Hardly a day passes without the media reminding us how alcohol is causing harm. Now the government has a golden opportunity to create a change in our binge drinking culture, so will it step up to the mark?

Another week in Godzone and we have seen yet more evidence of the harm alcohol can cause in the lives of our citizens. A study in the New Zealand Medical Journal showed how emergency department staff suffer physical and verbal abuse on a regular basis from drunk patients fronting up for treatment.[1] It also showed how these patients negatively affect other patients in the ED – by increasing waiting times, reducing the quality of care of other patients, as well as making the ED experience often intimidating and unpleasant.

Another study in the same issue of the Medical Journal reported on a nationwide survey that found one quarter of Kiwis had at least one heavy drinker in their life and the majority had experienced harm from this person’s drinking.[2] Both of these studies show, again, that alcohol does not just hurt the person drinking, but those around them.

How should we respond to this issue? When evidence was found of the harm from second-hand smoke to the health of non-smokers, such as children and hospitality workers, the government took bold steps to protect non-smokers by introducing the smokefree laws. In doing so, the culture around smoking changed.

We are now faced with another series of questions about protecting innocent people. Is protecting frontline emergency staff important to our society? Is improving the quality of care to all patients on weekends in the ED? Is reducing the roadtoll from drunk driving? Is protecting our young people from premature death due to alcohol intoxication? If so, then we have an opportunity now to do something about it, to introduce bold measures to change the drinking culture, with the Alcohol Reform Bill.

This means the government needs to pay attention to their own Chief Science Advisor Professor Sir Peter Gluckman. Along with this they need to take notice the thousands of submissions that were made to the Select Committee on the Alcohol Reform Bill and the extremely thorough and comprehensive recommendations made by the Law Commission on revising the Bill. Gluckman’s report is particularly relevant, given that it specifically focussed on how to reduce harm to mental health and social functioning during adolescence – including from alcohol. The Gluckman Report included recommendations to increase the purchase price of alcohol and restrict the marketing and availability of alcohol, as these measures have the weight of evidence behind them to reduce binge drinking and harm from alcohol use.

Why has the government been so reluctant to include policies that are known to work into the Alcohol Reform Bill? The most common barrier is a perception that they are not popular with voters.

However, lowering the blood alcohol level was widely supported by many New Zealanders and still the government resisted making this change, demanding New Zealand-specific evidence. As if Kiwi drunk drivers and road fatalities are somehow completely different from those in Australia or anywhere else in the world. Increased alcohol prices may not be popular with some voters, but they should also be concerned about their tax dollars going to patch up the health and social harms from our binge drinking culture. Also it is unlikely that people will march in the streets to protest if Lion Nathan is not allowed to sponsor the All Blacks or if we never see another Tui advert.

Another barrier is poor communication of the evidence, so that it appears ambiguous, distorted or unclear to the public or politicians. However, many reputable, independent organisations and researchers (including the Prime Minister’s personally appointed Chief Science Advisor) have reached a strong consensus about the evidence around pricing, marketing and advertising and other alcohol policies, so this does not appear to be a barrier.

Another possibility is that policies such as tax increases, advertising restrictions and lowering the blood alcohol level are strategies that cause grave concern to the alcohol industry, because these policies may cut into profits – which was the conclusion of a group of Australian researchers who accessed industry documents. [3]

By not accepting advice from the Law Commission and Gluckman’s report, but by cherry picking some of the options, the Alcohol Reform Bill is unlikely to substantially reduce alcohol-related harm in this country. It will not fundamentally address the problems faced by ED staff, patients in the ED, reduce the road toll, the number of young people dying from alcohol related causes or any of the many other harms caused by alcohol.

This is the time for the government to prove that they truly endorse and support evidence-based policy. This is an opportunity to pass a Bill that, like the Smokefree Environments Act 1990, leaves an enduring legacy of protecting innocent people from harm and is admired both nationally and internationally as a landmark piece of legislation. This is an opportunity that we cannot afford to waste.

 

This was co-authored with Caroline Shaw.

 

1. Imlach Gunasekara, F., et al., How do intoxicated patients impact staff in the emergency department? An exploratory study. NZ Med J, 2011. 124(1336).

2. Casswell, S., et al., Alcohol’s harm to others: self-reports from a representative sample of New Zealanders N Z Med J, 2011. 124(1336).

3. Bond, L., M. Daube, and T. Chikritzhs, Access to Confidential Alcohol Industry Documents: From ‘Big Tobacco’ to ‘Big Booze’. AMJ, 2009. 1(3).

 

 

Comments (9)

by Matthew Percival on June 21, 2011
Matthew Percival

I'm not convinced lowering the blood alcohol limit was popular with voters at the time it was mooted. Denying people the ability to drive following a couple of drinks after a hard weeks work punished those without a drinking issue whilst doing nothing at all about the problem drinkers.

Admittedly I skim read your article but one point worthy of discussion is the availablility of alcohol in supermarkets. This is a highly convenient low cost form of alcohol purchase which touches on other points you have made.

Another issue we need to raise is the lack of enforcement. I've been breath tested only 3 times in 10 years! Admittedly I'm not always driving in the high risk time periods but I'd like to think there was more enforcement than what appears to exist at the moment.

I believe we need a multi-pronged approach. I would look at the following:

- Tax increase on all alcoholic beverages

- Ban supermarkets from selling alcoholic beverages

- Increase enforcements funded by higher penalties including forfeiture of vehicles for repeat offenders

 

by Dean Knight on June 22, 2011
Dean Knight

I want to support the comprehensive package from the Law Commission, but I'm struck by some of its inadequacies.

First, while I would accept as a general proposition that alcohol consumption causes harm, I was troubled by some of the data relied on. For example, the Kypri study was relied on by the Law Commission (and govt). Its alarming conclusion was:

"Conclusions: Significantly more alcohol-involved crashes occurred among 15- to 19-year-olds than would have occurred had the purchase age not been reduced to 18 years. The effect size for 18- to 19-year-olds is remarkable given the legal exceptions to the pre-1999 law and its poor enforcement."

That sounds like a call to action. But when you actually read the study's report (like I did in 2006: http://www.laws179.co.nz/2006/01/drinking-age.html), you'll find the rate of alcohol related crash injuries for 18- to 19-year olds actually dropped following the lowering of the drinking age (by about 7%). The study had adopted a relative, not absolute approach.

I can guess the reasons a relative approach might be adopted. But it seems to me that this study has been wheeled out and interpreted for law reform purposes as if the lowering of the purchase age had cause an absolute increase in crash injuries.

Law-makers might have different views on the harm associated with lowering the purchase age if they realised alcohol-related crashes amongst 18 and 19 yr-olds had actually gone down, not up, after the purchase age was dropped.

Secondly, the law- and policy-making calculus is not merely about harm - or the avoidance of harm. There are liberty and other interests that needs to be weighed in the balance. I'm not saying that means nothing should change. Rather it's a balancing of harm avoidance vs costs of regulation.

My beef with the Law Commission report is its failure to adequately recognise this trade-off, esp as it relates to the proposed increase in the purchase age. It's is quite extraordinary that the Report's author - himself one of the authors of the Bill of Rights - fails to once mention in his report that increasing the purchase age amount to a (prima facie) breach of right to be free of age-discrimination.

Whether or not that breach is justified is another point, on which people may differ. But that's where the argument should be on the purchase age. Does the amount of alcohol harm caused to 18 yr and 19 yr olds outweigh the affront to their human dignity caused by treating them differently based on their age (particularly when very few similar age restrictions apply to them). I'm not convinced.

(I should note, too, I'm not one-eyed about alcohol. Elsewhere I've supported the lowering the blood alcohol to 50 mg, arguing that any loss of liberty is minimal - even in the light of uncertain evidence about the associated harm.)

 

by The Falcon on June 22, 2011
The Falcon

Every single word of this authoritarian drivel makes me feel physically sick. Sitting there in your ivory tower, trying to get the government to ban people from living their lives as they see fit. What a life.

by stuart munro on June 22, 2011
stuart munro

One would expect, in a state that pretends to democracy, government efforts to change culture would attract a certain scepticism.

Blood alcohol levels have changed 3 times since I left school, and the road toll, in spite of increased population, has fallen. So spare me your moral panic and tax increases. You can preserve your revenue stream by defunding the shock adverts that make NZ TV unwatchable.

by Bruce Carruthers on June 23, 2011
Bruce Carruthers

If binge drinking is simply to be used as an excuse for a scorched earth approach - to target those who consume alcohol, those who supply the product and those companies that produce and advertise their products, then this is the way to go.

The methods are similar in design to user pays (where the poor are priced out of the market) and the rationale is similar to the self-interested ideology that lies behind gated communities (leaving social venues reserved for the middle classes of the sort that live behind the residential walls of well to do suburbs of Teheran).

If anyone wanted to design a policy to target and marginalise binge drinking, as we did drink driving (and are still improving the policy design for achieving this by targeting repeat offenders), they would start by defining a blood alcohol level that would preclude entry to licenced premises and invite prosecution for public drunkenness. It's hard to pre-load if there is no place to enter afterwards and rather costly to be in town drunk if one can be locked up over-night and awake to a fine on release the next day.

by stuart munro on June 24, 2011
stuart munro

If anyone really gave a rat's nethers about binge drinking, they'd do few statistical analyses to track down sources of concentration, they way Newton did with coin clippers, and design a policy tailored to the centres of problematic behaviour.

But since we have a history of atrocious government (having slipped from parity with the US, 19 places in standard of living in the past 70-80 years), it is not to be expected that anything remotely rational or pro-social would appear - that after all would conflict with the corrupt rent-seeking 'elite' interests who are directly responsible for that decline.

by Frank Macskasy on July 01, 2011
Frank Macskasy

Some of the comments posted are interesting in their attempt to mitigate, minimise, or fullt deny the extent of alcohol problems in this country.

 

As an aside, I had an opportunity to reside in an eastern european country in 1978 and 1983. Alcohol of all sorts - not just beer and wine - was available in supermarkets. It was reasonably cheap. There were also plenty of bars and wine cellars (where you could buy wine decanted straight from massive oak barrels).

 

On one occassion, I suggested to some young associates that we hit the town and get plastered. They looked at me as if I'd grown an extra head. Then they patiently explained to me that being drunk in public, and becoming a nuisance, would attract the attention of the police. The police would have no hesitation in taking you down to the station; pumping your stomach; and letting you sleep it off in the morning.

 

As horrific as this might sound to my libertarian-minded fellow Kiwis, the streets of this major city were safe to walk through and in all that time, in a city of 2 million-plus people, I did not see one single drunk in the city streets at night.

 

And yet, the citizenry had a ripping good time, especially  in the wine cellars.

 

So whilst alcohol was easily available and very cheap, there was also a very clear expectation to drink with moderation (or stay of the streets if you got hammered) and behave responsibly.

 

And in case anyone believes that the locals were "wowsers" - think again. Their wine-making goes back one thousand years to the time of the Romans, when the land was called Pannonia. They know how to party, and we drank more than our fair share of good wine.

 

But one thing we didn't do was act like imbeciles; drive drunk; or test the patience of the community. It simply wasn't tolerated.

 

Here in New Zealand we have the freedom to get trolleyed; cause disruption; and create an expensive mess to deal with. And boy, are we paying for that mess.

 

by on September 26, 2011
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by danniel on October 31, 2013
danniel

If we want to talk about solutions on a national level then we need to talk about the laws. If they are not effective or not well targeted then we can't hope to see the results any time soon. There were campaigns warning people that alcohol causes illnesses and impotence. This didn't seem to have a big impact on the general consume. Harsher laws would definitely provide some better answers.

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