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We drink in the town and country, but who drinks more?

Urban areas have historically been the winners in terms of heavy drinking but the picture has changes. Brian/Flickr

So you’re back from up the country, Mister Lawson, where you went,

And you’re cursing all the business in a bitter discontent;

Well, we grieve to disappoint you, and it makes us sad to hear,

That it wasn’t cool and shady - and there wasn’t plenty beer.

Banjo Paterson, In Defence of the Bush (1892)

When Banjo Paterson and Henry Lawson swapped notes on the merits of rural life in 1892, they seemed to agree on very little except that it was easier to get a drink in the city than the bush.

The current perception of rural Australian life, 120 years later, is more or less the reverse. But how accurate is it?

Who’s drinking more?

The 2010 National Drug Strategy Household Survey shows that about 26% of people living in remote or very remote communities drink at risky levels on single occasions (five or more standard drinks at least once a week), compared to 15% of city-dwellers.

Rural or regional communities lie between these extremes at about 18%, but the relationship isn’t linear. It goes up a bit from cities to rural and regional areas, then substantially to remote communities.

The proportion of people who report drinking more than two drinks a day shows a similar pattern – 19% in cities, 23% in rural and regional areas and 31% in remote communities.

It’s tempting to simply conclude that people in remote communities drink more than people in rural communities who, in turn, drink more than people in cities.

But while generally true, this simplified picture hides a more nuanced picture uncovered in a large-scale project involving 20 rural New South Wales communities – the Alcohol Action in Rural Communities (AARC) project.

The project confirmed that rural rates of single occasion risky drinking were higher than in cities, but also found significant differences between individual communities. This has important implications for governments; it means we cannot simply treat all rural communities with the same approach, as if they have the same problems.

Of course, that’s true of local government areas in general – alcohol consumption patterns in Kings Cross or St Kilda are unlikely to be replicated in Wahroonga or Toorak.

But if alcohol consumption patterns are different in rural areas than in cities, what about alcohol-related harms?

Who’s hurting more?

An investigation of Victorian Emergency Department data shows people living in large and small rural centres are more likely to show up in an emergency department than those from metropolitan regions or very small rural or remote towns.

And that rates of alcohol-related injury in rural and regional areas have increased over time.

The AARC study also found rural rates of alcohol-related crime have steadily increased since 2000. A 2010 review of rural and regional alcohol research found people living in rural Australia are more likely to experience alcohol-related harm through violence, acute and chronic health problems, and drink driving.

Harms from drink driving in rural areas are especially worrisome. The AARC project showed that although rural alcohol-related traffic crashes are 1.5 times higher than in cities, their attributable cost is four times higher and fatalities are up to eight times higher.

Rates of alcohol consumption now appear higher in rural and remote communities. Tgraham/Flickr

Again, alcohol-related harms differ significantly between individual rural communities. The project showed some have very high rates of alcohol-related crime and traffic crashes, while others have relatively little.

The observation that consumption and alcohol-related harm differs between rural communities raises interesting questions about why this is so.

Some sobering findings

The first issue, of course, is that each community has its own raison d'être, from mining boom towns, such as Kalgoorlie and Broken Hill, to farming hamlets, such as Beeac, tourist destinations, such as Lorne and Byron Bay, and any number of combinations such as Mansfield (think winter skiing and mountain cattleman).

But the AARC project also identified more immediate reasons why alcohol harms differ between communities.

In the same way that research has traditionally focused on why some people drink more than others, the project was the first Australian study to try to identify why some communities drink more than others.

And some results were quite surprising.

Communities with more risky drinkers didn’t have higher proportions of Indigenous Australians. In fact, the opposite was true – communities with more Indigenous Australians had fewer risky drinkers.

Poorer communities did not have more alcohol-related crime. Again, the opposite was true.

These two findings are probably related and probably point to, ahem, a sobering truth – the wealthier we become, the more we drink and the more alcohol-related harm we cause.

To put it in reverse, community rates of excessive drinking and alcohol harms are not a function of being Indigenous or otherwise socioeconomically disadvantaged. They are a function of being non-Indigenous and being socioeconomically well off.

Other results were not surprising. Communities with more pubs and clubs had higher rates of risky alcohol consumption and alcohol crime, and communities with more young males had higher rates of alcohol-related traffic crashes.

Paterson or Lawson?

So where does this leave our understanding of alcohol problems in rural and remote Australia? If Banjo Paterson and Henry Lawson were right in 1892, then things have changed.

Rates of alcohol consumption now appear higher in rural and remote communities and, unsurprisingly, so do rates of alcohol-related harm. Most obviously among these is drink driving among young men to which we desperately need a solution.

But Banjo and Henry had the luxury of artistic licence that doesn’t extend to academia.

It also seems to be the case that the extent of differences between rural communities varies significantly, and perhaps almost disappears between some rural and urban communities. This suggests that the most fruitful approach to managing alcohol consumption and harms is likely to be at the level of local government areas, not at the level of the bush versus the city.

There’s no reason why researchers and local governments can’t work together to identify and respond to their own alcohol-related harms, be they rural or urban.

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