens University AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1514722020-12-07T19:06:54Z2020-12-07T19:06:54ZCaring for 66,455 revellers at risk delivers $7.5m harm-reduction benefit for Sydney<p>Our time of social isolation under COVID-19 restrictions has reinforced the importance of taking care of each other, particularly the most vulnerable in our community. As we consider what our post-COVID social world will look like, we have an opportunity to deliver services that make our cities safer and more inclusive. An example of how we might achieve this can be found in a Sydney harm-reduction service that has assisted tens of thousands of nightlife revellers who are vulnerable, in distress or at risk of harm since 2014. </p>
<p>A newly released <a href="https://ndarc.med.unsw.edu.au/resource/evaluation-take-kare-safe-space-program">evaluation</a> conservatively estimates the benefits of the <a href="http://thomaskellyyouthfoundation.org.au/take-kare-safe-space">Take Kare Safe Space</a> (TKSS) program from December 2014 to April 2019 at A$7.46 million. That benefit includes the value of serious harm averted and the value attached to lives saved through program interventions.</p>
<p>While it may have been less prominent in our public and political consciousness this year, nightlife, and the way we socialise after dark, is a major part of our social and cultural life. It will return. </p>
<p>In Sydney, where trading restrictions – the so-called <a href="https://www.smh.com.au/national/nsw/sydney-s-lock-out-laws-to-be-wound-back-from-january-14-20191128-p53eyh.html">lockout laws</a> – were lifted in January following five years of controversy, we need to do nightlife better. We need to find the balance between safety and vibrancy. The city is a great place to go out, but also a place where we need to provide the right services for when things inevitably go wrong.</p>
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Read more:
<a href="https://theconversation.com/where-are-they-now-what-public-transport-data-reveal-about-lockout-laws-and-nightlife-patronage-73521">Where are they now? What public transport data reveal about lockout laws and nightlife patronage</a>
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<h2>One part of the solution</h2>
<p>The TKSS program has been doing this throughout the lockout period in Sydney. Now operated by Stay Kind, the TKSS program was launched in 2014 following the unprovoked attack and subsequent <a href="https://www.smh.com.au/national/nsw/kieran-loveridge-sentence-for-killing-of-thomas-kelly-doubled-on-appeal-20140704-zsvk2.html">death of Thomas Kelly</a> in Kings Cross in 2012.</p>
<p>Operating year-round from 10pm to 4am on Friday and Saturday nights, it’s a non-judgmental, non-government, harm-reduction service. The program looks after nightlife revellers who are vulnerable, in distress or at risk of harm.</p>
<p>Teams of Take Kare ambassadors work in co-operation with the City of Sydney’s CCTV control room and other nightlife services to patrol key precincts, acting as critical intermediaries between emergency services. </p>
<p>During the evaluation, TKSS operated three static safe spaces at Town Hall, Kings Cross and Darling Harbour. Here, nightlife revellers can go to chill out, get help, charge their phones, or receive basic first aid.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/aUMQLVHCbkM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A 2019 Current Affair report on Sydney’s Take Kare Safe Spaces.</span></figcaption>
</figure>
<p>Between December 2014 and April 2019, TKSS supported 66,455 people. Two-thirds of them were aged 18-25. Many (46%) were perceived as heavily intoxicated and at risk of harm.</p>
<h2>What is the evidence? Does it work?</h2>
<p>Researchers from UNSW Sydney and Central Queensland University recently completed a comprehensive independent <a href="https://ndarc.med.unsw.edu.au/resource/evaluation-take-kare-safe-space-program">evaluation</a> of the TKSS program. Funded by the NSW Department of Communities and Justice, the evaluation team analysed crime, emergency department and ambulance data to establish the benefit-cost ratio of the program. We also interviewed key stakeholders and “clients” about their perceptions of the program.</p>
<p>From December 2014 to April 2019 (inclusive), the benefits were estimated at $7.46 million. With operating costs of $2.79 million, the benefit-cost ratio was 2.67:1. In other words, a $1 investment in the program resulted in $2.67 of benefits. When the TKSS program was fully operational in all three safe space sites (in 2016-17), the benefit-cost ratio increased to 3.83:1.</p>
<p>These results are conservative. The return on investment is likely to be much higher given the analysis does not quantify the full spectrum of benefits associated with the program. These include: improved public safety and amenity; more efficient resource allocation for service providers; improved partnership, communication and resourcing to manage Sydney nightlife; and flow-on effects for tourism and investment.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/sanitised-nightlife-precincts-become-places-where-some-are-not-welcome-95870">'Sanitised' nightlife precincts become places where some are not welcome</a>
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<h2>What are the strengths of TKSS?</h2>
<p>These non-quantifiable benefits featured strongly in interviews with stakeholders. They included staff from NSW Police and Ambulance, St Vincent’s Emergency Department, City of Sydney, licensed venues and those who used the service. They highlighted a number of key program strengths, including:</p>
<p><strong>1.</strong> the program fills a critical gap in nightlife safety – TKSS staff act as intermediaries between licensed premises and emergency services by providing services in public city spaces where people are most vulnerable – and it’s also easy to deploy in different locations as needed</p>
<p><strong>2.</strong> the non-judgmental, non-authoritative nature of the program meant intoxicated, vulnerable and distressed nightlife patrons were more comfortable speaking with TKSS ambassadors than other services – such as police, ambulance, venue security or city rangers – and this rapport helped encourage at-risk patrons to willingly get medical help when needed</p>
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Read more:
<a href="https://theconversation.com/fewer-alcohol-related-visits-to-inner-sydney-emergency-room-since-lockout-laws-introduced-92343">Fewer alcohol-related visits to inner Sydney emergency room since 'lockout laws' introduced</a>
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<p><strong>3.</strong> police, ambulance and accident and emergency staff said the TKSS program allowed them to focus on more urgent and pressing jobs</p>
<p><strong>4.</strong> the ambassadors are able to de-escalate conflict and provide welfare services through their early, proactive and non-judgmental interventions.</p>
<p>The evaluation shows the TKSS program provides a critical harm-reduction service in Sydney after dark. Its net economic benefit to the city is greatest when the full complement of Safe Spaces are operating and supported by sustained and stable funding. There is a clear case that the program should be part of the long-term future planning of a safe, inclusive and vibrant night-time economy.</p>
<p><em>Note: The TKSS program was suspended in March 2020 due to COVID-19 and is due to re-open in January 2021.</em></p><img src="https://counter.theconversation.com/content/151472/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phillip Wadds was one of the academic team who undertook the evaluation of Safe Spaces. That evaluation was funded by the NSW Department of Communities and Justice. He does not currently receive any other external research funding. Since 2018, Phillip has been a member of the City of Sydney's Nightlife and Creative Sector Advisory Panel. </span></em></p><p class="fine-print"><em><span>Anthony Shakeshaft was one of the academic team who undertook the evaluation of Safe Spaces. That evaluation was funded by the NSW Department of Communities and Justice.</span></em></p>Amid the controversy over Sydney’s lockout laws, a program that looked out for people at risk of harm in the city’s nightlife precincts more than proved its worth.Phillip Wadds, Senior Lecturer in Criminology, UNSW SydneyAnthony Shakeshaft, Professor and Deputy Director at National Drug and Alcohol Research Centre, UNSW SydneyChristopher Doran, Professor of Health Research Economics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1354602020-04-21T12:05:06Z2020-04-21T12:05:06ZHow the coronavirus is putting our relationship with alcohol to the test<figure><img src="https://images.theconversation.com/files/329189/original/file-20200420-152614-a3vqyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Beer sales are up.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-bearded-man-shopping-drinks-supermarket-1682342794">Iakov Filimonov / Shutterstock</a></span></figcaption></figure><p>It is not surprising to hear that sales of alcohol are rising during this COVID-19 pandemic. Retail sales <a href="https://www.thegrocer.co.uk/alcohol/coronavirus-crisis-drives-160m-additional-spend-on-supermarket-booze/603456.article#.XoQ9nGQxEOA.twitter">data</a> for the United Kingdom reported an additional £104 million was spent in the last week of March, which is when lockdown measures were introduced, compared to the week before. Lager is where the greatest spend was found, although sales of rum rose by 92.4%. </p>
<p>A recent YouGov survey found that respondents <a href="https://yougov.co.uk/topics/food/articles-reports/2020/04/08/how-are-british-drinking-habits-shifting-under-loc">reported</a> they are consuming as much alcohol now as they were prior to lockdown restrictions coming into force. Another commissioned by charity Alcohol Change UK <a href="https://s3.eu-west-2.amazonaws.com/files.alcoholchange.org.uk/images/Drinking-in-lockdown-press-release-final.pdf?mtime=20200415181333">found</a> two distinct reactions to the pandemic: 47% of those who were already drinking the least have cut down further or are abstaining. This is in contrast to the 21% who are drinking more since the introduction of lock down measures. </p>
<p>These surveys need to be treated with caution as they may not be entirely representative of the whole country and people are known to <a href="https://www.gov.uk/government/news/drinkers-can-underestimate-alcohol-habits">underestimate</a> their alcohol consumption. But they give an early indication of drinking habits as a result of the pandemic.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/326551/original/file-20200408-47450-1winm8s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/326551/original/file-20200408-47450-1winm8s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/326551/original/file-20200408-47450-1winm8s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=333&fit=crop&dpr=1 600w, https://images.theconversation.com/files/326551/original/file-20200408-47450-1winm8s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=333&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/326551/original/file-20200408-47450-1winm8s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=333&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/326551/original/file-20200408-47450-1winm8s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=419&fit=crop&dpr=1 754w, https://images.theconversation.com/files/326551/original/file-20200408-47450-1winm8s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=419&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/326551/original/file-20200408-47450-1winm8s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=419&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">YouGov alcohol survey.</span>
<span class="attribution"><span class="source">YouGov</span></span>
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</figure>
<p>It might be that alcohol is yet another commodity that many people are stockpiling, fearing there will be a shortage or even a ban on sales of alcohol. An <a href="https://www.bbc.co.uk/news/uk-52199185">estimated</a> 50 million pints are going unused in pubs, so some people are replacing drinking out with drinking at home. As some social media accounts imply, <a href="https://thepsychologist.bps.org.uk/its-virtual-happy-hour-again">drinking more to cope with the pressures</a> is both an intuitive and likely response for many.</p>
<p>In the wake of the coronavirus outbreak, rumours of a ban on alocohol sales <a href="https://www.reuters.com/article/uk-factcheck-alcohol-sales-coronavirus/false-claim-uks-national-health-service-bans-alcohol-consumption-and-sales-in-effort-to-combat-covid-19-idUSKBN21G0W6">were soon quashed</a>, although other governments around the world have <a href="https://www.thedrinksbusiness.com/2020/03/hk-bans-on-trade-alcohol-sales-amid-second-wave-of-covid-19/">introduced restrictions</a> for accessing alcohol. The UK government is, however, unlikely to even consider such a move given its <a href="https://www.alcoholpolicy.net/2018/05/new-alcohol-strategy-plans-and-further-minimum-pricing-review.html">record on alcohol policy</a>. </p>
<p>Far from restricting access to alcohol the UK government recently <a href="https://www.gov.uk/government/publications/further-businesses-and-premises-to-close/further-businesses-and-premises-to-close-guidance">deemed off licences as essential</a> retailers, placing them in the same category as pharmacies, ensuring we can all access our favourite drug. For many having a drink during this pandemic will be one of the few pleasures they have left. </p>
<h2>Health risks</h2>
<p>But if you are trying to optimise your immunity against COVID-19 it would be better to avoid alcohol or at least limit how much you drink as it <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590612/">can compromise</a> immunity – even if the risks to health for the majority of people will be low. Don’t fall for the fake news stories <a href="https://eu.usatoday.com/story/news/factcheck/2020/03/20/fact-check-drinking-alcohol-wont-reduce-coronavirus-risk/2881704001/">that claim</a> the opposite. </p>
<p>As the government does all it can to ensure the NHS has capacity to deal with
the surge in demand during this pandemic, alcohol has so far not featured in any of the announcements. In 2018-19 there were <a href="https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2020">1.26 million alcohol-related hospital admissions</a>, so <a href="https://www.alcoholpolicy.net/2016/12/phe-evidence-review-2016.html">more robust alcohol polices</a> would go some way to freeing up capacity, at least in the longer term.</p>
<p>This is not the time to suspend public health messaging about alcohol or smoking. As we are encouraged to exercise and eat a healthy diet to ensure we reduce the impact of COVID-19 should we contract the virus, there has been no airing of the chief medical officers <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf">recommended</a> guidelines on alcohol consumption. To keep the risk low, drinking within 14 units of alcohol a week is advised alongside having at least two alcohol-free days. </p>
<p>Meanwhile, sections of the alcohol industry are being encouraged to keep up marketing spend as it is now likely to be <a href="https://www.thedrinksbusiness.com/2020/04/wine-intelligence-continue-marketing-spend-its-more-effective-now/">“more effective than ever”</a>. In the public health camp, <a href="https://www.addiction-ssa.org/covid-19-and-alcohol-an-enduring-effect-on-home-drinking-habits/">concerns have been raised</a> that some people may be picking up more regular home drinking habits that could be hard to wind back. The daily government briefings on coronavirus would therefore be an ideal opportunity to be remind people about the CMO guidelines, but not one mention of these has been made.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/325809/original/file-20200406-51213-1pcuj79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/325809/original/file-20200406-51213-1pcuj79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325809/original/file-20200406-51213-1pcuj79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325809/original/file-20200406-51213-1pcuj79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325809/original/file-20200406-51213-1pcuj79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325809/original/file-20200406-51213-1pcuj79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325809/original/file-20200406-51213-1pcuj79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325809/original/file-20200406-51213-1pcuj79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Stick to a maximum of 14 units a week.</span>
<span class="attribution"><span class="source">Department of Health</span></span>
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</figure>
<p>The absence of government advice in relation to alcohol could simply be an oversight given all the other demands placed on ministers during this crisis. It is also likely to be sensitive to accusations of nanny-statism at a time when most people are likely to feel alcohol is a perfectly acceptable coping mechanism.</p>
<p>Nonetheless, the alcohol industry has proven itself to be very effective at <a href="https://academic.oup.com/jpubhealth/article/doi/10.1093/pubmed/fdz031/5434773">influencing</a> successive governments. It has on the whole ensured that policies aren’t introduced that hurt sales, pricing or consumption of their product. </p>
<p>There are several examples of this, including recent budgets and, significantly, the <a href="https://theconversation.com/why-im-fighting-alcohol-industry-obstruction-of-minimum-pricing-25126">long-running legal challenge</a> to stop the introduction of minimum unit pricing of alcohol in Scotland. After five years of protracted legal battles, minimum pricing was eventually introduced in 2018, but the industry were accused of having used deliberate delaying tactics that <a href="https://www.sheffield.ac.uk/news/nr/sheffield-research-backs-minimum-unit-price-alcohol-england-1.882659">cost</a> lives. Meanwhile in England, the government made an infamous u-turn and did not introduce minimum pricing in 2013. This followed extensive meetings between ministers with alcohol industry groups. An investigation by the British Medical Journal <a href="https://www.bmj.com/content/348/bmj.f7646.full">said</a> “politicians ignored the strong health evidence in favour of protecting the interests of industry”.</p>
<p>The extraordinary circumstances of the current pandemic would have been an ideal opportunity to change the relationship between politicians and the alcohol industry. But by continuing to have an alcohol policy that is driven by commerce and not by evidence, the government risks adding to the costs from COVID-19.</p><img src="https://counter.theconversation.com/content/135460/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Hamilton is affiliated with Alcohol Change UK. </span></em></p><p class="fine-print"><em><span>James Morris received PhD funding support from Alcohol Change UK and is Editor of Alcohol Policy UK.</span></em></p>Not just individuals, but the government’s too.Ian Hamilton, Associate Professor, Addiction and Mental Health, University of YorkJames Morris, PhD Student/Lecturer, London South Bank UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1316512020-02-25T06:20:37Z2020-02-25T06:20:37ZIf you’re ageing and on medication, it might be time to re-assess your alcohol intake<figure><img src="https://images.theconversation.com/files/316776/original/file-20200224-116138-c9xbnj.jpg?ixlib=rb-1.1.0&rect=3%2C0%2C2471%2C1651&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-friends-having-fun-doing-barbecue-1104408533">Shutterstock</a></span></figcaption></figure><p>Drinking patterns tend to change as we age. The older we get, the <a href="http://www.nceta.flinders.edu.au/files/4614/4892/9660/EN605.pdf">more likely we are to drink on a daily basis</a>. But older adults often perceive that drinking is only a problem if a person appears drunk. </p>
<p>Australia’s <a href="https://www.nhmrc.gov.au/health-advice/alcohol">draft alcohol guidelines</a> recommend healthy adults drink no more than ten standard drinks per week and no more than four in a day. This is down from 14 standard drinks per week in the <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol">previous guidelines</a> and no more than two standard drinks in any one day. </p>
<p>Anything above this is considered risky drinking because it <a href="https://www.nhmrc.gov.au/health-advice/alcohol">increases the risk of alcohol-related diseases</a>, such as cancer, and injuries.</p>
<p>Between 2007 and 2016, there was a <a href="https://ro.ecu.edu.au/ecuworkspost2013/5672/">17% increase</a> in risky drinking among Australians aged 60-69. In 2016, <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/data">18.2% of 60-69 year olds</a> drank at risky levels. </p>
<p>Among women, <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/ndshs-2016-key-findings/contents/alcohol-use">those aged 50-59 years</a> are now more likely to drink at risky levels (13%) than any other age group, including women aged 18 to 24 years (12.8%).</p>
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<strong>
Read more:
<a href="https://theconversation.com/older-australians-drinking-on-the-rise-and-they-dont-know-the-risks-50660">Older Australians' drinking on the rise and they don't know the risks</a>
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</em>
</p>
<hr>
<p>Older adults are more vulnerable to alcohol’s interactions with medicines, medical conditions that can be made worse by alcohol, and age-related changes in the metabolism of alcohol that mean we become more intoxicated from drinking the same amount of alcohol. Alcohol can also increase the risk of falls. </p>
<p>For some older people, this means that maintaining their current levels of alcohol consumption as they age inadvertently places them at risk. </p>
<h2>Alcohol and many medications don’t mix</h2>
<p>Older adults are <a href="https://onlinelibrary.wiley.com/doi/pdf/10.5694/mja2.50244">more likely</a> to be taking a number of medications; about two-thirds take <a href="https://www.ncbi.nlm.nih.gov/pubmed/20073039">four or more</a>. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4331237/">Many of these medications</a> can interact with alcohol. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/31769178">Our research</a> among risky drinkers aged 58 to 87 found 92% were taking medications that when combined with large amounts of alcohol could lead to serious adverse effects. This included common medications prescribed for high blood pressure.</p>
<p>For 97% of the people we studied, drinking alcohol reduced the effectiveness of the medication. This included Nexium, a medication commonly prescribed to treat gastric reflux.</p>
<h2>Why are older Australians drinking more?</h2>
<p>While age-related factors such as <a href="http://www.nceta.flinders.edu.au/files/4614/4892/9660/EN605.pdf">bereavement</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28382628">retirement</a> can increase the likelihood of drinking at risky levels, most often alcohol is part of an enjoyable social life as people age. </p>
<p>In <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/hsc.12110">our research</a>, alcohol use was closely linked to social engagement: more frequent opportunities to socialise were associated with more frequent drinking. </p>
<p>Among retirement village residents, having access to a social group “on tap” also encouraged more frequent drinking. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316787/original/file-20200224-24694-16ysx7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For many older drinkers, alcohol is part of their social life.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thai-old-woman-drinking-beer-czech-740350804">Shutterstock</a></span>
</figcaption>
</figure>
<p>In a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.12991">recent study of Australian and Danish women drinkers</a> aged 50 to 70, those who were drinking at risky levels said overwhelmingly their drinking was a normal, acceptable and enjoyable part of their lives, so long as they appeared to be in control. </p>
<p>In doing so, they were able to mentally distance their drinking from current and future health problems. </p>
<h2>Recognising heavy drinking as a health issue</h2>
<p>Australia’s <a href="https://www.nhmrc.gov.au/health-advice/alcohol">draft alcohol guidelines</a> don’t provide any specific recommendations for older adults, beyond those recommended for adults in general. </p>
<p>Rather, they recommend older adults speak with their GP to determine an appropriate level of drinking based on their medical history and medications they are taking. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cap-your-alcohol-at-10-drinks-a-week-new-draft-guidelines-128856">Cap your alcohol at 10 drinks a week: new draft guidelines</a>
</strong>
</em>
</p>
<hr>
<p>But <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/ijpp.12255">our research</a> found only 30% of older men and 20% of older women could recall their GP asking about their alcohol use over the past 12 months, regardless of what medication they were taking. </p>
<p>Even fewer could recall their community pharmacist asking about their alcohol use. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/316789/original/file-20200224-24685-1bp52mt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pharmacists should be asking about alcohol use when dispensing medicine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/angry-mature-female-patient-buying-medications-1230512227">Shutterstock</a></span>
</figcaption>
</figure>
<p>Promisingly, almost all participants were open to their GP asking about their alcohol use, particularly in relation to medication. </p>
<p>And more than half believed it was OK for their community pharmacist to raise this issue with them when being dispensed medication. </p>
<h2>So what can we do about it?</h2>
<p>Recognising the social context to older adults’ drinking and other drug use, and understanding how they make sense of these behaviours, is an important first step in preventing and minimising harm. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hazardous-drinking-research-finds-that-40-of-people-over-50-drink-too-much-104062">Hazardous drinking: research finds that 40% of people over 50 drink too much</a>
</strong>
</em>
</p>
<hr>
<p>At a population level, public health messages must resonate with older people by reflecting the context in which they drink.</p>
<p>At a community level, GPs and community pharmacists are well placed to help older adults minimise the risk of harm, but may require further training to develop their skills and confidence in broaching this topic with patients. </p>
<p>For older adults experiencing alcohol-related issues, Australia’s first older adult-specific service, called Older Wiser Lifestyles (OWL), has effectively identified and engaged with <a href="https://www.publish.csiro.au/ah/ah17013">more than 140 people</a> who didn’t realise their drinking could be placing their health at risk. </p>
<p>This Victorian initiative asks patients at GP clinics to complete a screening test on a iPad and notifies the GP if risks are identified. The person can then participate in an OWL early intervention program of education, brief counselling and harm-reduction advice. </p>
<p>So far the program has led to participants reducing their alcohol consumption and having fewer problems with medicines that interact with alcohol. </p>
<p>Such a scheme could be replicated across the country, and has the potential to improve lives, reduce preventable disease and premature deaths, and save the health system money.</p><img src="https://counter.theconversation.com/content/131651/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The number of older people who drink heavily is increasing. Here’s why that’s a problem.Stephen Bright, Senior Lecturer of Addiction, Edith Cowan UniversityJulie Dare, Senior Lecturer, Health Promotion, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1252272019-10-29T19:24:00Z2019-10-29T19:24:00ZSydney lockout laws review highlights vital role of transparent data analysis<p>The New South Wales Bureau of Crime Statistics and Research (BOCSAR) <a href="https://www.bocsar.nsw.gov.au/Pages/bocsar_media_releases/2019/mr-Impact-lockouts-on-the-CBD.aspx">recently claimed</a> Sydney’s alcohol licensing regulations, commonly known as <a href="https://theconversation.com/au/topics/lockout-laws-26282">lockout laws</a>, reduced non-domestic assaults by 13% in the CBD. Its calculation relied on a decision to allocate 1,837 of these offences to both Kings Cross and the CBD – that is, double-counting the data. <a href="https://www.parliament.nsw.gov.au/ladocs/submissions/63631/Submission%20734%20-%20Centre%20for%20Translational%20Data%20Science,%20University%20of%20Sydney.pdf">Our analysis</a> found this decision was critical to the conclusion that assaults decreased in the CBD. For every other choice about the areas to which offences data were allocated and type of analysis we found no decrease. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/298452/original/file-20191024-119433-7qnb4k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/298452/original/file-20191024-119433-7qnb4k.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=471&fit=crop&dpr=1 600w, https://images.theconversation.com/files/298452/original/file-20191024-119433-7qnb4k.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=471&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/298452/original/file-20191024-119433-7qnb4k.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=471&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/298452/original/file-20191024-119433-7qnb4k.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=592&fit=crop&dpr=1 754w, https://images.theconversation.com/files/298452/original/file-20191024-119433-7qnb4k.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=592&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/298452/original/file-20191024-119433-7qnb4k.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=592&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Map of Sydney and the entertainment precincts as used by BOCSAR in its analysis: blue – CBD entertainment precinct; red – Kings Cross entertainment precinct; green – nearby displacement areas; yellow – outer displacement areas.</span>
</figcaption>
</figure>
<p><a href="https://www.parliament.nsw.gov.au/ladocs/submissions/63631/Submission%20734%20-%20Centre%20for%20Translational%20Data%20Science,%20University%20of%20Sydney.pdf%5D">Our findings</a> highlight an important question: how do the choices of data collection, pre-processing and analysis affect policy decisions?</p>
<p>The allocation of crimes to areas is just one of several choices made when using data to assess policy impacts. Other choices include how to measure violent crime, what time period to consider and the geographical extent of the areas to include. The question is: if other choices were made, would the results affect a <a href="https://www.abc.net.au/news/2019-09-08/sydney-lockout-laws-rolled-back/11489806">decision to repeal or continue the laws</a>? </p>
<p>Our findings point to the need to follow a couple of principles when using data to inform policymaking. First, the institution that collects data and the institution that analyses the data should be independent of each other. Second,
we need as much transparency about the data and its analysis as possible.</p>
<h2>So what exactly did the analyses show?</h2>
<p>BOCSAR chose to use monthly non-domestic assaults from 2009 onwards. There is nothing wrong with these choices, but others could have been made.</p>
<p>For instance, why from 2009 onwards, not from 2005? Why monthly, not daily? Why reported non-domestic assaults, not reported assaults causing grievous bodily harm? Why divide the area into the CBD and Kings Cross only? </p>
<p>One way of assessing the impact of such choices is to use different subsets of data, different types of data pre-processing and different statistical and/or machine-learning techniques. If the conclusion still remains the same, then our decision is robust to this source of variability. If not, we need to understand why.</p>
<p>For the Kings Cross precinct, the analysis by the Centre for Translational Data Science at the University of Sydney showed the conclusion remained unchanged irrespective of the frequency and period over which data were collected and the analysis performed. Non-domestic assaults had declined following the introduction of the lockout laws in 2014.</p>
<p>For the CBD the reverse was true. Only if we make exactly the same choices as BOCSAR, in particular allocating 1,837 crimes to both the CBD and King Cross, could we conclude non-domestic assaults had decreased very slightly. </p>
<p>Under all other variations of the analyses, including data, methodology and spatial allocation of that data, we found no decrease. Non-domestic assaults in the CBD had been decreasing since 2008 and, if anything, more slowly after the lockout laws took effect. </p>
<p>So why was the inclusion of 1,837 crimes so critical to the conclusions about the CBD? </p>
<p>Using data provided by BOCSAR, we plotted the most likely location of those 1,837 crimes. Figure 1 shows these crimes occurred mainly in Kings Cross, an area in which the crime rate had fallen since 2014. We say “most likely location” because we have yet to receive the additional data we requested from BOCSAR to help us locate exactly where these crimes occurred.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/298427/original/file-20191023-119429-qgf5xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/298427/original/file-20191023-119429-qgf5xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/298427/original/file-20191023-119429-qgf5xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=588&fit=crop&dpr=1 600w, https://images.theconversation.com/files/298427/original/file-20191023-119429-qgf5xh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=588&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/298427/original/file-20191023-119429-qgf5xh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=588&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/298427/original/file-20191023-119429-qgf5xh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=739&fit=crop&dpr=1 754w, https://images.theconversation.com/files/298427/original/file-20191023-119429-qgf5xh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=739&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/298427/original/file-20191023-119429-qgf5xh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=739&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Counts of crimes (per SA1 region) that were assigned to both the CBD and Kings Cross.</span>
<span class="attribution"><span class="source">Centre for Translational Data Science</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>With the removal of those 1,837 crimes from the CBD, we detected no decrease in non-domestic assaults. But BOCSAR apparently did. After removing those crimes from the CBD, BOCSAR released an <a href="https://www.bocsar.nsw.gov.au/Documents/BB/2019-Report-Effect-of-lockout-and-last-drinks-laws-on-assaults-BB142.pdf">updated report</a> to a <a href="https://www.parliament.nsw.gov.au/committees/listofcommittees/Pages/committee-details.aspx?pk=260">parliamentary inquiry into Sydney’s night-time economy</a>. This report claimed assaults in the CBD decreased by 4% (much less than the original 13%). </p>
<p>The committee then asked for our <a href="https://www.parliament.nsw.gov.au/ladocs/other/12591/Centre%20for%20Translational%20Data%20Science.pdf">comments</a>. We found the report did not provide a confidence interval for this decrease. Yet the report made a virtue of reporting uncertainty estimates for other quantities and elsewhere it claimed “statistically significant” results. </p>
<p>We replicated BOCSAR’s analysis and found the change in crime could have been as low as a 12% decrease and as high as a 6% increase. In other words, the result is “statistically insignificant”. </p>
<h2>What are the implications for making policy?</h2>
<p>Why does this matter? There are two reasons. </p>
<p>First, the danger in not explaining, quantifying and reporting uncertainty is that the public loses trust in data-driven policymaking. Only if conclusions acknowledge and explain the uncertainty inherent in inferring complex quantities from data can we make robust and explainable policy decisions that build trust with the public. </p>
<p>Second, if we don’t accept and report uncertainty we could stop looking for other explanations. We might then fail to achieve an outcome that everyone wants: a reduction in violence and a healthy night-time economy.</p>
<p>How do we proceed from here? We’d make two recommendations: </p>
<ol>
<li><p>The institution that collects and curates the data should be distinct, informed but independent from the institution/s that analyse the data. </p></li>
<li><p>There should be as much data transparency as possible, which would enable different groups to perform different types of analyses, using different sources of data. </p></li>
</ol>
<p>We are almost certain these different groups would produce different findings, but the subsequent discussion could provide insights that move us closer to more robust and acceptable policy decisions. </p>
<p>To <a href="https://www.brainpickings.org/2012/08/27/richard-feynman-on-the-role-of-scientific-culture-in-modern-society/">quote</a> Nobel Prize-winning physicist Richard Feynman:</p>
<blockquote>
<p>If we will only allow that, as we progress, we remain unsure, we will leave opportunities for alternatives … to make progress, one must leave the door to the unknown ajar.</p>
</blockquote>
<p>The <a href="https://www.parliament.nsw.gov.au/ladocs/inquiries/2519/Report%20-%20Sydneys%20night%20time%20economy.pdf">parliamentary committee’s recommendation</a> that BOCSAR and the Centre for Translational Data Science work together more closely appears to do just that. We look forward to an ongoing collaboration to further our understanding of the drivers of violent crime.</p><img src="https://counter.theconversation.com/content/125227/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The collection and analysis of data used for making policy should be independent and open to ensure public trust in decision-making. The debate over alcohol licensing shows why this matters.Sally Cripps, Professor of Statistics, Director of Centre for Translational Data Science, University of SydneyRoman Marchant, Senior research fellow and lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1240782019-09-24T20:14:48Z2019-09-24T20:14:48ZPoliticians who become lobbyists can be bad for Australians’ health<figure><img src="https://images.theconversation.com/files/293742/original/file-20190924-54767-1fxlo2r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lobbyists try to water down policies that could restrict the public's access to their harmful products.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1412909225?size=huge_jpg">Motortion Films/Shutterstock</a></span></figcaption></figure><p>The impacts of heavy drinking, gambling and unhealthy food are among <a href="https://ncdalliance.org/news-events/blog/australias-new-health-tracker-reveals-weak-progress-towards-ncd-targets">the leading causes of preventable health harm in Australia</a>. And for the most part, we know what to do to reduce them.</p>
<p>Most of us would hope the policies governments introduce are based on the best available evidence. However, <a href="https://doi.org/10.17061/phrp2931921">our study</a> published today suggests that may not be the case.</p>
<p>We found former politicians, staffers and public servants who go on to work for the industries they once regulated have a major influence on the current policy environment. They’re paid to advocate what’s best for their client, not for the Australian public. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/big-food-lobbying-tip-of-the-iceberg-exposed-23232">Big Food lobbying: tip of the iceberg exposed</a>
</strong>
</em>
</p>
<hr>
<p>Of the 560 people on the Australian government Register of Lobbyists in 2017, 197 stated they had previously been a government representative. This is just the tip of the iceberg, as most “lobbyists” are directly employed by the companies they lobby for and are therefore not recorded on the register.</p>
<p>In interviews with former politicians and advisers, we found the policymaking process could be corrupted by using knowledge gained in service of the community to advocate for industry. </p>
<h2>Lessons from tobacco lobbying</h2>
<p>Just like tobacco lobbyists have done over the past 50 years, profit-driven industries such as alcohol, junk food and gambling seek to deter, delay and water down effective public health polices that could restrict the availability of their harmful products. </p>
<p>These industries use <a href="https://espace.curtin.edu.au/bitstream/handle/20.500.11937/45684/150446_26119_BondDaubeCHIKRITZHSSellingAddictionsAustralMJ.pdf?sequence=2&isAllowed=y">lobbying tactics established by the tobacco industry</a> to achieve their goals – from offering free tickets to sporting events and parliamentary wine-tastings, to faking grassroots campaigns and using <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.2011.03499.x">PR organisations</a>, to donating to political parties.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/profits-death-and-disease-big-tobaccos-business-model-28150">Profits, death and disease: big tobacco's business model </a>
</strong>
</em>
</p>
<hr>
<p>These strategies have been <a href="https://www.ingentaconnect.com/content/tpp/pap/2014/00000042/00000001/art00004">described as</a> “water dripping on stone”. They rely on persistence, rather than force, to persuade. </p>
<p>Another key tactic is to employ political representatives and public servants into industries they have recently been tasked with governing.</p>
<h2>Our research</h2>
<p>We obtained basic data about this last tactic from three soures: the Australian Government Register of Lobbyists, LinkedIn, and lobbyist business websites.</p>
<p>We have analysed the results from the Register of Lobbyists <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12583">previously</a> in 2014 and 2015. We found the registers did not meet the stated objective of making lobbying activity transparent to the Australian public. </p>
<p>In that study, we concluded the processes were in urgent need of reform in order to keep accurate records on lobbying, allow free and real-time access to the public, and ensure the records were adequately archived.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293768/original/file-20190924-54790-lhf1jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293768/original/file-20190924-54790-lhf1jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293768/original/file-20190924-54790-lhf1jf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293768/original/file-20190924-54790-lhf1jf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293768/original/file-20190924-54790-lhf1jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293768/original/file-20190924-54790-lhf1jf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293768/original/file-20190924-54790-lhf1jf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The policymaking process is corrupted when knowledge gained in service of the community is used to advocate for industry.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/415631953?size=huge_jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>For this latest study, we looked at the job history of 122 lobbyists. Of those, most had held influential positions: 18% had been a member of parliament or senator and 47% had been a senior advisor or chief of staff. </p>
<p>The majority had spent more than ten years in government prior to their roles as lobbyists.</p>
<p>We also interviewed 28 <a href="http://www.industryinsight.info/">key informants</a>, including current and former Australian politicians, journalists, former political staffers, current civil servants and lobbyists.</p>
<p>These interviewees reported on several examples of people working at senior levels of government going on to work directly for alcohol, food or gambling industries, often in areas directly related to their previous government role.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lobbying-101-how-interest-groups-influence-politicians-and-the-public-to-get-what-they-want-60569">Lobbying 101: how interest groups influence politicians and the public to get what they want</a>
</strong>
</em>
</p>
<hr>
<h2>What’s the problem?</h2>
<p>This so-called “revolving door” between government and the food, alcohol and gambling industries can potentially favour industry interests by enhancing insider knowledge and providing access to policymakers through personal ties.</p>
<p>Allowing these industries privileged access to government threatens unbiased policymaking and creates an imbalance between the influence of industry and evidence-based public health advocacy. </p>
<p>One example of industry influence undermining evidence-based policy is the continued delays in implementing <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12399">alcohol warning labels</a>. The alcohol industry successfully delayed the mandatory implementation of alcohol warning labels about drinking when pregnant for more than six years after a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House_of_Representatives_Committees?url=spla/fasd/report.htm">parliamentary committee</a> called for them in 2012. </p>
<p>Other warning labels about the links between alcohol use and cancer remain off the agenda completely. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293771/original/file-20190924-54759-1tjb5fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293771/original/file-20190924-54759-1tjb5fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293771/original/file-20190924-54759-1tjb5fx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293771/original/file-20190924-54759-1tjb5fx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293771/original/file-20190924-54759-1tjb5fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293771/original/file-20190924-54759-1tjb5fx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293771/original/file-20190924-54759-1tjb5fx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alcohol labels won’t warn about the risk of cancer any time soon.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/777795184?src=6ewNGR0uX3S5WrMwAn8h1g-1-48&size=huge_jpg">Herlanzer/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/alcohol-increases-cancer-risk-but-dont-trust-the-booze-industry-to-give-you-the-facts-straight-83632">Alcohol increases cancer risk, but don't trust the booze industry to give you the facts straight</a>
</strong>
</em>
</p>
<hr>
<p>A second example is the lack of gambling reform, despite strong public support. Simple reforms such as bet limiting or <a href="https://www.pokiesplayyou.org.au/victoria_action">allowing communities to self-determine the number of pokies they have</a> remain off the agenda.</p>
<h2>What can we do about the ‘revolving door’?</h2>
<p>Participants also spoke about the importance of the networks and relationships established through the revolving door.</p>
<p>One politician told us: </p>
<blockquote>
<p>So someone retires from politics and then they have a ready-made set of relationships nurtured over many years of being colleagues with other Members of Parliament that they can then go and leverage on behalf of a commercial partner.</p>
</blockquote>
<p>Another former politician reported: </p>
<blockquote>
<p>You see former politicians popping up in these lobbying organisations, and the only reason they’re employed is because they can wield influence.</p>
</blockquote>
<p>We urgently need to rethink how we regulate this process.</p>
<p>We need tighter and more robustly enforced regulations around “cooling-off periods” between government employment and lobbying roles. Although rules prevent federal ministers and parliamentary secretaries from lobbying in related areas for 18 months, these rules are poorly enforced.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-political-lobbying-regime-is-broken-and-needs-urgent-reform-123003">Australia's political lobbying regime is broken and needs urgent reform</a>
</strong>
</em>
</p>
<hr>
<p>Other countries have considerably longer cooling-off periods, with both <a href="https://www.abc.net.au/news/2017-01-29/trump-puts-lobbying-restriction-on-administration-officials/8221104">the United States</a> and Canada adopting a <a href="https://policyoptions.irpp.org/magazines/march-2019/why-expand-the-cooling-off-period-for-public-office-holders/">five-year ban on administration officials</a> working in lobbying roles. Australia should follow the Canadian example as best practice.</p>
<p>Our research adds even more weight to existing calls for a federal anti-corruption body to provide oversight and transparency.</p>
<p>Government’s continued failure to adequately regulate the behaviour of former politicians, political staffers and public servants isn’t just an issue for public health policy. It also represents a fundamental corruption of our democracy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essays-on-health-how-food-companies-can-sneak-bias-into-scientific-research-65873">Essays on health: how food companies can sneak bias into scientific research</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/124078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Central Australian Aboriginal Congress, Northern Territory government, Australian Rechabites Foundation, Northern Territory Primary Health Network, Lives Lived Well, Queensland government and Australian Drug Foundation, travel and related costs from Queensland Police Service, Queensland Office of Liquor Gaming and Racing and the Australasian Drug Strategy Conference. He has acted as a paid expert witness on behalf of a licensed venue and a security firm.</span></em></p><p class="fine-print"><em><span>Gary Sacks receives funding from the National Heart Foundation of Australia, the Australian National Health and Medical Research Council and the Canadian Institutes of Health Research. He is an academic partner on a project to test marketing strategies in supermarkets to encourage healthier purchasing (with VicHealth, the City of Greater Bendigo and IGA supermarkets). He has undertaken research placements at the World Health Organization and the Victorian Department of Health and Human Services.
</span></em></p><p class="fine-print"><em><span>Narelle Robertson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The steady flow of politicians and government staffers switching sides to lobby for powerful food, alcohol and gambling companies is a threat to public health.Peter Miller, Professor of Violence Prevention and Addiction Studies, Deakin UniversityGary Sacks, Associate Professor, Deakin UniversityNarelle Robertson, Research Fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1225672019-09-20T10:06:10Z2019-09-20T10:06:10ZAlcohol advice for pregnant women – a lost opportunity to communicate new guidelines<figure><img src="https://images.theconversation.com/files/292425/original/file-20190913-8687-1nomvi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-image-midwife-measuring-blood-pressure-638474116?src=wzkcZpuhqZ3gI4s5Op3B4Q-1-10">Shutterstock/Newman Studio</a></span></figcaption></figure><p>Pregnant women in the UK are now <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf">officially advised</a> to consume no alcohol at all. These guidelines, from the Chief Medical Officer (CMO), were issued in January 2016, and replaced a previous recommendation that women should limit themselves to one or two units of alcohol, once or twice per week, and not get drunk. </p>
<p>But how widely were these more recent guidelines promoted, and how well did such an important message get passed on to mothers-to-be? In our <a href="http://www.ias.org.uk/uploads/pdf/IAS%20reports/rp37092019.pdf">recent study</a>, we examined awareness and implementation among midwives. And our findings show that more than three years after the guidelines were published, only 58% said they were of aware of them. </p>
<p>There was also variation in what midwives thought the content of the CMO guidelines were. Alongside abstinence, some 19% believed it to be the same limit of units as before – a limit set in <a href="https://www.nice.org.uk">National Institute for Health and Care Excellence</a> (NICE) guidelines.</p>
<p>Midwives told us that NICE guidelines are commonly used to inform their work. Since those were not updated to align with the government’s alcohol guidelines until December 2018, it is perhaps unsurprising that midwives gave mixed responses. </p>
<p>Nonetheless, we found that 97% of midwives said they advised all women to abstain from alcohol at the first antenatal appointment, which usually takes place during the first ten weeks of pregnancy. In subsequent appointments, however, only around two fifths of midwives always or usually advised women to abstain. </p>
<p>This might reflect what midwives told us in interviews about taking time to build a trusting relationship with women, and that bringing up the subject of alcohol later on was felt to be a good strategy.</p>
<p>Our survey also showed that after qualifying, midwives received little – if any – follow up training on alcohol. Nor is alcohol included in annual training updates, unlike smoking, which is. </p>
<p>This is an important gap, given the changes in guidelines over time. And it reflects what seems to be a missed opportunity to ensure that alcohol is prioritised within governmental maternal health policy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-problem-of-drinking-in-pregnancy-and-what-to-do-about-it-106129">The problem of drinking in pregnancy – and what to do about it</a>
</strong>
</em>
</p>
<hr>
<h2>The pressure in maternity care</h2>
<p>In recent years, the public health role of midwives has become vastly more extensive. It covers a range of topics including antenatal screening, immunisation, mental health and risks like smoking, alcohol and drug use. </p>
<p>Yet we found that while midwives acknowledged that public health is an important part of their role, they often feel limited by time constraints during antenatal appointments for women with uncomplicated pregnancies.</p>
<p>With a <a href="https://www.rcm.org.uk/news-views/rcm-opinion/2019/england-short-of-almost-2-500-midwives-new-birth-figures-confirm/">national staff shortage of midwives</a> it’s hardly surprising that attending extra training sessions is a challenge in itself. </p>
<p>So, did the government succeeded with introducing their updated CMO guidelines in 2016? Our study suggests not, likely due to the NICE guidelines remaining unchanged for a substantial amount of time after the adjustment. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/293195/original/file-20190919-22433-yojaye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/293195/original/file-20190919-22433-yojaye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/293195/original/file-20190919-22433-yojaye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/293195/original/file-20190919-22433-yojaye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/293195/original/file-20190919-22433-yojaye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=397&fit=crop&dpr=1 754w, https://images.theconversation.com/files/293195/original/file-20190919-22433-yojaye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=397&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/293195/original/file-20190919-22433-yojaye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=397&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sticking to the soft stuff.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-pouring-purified-fresh-drink-water-658012429?src=u1CBEbNYSfJuR53ejxoklA-1-0">Shutterstock/Cozine</a></span>
</figcaption>
</figure>
<p>This does not mean that midwives did not advise abstinence as the guidelines recommended. But in order to ensure that a workforce that is under increasing pressure are aware of changes to guidelines, better communication is required. </p>
<p>The problem of lack of knowledge about drinking guidelines is not isolated to health professionals, of course. <a href="https://academic.oup.com/alcalc/article/53/4/453/4812631">A study of the general population</a> showed that while 71% were aware that general alcohol guidelines had been updated in 2016, only 8% knew what they were (a maximum of 14 units per week for both men and women spread over three days or more). </p>
<p>Updating drinking guidelines in line with the latest research is a good idea. It can help people change their behaviours and reduce harm. But those updates seem futile unless they are accompanied by investing in efforts to support health professionals in their efforts to share the latest information with the people under their care.</p><img src="https://counter.theconversation.com/content/122567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Schölin has received funding from the Institute for Alcohol Studies. Lisa Schölin currently works as a temporary policy analyst at Foundation for Alcohol Research and Education. </span></em></p><p class="fine-print"><em><span>Lesley Smith does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Front line professionals need more support and time.Lisa Schölin, Visiting Research Fellow, Liverpool John Moores UniversityLesley Smith, Professor of Women's Public Health, Institute of Clinical and Applied Health Research, University of HullLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1211172019-08-14T19:58:44Z2019-08-14T19:58:44ZTighter alcohol licensing hasn’t killed live music, but it’s harder for emerging artists<figure><img src="https://images.theconversation.com/files/287327/original/file-20190808-144862-49ovmf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fortitude Valley is unique in Australia for its concentration of live music venues, like The Valley Drive In, in one small neighbourhood.</span> <span class="attribution"><a class="source" href="https://www.facebook.com/thevalleydrivein/">The Valley Drive In/Facebook</a></span></figcaption></figure><p><em>This is the fourth in a <a href="https://theconversation.com/au/topics/quantem-74665">series of articles</a> discussing a <a href="http://statements.qld.gov.au/Statement/2019/7/26/evaluation-of-measures-to-tackle-alcoholfuelled-violence">recently released</a> <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">comprehensive evaluation</a> of the Queensland government’s <a href="https://www.legislation.qld.gov.au/view/html/asmade/act-2016-004#">2016 policy reforms to tackle alcohol-fuelled violence</a> and the implications for liquor regulation and the night-time economy in Queensland and Australia. A <a href="http://quantem.info/">summary report</a> is also available.</em></p>
<hr>
<p>The effect on live music of changes to trading conditions in nightlife precincts <a href="https://theconversation.com/beyond-lockouts-sydney-needs-to-become-a-more-inclusive-city-55821">generates heated debate</a>. That’s because live music matters. It is a unique and important part of the <a href="https://theconversation.com/is-melbourne-the-music-capital-of-australia-sydney-or-adelaide-might-pip-it-to-the-post-77087">late-night rhythm and culture of the city</a>.</p>
<p>In both <a href="https://theconversation.com/melbourne-music-week-rocks-but-dont-take-the-feedback-for-granted-19147">Melbourne</a> and <a href="https://theconversation.com/lockout-laws-repeat-centuries-old-mistake-of-denying-value-of-cities-as-messy-places-58281">Sydney</a>, we’ve seen sustained debate about how urban development and regulation of licensed venues affect opportunities for live performance.</p>
<p>Contrary to some of the claims made in these debates, our evaluation of the Queensland government’s <a href="http://statements.qld.gov.au/Statement/2019/7/26/evaluation-of-measures-to-tackle-alcoholfuelled-violence">tightening of liquor licensing restrictions in 2016</a> suggests no change to the number of venues or impact on the overall trend of an increase in live music performances. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lessons-from-queensland-on-alcohol-violence-and-the-night-time-economy-121114">Lessons from Queensland on alcohol, violence and the night-time economy</a>
</strong>
</em>
</p>
<hr>
<p>But staging smaller shows by emerging artists has become more difficult because of the costs of new security requirements. The viability of the venues depends on selling alcohol. As a result, many venues depend on alcohol sales in late-night trade when they convert to being a bar or club with DJs.</p>
<h2>What happened in Fortitude Valley?</h2>
<p>In July 2016, the Queensland government <a href="https://theconversation.com/lessons-from-queensland-on-alcohol-violence-and-the-night-time-economy-121114">changed laws</a> affecting designated safe night precincts like Fortitude Valley in Brisbane. This included serving last drinks at 3am and mandatory ID scanning in venues trading after midnight.</p>
<p>We <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">monitored what impact these changes to trading conditions might have on live music</a> in Fortitude Valley.</p>
<p>The Valley is unique in Australia for its concentration of live music venues in one small neighbourhood and the early development of <a href="https://www.brisbane.qld.gov.au/planning-and-building/planning-guidelines-and-tools/other-plans-and-projects/valley-special-entertainment-precinct/valley-music-harmony-plan">policy </a> to protect and foster live music in the area. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-live-music-scene-needs-a-live-music-policy-20140">A live music scene needs a live music policy</a>
</strong>
</em>
</p>
<hr>
<p>The Valley has two overlapping precincts. The special entertainment precinct was created in 2006 to provide regulatory certainty for live music venues. The safe night precinct is the area subject to the 2016 <a href="https://www.legislation.qld.gov.au/view/html/asmade/act-2016-004#">Tackling Alcohol-Fuelled Violence legislation</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286840/original/file-20190805-117871-6cnkl2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286840/original/file-20190805-117871-6cnkl2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286840/original/file-20190805-117871-6cnkl2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=471&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286840/original/file-20190805-117871-6cnkl2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=471&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286840/original/file-20190805-117871-6cnkl2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=471&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286840/original/file-20190805-117871-6cnkl2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=592&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286840/original/file-20190805-117871-6cnkl2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=592&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286840/original/file-20190805-117871-6cnkl2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=592&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Map of the special entertainment precinct (red) and safe night precinct (blue) boundaries in Fortitude Valley. MPC = Monthly Percentage Change.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Live music venues in the Valley compete with large clubs and pubs for space. They are subject to the regulatory and compliance frameworks introduced to contain harms in the precinct. As a result, they are having to rethink how they maintain their distinctive music scenes in rapidly changing neighbourhoods.</p>
<h2>Have live music venue numbers changed?</h2>
<p>Despite its cultural and economic importance of original live music venues, their numbers and performances are not systematically and independently monitored in Australia. Music industry bodies could work with performers and venues to publish independent and reliable information about the number and type of venues and gigs over time.</p>
<p>Music rights licensing organisation <a href="http://apraamcos.com.au/">APRA/AMCOS</a> asks live music performers to submit performance returns that document all their live performances. Our analysis of this data shows live music performances in The Valley have been trending upward since 2001. Our evaluation suggests the Tackling Alcohol-Fuelled Violence policy measures had no impact on this trend. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286842/original/file-20190805-117910-1szi7jw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286842/original/file-20190805-117910-1szi7jw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286842/original/file-20190805-117910-1szi7jw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286842/original/file-20190805-117910-1szi7jw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286842/original/file-20190805-117910-1szi7jw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286842/original/file-20190805-117910-1szi7jw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286842/original/file-20190805-117910-1szi7jw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286842/original/file-20190805-117910-1szi7jw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The number of live music performances per month in Fortitude Valley between the 2001 and 2018 financial years. MPC refers to Monthly Percentage Change.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>This APRA/AMCOS performance data, however, cover everything from cover bands, DJs and ambient music in restaurants and bars to original live music performances in small venues through to stadium rock shows.</p>
<p>We also used a combination of precinct walk-throughs (where we observed original live music venues trading on Saturday nights), street press and social media. We found the number of original live music venues in the Valley has not changed since last drinks and ID scanner regulations were introduced in 2016. While original live music venues come and go, change owners and change names, the overall number in the area has been stable for much of the past 15 years.</p>
<h2>Live music is dependent on late-night trade</h2>
<p>While the trading pattern of venues on Saturday nights has not changed, in interviews we conducted venue owners and managers reported various ways they subsidised or supplemented the income from live music.</p>
<p>Nearly all original live music venues only generate income from bar sales. Proceeds from tickets and the door go to production costs and the musicians. The viability of the venues depends on selling alcohol before, during and after performances.</p>
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Read more:
<a href="https://theconversation.com/queenslanders-are-among-our-heaviest-drinkers-on-nights-out-and-changing-that-culture-is-a-challenge-121115">Queenslanders are among our heaviest drinkers on nights out, and changing that culture is a challenge</a>
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<p>Some venues used profit generated on large weekend shows to subsidise smaller local weeknight shows. These shows matter because they provide opportunities for emerging artists to hone their craft and are part of the distinctive cultural fabric of the city.</p>
<p>However, venue owners indicated that staging these smaller shows has become more difficult because of the prohibitive cost of employing security to operate the mandatory ID scanners. This illustrates how, according to venue owners, efforts to contain harm in the nightlife economy can have unintended damaging effects on cultural scenes.</p>
<p>The majority of venues that support original live music in the precinct are less than ten years old. Many seem well adapted to the commercialised late-night precinct because they combine live music with late-night trade. They put on a show early in the evening and then by midnight convert to a late-night bar or club with DJs.</p>
<p>Some of these venues claimed they would not be commercially viable if they only put on original live music before midnight and then closed. Others indicated live music enabled them to generate revenue earlier in the evening - before a clubbing crowd comes in.</p>
<h2>A policy dilemma</h2>
<p>This kind of adaptation is what you’d expect to see in a market as it reacts to changes in both consumer culture and policy. But it raises thorny questions for cultural and public health policy.</p>
<p>From a public health perspective we might be concerned about original live music becoming dependent on late-night trade and mass alcohol consumption in nightlife precincts. From a cultural policy perspective the ingenuity of venues using the earlier hours of an evening to stage original live music is something to encourage.</p>
<p>The Valley has a unique concentration of live music venues, and cultural policy has played a role in fostering and sustaining this vibrant cultural scene. In one sense that’s a success story the city should celebrate and look to capitalise on alongside the effort to reduce harms in nightlife precincts. But, in another sense, a critical issue is that the effort to both maintain cultural vibrancy and reduce harms is potentially thwarted by venues shifting to a homogenous late-night clubbing model.</p><img src="https://counter.theconversation.com/content/121117/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Carah's research has been funded by Queensland state government. He is affiliated with the Foundation for Alcohol Research and Education as a non-executive director. </span></em></p><p class="fine-print"><em><span>Jason Ferris receives funding from from Australian Research Council and Australian National Health and Medical Research Council, grants from State (Tasmania, Victoria, Queensland) and Federal Governments, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, University of Queensland, National Institute of Health, Global Drug Survey. He is affiliated with the Global Drug Survey and the Queensland Mental Health Commission.</span></em></p><p class="fine-print"><em><span>Lachlan Goold and Scott Regan do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The good news is that the growth of live music continued under Queensland’s liquor licensing reforms. The bad news is that venues rely on late-night alcohol sales to cover costs.Nicholas Carah, Senior Lecturer in Communication, The University of QueenslandJason Ferris, Associate Professor, Program Leader for Research and Statistical Support Service and Program Leader for Substance Use and Mental Health, Centre for Health Services Research, The University of QueenslandLachlan Goold, Head of Audio Engineering and Sound Production (Brisbane), JMC AcademyScott Regan, Lecturer in Music and Sound, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1211162019-08-13T20:17:52Z2019-08-13T20:17:52ZUnwanted sexual attention plagues young women going out at night<figure><img src="https://images.theconversation.com/files/287453/original/file-20190809-144851-1p50545.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For young women in Queensland, the risk of unwanted sexual attention is high when they go out at night.</span> <span class="attribution"><span class="source">vchalShutterstock</span></span></figcaption></figure><p><em>This is the third in a <a href="https://theconversation.com/au/topics/quantem-74665">series of articles</a> discussing a <a href="http://statements.qld.gov.au/Statement/2019/7/26/evaluation-of-measures-to-tackle-alcoholfuelled-violence">recently released</a> <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">comprehensive evaluation</a> of the Queensland government’s <a href="https://www.legislation.qld.gov.au/view/html/asmade/act-2016-004#">2016 policy reforms to tackle alcohol-fuelled violence</a> and the implications for liquor regulation and the night-time economy in Queensland and Australia. A <a href="http://quantem.info/">summary report</a> is also available.</em></p>
<hr>
<p>A disturbingly high proportion of young people, particularly women, experience unwanted sexual attention in entertainment districts across Queensland. </p>
<p>This is the bad news from a two-year, <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">independent evaluation</a> of the Queensland government’s 2016 “Tackling Alcohol-Fuelled Violence” (TAFV) policy (the good news included a <a href="https://theconversation.com/lessons-from-queensland-on-alcohol-violence-and-the-night-time-economy-121114">significant statewide reduction in serious assaults</a>). </p>
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Read more:
<a href="https://theconversation.com/lessons-from-queensland-on-alcohol-violence-and-the-night-time-economy-121114">Lessons from Queensland on alcohol, violence and the night-time economy</a>
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<p>One in three patrons reported unwanted sexual attention – including harassment, unwanted touching, or sexual gestures – in or around a licensed venue in the preceding three months. Among those who reported unwanted sexual attention, two in three women (68%) also reported physical and/or verbal aggression.</p>
<p>The rate of unwanted sexual attention was highest for young women (ages 18-24). More than 50% had experienced this harm in the previous three months, as the chart below shows.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/286856/original/file-20190805-117861-kq3dkw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286856/original/file-20190805-117861-kq3dkw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=370&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286856/original/file-20190805-117861-kq3dkw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=370&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286856/original/file-20190805-117861-kq3dkw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=370&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286856/original/file-20190805-117861-kq3dkw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=465&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286856/original/file-20190805-117861-kq3dkw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=465&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286856/original/file-20190805-117861-kq3dkw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=465&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Proportion of patrons in Cairns, Fortitude Valley and Surfers Paradise entertainment districts who experienced unwanted sexual attention in the 3 months prior, by sex and age category.</span>
</figcaption>
</figure>
<p>In the Fortitude Valley entertainment district, a staggering one in four reported unwanted sexual attention on the night they were interviewed (26% of 262 female patrons interviewed and followed up the next day).</p>
<p>Over the two-year evaluation, 4,055 patrons (43% female) were interviewed on Saturday nights on the streets of three entertainment districts – Cairns, Fortitude Valley (Brisbane) and Surfers Paradise (Gold Coast). </p>
<p>While the rates fluctuated over time in these areas, the rate of unwanted sexual attention didn’t change when comparing the months before and after the TAFV policy took effect. The chart below shows the trend for Fortitude Valley.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/286857/original/file-20190805-117893-237abq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286857/original/file-20190805-117893-237abq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=331&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286857/original/file-20190805-117893-237abq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=331&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286857/original/file-20190805-117893-237abq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=331&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286857/original/file-20190805-117893-237abq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=416&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286857/original/file-20190805-117893-237abq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=416&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286857/original/file-20190805-117893-237abq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=416&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Proportion of patrons in Fortitude Valley entertainment district who experienced unwanted sexual attention by month and year (June 2016 – June 2018).</span>
</figcaption>
</figure>
<h2>Uncomfortable truths</h2>
<p>These findings highlight some uncomfortable truths. </p>
<p>First, the unwanted sexual attention young women experience in the night-time economy is an intransigent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30991-7/fulltext">public health</a> and safety problem. </p>
<p>Second, the issue is considerably <a href="https://www.tandfonline.com/doi/abs/10.1080/10345329.2012.12035957">under-researched</a>. </p>
<p>Third, overcoming the problem requires discussion beyond alcohol accessibility and drinking practices.</p>
<p>The findings of the evaluation sit against a backdrop of increasing global intolerance of the sexual abuse and harassment of women. For example, the number of women reporting sexual assault to Queensland Police has <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4510.0%7E2018%7EMain%20Features%7EQueensland%7E9">increased for the past six years</a>. This increase might be attributable to the raising of public consciousness (e.g. <a href="https://theconversation.com/metoo-has-changed-the-media-landscape-but-in-australia-there-is-still-much-to-be-done-111612">the “Me Too” campaign</a>).</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/metoo-has-changed-the-media-landscape-but-in-australia-there-is-still-much-to-be-done-111612">#MeToo has changed the media landscape, but in Australia there is still much to be done</a>
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<p>Such awareness-raising has had impacts on broader social norms around sexual aggression towards women. But the evaluation suggests this messaging has largely failed to permeate the social norms of the night-time economy. </p>
<h2>Why haven’t nightlife norms changed?</h2>
<p>Understanding and addressing the mechanisms behind unwanted social attention in this context is particularly challenging. In addition to the broader social norms, licensed venues have their own cultural norms – including sexualised environments and heavy drinking – that often <a href="https://www.tandfonline.com/doi/abs/10.1080/10345329.2012.12035957">contribute to unwanted sexual attention</a>. </p>
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Read more:
<a href="https://theconversation.com/queenslanders-are-among-our-heaviest-drinkers-on-nights-out-and-changing-that-culture-is-a-challenge-121115">Queenslanders are among our heaviest drinkers on nights out, and changing that culture is a challenge</a>
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<p>Recent experimental research suggests unwanted sexual attention in these settings may be related to males misperceiving the social environmental cues. They read <a href="https://www.tandfonline.com/doi/full/10.1080/14659891.2016.1179804">alcohol presence</a>, <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12214">alcohol consumption and revealing dress</a> by females as signs of sexual interest. They might have been influenced by decades of sexualised alcohol marketing. </p>
<p>Such research highlights the need to better understand the risk and protective factors affecting victims and perpetrators of sexual aggression, and how these factors interact with cues in the physical environment. </p>
<h2>Responsibility is broadly shared</h2>
<p>These findings have many implications for policy and practice. </p>
<p>For a start, many experiences of unwanted sexual attention sit beyond the boundaries of the law. This raises a number of questions. Who is responsible for acting on unwanted sexual attention in and around licensed venues? And is it time to reassess the <a href="https://www.tandfonline.com/doi/full/10.1080/0966369X.2015.1090413">individualisation of responsibility</a> in entertainment districts?</p>
<p>One strategy that attributes some responsibility to venue staff has been trialled in cities such as London, Chicago, Vancouver and Melbourne. The <a href="http://www.goodnightoutcampaign.org/">Good Night Out initiative</a> aims to train and empower licensed venue staff to act as capable guardians (instead of bystanders) who intervene in incidents of unwanted sexual attention. While theoretically such approaches are promising, the evidence for such targeted strategies remains limited. </p>
<p>The pervasive problem of unwanted sexual attention in night-time economies also requires attention from local and state governments. Strategies that specifically address this harm should be embedded in alcohol policy. </p>
<p>Without a more sophisticated approach that targets all types of aggression, young women will likely continue to experience high rates of unwanted sexual attention on their nights out.</p>
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<strong>
Read more:
<a href="https://theconversation.com/no-harm-done-sexual-entertainment-districts-make-the-city-a-more-threatening-place-for-women-81091">No harm done? 'Sexual entertainment districts' make the city a more threatening place for women</a>
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<img src="https://counter.theconversation.com/content/121116/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominique de Andrade was a member of the research team led by Deakin University (Peter Miller) and University of Queensland (Jason Ferris) to evaluate the Queensland Government’s “Tackling Alcohol-Fuelled Violence” (TAFV) legislation.</span></em></p><p class="fine-print"><em><span>Cheneal Puljevic was a member of the research team led by Deakin University (Peter Miller) and The University of Queensland (Jason Ferris) to evaluate the Queensland Government’s “Tackling Alcohol-Fuelled Violence” (TAFV) legislation.</span></em></p><p class="fine-print"><em><span>Kerri Coomber receives funding from the Australian Research Council, Northern Territory Government, and Queensland Government. </span></em></p><p class="fine-print"><em><span>Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Central Australian Aboriginal Congress, Northern Territory government, Australian Rechabites Foundation, Northern Territory Primary Health Network, Lives Lived Well, Queensland government and Australian Drug Foundation, travel and related costs from Queensland Police Service, Queensland Office of Liquor Gaming and Racing and the Australasian Drug Strategy Conference. He has acted as a paid expert witness on behalf of a licensed venue and a security firm. </span></em></p>Rates of unwelcome advances haven’t changed under Queensland’s ‘Tackling Alcohol-Fuelled Violence’ policies. In one entertainment district, it happened to 26% of women the night they were interviewed.Dominique de Andrade, The University of QueenslandCheneal Puljević, Research Fellow, Centre for Health Services Research, The University of QueenslandKerri Coomber, Research Fellow, Deakin UniversityPeter Miller, Professor of Violence Prevention and Addiction Studies, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1211152019-08-12T20:03:40Z2019-08-12T20:03:40ZQueenslanders are among our heaviest drinkers on nights out, and changing that culture is a challenge<figure><img src="https://images.theconversation.com/files/287143/original/file-20190807-84240-1kugd6f.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Queenslanders are drinking heavily when they go out and breathalyser tests show most don't realise how drunk they are.</span> </figcaption></figure><p><em>This is the second in a <a href="https://theconversation.com/au/topics/quantem-74665">series of articles</a> discussing a <a href="http://statements.qld.gov.au/Statement/2019/7/26/evaluation-of-measures-to-tackle-alcoholfuelled-violence">recently released</a> <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">comprehensive evaluation</a> of the Queensland government’s <a href="https://www.legislation.qld.gov.au/view/html/asmade/act-2016-004#">2016 policy reforms to tackle alcohol-fuelled violence</a> and the implications for liquor regulation and the night-time economy in Queensland and Australia. A <a href="http://quantem.info/">summary report</a> is also available.</em></p>
<hr>
<p><a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">Our evaluation</a> of the Queensland government’s 2016 “<a href="https://www.thepremier.qld.gov.au/newsroom/alcohol-fuelled-violence.aspx">Tackling Alcohol-Fuelled Violence</a>” (TAFV) policy has found Queenslanders are still drinking more heavily than people in other states when going out at night. </p>
<p>Despite <a href="https://theconversation.com/lessons-from-queensland-on-alcohol-violence-and-the-night-time-economy-121114">significant reductions in serious assaults and other health-related outcomes</a>, reported levels of aggression are also high. </p>
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Read more:
<a href="https://theconversation.com/lessons-from-queensland-on-alcohol-violence-and-the-night-time-economy-121114">Lessons from Queensland on alcohol, violence and the night-time economy</a>
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<p>Queenslanders report much higher levels of aggression than reported in our previous studies, which asked the same question in <a href="http://www.deakinvpg.info/dashed">Canberra, Hobart</a>, <a href="http://www.deakinvpg.info/pointed">Melbourne, Sydney, Perth, Wollongong, Geelong</a> and <a href="http://www.deakinvpg.info/dante">Newcastle</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=331&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=331&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=331&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=416&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=416&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287147/original/file-20190807-84210-39li2s.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=416&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Table 1. Percentage of interviewees who report being involved in aggression in and around night-time entertainment precincts in the previous three months.</span>
<span class="attribution"><a class="source" href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Female patrons reported experiencing more of all types of aggression than men across all precincts. The next article in this series highlights the worrying number of women who experience unwanted sexual attention while out.</p>
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<p>
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Read more:
<a href="https://theconversation.com/unwanted-sexual-attention-plagues-young-women-going-out-at-night-121116">Unwanted sexual attention plagues young women going out at night</a>
</strong>
</em>
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<p>To measure the impact of the 2016 policy changes on alcohol consumption, illicit drug use and aggression, our research teams conducted <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4811-9">street intercept surveys</a> on Saturday nights in Fortitude Valley (Brisbane), Surfers Paradise and Cairns between 2016 and 2018. All participants were breathalysed. Every fifth person was invited to participate in a saliva drug swab. </p>
<p>Across the precincts, 4,401 people – 57% of them male – completed surveys. </p>
<h2>Blood alcohol concentration (BAC)</h2>
<p>Half of patrons’ blood alcohol concentration (BAC in g/dL) readings were over 0.077 (the median value, with a range of 0.000-0.300) in Fortitude Valley, 0.086 (range 0.000-0.290) in Surfers Paradise and 0.087 (range 0.000-0.289) in Cairns. The highest reading, 0.300, is six times the legal driving limit.</p>
<p>These median BAC levels are much higher than other, previously studied cities. The results highlight the challenges of achieving change in Queensland’s drinking culture.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=277&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=277&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=277&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=348&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=348&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287337/original/file-20190808-144892-1m484o4.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=348&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Table 2. Patrons’ median blood alcohol concentration (BAC in g/dL) and range of readings.</span>
<span class="attribution"><a class="source" href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Interestingly, most patrons are more drunk than they <em>think</em> they are. Before undertaking a breath test patrons were asked to guess their level of intoxication. For example, in Cairns, patrons’ median guess of their BAC reading was 0.070, compared to the measured median of 0.087. </p>
<h2>Pre-drinking</h2>
<p>High alcohol consumption when going out to night-time entertainment precincts includes <a href="https://academic.oup.com/alcalc/article/54/4/378/5486344">pre-drinking</a> (drinking at home before going out; also known as pre-gaming, pre-partying or pre-loading in other countries). As our research teams have documented <a href="http://www.deakinvpg.info/pointed">since 2012</a>, pre-drinking has continued to increase. </p>
<p>With 84% of all patrons reporting pre-drinking before going out, Queensland shows higher levels than in most other previously studied cities. </p>
<p>Overall, male patrons drank significantly more than female patrons when pre-drinking. In Fortitude Valley, though, female patrons were significantly more likely to pre-drink than males.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/womens-alcohol-consumption-catching-up-to-men-why-this-matters-67454">Women's alcohol consumption catching up to men: why this matters</a>
</strong>
</em>
</p>
<hr>
<p>It’s a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12525">common belief</a> that patrons choose to pre-drink to avoid buying more expensive drinks while they’re out in bars or clubs. But we found patrons who reported pre-drinking were more likely to drink more heavily across the night. They also reported drinking for longer than those who did not pre-drink.</p>
<p><a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">Our report</a> also shows the rate of pre-drinking across the precincts remained mostly stable in the two years after the TAFV policy was introduced in 2016. This suggests it did not affect rates of pre-drinking.</p>
<h2>Illicit drug use</h2>
<p>Rates of self-reported illicit drug use varied between precincts, from 13% of patrons in Fortitude Valley to 25% of all patrons in Surfers Paradise.</p>
<p>Ecstasy was the most commonly used illicit substance reported by patrons (5.5%), followed by cannabis (4%).</p>
<p>Among those who completed saliva drug swabs, the most commonly detected substances were amphetamines in Fortitude Valley and Cairns. In Surfers Paradise, however, it was methamphetamine; with 23.5% of patrons interviewed in Surfers Paradise testing positive for the substance.</p>
<p>Although rates of illicit drug use fluctuated in the two years after the TAFV policy was introduced, overall rates remained largely stable. This indicates the policy did not result in a clear increase or decrease in illicit drug use.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fact-check-only-drugs-and-alcohol-together-cause-violence-12466">Fact check: only drugs and alcohol together cause violence</a>
</strong>
</em>
</p>
<hr>
<h2>So what does it all mean?</h2>
<p>Historically, Queensland has high levels of harmful consumption of alcohol, especially in high-risk groups. Around <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2017-18%7EMain%20Features%7EAlcohol%20consumption%7E100">46% of Queenslanders</a> have exceeded single-occasion risk guidelines in the past year, higher than in New South Wales and Victoria. </p>
<p>There has been significant investment in education campaigns across social media and in schools. Despite this, Queenslanders continue to show hazardous levels of alcohol consumption, illicit drug use and experiences of aggression. </p>
<p>Changing cultural patterns relating to pre-drinking and alcohol-related harms will not be easy. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.12274">Previous research</a> suggests further tightening of licensed venues’ trading hours will help. Our report recommendations include introducing a <a href="https://www.ncbi.nlm.nih.gov/pubmed/26098040">minimum unit price on alcohol</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/19594797">promoting low-risk drinking guidelines</a> at all points of sale across Queensland. </p>
<p>Our report also recommends trialling live music early in the night to try to bring people into entertainment districts earlier. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tighter-alcohol-licensing-hasnt-killed-live-music-but-its-harder-for-emerging-artists-121117">Tighter alcohol licensing hasn't killed live music, but it's harder for emerging artists</a>
</strong>
</em>
</p>
<hr>
<p>Despite the promising results of government policy efforts to date, our evaluation suggests the work to reduce alcohol-related harm across Queensland is not finished. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/factcheck-can-you-change-a-violent-drinking-culture-by-changing-how-people-drink-38426">FactCheck: can you change a violent drinking culture by changing how people drink?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/121115/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Ferris receives funding from from Australian Research Council and Australian National Health and Medical Research Council, grants from State (Tasmania, Victoria, Queensland) and Federal Governments, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, University of Queensland, National Institute of Health, Global Drug Survey. He is affiliated with the Global Drug Survey and the Queensland Mental Health Commission.</span></em></p><p class="fine-print"><em><span>Cheneal Puljevic was a member of the research team led by Deakin University (Peter Miller) and The University of Queensland (Jason Ferris) to evaluate the Queensland Government’s “Tackling Alcohol-Fuelled Violence” (TAFV) legislation.</span></em></p><p class="fine-print"><em><span>Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Central Australian Aboriginal Congress, Northern Territory government, Australian Rechabites Foundation, Northern Territory Primary Health Network, Lives Lived Well, Queensland government and Australian Drug Foundation, travel and related costs from Queensland Police Service, Queensland Office of Liquor Gaming and Racing and the Australasian Drug Strategy Conference. He has acted as a paid expert witness on behalf of a licensed venue and a security firm. </span></em></p><p class="fine-print"><em><span>Barbara Wood does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even after ‘Tackling Alcohol-Fuelled Violence’ policies took effect in 2016, Queenslanders still drink more heavily on nights out. Reported levels of aggression are higher than in other states too.Jason Ferris, Associate Professor, Program Leader for Research and Statistical Support Service and Program Leader for Substance Use and Mental Health, Centre for Health Services Research, The University of QueenslandBarbara Wood, Research Assistant, The University of QueenslandCheneal Puljević, Research Fellow, Centre for Health Services Research, The University of QueenslandPeter Miller, Professor of Violence Prevention and Addiction Studies, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1211142019-08-11T19:56:47Z2019-08-11T19:56:47ZLessons from Queensland on alcohol, violence and the night-time economy<p><em>This is the first in a <a href="https://theconversation.com/au/topics/quantem-74665">series of articles</a> on a <a href="http://statements.qld.gov.au/Statement/2019/7/26/evaluation-of-measures-to-tackle-alcoholfuelled-violence">recently released</a> <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">comprehensive evaluation</a> of the Queensland government’s <a href="https://www.legislation.qld.gov.au/view/html/asmade/act-2016-004#">2016 policy reforms to tackle alcohol-fuelled violence</a> and the implications for alcohol regulation and the night-time economy in Queensland and Australia. A <a href="http://quantem.info/">summary report</a> is also available.</em></p>
<hr>
<p>Under the “<a href="https://www.thepremier.qld.gov.au/newsroom/alcohol-fuelled-violence.aspx">Tackling Alcohol-Fuelled Violence</a>” policy, which among other things introduced statewide restrictions on trading hours, Queensland has recorded reductions in assaults, ambulance attendances and hospital admissions. These reductions represent a substantial cost saving to the Queensland community. At the same time, tourism and the number of liquor licences have continued to grow in many areas. </p>
<p>Despite this, levels of alcohol-related harm still remain too high, which calls for further effort.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/all-in-it-together-why-stopping-alcohols-harms-needs-everyone-24212">All in it together: why stopping alcohol's harms needs everyone</a>
</strong>
</em>
</p>
<hr>
<p>In this article we describe the report findings from “archival” data – data collected by government services. The next three articles will:</p>
<ul>
<li>describe the data from patron interviews, highlighting levels of intoxication and harm</li>
<li>highlight the unwanted sexual attention reported by patrons</li>
<li>explore the impact on live music.</li>
</ul>
<p>The Queensland government has provided an <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1076.pdf">interim response</a> to the report’s 38 recommendations. Community consultation will continue to the end of 2019. </p>
<h2>What were the 2016 policy changes?</h2>
<p>In 2016, the government responded to community concerns about alcohol-related harm by implementing a multifaceted policy with three broad aims:</p>
<ol>
<li>a safer night-time environment, in particular in entertainment precincts</li>
<li>cultural change, including more responsible drinking practices within designated safe night precincts (SNPs)</li>
<li>a regulatory framework that balances the interests of the liquor industry with a reduction in alcohol-fuelled violence.</li>
</ol>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287117/original/file-20190806-84230-1j7v9vp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287117/original/file-20190806-84230-1j7v9vp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287117/original/file-20190806-84230-1j7v9vp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287117/original/file-20190806-84230-1j7v9vp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287117/original/file-20190806-84230-1j7v9vp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287117/original/file-20190806-84230-1j7v9vp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287117/original/file-20190806-84230-1j7v9vp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287117/original/file-20190806-84230-1j7v9vp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Table 1. Measures introduced as a part of the ‘Tackling Alcohol-Fuelled Violence’ policy (click to enlarge).</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The policy measures were partly based on the successful “<a href="http://www.ndlerf.gov.au/publications/monographs/monograph-43">Newcastle intervention</a>” in New South Wales. From 2008, Newcastle CBD venues closed at 3.30am and had a 1.30am one-way door (or “lockout”). These changes resulted in steady reductions in harms over time. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/last-drink-laws-not-lockouts-reduce-alcohol-fuelled-violence-52815">‘Last drink’ laws, not lockouts, reduce alcohol-fuelled violence</a>
</strong>
</em>
</p>
<hr>
<p>The measures introduced in Queensland differed from those in Newcastle in four key ways: </p>
<ol>
<li>licensed venues were permitted to remain open after 3am, but not to serve alcohol</li>
<li>the 1.30am one-way door, although originally proposed, was later repealed in light of an <a href="https://www.thepremier.qld.gov.au/newsroom/assets/alcohol-fuelled-violence-six-mth-report.pdf">interim report</a></li>
<li>the government introduced mandatory networked ID scanners</li>
<li>venues were able to apply for up to six extended trading permits allowing trade until 5am (reduced from 12 in February 2017).</li>
</ol>
<p>The measures were implemented in a series of steps, shown in the timeline below. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287024/original/file-20190806-84244-yu67r6.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287024/original/file-20190806-84244-yu67r6.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287024/original/file-20190806-84244-yu67r6.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=211&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287024/original/file-20190806-84244-yu67r6.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=211&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287024/original/file-20190806-84244-yu67r6.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=211&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287024/original/file-20190806-84244-yu67r6.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=265&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287024/original/file-20190806-84244-yu67r6.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=265&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287024/original/file-20190806-84244-yu67r6.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=265&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Timeline for implementing TAFV measures (click to enlarge).</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>How did we measure impact?</h2>
<p>We were able to collect and report on more than 40 datasets. The <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1074.pdf">full report</a> provides detailed methods. The main elements include:</p>
<ol>
<li><p>administrative service and business data (police, ambulance, hospital, liquor licensing, alcohol sales, transport)</p></li>
<li><p>interviews with patrons in the street (including follow-up surveys)</p></li>
<li><p>interviews with key informants (licensees, police, support service workers, doctors, licensing officials etc)</p></li>
<li><p>structured venue observations</p></li>
<li><p>precinct streetscape and business mapping</p></li>
<li><p>foot traffic counting</p></li>
<li><p>ID scanner data</p></li>
<li><p>live music performances (based on events recorded by music rights licensing organisation APRA-AMCOS and Facebook)</p></li>
<li><p>population surveys</p></li>
<li><p>education campaign assessments</p></li>
<li><p>tourism data and survey</p></li>
<li><p>economic evaluation.</p></li>
</ol>
<h2>What did we find?</h2>
<p><strong>SAFETY</strong></p>
<p>After 2016, there were no deaths around licensed venues in a safe night precinct. </p>
<p>Statewide, the rate of serious assaults from 3am-6am fell by 29% per month on average. But serious assaults increased by 19% earlier in the night (8pm to midnight).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286892/original/file-20190805-36399-643l1w.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286892/original/file-20190805-36399-643l1w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286892/original/file-20190805-36399-643l1w.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286892/original/file-20190805-36399-643l1w.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286892/original/file-20190805-36399-643l1w.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286892/original/file-20190805-36399-643l1w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286892/original/file-20190805-36399-643l1w.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286892/original/file-20190805-36399-643l1w.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 2. Rate of serious assault (per 100,000 population) during high alcohol hours (8pm-6am Friday and Saturday nights), Queensland.</span>
<span class="attribution"><a class="source" href="https://static1.squarespace.com/static/578598c7e4fcb510ac255c7c/t/5d3e38c75339530001bac928/1564358863617/QUANTEM+Final+report+-+Summary_2Apr19.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>A 40% reduction in serious assaults was recorded in Fortitude Valley between 3am and 6am and 35% in Toowoomba (3-6am). Trends were stable elsewhere.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286893/original/file-20190805-36403-921jmk.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286893/original/file-20190805-36403-921jmk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286893/original/file-20190805-36403-921jmk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286893/original/file-20190805-36403-921jmk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286893/original/file-20190805-36403-921jmk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286893/original/file-20190805-36403-921jmk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=551&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286893/original/file-20190805-36403-921jmk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=551&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286893/original/file-20190805-36403-921jmk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=551&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 3. Quarterly counts of serious assault during high alcohol hours, Fortitude Valley.</span>
<span class="attribution"><a class="source" href="https://static1.squarespace.com/static/578598c7e4fcb510ac255c7c/t/5d3e38c75339530001bac928/1564358863617/QUANTEM+Final+report+-+Summary_2Apr19.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="https://apps.who.int/iris/bitstream/handle/10665/66529/WHO_MSD_MSB_00.4.pdf;sequence=1">Alcohol-related</a> ambulance call-outs were reduced significantly statewide: 11% on average per month 3-6am, and in all safe night precincts (29% 3-6am).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286895/original/file-20190805-36386-3c7zo3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286895/original/file-20190805-36386-3c7zo3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286895/original/file-20190805-36386-3c7zo3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=426&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286895/original/file-20190805-36386-3c7zo3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=426&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286895/original/file-20190805-36386-3c7zo3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=426&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286895/original/file-20190805-36386-3c7zo3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286895/original/file-20190805-36386-3c7zo3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286895/original/file-20190805-36386-3c7zo3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 4. Rate of monthly alcohol-related ambulance call-outs for Queensland, July 2011 to June 2018.</span>
<span class="attribution"><a class="source" href="https://static1.squarespace.com/static/578598c7e4fcb510ac255c7c/t/5d3e38c75339530001bac928/1564358863617/QUANTEM+Final+report+-+Summary_2Apr19.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Hospital admissions for ocular bone fractures also fell significantly statewide, as did intracranial injuries in Greater Brisbane. These are some of the most common fractures related to alcohol.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286898/original/file-20190805-36372-17kv83r.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286898/original/file-20190805-36372-17kv83r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286898/original/file-20190805-36372-17kv83r.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=435&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286898/original/file-20190805-36372-17kv83r.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=435&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286898/original/file-20190805-36372-17kv83r.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=435&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286898/original/file-20190805-36372-17kv83r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=547&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286898/original/file-20190805-36372-17kv83r.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=547&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286898/original/file-20190805-36372-17kv83r.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=547&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 5. Monthly count of intracranial injury hospital admissions among 16-to-65-year-olds, Brisbane.</span>
<span class="attribution"><a class="source" href="https://static1.squarespace.com/static/578598c7e4fcb510ac255c7c/t/5d3e38c75339530001bac928/1564358863617/QUANTEM+Final+report+-+Summary_2Apr19.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Hospital admissions for alcohol intoxication and a range of injuries, which had been increasing, also levelled out statewide and in Brisbane.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286897/original/file-20190805-36353-fijzae.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286897/original/file-20190805-36353-fijzae.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286897/original/file-20190805-36353-fijzae.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286897/original/file-20190805-36353-fijzae.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286897/original/file-20190805-36353-fijzae.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286897/original/file-20190805-36353-fijzae.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286897/original/file-20190805-36353-fijzae.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286897/original/file-20190805-36353-fijzae.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Figure 6. Monthly rate of alcohol intoxication hospital admissions among 16-to-65-year-olds per 10,000 population, Queensland.</span>
<span class="attribution"><a class="source" href="https://static1.squarespace.com/static/578598c7e4fcb510ac255c7c/t/5d3e38c75339530001bac928/1564358863617/QUANTEM+Final+report+-+Summary_2Apr19.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fewer-alcohol-related-visits-to-inner-sydney-emergency-room-since-lockout-laws-introduced-92343">Fewer alcohol-related visits to inner Sydney emergency room since 'lockout laws' introduced</a>
</strong>
</em>
</p>
<hr>
<p>Other key findings included:</p>
<ul>
<li><p>no displacement of issues to outside safe night precincts for most of the state</p></li>
<li><p>at least one serious crime solved (such as rape and grievous bodily harm) per week using ID scanner data.</p></li>
</ul>
<p><strong>DRINKING CULTURE</strong></p>
<p>Key findings included:</p>
<ul>
<li>the proportion of patrons in safe night precincts reporting pre-drinking remains high and has not changed</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/queenslanders-are-among-our-heaviest-drinkers-on-nights-out-and-changing-that-culture-is-a-challenge-121115">Queenslanders are among our heaviest drinkers on nights out, and changing that culture is a challenge</a>
</strong>
</em>
</p>
<hr>
<ul>
<li>education/awareness campaigns were ineffective at reducing intoxication and violence.</li>
</ul>
<p><strong>BUSINESS IMPACTS</strong></p>
<p>The economic evaluation identified a A$16 million overall benefit from the changes to the Queensland community. The returns on every dollar spent by govt on implementation have been A$1.96-6.80. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/287122/original/file-20190807-84210-p1kig6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/287122/original/file-20190807-84210-p1kig6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287122/original/file-20190807-84210-p1kig6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=141&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287122/original/file-20190807-84210-p1kig6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=141&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287122/original/file-20190807-84210-p1kig6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=141&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287122/original/file-20190807-84210-p1kig6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=177&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287122/original/file-20190807-84210-p1kig6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=177&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287122/original/file-20190807-84210-p1kig6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=177&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Table 2. Benefit, cost, net present value (NPV) and benefit-cost ratio (BCR) sensitivity analysis using 50% of implementation cost to the government (in 2018 dollars)</span>
<span class="attribution"><a class="source" href="https://static1.squarespace.com/static/578598c7e4fcb510ac255c7c/t/5d3e38c75339530001bac928/1564358863617/QUANTEM+Final+report+-+Summary_2Apr19.pdf">QUANTEM final report</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Other findings included:</p>
<ul>
<li><p>increased number of liquor licences across Queensland</p></li>
<li><p>increased number of people using transport (public transport, taxis and Uber) on weekend nights in Fortitude Valley over time</p></li>
<li><p>tourism continues to grow strongly statewide</p></li>
<li><p>all live music performances have continued to increase. However, the number of original live music performances may have continued declining since 2012.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tighter-alcohol-licensing-hasnt-killed-live-music-but-its-harder-for-emerging-artists-121117">Tighter alcohol licensing hasn't killed live music, but it's harder for emerging artists</a>
</strong>
</em>
</p>
<hr>
<h2>Building on the gains</h2>
<p>The findings are terrific news in terms of reductions in ambulance callouts, serious assaults and hospital admissions, although alcohol-related harm across much of Queensland has remained stable. Further, the policy has not significantly harmed business and has delivered an overall economic benefit to the community. </p>
<p>The report made <a href="https://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2019/5619T1076.pdf">recommendations</a> to further reduce alcohol-related harm. These include increasing banning periods for unruly patrons, shutting venues at 3.30am and introducing point-of-sale health promotion. </p>
<p>But, overall, the evaluation is a good news story for the people of Queensland. These findings hold important lessons for other states grappling with how to reduce alcohol-related violence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/designer-nights-out-good-urban-planning-can-reduce-drunken-violence-52768">Designer nights out: good urban planning can reduce drunken violence</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/121114/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Central Australian Aboriginal Congress, Northern Territory government, Australian Rechabites Foundation, Northern Territory Primary Health Network, Lives Lived Well, Queensland government and Australian Drug Foundation, travel and related costs from Queensland Police Service, Queensland Office of Liquor Gaming and Racing and the Australasian Drug Strategy Conference. He has acted as a paid expert witness on behalf of a licensed venue and a security firm. </span></em></p><p class="fine-print"><em><span>Jason Ferris receives funding from from Australian Research Council and Australian National Health and Medical Research Council, grants from State (Tasmania, Victoria, Queensland) and Federal Governments, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, University of Queensland, National Institute of Health, Global Drug Survey. He is affiliated with the Global Drug Survey and the Queensland Mental Health Commission.</span></em></p><p class="fine-print"><em><span>Kerri Coomber receives funding from the Australian Research Council, Northern Territory Government, and Queensland Government.</span></em></p>A comprehensive two-year evaluation of statewide measures introduced in 2016 has shown it’s possible to reduce alcohol-related violence while also producing economic benefits.Peter Miller, Professor of Violence Prevention and Addiction Studies, Deakin UniversityJason Ferris, Associate Professor, Program Leader for Research and Statistical Support Service and Program Leader for Substance Use and Mental Health, Centre for Health Services Research, The University of QueenslandKerri Coomber, Research Fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1018272018-09-24T20:16:49Z2018-09-24T20:16:49ZThe NT is putting a minimum floor price on alcohol, because evidence shows this works to reduce harm<figure><img src="https://images.theconversation.com/files/237658/original/file-20180924-88806-224j88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The NT government introduced trial restrictions on the availability of alcohol in Alice Springs in 2002.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/cameliatwu/9379152535/in/photolist-fhNBht-6MqpDD-6MuDMC-fFDsFG-poeW1d-8we1h4-osSNLR-8wdR3x-6hJrHX-dhXxzt-fFmfLt-cokrfE-5jBstU-5kPN5f-5kPSZs-5kKFRM-58jory-58jyc3-5kBUuX-6MqBFk-6MuKNy-5kPQRY-5ZCKm-aaW8A4-9h2YXy-fFmibv-5uRh1Q-5ZCrc-5gwqn3-5jx8QD-fFmjoV-fFmiKv-fFmg4r-fFDp3A-7MWY6k-9gYVUv-mJMWbt-mJMTt2-mJLktH-5kCiy2-5kGrX9-fFCT4W-fFmhux-fFCRou-fFmiux-fFDibL-fFmGt2-fFDkgQ-fFCPzN-dFLci1">CameliaTWU/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>From October 1, 2018, one standard drink in the Northern Territory will cost a minimum of A$1.30. This is known as floor price, which is used to calculate the minimum cost at which a product can be sold, depending on how many standard drinks the product contains.</p>
<p>People in the Northern Territory consume alcohol at much higher levels and <a href="https://alcoholreform.nt.gov.au/__data/assets/pdf_file/0005/453497/Alcohol-Policies-and-Legislation-Review-Final-Report.pdf">have the highest rate</a> of risky alcohol consumption in Australia. In 2014, around 44% of people in the NT were drinking alcohol at a level that <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/2013-ndshs-detailed/contents/table-of-contents">put them at risk of injury</a> or other harms at least once in the past month. This was compared to 26% of people nationally. </p>
<p>The implementation of the minimum floor price is the result of <a href="https://alcoholreform.nt.gov.au/floor-price">legislation</a>, recently passed to minimise alcohol-related harms in the NT. From October, the NT will become one of the first places in the world to introduce a minimum price for alcohol.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-charts-on-australias-changing-drug-and-alcohol-habits-78597">Three charts on: Australia's changing drug and alcohol habits</a>
</strong>
</em>
</p>
<hr>
<h2>A history of alcohol restrictions</h2>
<p>The NT government <a href="https://justice.nt.gov.au/__data/assets/pdf_file/0018/252504/030710_Alice_Springs_Post_Evaluation_Trial_Restrictions.pdf">introducted trial restrictions</a> on the availability of alcohol in Alice Springs in 2002. This came after many years of campaigning for restrictions on alcohol sales by Aboriginal community organisations and the People’s Alcohol Action Coalition (an Alice Springs-based alcohol reform group).</p>
<p>The trial restrictions limited the hours during which take-away alcohol could be sold on weekdays to 2-9pm. They also attempted to address the sale of cheap 4L or 5L casks of wine by prohibiting the sale of take-away alcohol in containers larger than 2L. This super cheap alcohol was <a href="http://ndri.curtin.edu.au/ndri/media/documents/publications/r207.pdf">most implicated</a> in the town’s social and health problems.</p>
<p>The trial had some positive effects but was substantially undermined by drinkers <a href="https://ndri.curtin.edu.au/ndri/media/documents/publications/T220.pdf">switching from cask-wine</a> to other cheap forms of alcohol – in particular fortified wine sold in flagons and casks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-mandatory-treatment-for-public-drunkenness-is-failing-aboriginal-people-44145">How mandatory treatment for public drunkenness is failing Aboriginal people</a>
</strong>
</em>
</p>
<hr>
<p>This led to renewed advocacy for more effective approaches to alcohol–related harm. In 2006, the NT government implemented the Alice Springs Liquor Supply Plan (<a href="https://justice.nt.gov.au/__data/assets/word_doc/0004/252787/060907_Alice_Springs_Liquor_Supply_Plan_332.docx">LSP</a>). This continued the earlier restrictions on the hours of sale for take-away alcohol. But it also extended the ban on the sale of cheap alcohol to include both wine in containers larger than two litres <em>and</em> fortified wine in containers larger than one litre.</p>
<h2>What the liquor supply plan achieved</h2>
<p>A 2011 government commissioned <a href="https://ndri.curtin.edu.au/ndri/media/documents/publications/T220.pdf">study found</a> removing the two cheapest forms of alcohol (cask wine and fortified wine in casks and large bottles) from the market increased the price of alcohol in Central Australia. Before the introduction of the liquor supply plan, the average wholesale price per standard drink was around A$0.80. Under the plan, this increased to about A$1.10 per standard drink. </p>
<p>This increase was primarily achieved by the bans on cheap alcohol, effectively doubling the minimum unit price from about A$0.25 per standard drink to A$0.50 per standard drink. As the figure below shows, the introduction of the liquor supply plan in Alice Springs led to a significant decrease in alcohol consumption (estimated by using wholesale sales data) – from around 24 standard drinks per week for every person aged 15 years and over to around 20 standard drinks per week.</p>
<hr>
<iframe src="https://public.flourish.studio/visualisation/111877/embed" frameborder="0" scrolling="no" style="width:100%;height:500px;" width="100%" height="400"></iframe>
<div style="width:100%!;margin-top:4px!important;text-align:right!important;"><a class="flourish-credit" href="https://public.flourish.studio/visualisation/111877/?utm_source=embed&utm_campaign=visualisation/111877" target="_top"><img alt="Made with Flourish" src="https://public.flourish.studio/resources/made_with_flourish.svg"> </a></div>
<hr>
<p>As expected, the ban on cheap cask and fortified wine led some drinkers to turn to other types of alcohol. But while there was a 70% increase in the consumption of more expensive full-strength beer, the decline in the consumption of cheap alcohol more than offset this. This led to the overall 20% decline in consumption.</p>
<p>The reductions in alcohol consumption were accompanied by a significant decrease in social harms and adverse health impacts. Treatments for alcohol-related harms at Alice Springs Hospital, which had been rising steeply, levelled off. Though they continued to rise, they did so at a much reduced rate. </p>
<p>This included reductions in those who were admitted to hospital because of assaults. In particular, the liquor supply plan led to around 120 fewer than projected Aboriginal women being hospitalised per year for assault. A similar pattern was seen for emergency department presentations, with a significant decrease in people presenting as a result of assault.</p>
<p>The LSP also saw significant reductions in the proportion of alcohol-related anti-social behaviour incidents recorded in Alice Springs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/minimum-price-on-alcohol-in-the-nt-will-likely-reduce-harm-92577">Minimum price on alcohol in the NT will likely reduce harm</a>
</strong>
</em>
</p>
<hr>
<h2>A minimum floor price works</h2>
<p>It’s clear restrictions on the sale of cheap alcohol are effective in reducing alcohol-related harm. And while the causes of family and community violence are complex, bans on cheap alcohol are especially effective in reducing the number of Aboriginal women subjected to assault.</p>
<p>Some have argued Aboriginal drinking is not affected by price as these drinkers will simply increase their expenditure on alcohol to maintain their consumption. But the liquor supply plan provides powerful evidence this assumption is incorrect. The reduction in assaults of Aboriginal women strongly suggests the increases in price were accompanied by a reduction in consumption.</p>
<p>The implementation of the minimum floor price shows the importance of local advocacy by Aboriginal organisations and community groups in moving policy and practice in alcohol control forward.</p>
<p><em>This article was co-authored by Donna Ah Chee, CEO of the Central Australian Aboriginal Congress and Mr Edward Tilton, Health Policy Consultant at the Central Australian Aboriginal Congress.</em></p><img src="https://counter.theconversation.com/content/101827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Boffa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The NT has become the first jurisdiction in Australia to introduce a minimum price for alcohol.John Boffa, Adjunct Associate Professor, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/925772018-03-01T01:00:29Z2018-03-01T01:00:29ZMinimum price on alcohol in the NT will likely reduce harm<figure><img src="https://images.theconversation.com/files/208360/original/file-20180228-36689-4fagju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A floor price is a minimum amount under which alcohol can't be sold.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>The Northern Territory government this week made a series of announcements on alcohol policy, including a commitment to implement a minimum price for alcohol of A$1.30 per standard drink across the territory. This makes the NT the <a href="http://www.abc.net.au/news/2018-02-27/nt-first-australian-jurisdiction-minimum-alcohol-floor-price/9488320">first Australian jurisdiction</a> to bring in a floor price as a mechanism to reduce alcohol-related harm. </p>
<p>There is a wealth of international evidence a minimum floor price is effective, but there are also downsides to such a policy.</p>
<p>A floor price is a minimum amount under which alcohol can’t be sold. So, for instance, if a bottle of wine costs A$8, at an average of <a href="http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/content/drinksguide-cnt">eight standard drinks</a>, it would have to be sold for at least A$10.40. The impacts on cask wine will be even more dramatic, with prices increasing from around A$20 for a 2 litre cask to at least A$27. Products currently priced at or above the minimum price should be unaffected.</p>
<p>As <a href="http://fare.org.au/archives/80839">suggested by policy advocates</a>, the minimum price will be indexed, meaning it will increase along with inflation.</p>
<p>The floor price is part of a suite of other measures being introduced after last year’s <a href="https://alcoholreview.nt.gov.au/governance?a=453497">Riley review</a> of the Territory’s alcohol policy. These will complement existing approaches such as the <a href="https://health.nt.gov.au/professionals/alcohol-and-other-drugs-health-professionals/alcohol-for-health-professionals/banned-drinker-register">banned drinkers register</a> (where ID needs to be shown to buy takeaway alcohol). It also includes improvements to the treatment system, education and more. </p>
<h2>Does a minimum floor price work?</h2>
<p>Implementing a floor price is a bold response to the NT’s particular problems with alcohol. Territorians <a href="https://alcoholreview.nt.gov.au/governance?a=453497">drink more alcohol per capita</a> than people in any other Australian jurisdiction, and experience substantially higher rates of harm. While discussion of alcohol-related harm in the NT tends to centre around Aboriginal and Torres Strait Islander people, the issue is widespread. Alcohol does not just cause harm <a href="http://onlinelibrary.wiley.com/doi/10.1111/dar.12299/full">in one group of the population</a>.</p>
<p>There is a growing body of evidence minimum pricing policies can reduce alcohol-related harm. In Canada, where a number of provinces have implemented a minimum price, researchers have found reductions in <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301094">consumption</a>, alcohol-related <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301289">hospital admissions</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12139/full">deaths</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/minimum-alcohol-pricing-canadas-accidental-public-health-strategy-25185">Minimum alcohol pricing: Canada's accidental public health strategy</a>
</strong>
</em>
</p>
<hr>
<p>Researchers in the UK have conducted modelling based on survey data and health records to examine the impact of price policies. <a href="https://www.sciencedirect.com/science/article/pii/S014067361060058X">They estimated</a> a £0.50 minimum price (AU$0.90) would reduce alcohol consumption by 6.9%, and prevent 2,930 deaths per year. Importantly, <a href="https://www.sciencedirect.com/science/article/pii/S0140673613624174">their modelling</a> suggests minimum price policies particularly affect the heaviest drinkers. </p>
<p>In a survey of 2,020 Australians conducted in 2013, heavy drinkers were <a href="https://academic.oup.com/alcalc/article/50/6/647/193036">nearly twice as likely</a> to buy cheap alcohol as moderate drinkers. Cask wine appears to be a key driver of this, with respondents reportedly spending <a href="http://onlinelibrary.wiley.com/doi/10.1111/dar.12402/abstract">an average of A$0.65</a> per standard drink for cask wine. Average prices were higher than A$1.30 for all other beverage types.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/208361/original/file-20180228-36703-harcrx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/208361/original/file-20180228-36703-harcrx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/208361/original/file-20180228-36703-harcrx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/208361/original/file-20180228-36703-harcrx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/208361/original/file-20180228-36703-harcrx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/208361/original/file-20180228-36703-harcrx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/208361/original/file-20180228-36703-harcrx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Research shows that heavy drinkers are more likely to buy cheap alcohol than moderate drinkers.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Minimum pricing policies probably have a disproportionate effect on <a href="https://www.sciencedirect.com/science/article/pii/S0140673613624174">lower income groups</a>, although these effects are small for light and moderate drinkers. <a href="https://academic.oup.com/alcalc/article/50/6/647/193036">Australian data</a> suggests the amount of low-cost alcohol purchased is broadly similar across income groups. But among low-income respondents, it makes up a larger proportion of alcohol purchased. This means that, on average, higher-income groups drink more alcohol.</p>
<p>Importantly, alcohol-related harms are a <a href="https://academic.oup.com/ije/article/43/4/1314/740212">key driver of health inequalities</a>. And <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001963">modelling suggests</a> that minimum pricing can contribute to more equal health outcomes.</p>
<h2>A suite of measures</h2>
<p>A minimum floor price will significantly affect the price of cheap alcohol in the NT, especially outside of Alice Springs and Central Australia where a range of <a href="https://nt.gov.au/law/alcohol/buying-takeaway-alcohol/takeaway-alcohol-in-alice-springs-and-central-australia">policies are already in place</a>. These include times and days you can buy takeaway alcohol and how much you can buy of certain types of alcohol each day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-mandatory-treatment-for-public-drunkenness-is-failing-aboriginal-people-44145">How mandatory treatment for public drunkenness is failing Aboriginal people</a>
</strong>
</em>
</p>
<hr>
<p>The NT has previous experience with increasing alcohol prices to reduce alcohol-related harms. In the 1990s the government introduced the <a href="https://www.tandfonline.com/doi/abs/10.1080/09595230120079558?journalCode=idar20">Living With Alcohol</a> (LWA) program. A levy of A$0.05 per standard drink was charged on alcoholic beverages with more than 3% alcohol. The additional money was then used for a range of prevention and treatment services.</p>
<p>The levy was removed in 1997, following a <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/CIB/CIB9798/98cib01">High Court case about tobacco taxation</a> that cast state-based levies into a vulnerable light, constitutionally. But the prevention programs continued for a further five years. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01234.x/abstract">Evaluations of the LWA program</a> found significant reductions in deaths, especially while the levy was in place. This suggests the price effects were particularly important.</p>
<p>Overall it was the combination of pricing policies along with other programs that succeeded in reducing harm. Fortunately, the Riley review recommends a similarly broad suite of programs and policies to complement the introduction of minimum pricing. </p>
<p>These include improvements to the treatment system, changes to family and youth programs, education and a range of other supply, demand and harm reduction programs. Funding for these will be critical. Working with Aboriginal communities, leaders and health professionals will also be key to ensure local ownership of the impact of this new policy approach.</p>
<h2>Downsides to a minimum price</h2>
<p>A major downside to minimum pricing policy is that the additional money spent on alcohol goes to the industry – <a href="https://www.nice.org.uk/guidance/ph24/evidence/economic-modelling-report-371533357">evidence suggests</a> the decline in consumption won’t fully offset the increased prices. In the LWA example, the levy was collected by the government and used specifically to fund alcohol programs in the NT. </p>
<p>Reforms to the taxation system at the federal level could have similar effects to a minimum price, while providing extra revenue to governments. This could then be allocated to prevention programs. Australia’s <a href="https://theconversation.com/calling-time-on-alcohol-taxation-in-australia-6585">taxation system is complex</a>, but a key issue is the price-based (rather than alcohol content-based) taxation of wine, which means cheaper products attract lower taxes. This not only encourages the sale of cheap alcohol, it is <a href="https://www.smh.com.au/business/the-economy/money-down-the-drain-how-wine-is-emptying-the-federal-budget-20180227-p4z20q.html">hurting the budget bottom line</a>.</p>
<p>A tax system that was based on alcohol content for all products, with revenue allocated to prevention programs would be the ideal outcome for public health across Australia. For now though, in the absence of any action from the Commonwealth, the NT government is breaking new ground. Comprehensive evaluations are obviously needed, but the evidence suggests this is a big step in the right direction.</p><img src="https://counter.theconversation.com/content/92577/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Livingston receives funding from the National Health and Medical Research Council, The Australian Research Council, VicHealth, The Foundation for Alcohol Research and Education and Systembolaget (Swedish funding).</span></em></p><p class="fine-print"><em><span>Sarah Callinan receives funding from the Australian Research Council for a Discovery Early Career Research Award. Data cited in this piece was taken from a project funded by the Australian National Preventive Health Association. She has also received funding from the Foundation for Alcohol Research and Education, the National Health and Medical Research Council, VicHealth and Healthway for work on projects other than this one.</span></em></p>International evidence shows minimum pricing policies can reduce alcohol-related harm. But a downside of the mechanism is that the extra money will go to industry rather than government.Michael Livingston, Postdoctoral Research Fellow, Centre for Alcohol Policy Research, La Trobe UniversitySarah Callinan, Research Fellow at the Centre for Alcohol Policy Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808902017-07-17T03:59:15Z2017-07-17T03:59:15ZWe need more than just laws to ensure responsible alcohol service<figure><img src="https://images.theconversation.com/files/178360/original/file-20170716-14254-1g97jxj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is little evidence that training alone reduces the propensity for over-service of alcohol.</span> <span class="attribution"><span class="source">AAP/Alan Porritt</span></span></figcaption></figure><p>Australian law prohibits the sale of alcohol to drunk people. Despite the shifting sands of alcohol policy, <a href="http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/LTObject_Store/LTObjSt7.nsf/DDE300B846EED9C7CA257616000A3571/70AC1BBE193EBF8BCA257B10001DF528/$FILE/98-94aa067%20authorised.pdf">Responsible Service of Alcohol (RSA) legislation</a> has remained a stalwart figure.</p>
<p>In Australia, RSA imposes mandatory training requirements for liquor industry workers to educate alcohol servers about signs of intoxication, when to refuse service, and the harms of over-service. Internationally, RSA training is considered a cost-effective strategy to reduce the sale of alcohol to drunk people.</p>
<p>However, <a href="http://www.sciencedirect.com/science/article/pii/S0140673616324205?via%3Dihub">there is little evidence</a> that training alone reduces the propensity for over-service. It may have some effect when coupled with penalties for sales to drunk people and strict enforcement.</p>
<p>Given the longstanding restrictions on the sale of alcohol to intoxicated patrons, it seems perplexing that public drunkenness remains a notable problem – especially when we consider that public knowledge about RSA in Australia appears to be extremely high.</p>
<p>In the <a href="https://www.globaldrugsurvey.com/the-global-drug-survey-2015-findings/">2015 Global Drug Survey</a> of alcohol and drug users, Australian respondents were overwhelmingly aware that it is illegal for bar staff to serve an intoxicated patron.</p>
<p>Awareness varied across states. South Australians were the least aware: 85.2% responded it was illegal to serve alcohol to a drunk person. Western Australians were most aware: 94.7% responded it was illegal.</p>
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<p>In spite of this high awareness, a large proportion of respondents also agreed that a drunk person would be served alcohol in Australian licensed venues.</p>
<p>Again, agreement varied across states. In New South Wales, 45% of respondents agreed that a drunk person would be served alcohol. More than 60% of Victorian respondents agreed a drunk person would be served – despite the practice being illegal.</p>
<p>These statistics seem to suggest that current RSA legislation is effective in increasing public knowledge about responsible alcohol service of alcohol, but it may not be effective in deterring public drunkenness or encouraging responsible drinking in Australian bars and nightclubs.</p>
<p>Perhaps more worryingly, these statistics may indicate some patrons buy alcohol even when they are intoxicated, putting bar staff at risk of monetary penalty. There is no penalty for the patron – only for the alcohol server and the venue.</p>
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<iframe src="https://datawrapper.dwcdn.net/fix9D/1/" scrolling="no" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="300"></iframe>
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<h2>Combining training with law enforcement</h2>
<p>In Australia, RSA was <a href="http://www.austlii.edu.au/cgi-bin/sinodisp/au/legis/nsw/num_act/placa1830n12395/placa1830n12395.html?stem=0&synonyms=0&query=new%20south%20wales%20liquor">first introduced in NSW</a> in 1830. Since then, it has been adopted across all jurisdictions.</p>
<p>In Australia, mandatory training is coupled with a legislative framework that imposes monetary penalties for the sale of alcohol to anyone who is unduly intoxicated. </p>
<p>Patrons are considered to be unduly intoxicated when their speech, balance, co-ordination and behaviour are noticeably affected, and there are reasonable grounds to believe it is due to alcohol and/or drug use. </p>
<p>In <a href="http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/LTObject_Store/LTObjSt7.nsf/DDE300B846EED9C7CA257616000A3571/70AC1BBE193EBF8BCA257B10001DF528/$FILE/98-94aa067%20authorised.pdf">Victoria</a>, <a href="http://www.austlii.edu.au/au/legis/wa/consol_act/lca1988197/">WA</a>, <a href="http://www.austlii.edu.au/au/legis/tas/consol_act/lla1990190/">Tasmania</a>, and <a href="http://www.legislation.nsw.gov.au/inforce/8a197a07-ffb9-eceb-a956-ce6b1f11a313/2007-90.pdf">NSW</a>, it is also illegal for patrons to supply alcohol to another person or assist them in obtaining alcohol if the other person is intoxicated.</p>
<p>Penalties for over-service apply to licensees, managers and individual employees who serve alcohol to intoxicated patrons. </p>
<ul>
<li><p>Monetary penalties for licensees range from A$7,850 (Tasmania) to $63,075 (Queensland). </p></li>
<li><p>Employees who sell alcohol to drunk patrons can be fined anywhere from $1,500 (ACT) to $11,000 (NSW). </p></li>
<li><p>Monetary penalties for patrons who supply alcohol to intoxicated individuals range from $1,100 (NSW) to $7,850 (Tasmania).</p></li>
</ul>
<p>No states or territories impose jail time for the sale or supply of alcohol to intoxicated patrons. Despite long-existing legislation and the potential for heavy penalties, convictions are extremely rare.</p>
<h2>Australia compares favourably on knowledge and laws</h2>
<p>Compared to other countries, though, Australia appears to be performing well when it comes to alcohol and responsibility.</p>
<p>A <a href="http://bmjopen.bmj.com/content/5/12/e010112">recent paper</a> with respondents from 19 countries found Australians were <a href="http://bmjopen.bmj.com/content/bmjopen/suppl/2015/12/23/bmjopen-2015-010112.DC1/bmjopen-2015-010112supp.pdf">second only to New Zealand</a> in relation to knowledge about the illegality of serving drunk patrons.</p>
<p>The research found that in countries where public knowledge is highest, respondents are least likely to agree that a drunk person will be served.</p>
<p>While public knowledge is not enough to stop service to drunk patrons, perhaps informal regulation or self-regulation is enacted through public knowledge. People are less likely to attempt to purchase alcohol when intoxicated if they are aware of the law. And alcohol servers are less inclined to serve drunks if they sense patrons are aware of the legislation and may report their behaviour.</p>
<h2>Room for improvement</h2>
<p>However, the variation in responses between Australia’s states and territories suggests there remains room for improvement. </p>
<p>Focusing on further refinements to the content and delivery of RSA training is unlikely to be the answer. While evidence regarding the effectiveness of RSA training is mixed, there are core limitations of this approach that cannot be tackled through better training methods. </p>
<p>RSA training provides knowledge to servers about signs of intoxication. But these may be difficult to identify in a bar or club where lighting is poor, noise levels are high, and the interaction between bar staff and patrons is brief. </p>
<p>Given the liquor industry’s core business is the sale of alcohol, it’s easy to see why licensees and bar staff may be conflicted when it comes to refusing service. Such an action will likely result in loss of profit, and may lead to outrage or conflict from patrons. </p>
<p>Finally, any systematic approach to enforcement is likely to be resource-intensive and costly. Convictions are difficult to achieve: this requires proof the server was aware of the patron’s intoxication level.</p>
<p>This is not to suggest Australia should do away with its current RSA legislation. Instead, this approach should be coupled with public discussion that encourages people to take responsible for their own drinking behaviour, rather than placing the burden on servers to set drinking limits for patrons.</p>
<hr>
<p><em>This article was co-authored by Emily Kilpatrick, a masters student at the University of Queensland.</em></p><img src="https://counter.theconversation.com/content/80890/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Ferris is the chief biostatistican and part of the core research team in the Global Drug Survey.
Jason Ferris receives and has received financial support from the Australian National Health and Medical Research Council
(APP1089395, APP1122200), Australian Research Council (LP160100067, LP120100689, RFQ2009/30), Foundation for Alcohol Research and Education, Queensland Government, Criminology Research Council, Queensland Alliance for Environmental Health Science, Australian & New Zealand Association of Oral & Maxillofacial Surgeons, Tasmanian Department of Health and Human Services, The University of Queensland, Victorian Law Enforcement Drug Fund, Department of Health and Ageing, VicHealth, Australian National Preventive Health Agency.</span></em></p><p class="fine-print"><em><span>Adam Winstock is founder of the annual Global Drugs Survey.</span></em></p><p class="fine-print"><em><span>Larissa J. Maier and Renee Zahnow do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Responsible Service of Alcohol laws should be coupled with public discussion that encourages people to take responsible for their own drinking behaviour.Jason Ferris, Senior Research Fellow, NHMRC Postdoctoral Research Fellow, Institute for Social Science Research, The University of QueenslandAdam Winstock, Founder of the Global Drug Survey and Senior Lecturer, King's College LondonLarissa J. Maier, Postdoctoral Research Fellow, University of ZurichRenee Zahnow, Postdoctoral Research Fellow, Institute for Social Science Research, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/735212017-04-10T20:12:53Z2017-04-10T20:12:53ZWhere are they now? What public transport data reveal about lockout laws and nightlife patronage<figure><img src="https://images.theconversation.com/files/160264/original/image-20170310-3680-19g6uxv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In one regard, lockout laws have succeeded in decreasing crime. But take a step back to see a city-wide perspective, and there are many other issues to consider.</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>It is vital that public policy be driven by rigorous research. In the last decade key policy changes have had profound impacts on nightlife in Sydney’s inner city and suburbs. The most significant and controversial of these has been the 2014 “lockout laws”. </p>
<p>These were a series of legislative and regulatory policies aimed at reducing alcohol-related violence and disorder through new criminal penalties and key trading restrictions, including 1.30am lockouts and a 3am end to service in select urban <a href="http://www.bocsar.nsw.gov.au/Pages/bocsar_news/Mapping-the-impact-of-the-Sydney-lockout-laws-on-assault.aspx">“hotspots”</a>.</p>
<p>A range of lobbyists, including New South Wales Police and accident and emergency services, welcomed these initiatives. </p>
<p>By contrast, venue operators, industry organisations and patron groups have made repeated but largely anecdotal claims that these changes caused a sharp downturn in profit, employment and <a href="https://theconversation.com/lockout-laws-repeat-centuries-old-mistake-of-denying-value-of-cities-as-messy-places-58281">cultural vibrancy</a> in targeted areas. They also claim that the “lockouts” have caused drinking-related problems to spill over into urban areas that are less equipped to cope with them. </p>
<h2>Crime is down</h2>
<p>However, in late 2016, the <a href="https://theconversation.com/callinan-review-largely-backs-sydney-lockout-laws-but-alcohols-role-in-family-violence-is-a-blind-spot-65404">Callinan Review</a> referenced <a href="http://www.bocsar.nsw.gov.au/Documents/CJB/CJB183.pdf">compelling evidence</a> in <a href="https://www.mja.com.au/journal/2015/203/9/presentations-alcohol-related-serious-injury-major-sydney-trauma-hospital-after?0=ip_login_no_cache%3D81fb0c422065f4e0fd465916db3c81bd">support of the current policy</a>. </p>
<p>According to the <a href="http://www.bocsar.nsw.gov.au/Documents/CJB/Report-2017-Effect-of-lockout-and-last-drinks-laws-on-non-domestic-assaults-cjb201.pdf">latest research</a>, recorded rates of crime are down by around 49% in the designated Kings Cross precinct and 13% in Sydney’s CBD. </p>
<p>In contrast, what little research has been produced by opponents of strict nightlife regulation has been criticised as <a href="http://www.smh.com.au/comment/flawed-city-of-sydney-report-fuels-alcohol-lobby-20160207-gmnmgg.html">unreliable, inaccurate and poorly deployed</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/160275/original/image-20170310-3700-7ihbcv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/160275/original/image-20170310-3700-7ihbcv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/160275/original/image-20170310-3700-7ihbcv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/160275/original/image-20170310-3700-7ihbcv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/160275/original/image-20170310-3700-7ihbcv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/160275/original/image-20170310-3700-7ihbcv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/160275/original/image-20170310-3700-7ihbcv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/160275/original/image-20170310-3700-7ihbcv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The pattern of assaults has shifted since the lockout laws began.</span>
<span class="attribution"><span class="source">BOCSAR</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The Callinan Review noted the lack of verifiable claims about the negative impacts of the policy in submissions from the main opponents of the lockout laws. This has led to a great deal of assumption in the final report about where, for example, revellers, jobs, entertainment and revenue might have been displaced to, or how the policy changes affected them. </p>
<p>In many respects, the passing over of claims made by anti-lockout groups is rather unfair. These groups are not official state bodies with the capacity to produce the type of data or evidence on which the policy has been justified and defended. As such, their <a href="https://theconversation.com/the-24-7-city-creativity-and-the-lockout-laws-56271">“unscientific” observations</a> and experiences have been largely dismissed. </p>
<p>To critically balance and juxtapose opposing claims, more impact data and research are needed.</p>
<h2>We must take a city-wide perspective</h2>
<p>If the lockout policy is judged on the original goal of decreasing crime in designated “hotspots”, then it appears to have been a success. </p>
<p>However, from a city-wide perspective there are other issues to consider. Not the least of these is the effects in other nightlife sites across Sydney. </p>
<p>Despite initially finding <a href="http://www.bocsar.nsw.gov.au/Documents/CJB/CJB183.pdf">no displacement of violence</a> to nearby nightlife sites, the NSW Bureau of Crime Statistics and Research (BOCSAR) has just <a href="http://www.bocsar.nsw.gov.au/Documents/CJB/Report-2017-Effect-of-lockout-and-last-drinks-laws-on-non-domestic-assaults-cjb201.pdf">released findings</a> showing significant displacement in rates of recorded non-domestic-related violence in destinations outside the lockout zone. </p>
<p>Reported crime rates in Newtown, one of the displacement sites listed in the BOCSAR study (along with Bondi and Double Bay), increased by 17% in the 32 months following the lockouts. </p>
<p>These new findings appear to vindicate some local complaints about increased night violence – including attacks targeting LGBTI victims – that has led to much resident irritation and even political protest in recent years. </p>
<h2>Adjusting our nightlife habits</h2>
<p>So, how can we better judge the veracity of these claims about the displacement of nuisance and violence? </p>
<p>Mapping patronage trends is a key means of understanding how and why rates of assault have now increased despite initially showing little to no change. </p>
<p>To this end, Kevin McIsaac and I, with data from Transport for NSW, have set out to ascertain if and how nightlife participation in Sydney has been influenced by the lockouts. </p>
<p>Our analysis focused on night-time aggregated train validation data (turnstile counts) from January 2013 to July 2016 for stations servicing the designated nightlife precincts (Kings Cross, Town Hall) and precincts outside the lock-out zone (Newtown, Parramatta). </p>
<p>Using Bayesian Change Point (BCP) detection we found the following:</p>
<ul>
<li><p>no evidence of changes to Kings Cross or Parramatta exit traffic from the introduction of the lockout laws;</p></li>
<li><p>evidence of strong growth in the Parramatta Friday-night exit traffic by about 200% since January 2013, which is independent of the lockout laws;</p></li>
<li><p>evidence of an increase of about 300% in the Newtown Friday-night exit traffic as a result of the lock-out laws; and</p></li>
<li><p>in all stations, the BCP algorithm detected a change when OPAL card usage exceeded magnetic ticket usage. This suggests the jumps seen in the graphs below are due to the higher exit reporting from OPAL. The switch from flat to slow growth in trend is probably an artefact of the relative increase in OPAL usage.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159919/original/image-20170308-27355-16o7ft2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159919/original/image-20170308-27355-16o7ft2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159919/original/image-20170308-27355-16o7ft2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=194&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159919/original/image-20170308-27355-16o7ft2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=194&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159919/original/image-20170308-27355-16o7ft2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=194&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159919/original/image-20170308-27355-16o7ft2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=244&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159919/original/image-20170308-27355-16o7ft2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=244&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159919/original/image-20170308-27355-16o7ft2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=244&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kings Cross change point Friday night.</span>
</figcaption>
</figure>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159920/original/image-20170308-27327-g37eyu.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159920/original/image-20170308-27327-g37eyu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159920/original/image-20170308-27327-g37eyu.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=194&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159920/original/image-20170308-27327-g37eyu.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=194&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159920/original/image-20170308-27327-g37eyu.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=194&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159920/original/image-20170308-27327-g37eyu.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=244&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159920/original/image-20170308-27327-g37eyu.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=244&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159920/original/image-20170308-27327-g37eyu.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=244&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kings Cross change point Saturday night.</span>
</figcaption>
</figure>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159921/original/image-20170308-27347-qggfez.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159921/original/image-20170308-27347-qggfez.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159921/original/image-20170308-27347-qggfez.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=194&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159921/original/image-20170308-27347-qggfez.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=194&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159921/original/image-20170308-27347-qggfez.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=194&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159921/original/image-20170308-27347-qggfez.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=244&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159921/original/image-20170308-27347-qggfez.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=244&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159921/original/image-20170308-27347-qggfez.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=244&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Newtown change point Friday night.</span>
</figcaption>
</figure>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159922/original/image-20170308-27360-2tvpi9.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159922/original/image-20170308-27360-2tvpi9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159922/original/image-20170308-27360-2tvpi9.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=194&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159922/original/image-20170308-27360-2tvpi9.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=194&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159922/original/image-20170308-27360-2tvpi9.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=194&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159922/original/image-20170308-27360-2tvpi9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=244&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159922/original/image-20170308-27360-2tvpi9.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=244&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159922/original/image-20170308-27360-2tvpi9.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=244&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Newtown change point Saturday night.</span>
</figcaption>
</figure>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159923/original/image-20170308-27373-11053fc.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159923/original/image-20170308-27373-11053fc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159923/original/image-20170308-27373-11053fc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=194&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159923/original/image-20170308-27373-11053fc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=194&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159923/original/image-20170308-27373-11053fc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=194&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159923/original/image-20170308-27373-11053fc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=244&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159923/original/image-20170308-27373-11053fc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=244&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159923/original/image-20170308-27373-11053fc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=244&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parramatta change point Friday night.</span>
</figcaption>
</figure>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/159925/original/image-20170308-27341-1lwtmba.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159925/original/image-20170308-27341-1lwtmba.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/159925/original/image-20170308-27341-1lwtmba.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=194&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159925/original/image-20170308-27341-1lwtmba.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=194&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159925/original/image-20170308-27341-1lwtmba.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=194&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159925/original/image-20170308-27341-1lwtmba.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=244&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159925/original/image-20170308-27341-1lwtmba.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=244&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159925/original/image-20170308-27341-1lwtmba.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=244&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Parramatta change point Saturday night.</span>
</figcaption>
</figure>
<p>These findings provide new insights into the way people have adjusted their nightlife habits. The most interesting finding is the dramatic increase in access to Newtown nightlife. Exits in Newtown have increased 300% since the lock-outs were introduced in 2014. </p>
<p>As can be seen from the graph, the rate of increase has been steady over the study period. This raises questions about whether there is a threshold at which patron density becomes an issue that potentially results in increased nuisance and violence. </p>
<h2>Big data’s capacity to help</h2>
<p>While this research is still in its early phases, the transport data tell one small, yet significant, part of the story. However, to draw definite conclusions, there is far more that needs to be considered. </p>
<p>Many nightlife patrons travel into the city by different means, or don’t travel at all (those who live in and around the city). </p>
<p>We need alternative data to try to identify patterns concerning these groups. Several different organisations have data that could help paint a more complete picture, including telcos, Google, Taxis NSW and Uber. </p>
<p>While these organisations should be protective of their data, the value of anonymous aggregate location data is how it can inform and advance public policy through ethical research. This information is key to breaking down access barriers. Without access to these anonymous aggregations of privately controlled data, the capacity of research is limited.</p>
<p>As such, there is a need for greater communication, collaboration and co-operation between producers of big data, the government and researchers into social impact. By building stronger evidence for all manner of policies, such partnerships have an amazing potential to contribute to the public good.</p><img src="https://counter.theconversation.com/content/73521/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phillip Wadds does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Policy changes such as the ‘lockout laws’ have had profound impacts on inner Sydney nightlife. Transport data help us see whether these have caused problems to spill over into neighbouring areas.Phillip Wadds, Lecturer in Criminology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/528152016-01-07T19:22:02Z2016-01-07T19:22:02Z‘Last drink’ laws, not lockouts, reduce alcohol-fuelled violence<figure><img src="https://images.theconversation.com/files/107483/original/image-20160107-9280-7yoj1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sydney's Kings Cross precinct has 3AM 'last-drinks' laws and 1:30AM lockouts for premises that serve alcohol.</span> <span class="attribution"><span class="source">AAP/April Fonti</span></span></figcaption></figure><p>Each state and territory of Australia has laws concerning times when alcohol can be sold. As Queensland considers <a href="http://www.brisbanetimes.com.au/queensland/cole-millers-death-govt-committed-to-antiviolence-lockout-laws-says-dath-20160104-glz1a3.html">new laws</a>, several policy experiments that have occurred in recent years can provide valuable lessons.</p>
<h2>The Newcastle experiment</h2>
<p>Newcastle was the setting of what is arguably a turning point in a decades-long trend of increasing availability and promotion of alcohol in Australia.</p>
<p>In March 2008, following complaints from the community and police about late-night violence and disorder, the NSW Liquor Administration Board <a href="http://www.ncbi.nlm.nih.gov/pubmed/20840191">required 14 pubs</a> in the Newcastle CBD to close by 3am. Previously, they’d been allowed to open until 4.30am or 5am.</p>
<p>The board also imposed a 1.30am “lockout”. This was a uniquely Australasian intervention that permitted patrons to remain drinking in premises until closing but not to enter other premises.</p>
<p>It was a landmark decision; such restrictions had not previously been applied across an entire precinct. The scale of the intervention and the fact that late-trading pubs in neighbouring Hamilton were not included in the decision created an opportunity to study the kind of policy experiment governments frequently undertake, but rarely learn from.</p>
<p>The outcome was a <a href="http://www.ncbi.nlm.nih.gov/pubmed/20840191">one-third reduction in assaults</a> in the 18 months following the restrictions. There was no sign of displacement to earlier in the evening or to Hamilton, where the assault rate continued increasing. </p>
<p>The usual chorus of vested interests and commentators claiming effects would be <a href="https://theconversation.com/earlier-pub-closing-times-key-to-reducing-alcohol-fuelled-assaults-23829">short-lived</a> followed. But assault rates remained lower in the Newcastle CBD <a href="http://www.ncbi.nlm.nih.gov/pubmed/24589092">for years afterwards</a>. They’re now <a href="http://www.ncbi.nlm.nih.gov/pubmed/26424538">half what they were</a> before 2008.</p>
<h2>Reducing hours of drinking works; lockouts alone probably don’t</h2>
<p>Notably, there has been <a href="http://www.ncbi.nlm.nih.gov/pubmed/26424538">little if any improvement</a> in Hamilton, despite the introduction of a 1am weekend lockout there in 2010. This finding is consistent with <a href="http://www.ncbi.nlm.nih.gov/pubmed/22050294">other studies</a> that show no benefit of lockouts when they are used as a sole measure.</p>
<p>The Newcastle experience is consistent with reviews of international and other Australian studies in <a href="http://www.uvic.ca/research/centres/carbc/assets/docs/report-do-relaxed-trading-hours.pdf">2009</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21084080">2010</a>, which show that when trading hours increased, so did rates of violence.</p>
<p>Studies since these reviews were published – from <a href="http://www.ncbi.nlm.nih.gov/pubmed/26189565">Western Australia</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/21906198">Norway</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/25689068">the Netherlands</a> – replicate their findings.</p>
<h2>‘Freedom to’ versus ‘freedom from’</h2>
<p>In February 2014, the O’Farrell government in NSW introduced 3am “last-drinks” laws and 1.30am lockouts in the Sydney CBD and Kings Cross.</p>
<p>Independent evaluations that followed show large reductions in <a href="http://www.bocsar.nsw.gov.au/Documents/CJB/CJB183.pdf">police apprehensions</a> for assault and <a href="http://www.ncbi.nlm.nih.gov/pubmed/26510806">emergency department presentations</a> for alcohol-related serious injury. </p>
<p>Requiring premises merely to stop selling alcohol rather than close was a step forward from the Newcastle experiment. If patrons wish to eat, listen to music, or watch a striptease, it should not be for government to decide whether premises are allowed to provide these services. </p>
<p>The aim of government regulation must surely be to strike a balance between what philosopher Isaiah Berlin <a href="https://www.wiso.uni-hamburg.de/fileadmin/wiso_vwl/johannes/Ankuendigungen/Berlin_twoconceptsofliberty.pdf">termed</a> “freedom to” versus “freedom from” – in this case, the individual right to drink in public in the early hours versus the public right to safety. Whether businesses remain open when they can no longer sell alcohol should be up to them.</p>
<h2>New limits for Queensland?</h2>
<p>The Queensland parliament is <a href="http://www.legislation.qld.gov.au/Bills/55PDF/2015/TacklingAFVLegAB15.pdf">set to consider</a> whether the state should adopt a 2am last-drinks limit – except in entertainment precincts, where 3am last drinks and a 1am lockout may be approved.</p>
<p>This is a further advance in the evolution of these laws, bringing them closer to the scientific evidence. The proposal advances the public interest by extending the policy state-wide, affording citizens in smaller centres and towns the benefits enjoyed by those living in major cities. It also limits the reliance on lockouts, whose efficacy is at best uncertain. </p>
<p>The Queensland bill would be better still if it applied the 2am limit across the state and required that alcohol consumption (rather than sales) cease by 2am (“last drinking”, as happens in the US state of <a href="http://www.abc.ca.gov/FORMS/ABC608.pdf">California</a>). </p>
<p>A second reading of the bill when Queensland’s parliament resumes in February will reveal whether the government has the numbers to pass the legislation in a precariously balanced parliament.</p>
<p>Meanwhile, the NSW government is considering the merits of continuing with the Sydney conditions, which have dramatically reduced harm in the CBD and Kings Cross. It would be wise to take note of the openness to evidence and focus on the public interest north of the border.</p><img src="https://counter.theconversation.com/content/52815/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kypros Kypri receives funding from the National Health & Medical Research Council in the form of a Senior Research Fellowship and Project Grant, and from the Australian Research Council in the form of Project Grants. He also received funding from the Health Research Council of New Zealand. </span></em></p>As Queensland considers new laws to curb alcohol-fuelled violence in response to a one-punch death, several policy experiments that have occurred in recent years can provide valuable lessons.Kypros Kypri, Professor and Senior Brawn Research Fellow, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/418842015-05-21T04:36:07Z2015-05-21T04:36:07ZDon’t believe the hype, teens are drinking less than they used to<figure><img src="https://images.theconversation.com/files/82340/original/image-20150520-25039-1mkxm2i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Teenage drinking in Australia has declined dramatically over the past fifteen years.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/wanderlust_heart/4602555704/">tristanforestjames/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Ask your friends and colleagues about young Australians and alcohol and I bet they’ll say something about a <a href="http://www.news.com.au/lifestyle/parenting/drunk-and-confused-weekend-drinking-is-hitting-the-performance-of-our-teenagers-in-school/story-fnjco7gt-1226846282552.">generation out of control</a> or a <a href="http://www.heraldsun.com.au/news/victoria/young-women-in-binge-drinking-epidemic/story-e6frf7kx-1226630740211">binge-drinking epidemic</a>. </p>
<p>The media regularly brings the <a href="http://www.abc.net.au/news/2014-08-16/sydney-alcohol-free-gigs-tackle-booze-culture/5675484">worst outcomes</a> of young people’s drinking to our attention and points to a problematic drinking culture supposedly unique to young Australians. Little wonder people believe things have never been so bad.</p>
<p>The reality is startlingly different. Data <a href="http://abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4307.0.55.001Main+Features12013-14?OpenDocument">recently released by the Australian Bureau of Statistics</a> shows alcohol consumption in Australia has reached its lowest point since the early 1960s, having declined steadily since the mid-2000s. Survey data suggests this decline has been driven almost entirely by reductions in youth drinking. </p>
<p>According to the <a href="http://onlinelibrary.wiley.com/doi/10.1111/dar.12255/abstract">National Drug Strategy Household Survey</a>, the proportion of 12- to 15-year-olds who reported any drinking in the past year halved, from 35% in 2004 to 18% in 2013. Over the same time, drinking by 16- to 17-year-olds fell sharply as well, from 81% to 59%. </p>
<p>In case you think there must be something wrong with this survey, results from the <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/school11">Australian Secondary Students Alcohol and Drug Survey</a> show similar trends. Between 2002 and 2011, drinking in the past week fell by more than half for 12- to 15-year-olds (from 29% to 11%) and nearly as sharply for 16-17 year olds (48% to 33%). </p>
<p>Rates of heavy drinking have <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/school11">fallen</a> as well. Teenagers in Australia are drinking less alcohol now than they have at any time since these surveys began in the early 1980s.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/82350/original/image-20150520-24994-1xk16xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82350/original/image-20150520-24994-1xk16xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82350/original/image-20150520-24994-1xk16xy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82350/original/image-20150520-24994-1xk16xy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82350/original/image-20150520-24994-1xk16xy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82350/original/image-20150520-24994-1xk16xy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82350/original/image-20150520-24994-1xk16xy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In 2011, one-third (33%) of 16- to 17-year-olds reported drinking in the past week, down from almost half (48%) in 2002.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/garryknight/4660207930/">Garry Knight/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>There is increasing evidence that these patterns are holding as this cohort of teenagers moves into young adulthood, with <a href="http://www.aihw.gov.au/publication-detail/?id=60129549469">weekly risky drinking</a> among 18- to 24-year-olds dropping from 32% to 22% between 2010 and 2013. Declines in drinking are occurring for boys and girls, across all socioeconomic groups and in regional and urban areas. The changes are <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12524/abstract">not isolated</a> in particular population sub-groups. </p>
<p>Remarkably, these trends seem to be part of a global shift. A <a href="http://eurpub.oxfordjournals.org/content/25/suppl_2/69">recent paper</a> identified significant declines in underage drinking in 20 of the 28 countries studied. In countries with similar drinking cultures to Australia such as the United Kingdom, Canada, and Sweden, teen drinking has halved. </p>
<p>Somewhat surprisingly, little attention has been paid to these trends or the reasons behind them. Based on <a href="http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/school11">Australian data</a>, we can be reasonably confident that young people aren’t shifting to illicit drugs instead of alcohol. Rates of cannabis and meth/amphetamine use have also declined in the past decade. </p>
<p>Similarly, it doesn’t seem likely that major policy changes have caused the trends. The decline in youth drinking started well before the <a href="http://www.theage.com.au/articles/2008/04/27/1208743339515.html">alcopops tax</a> in 2008, and alcohol has become more widely available and promoted in recent years. </p>
<p>Attitudes to alcohol have clearly been shifting in Australia, with <a href="http://www.fare.org.au/wp-content/uploads/2013/07/Australian-attitudes-towards-policy-FINAL.pdf">greater support</a> for restrictive policies, more <a href="http://alcalc.oxfordjournals.org/content/49/3/336">negative media coverage</a> and <a href="http://www.aihw.gov.au/publication-detail/?id=60129549469">increasing public concern</a>. These attitude shifts may be driving the declines in youth drinking, although it is notable that drinking among Australians older than 30 remains unchanged. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/82351/original/image-20150520-25033-1k375hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82351/original/image-20150520-25033-1k375hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82351/original/image-20150520-25033-1k375hb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82351/original/image-20150520-25033-1k375hb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82351/original/image-20150520-25033-1k375hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82351/original/image-20150520-25033-1k375hb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82351/original/image-20150520-25033-1k375hb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Social media has reduced the centrality of drinking in socialising.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/eunix/3125117477/">Evgeny Pavlov/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>It may be that decades of public education campaigns and school programs focusing on youth drinking have finally been effective, but <a href="http://onlinelibrary.wiley.com/doi/10.1002/ebch.1829/full">the broader research literature</a> suggests this is unlikely.</p>
<p>The global consistency of the trends suggests a broader shift in youth cultures might be driving change. One possibility is that the increase in the use of social media has altered the way young people interact, reducing the centrality of drinking in socialising. The <a href="http://www.cybersmart.gov.au/About%20Cybersmart/Research/ACMA%20research/Like-post-share.aspx">impact of the internet and social media</a> in young people’s lives has increased enormously in recent years. But there is little research into how these changes have affected drinking. </p>
<p><a href="http://search.informit.com.au/documentSummary;dn=200906331;res=IELAPA">Research has also shown</a> that exercising, eating well and avoiding alcohol and other drugs are important lifestyle choices for many young people. An increasing focus on healthy living may be an important factor in declining youth drinking. </p>
<p>The declines in youth drinking may have been caused by a combination of all of these factors. Further research is crucial so that current trends can be supported through appropriate interventions. </p>
<p>The recent dramatic reductions in teenage drinking is good news for public health, and is a refreshing counter-argument to the <a href="https://theconversation.com/images-of-australian-youth-from-symbols-of-hope-to-disposable-lives-27126">way young Australians</a> are often presented.</p><img src="https://counter.theconversation.com/content/41884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Livingston has received research funding from The National Health and Medical Research Council, The Australian Research Council, The Victorian Health Promotion Foundation, The Australian National Preventative Health Agency and the Foundation for Alcohol Research and Education. He is currently funded by an Early Career Fellowship from the National Health and Medical Research Council (APP1053029). He is affiliated with the Drug Policy Modelling Program in the National Drug and Alcohol Research Centre at the University New South Wales and the Centre for Alcohol Policy Research at Turning Point.</span></em></p><p class="fine-print"><em><span>Amy Pennay has received research funding from the Australian Research Council, the National Health and Medical Research Council, the National Drug Law Enforcement Research Fund, Beyond Blue, the Victorian Health Promotion Foundation, the Foundation for Alcohol Research and Education and NSW Health. She is currently funded by an Early Career Fellowship from the National Health and Medical Research Council (APP1069907), and is affiliated with the School of Population and Global Health at the University of Melbourne and the Centre for Alcohol Policy Research at Turning Point. </span></em></p>Ask your friends and colleagues about young Australians and alcohol and I bet they’ll say something about a generation out of control or a binge-drinking epidemic.Michael Livingston, Post-Doctoral Research Fellow at The National Drug and Alcohol Research Centre, UNSW SydneyAmy Pennay, Research Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/418952015-05-18T20:03:09Z2015-05-18T20:03:09ZMy problem with your drinking: Australia’s hate-love relationship with alcohol<figure><img src="https://images.theconversation.com/files/81984/original/image-20150518-25422-yjz0la.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's simply easier to say others are flawed than admit _you_ might be the one who is flawed.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/">Shutterstock</a></span></figcaption></figure><p>In this year’s <a href="http://www.fare.org.au/AlcPoll2015/">annual alcohol poll</a>, 34% of Australians said they drink to get drunk, 43% said they had vomited as a result of drinking and 75% said Australia has a problem with excess drinking or alcohol abuse. </p>
<p>But in the same Foundation for Alcohol Research and Education poll, 92% of Australians identified themselves as responsible drinkers.</p>
<p>As the young people might say, what the …? A majority of Australians agree we have a problem with alcohol. But almost all say it’s not a problem of theirs – it’s a problem that exists somewhere outside of their world.</p>
<p>There are both contradictions and abstractions in this discussion. But it makes perfect sense to me.</p>
<p>It’s simply easier to say others are flawed than admit <em>you</em> might be the one who is flawed. Psychologists refer to it as the self-serving or <a href="http://www.du.edu/ahss/psychology/gem/media/documents/mezulis_positivitybias.pdf">positivity bias</a>; it’s the only way to protect our “fragile ego from the blows of reality” and to reconcile our often contradictory behaviour in a complex world. </p>
<p>To think our own behaviour is irresponsible requires us to actually admit we might be a failure, or that we are out of control. And this would be a serious attack on our ego. </p>
<p>So, we seek out evidence, in all its flimsy forms, that confirms how we would like to see ourselves, and then interpret a question in the way that suits that approach.</p>
<h2>Abstract language</h2>
<p><a href="https://theconversation.com/drinkwises-cynical-campaign-shouldnt-fool-anyone-23813">Terminology</a> such as “drinking responsibly” or “wisely” or “properly” is abstract at best, and diverting at worst.</p>
<p>What exactly is a responsible drinker? If I drink two or three glasses of wine at dinner during the week am I “<a href="http://www.smh.com.au/comment/drinkwise-a-message-about-alcohol-moderation-most-people-support-20141001-10o78b.html">Drinking Wise</a>”? What about two beers after work on Friday, plus a cocktail at the Comedy Festival for a bit of treat?</p>
<p>Upon which the inevitable question arises: am I okay to admit that I might be an irresponsible drinker (whatever that means)? Irresponsible sounds pretty bad, doesn’t it?</p>
<p>And accusing <a href="http://www.smh.com.au/federal-politics/political-news/prime-minister-tony-abbott-skols-a-beer-in-a-sydney-pub-20150418-1mo3ak.html">someone else</a> of being irresponsible, because they were having “a couple of beers with their mates” or a few glasses of wine after a hard day at work, would likely result in cries of being “unAustralian”, “politically correct” or some other cliché that is rolled out whenever someone challenges the status quo.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/81987/original/image-20150518-25422-en49ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/81987/original/image-20150518-25422-en49ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/81987/original/image-20150518-25422-en49ij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/81987/original/image-20150518-25422-en49ij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/81987/original/image-20150518-25422-en49ij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/81987/original/image-20150518-25422-en49ij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/81987/original/image-20150518-25422-en49ij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s easier to be a drinker, than to not be a drinker..</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/15205252@N00/3688111285/">jofo2005</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>The problem is that alcohol is such an integral part of most adult (and adolescent) life in Australia that it has become a social norm. It <a href="http://www.couriermail.com.au/news/opinion/prime-minister-tony-abbott-calls-for-action-on-binge-drinking-and-alcohol-fuelled-violence/story-fnihsr9v-1226798544118">requires</a> significant psychological resources to challenge these norms.</p>
<p>Think about it. When you refuse alcohol at social events, it is often followed by a “why?”, an assumption that you are pregnant or on some “health” regime, or participating in a fundraising abstinence month the questioner wasn’t aware of. It’s easier to be a drinker than to not be a drinker.</p>
<h2>Diverting the problem</h2>
<p>The use of imprecise language, rather than specific, measurable metrics, makes it difficult for anyone to judge their behaviour in comparison to others. By telling people to behave “responsibly”, we create a sense that something is being done. But at an individual level, it is up to us to decide what it actually means.</p>
<p>This “hands-off” approach to public health issues is common across a range of contexts. People are expected to assume total responsibility for managing their own well-being.</p>
<p>It’s a common technique in many sectors where a risk has been identified, but governments are uncomfortable about regulation. By emphasising threats to personal freedom and liberty, opponents to state-based interventions on public health grounds establish an argument that, at face value, sounds plausible.</p>
<p>Industry and conservative stakeholders use the term “nanny state”, for example, to discredit any opposition and deride government public health interventions, despite the fact that traditionally nannies are people who are credited with being caring, considerate people, who have the best interests of their charges at heart. </p>
<p>So, they do something that looks like they’re doing something. It’s a kind of “regulatory theatre”. </p>
<p>People not really qualified to make judgements about human behaviour, work together to come up with simple interventions, such as “Drink Responsibly” or “Drink Wise” labelling, along with industry codes of conduct. These campaigns work to some degree by gently modifying social norms, but their impact is minimal.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/81988/original/image-20150518-25400-2efquq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/81988/original/image-20150518-25400-2efquq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/81988/original/image-20150518-25400-2efquq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/81988/original/image-20150518-25400-2efquq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/81988/original/image-20150518-25400-2efquq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/81988/original/image-20150518-25400-2efquq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/81988/original/image-20150518-25400-2efquq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Behavioural change requires significant resources, repetition, modelling, and support.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/johnjoh/6434001849/">star5112/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>That said, public health practitioners are often their own worst enemies. Because of their desire to be in a position to defend their approach and be seen to be responsible (there’s that word again), sometimes they over-complicate or provide too much advice, get caught up in statistics, or approach the message in an overly rational way. </p>
<h2>Marketing the message</h2>
<p>In any marketing campaign, whether you are trying to get people to “buy” your product (and in this context, the product would be to reduce drinking) or maintain loyalty (continue to drink less or not at all), programs need to communicate to the target market in a way that is, direct, accessible, personal and incremental.</p>
<p>So, instead of general, vague language such as “responsible”, “wise” or “proper”, we should be helping vulnerable segments to understand what actually is wise, proper or responsible: How many drinks are safe? What actually constitutes a standard drink, in comparison to what we are actually served?</p>
<p>But, we also need to be careful not to get into the complexity of weight, height, alcohol content, sex, and so on, which will simply confuse the campaign. Marketers of commercial products recognise that they have to gently, incrementally, move their customers towards a place where the only sensible option is to buy the product: in this case, a reduction in the consumption of alcohol.</p>
<p>Simply running an advertisement telling people to stop doing something because it’s bad for them, or because their friends will reject them, is not the way to change behaviour.</p>
<p>Don’t get me wrong, awareness campaigns are a start. However, behavioural change requires significant resources, repetition, modelling, and support from range of individuals, institutions, leaders, and infrastructure for them to be successful.</p>
<p>You also need to build a support network around the target market, that makes it easy for them to adopt the new behaviour, and more difficult for them to return to their old habits.</p>
<p>The only way forward is to recognise that there are a range of parties who must be involved in addressing the problem: the individual, family and friends, government and institutions, and the alcohol industry.</p>
<p>Of course, the individual has to have responsibility for their behaviours. </p>
<p>But we need to have a realistic understanding of how choice is undertaken, how implicit attitudes and the effect of other people and institutions influence our choices, support from a range of stakeholders, and clear information to help guide our own behaviour.</p><img src="https://counter.theconversation.com/content/41895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Harrison does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A majority of Australians agree we have a problem with alcohol. But almost all say that it’s not a problem of theirs – it’s a problem that exists somewhere outside of their world.Paul Harrison, Senior lecturer, Deakin Business School; Director, Centre for Organisational Health and Consumer Wellbeing, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/396432015-04-09T04:40:55Z2015-04-09T04:40:55ZEarly pub closing times work for Kings Cross – they will for Queensland too<figure><img src="https://images.theconversation.com/files/77434/original/image-20150409-15240-10k8trn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Early closing times reduce alcohol-fuelled violence but still face opposition from businesses</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/brunogirin/70449421">Bruno Girin/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The newly elected <a href="http://www.brisbanetimes.com.au/queensland/lockouts-and-3am-closing-time-served-up-20150326-1m8rwn.html">Queensland government has said it will push ahead</a> with its plan to introduce lockouts and 3am closing times for pubs and clubs. Despite objections from vested interests, there’s now plenty of evidence to show this is a good idea for patrons and businesses alike.</p>
<p>Just 12 months after they were introduced, early closing times for pubs and clubs in central Sydney have caused a massive decline in crime throughout the previously violence-ridden Sydney suburb of Kings Cross. NSW Police data <a href="http://www.dailytelegraph.com.au/news/opinion/cross-clean-up-is-a-victory-for-sydney/story-fni0cwl5-1227286782205">reported in Sydney’s Daily Telegraph</a> last week illustrates the impact of trading hours restrictions in King Cross after 12 months. It shows:</p>
<ul>
<li>sexual assaults in the area are down by 20.8%</li>
<li>assaults causing grievous bodily harm are down by 43%</li>
<li>assaults causing actual bodily harm have declined by 50.3%</li>
<li>robberies have fallen by a huge 57.1%</li>
<li>car theft is down by 44.6%, and </li>
<li>stealing from motor vehicles is down by 47.5%.</li>
</ul>
<p>Probably the most important gain – and one that’s not mentioned above – is the one <a href="http://www.dailytelegraph.com.au/news/opinion/cross-clean-up-is-a-victory-for-sydney/story-fni0cwl5-1227286782205">highlighted by Kings Cross local area commander</a> Superintendent Mick Fitzgerald: </p>
<blockquote>
<p>The man hours saved and the way we are able to reallocate our resources has been phenomenal.</p>
</blockquote>
<p>Many state governments in Australia expend massive resources on extra policing to effectively subsidise late-night venues by facilitating people drinking between 3am and 7am (despite the fact that <a href="http://www.fare.org.au/wp-content/uploads/2011/07/FARE-Alcohol-Poll-2014_LR.pdf">around 80% of the population</a> want pubs shut at 3am). But police in Kings Cross are now able to use their time dealing with criminal activity.</p>
<h2>Compelling arguments</h2>
<p>The state of Kings Cross a year on provides clear support for the newly elected <a href="http://www.brisbanetimes.com.au/queensland/lockouts-and-3am-closing-time-served-up-20150326-1m8rwn.html">Queensland government’s proposal</a> but, not unexpectedly, industry groups are critical of the idea. They argue “<a href="http://www.brisbanetimes.com.au/queensland/lockouts-and-3am-closing-time-served-up-20150326-1m8rwn.html">anti-social behaviour is a cultural problem, not an operational one</a>” and that the proposal will have a negative impact on the economy as well as worsening “<a href="http://www.brisbanetimes.com.au/queensland/lockouts-and-3am-closing-time-served-up-20150326-1m8rwn.html">law and order issues surrounding entertainment zones</a>”. </p>
<p>The experience of Kings Cross has already proven them wrong about the latter point. And the seven years since similar measures were introduced in Newcastle provide the other nails in the coffin of that argument. </p>
<p>The story from Newcastle is that you can change drinking culture and <a href="http://www.ndlerf.gov.au/publications/monographs/monograph-43">businesses don’t have to suffer</a>. There are now <a href="olgr.nsw.gov.au">almost 50% more liquor licences</a> in Newcastle than there were in 2008 when the original 3am close was put in place. And the new venues are mostly small bars and restaurants.</p>
<p>In research my colleagues and I did to explore what measures were effective for reducing alcohol-related harm, we compared Newcastle, with its blanket 3am closing time, to Geelong, where pubs could stay open until 7am. <a href="http://dro.deakin.edu.au/view/DU:30062340">We found</a> people were actually spending more money, on average, in Newcastle. </p>
<p>Venue operators in Newcastle didn’t mind going home earlier, particularly once they adapted their business models to focus on alternative forms of entertainment and especially providing meals. These venues are now thriving and have very low levels of <a href="http://www.ncbi.nlm.nih.gov/pubmed/24589092">alcohol-related assaults</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/24612319">emergency department attendances</a>.</p>
<p>While we don’t have Australian data on how much money changes hands in the night-time economy, <a href="http://lordmayors.org/site/wp-content/uploads/2015/02/PN041230_TheAustralianNTE_vFinal.pdf">UK studies show</a> only 20% of sales made between 6pm and 6am occur after midnight. When you consider how busy most pubs are between midnight and 2am, it seems unlikely that closing times at 3am, when crowds have dwindled, will have a significant impact on business bottom lines.</p>
<h2>A better culture</h2>
<p>Many licensees in Newcastle were ultimately <a href="http://www.deakin.edu.au/dante">glad to have legislation put into place</a>, because previously there was always a rogue or desperate trader who wanted to open later. The legislation meant everyone was competing on a level playing field. </p>
<p>According to my count in Geelong, where no restrictions are in place, 19 licensed businesses have gone broke in the past six years. </p>
<p>While elements of the alcohol industry oppose earlier closing, they don’t provide any evidence to support their arguments. If they considered the benefits this will bring to individual businesses, they would support closing pubs earlier and begin planning to build their businesses on a different drinking culture – a culture that encourages people to go out earlier, eat more and pre-load less, rather than one that’s all about fuelling drunken patrons to dangerous levels.</p>
<p>The evidence overwhelmingly supports the Queensland government’s proposed state-wide reduction of hours when alcohol is sold. The results of early closing times in Kings Cross and Newcastle show the objections of self-interested minorities are baseless, especially when considering the huge economic and social benefits seen elsewhere.</p><img src="https://counter.theconversation.com/content/39643/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Disclosure statement
Peter Miller receives funding from Australian Research Council and Australian National Health and Medical Research Council, grants from NSW Government, National Drug Law Enforcement Research Fund, Foundation for Alcohol Research and Education, Cancer Council Victoria, Queensland government and Australian Drug Foundation, travel and related costs from Australasian Drug Strategy Conference. He is affiliated with academic journal Addiction. He has acted as a paid expert witness on behalf of a licensed venue and a security firm.</span></em></p>The Queensland government has said it will push ahead with its plan to introduce lockouts and 3am closing times for pubs and clubs. This is a good idea for patrons and businesses alike.Peter Miller, Principal Research Fellow, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/357692015-03-25T06:31:31Z2015-03-25T06:31:31ZCall time on soft approach to Big Alcohol<figure><img src="https://images.theconversation.com/files/75669/original/image-20150323-17672-1j84zxk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gauging the pressure to make changes to the law.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ell-r-brown/4178017589/in/photolist-7ncr52-cFdGJs-vQHTS-8AGoVZ-9AEMYz-bqcxCB-a6x7e7-7ncq6F-nCzUe9-fEjzjc-9AW9tM-pTCrPZ-6vZmkH-9wVUMY-r4Zx9t-D1rWM-kqZqB-kqZut-66vK3f-EnBFd-4WFVY8-q5h5Dc-4MucdR-gTBSu-4E4LbL-gTBZf-6vZm5B-6vZkVk-8hmiVP-9tNMYN-9RAFrM-p4Lmu5-5MTQFf-oc8NK-pkNU5-aeXTYp-ayjuwp-bx2Vxb-kfV7G8-9XMwPs-9RDA7A-5rBhcE-ekT6f8-64jAPc-c16vD9-braE6a-fEBcxL-bgM1rD-9iHtmr-aqSzuE">Elliott Brown</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Ten years ago the World Health Organisation’s <a href="http://www.who.int/fctc/en/">Framework Convention on Tobacco Control</a> (FCTC) came into force. It was <a href="http://apps.who.int/iris/handle/10665/89478">not the first</a> international health treaty negotiated by the WHO, but in many ways it was the most remarkable. Achieving global consensus around any kind of public health treaty is quite a feat. So achieving a consensus when the main target of the treaty was, in effect, that most slippery and dangerous of customers – Big Tobacco – was close to miraculous. </p>
<p>Within a year, <a href="http://www.who.int/fctc/signatories_parties/en/">168 states</a> had signed the treaty and <a href="http://www.fctc.org/about-fca/tobacco-control-treaty/latest-ratifications">many more</a> are now parties to the convention. As the WHO <a href="http://www.who.int/fctc/about/en/">loudly (and rightly) trumpets</a>, this makes it “one of the most rapidly and widely embraced treaties in the history of the United Nations”. </p>
<p>In the decade that has passed since the FCTC earthquake shook the international health law landscape, the global public health community has increasingly turned its attention to another industry: <a href="https://theconversation.com/big-alcohol-and-big-tobacco-boozem-buddies-9668">Big Alcohol</a>. So far the WHO has stopped short of using its authority to create a Framework Convention on Alcohol Control (FCAC). </p>
<p>Instead it has opted for a more softly-softly approach. This has primarily taken the form of a <a href="http://www.who.int/substance_abuse/activities/gsrhua/en/">global strategy</a> to reduce the harmful use of alcohol which was endorsed by the 63rd World Health Assembly in 2010. This strategy is designed to tackle the growing impact of alcohol on individuals and society. However, <a href="http://www.who.int/substance_abuse/alcstratenglishfinal.pdf?ua=1">as a</a> “portfolio of policy options and measures that could be considered for implementation and adjusted as appropriate at the national level” it growls more than it bites. </p>
<h2>The calls for FCAC</h2>
<p>The unwillingness of the WHO to grasp the framework nettle has annoyed many a medical expert. The <a href="http://www.wma.net/en/30publications/10policies/a22/">World Medical Association</a>, the <a href="http://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/07/11/50/a-call-for-a-framework-convention-on-alcohol-control">American Public Health Association</a> and the <a href="http://www.asam.org/docs/publicy-policy-statements/1est-of-framework-convention-4-07.pdf?sfvrsn=0">American Society of Addiction Medicine</a> have issued policy statements calling for an international convention to control alcohol and many leading medical journals <a href="http://bit.ly/1CKc3WV">such as The Lancet</a> have published supportive editorials. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75694/original/image-20150323-17702-1ordm7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smoking and drinking both cost.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-67545415/stock-photo-thoughtful-gangster.html?src=iThofN1zi4CUBtQ_WGGu-g-1-30">Drinking by Shutterstock</a></span>
</figcaption>
</figure>
<p>The underlying reason for these calls relates to the fact alcohol is beginning to rival tobacco in the deadly harvest that it reaps. Tobacco still rules the roost in terms of the global impact on health; around <a href="http://www.who.int/mediacentre/factsheets/fs339/en/">half of the billion-strong smokers</a> living today will probably die of tobacco-related diseases. However, the <a href="http://www.who.int/substance_abuse/facts/global_burden/en/">global burden of disease</a> attributable to alcohol is very similar to the burden attributable to tobacco and in certain groups, <a href="http://www.who.int/mediacentre/factsheets/fs349/en/">especially the young</a>, alcohol may already cause more havoc.</p>
<h2>Harm caused by alcohol</h2>
<p>In 2012, 5.9% of all global deaths and 5.1% of the global burden of disease and injury were <a href="http://www.who.int/substance_abuse/facts/alcohol/en/">attributable to drinking alcohol</a>. This translates into 3.3m souls succumbing to the allure of beer, wine and spirits. The problem is especially acute <a href="http://www.theguardian.com/world/2014/jan/31/russian-men-losing-years-to-vodka">in countries like Russia</a>. But the UK is <a href="http://www.theguardian.com/society/2013/nov/13/britain-liver-disease-epidemic-alcohol-cirrhosis-young-people">badly affected</a> too. </p>
<p>Alcohol, like tobacco, can also affect third parties. Adults and <a href="http://www.theguardian.com/commentisfree/2014/may/14/tobacco-farm-child-labor-laws">children</a> who <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497768/">cultivate tobacco</a> are exposed to a number of hazards and may develop conditions like acute nicotine sickness. <a href="http://www.nhs.uk/chq/pages/2289.aspx?categoryid=53&">Passive smokers</a> are also at risk. However, alcohol has much more wide-ranging impacts on third parties. <a href="http://www.who.int/roadsafety/projects/manuals/alcohol/drinking_driving.pdf">Road traffic incidents</a> and <a href="http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/ft_intimate.pdf">domestic violence</a> are prime examples. </p>
<p>Alcohol also downs a lot of resources. The NHS forks out <a href="http://www.hscic.gov.uk/catalogue/PUB10932/alc-eng-2013-rep.pdf">£3.5 billion annually</a> to treat the consequences of alcohol misuse. This is a bit more than the cost to the NHS of <a href="http://www.ash.org.uk/files/documents/ASH_121.pdf">treating diseases caused by smoking</a>.
When other costs, such as policing and lost productivity are added, the total bill for England alone is about <a href="https://www.alcoholconcern.org.uk/help-and-advice/statistics-on-alcohol/">£21 billion</a> per annum. This dwarfs the UK-wide tax receipts generated from alcohol duties which amounted to <a href="http://www.ias.org.uk/Alcohol-knowledge-centre/Price/Factsheets/Taxation.aspx#sdendnote5sym">£10 billion</a> in 2013-2014. </p>
<h2>Tobacco but not alcohol?</h2>
<p>Given the similarities between alcohol and tobacco it may seem odd that there is a legal framework for tobacco but not for alcohol. </p>
<p>Two simple explanations for the difference in approach can be dismissed quite quickly. The first is that tobacco, unlike alcohol, is always dangerous. The second is that alcohol, unlike tobacco, has health benefits. The first claim is strained. If your total tobacco consumption amounts to smoking one – and only one – cigar on your birthday the extra risk to your health is either non-existent or infinitesimally small. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/75696/original/image-20150323-17688-4ktndi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Red wine debate still bubbling away.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/derekgavey/5677844045/in/photolist-9DJrdR-qt3acr-m8mtF2-pJTLyf-pJTLtW-pJTLD5-9yjfkM-pNtsHQ-qpkzdq-49tx65-bAtSF6-5BesSM-5MHsQR-f8o9BN-ddYyaX-osBGNB-gZi161-qHu6GL-614Ty7-4NMsRm-dskyuL-dskzjb-9dqh3D-dskz3U-dskpoM-dskzmG-qpkzoA-qprVaB-8KYRv5-9jVDyY-mVDSZX-GKfFU-9aNZ2Q-5hBvae-4ruiuE-qDBfSN-e9J1QW-dNK14C-7EYX31-qgH4JR-7Hjzmo-dFAKR3-5XNqLh-8LpdFz-nK9Utz-6aGgY1-73UjZA-dQrfUs-7gwT6b-9aFAz3">Derek Gavey</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The second claim has more force, especially (<a href="http://heart.bmj.com/content/94/7/821.extract">perhaps</a>) when the alcohol consumed takes the form of <a href="http://www.ncbi.nlm.nih.gov/pubmed/86728">red wine</a>. However, the health benefits of alcohol are increasingly contested and according to some experts may <a href="http://www.bmj.com/content/350/bmj.h407">evaporate entirely</a> when the evidence is properly scrutinised. </p>
<p>What other reason could there be for the different approach to alcohol? One procedural explanation is that international legal treaties take a lot of time and effort to negotiate – the FCTC took ten years and cost <a href="http://www.amphoraproject.net/files/Addiction%20fcac%20Taylor.pdf">in excess of US$34m</a>. Having expended so much effort on the FCTC is it possible that framework-fatigue has already kicked in? </p>
<p>A more cynical explanation is that Big Alcohol has lobbied the WHO more effectively than Big Tobacco ever managed to do. The recent debacle in England regarding a minimum price for a unit of alcohol certainly suggests that policymakers can be <a href="http://www.bmj.com/content/348/bmj.f7646">under the influence</a>. </p>
<h2>Calling time</h2>
<p>Even the most ardent supporter of tobacco and alcohol – and I speak as a <a href="https://www.salimetrics.com/article/smoking-definitions">never smoker</a> but a regular drinker – must admit that these products are causing an immense amount of ill-health to users around the world, and significant harm to children and third-parties. As such, a firm legislative and global response is needed. </p>
<p>This is not some kind of paean to prohibition. Aside from the fact that criminalising consumption or sale of alcohol or tobacco <a href="http://www.theguardian.com/film/2012/aug/26/lawless-prohibition-gangsters-speakeasies">does not work</a>, competent adults have the right to take risks with their own health. </p>
<p>Instead, this is a call for legally binding international conventions to help <a href="http://jech.bmj.com/content/64/6/473.extract">defend tobacco and alcohol control policies in trade courts</a> and help countries deal with issues, such as web advertising, that can leak across national borders. It is also a call for global conventions that would enable ministries of health to implement strong domestic regulation and would empower non-governmental organisations to bring <a href="http://www.nature.com/nature/journal/v482/n7385/full/482302a.html">legal and social pressure</a> to bear on corporations and corrupt legislators. </p>
<p>Thanks to the WHO we already live in a world governed by such a convention relating to tobacco. We should now call time on the soft approach to Big Alcohol by implementing some hard law.</p><img src="https://counter.theconversation.com/content/35769/count.gif" alt="The Conversation" width="1" height="1" />
The most ardent supporters of alcohol must admit it causes an immense amount of harm.Carwyn Hooper, Senior Lecturer in Medical Ethics and Law, St George's, University of LondonLicensed as Creative Commons – attribution, no derivatives.