Why we support measures to control the supply of alcohol: Aboriginal Medical Services Alliance NT
In her recent Parliamentary statement on Closing the Gap, the Prime Minister raised concerns about the winding back of alcohol control policies in the NT and Queensland.
She said alcohol-related harms had increased after the NT Government’s dismantling of the Banned Drinkers Register last year, and called for the register’s reinstatement. She also called on the Queensland Government “to exercise extreme caution in reviewing remote community alcohol restrictions”.
“I have a real fear that the rivers of grog that wreaked such havoc among Indigenous communities are starting to flow once again,” she said.
In a subsequent article for Crikey titled Gillard is wrong, bans won’t stop those “rivers of grog”, journalist Chris Graham took issue with the PM’s claims, and argued that the solutions to alcohol-related problems lie in the communities themselves rather than in government-imposed policies.
In the article below, John Paterson writes on behalf of the Aboriginal Medical Services Alliance Northern Territory that Chris Graham’s analysis is strong on rhetoric but short on evidence.
Controls on the supply of alcohol are vital for improving Aboriginal health and life expectancy, and are widely supported by communities, as demonstrated by recent successful initiatives in Alice Springs, he says.
A look at the evidence shows why alcohol control measures are widely supported in the NT
John Paterson writes:
Any analysis of alcohol issues is complex and requires a very careful look at multiple data sets and knowledge of what is going on to explain data trends.
Unfortunately, the article by Graham contains many errors due to a lack of knowledge about – and detailed analysis of – what is going on in the NT.
This lack of adequate knowledge and analysis prevents readers from reaching a comprehensive understanding of what has been happening in the NT. (We are not commenting specifically on the Cape York situation as we are not as familiar with the data and the various evaluations that have been done there).
At the outset, Graham’s assertion that it has been Canberra that has led the game in positing alcohol bans is completely inaccurate and ahistorical.
And, frankly, anti-Aboriginal.
First, there is a very well documented history in the Northern Territory of Aboriginal communities that have successfully demanded – as acts of self determination— alcohol bans in nearly 100 communities across the Territory. Chris Graham should be aware of this.
Second, Aboriginal communities, and the health and other organisations they control, have never argued that prohibition is a silver bullet. Other initiatives—that have been fiercely resisted by government and the alcohol industry—such as restrictions to the volume of grog and number of outlets, the times allowed for take away sales, and floor pricing, have been put forward by these groups, backed by a solid evidence base.
Third, Graham makes no comment on the role of the alcohol industry—as if it is some sort of disinterested but benign third party that has no particular role in human misery.
We hold no particular brief for the Prime Minister in her statement—far from it.
However, Prime Minister Gillard does not suggest that alcohol restrictions alone will solve the alcohol problem – this is an oversimplification of her position.
However, one of the reasons why the NT has the fastest rate of improvement in Aboriginal life expectancy is the decline that has occurred in the consumption of pure alcohol. Addressing alcohol is no magic bullet but is a key part of what needs to be done. This is the view of the Prime Minister, and Graham misrepresents this.
Unfortunately, the article does not make sufficient distinction between alcohol supply reduction measures that apply to the whole community, for example the measures in place in the large population centres in the Northern Territory such as Alice Springs, Tennant Creek, Alyangula and Nhulunbuy, and the special measures that are in place in various permutations in almost one hundred remote Aboriginal communities – measures which also apply to the non-Aboriginal residents in these communities, who usually comprise at least 10% of these populations anyway. The latter must be special measures which comply with the Racial Discrimination Act, and cannot be imposed without community support.
The Prime Minister has not suggested imposing alcohol measures on Aboriginal people only, but she has expressed concern at the dismantling of measures that have been introduced by the demands of the communities affected, are working and have community support. We share that concern.
There have been some very effective population wide measures in place in the NT, such as the de facto alcohol floor price in Alice Springs, achieved by a combination of Licensing Commission action (against selling wine casks larger than two litres) and an agreement operating amongst liquor retailers not to sell bottled wine for less than $8 per bottle and two litre casks for less than $16. This has seen the minimum price increase from 25 cents per standard drink to around 76 cents per standard drink.
This very effective measure has reduced alcohol consumption across the whole Alice Springs population by about 20%. The measure has been formally evaluated by the National Drug Research Institute.
The decline in alcohol consumption in Alice has seen projected admissions for assault to Alice Springs Hospital for Aboriginal women reduced by about 130 per year. This is in spite of the fact that the police assault data in this period has risen sharply.
Although Chris Graham attempts to dismiss this issue in this article, the reality is that police assault data is very subjective and changes in relation to police numbers, new legislation, community reporting, new computer systems and a range of other variables.
Police data cannot be relied upon to objectively measure the true incidence and prevalence of assault in the community. For accurate data we need to turn to more objective endpoints such as hospital admissions. It is important to consider multiple data sources prior to making any sweeping generalisations from a single data source as Graham has done.
The following graph is from the recent report from the National Drug Research Institute (2012) looking at alcohol sales, price and consumption in Alice Springs from 2000 to 2010. It shows a very strong correlation over time between price and consumption. As the price increased, consumption decreased and as the price decreased, consumption increased:
The “river of grog” throughout the NT has been declining significantly since 2007, largely through the removal from sale of cheap, bulk cask wine. This data is published by the Northern Territory Department of Justice.
This reflects a significant change in alcohol consumption in the NT, and the article’s author, Chris Graham, who seems to be unaware of this data, mistakenly claims that not much has changed. This is what has happened to the consumption of pure alcohol per person:
There has been no suggestion by Gillard to impose alcohol restrictions in the NT on Aboriginal people only. As Graham acknowledges, the Banned Drinkers Register (BDR) applied to everyone. There were many non-Aboriginal people on the register as well, usually placed there for high range drink driving offences etc.
The problem we have is that since the register was suddenly withdrawn there has been no evaluation to objectively look at its impact. There is a huge amount of anecdotal evidence that there has been a very negative impact from its removal.
There is also evidence that at least one of the major hotels has seen a large increase in its takings, due to the greatly increased clientele (comprised of the formerly banned drinkers) in the large bars commonly referred to as “Animal Bars” subsequent to the removal of the BDR. The main call to re-instate the BDR was made at a recent Aboriginal Peak Organisations NT summit on alcohol, so the Prime Minister is simply asking for the return of a measure which has broad support within the Aboriginal community in the NT.
In terms of the voluntary alcohol restrictions that exist in nearly 100 remote communities throughout the NT, these measures have been in place for many years at the request of Aboriginal communities.
Acts of self-determination
Guess what? These have been acts of self-determination, not a directive from Canberra, Darwin, or anywhere else other than the local community. They have not been imposed by governments, and existed prior to the Intervention. The new CLP government, despite some initial fumbling on the issue, has so far decided to leave these measures in place, something about which Graham seems to be unaware.
The stark reality for some remote Aboriginal communities is that the level of susceptibility to habitual excessive consumption of alcohol and other substances is far greater than for mainstream communities. This is not due to any genetic susceptibility but rather it is mainly due to the consequences of extreme disadvantage on the growth and development of young children in early childhood in particular, leading them to be much more vulnerable to bingeing behaviours, and very susceptible to dangerous levels of over-use and habitual use of substances.
These susceptibilities are then greatly compounded by the effects of the social gradient of social determinants of health in general, such as lack of adequate access to good education, employment and comprehensive primary healthcare. Aboriginal Australia is not unique in this respect.
The Australian Early Development Index (AEDI) scores reveal this level of vulnerability – the reality is that many children from disadvantaged homes where excessive alcohol consumption occurs lack the capacity for effective self-regulation, and are much more impulsive than other children at age 4.
These are the vulnerabilities that mean that they do not have the same capability as other children to control their substance use when they encounter peer pressure to experiment with volatile inhalants and drugs such as tobacco, alcohol, cannabis, amphetamines and kava later during their development.
While this susceptibility is present in a very large number of young people, there is a serious need for special measures such as many remote Aboriginal communities have demanded for themselves. When the AEDI scores of Aboriginal children become comparable to those displayed by children of the rest of the population at age 5, then we can expect after another 10 years have passed to witness a situation where the average susceptibility to alcohol and other substance over-uses is similar to the average levels applying to the total population. At this point communities themselves will know that they no longer need to request special measures to give additional protection against substance misuse.
Until that time, greater alcohol regulation is needed. And guess what: It is Aboriginal communities, as reflected through the demands of the APO NT Grog Summit late last year, who are demanding this. It is not Gillard—or indeed Chris Graham—that holds sway over these views.
The final point that needs to be addressed is the continual suggestion that alcohol is not a key determinant of Aboriginal health. Alcohol is not just a symptom of disadvantage it is a cause.
Prof Sir Michael Marmot, the chair of the WHO Commission on the Social Determinants of Health, following a visit to Aboriginal communities in the NT last year, declared alcohol and other drug use one of the six key determinants of Aboriginal health that needed to be addressed.
Making a difference in Alice Springs
The impact of even addressing alcohol in isolation has just been experienced by Alice Springs in the recent weekend of the Aboriginal All Stars Football match.
There was remarkable quiet and calm in the town, very different from a normal Friday night, let alone one of the busiest nights of the year, with several thousand extra people from remote communities in Alice to enjoy the game and have a break from bush life. There were almost no incidents involving violence or requiring the presence of police. Drunken revellers were conspicuous by their absence.
This atmosphere was the same at the game itself, where there were a lot of families with children having fun, and very few obvious incidents of drunken violence. Taxis and the casino and bars were busy, but ambulances were not.
There have been few violent incidents, and hardly any arrests. Police had one of their slowest nights on record with only one Domestic Violence call-out on Thursday night (the first of three days of additional restrictions) compared with thirteen on the previous Monday night.
This shows what can be achieved when agreement is reached on a set of evidence-based, sensible alcohol restrictions which included:
1. An effective floor price at $1 per standard drink, because cheap two-litre wine casks and fortified wines were not on sale at all.
2. A reduction in total of nine hours in take-away alcohol trading time over three days.
3. The use of photo ID scanning to prevent large volume purchases of beer and mixed drinks (limited to one slab per person per day.)
4. An increased police presence and full-time monitoring of all take-away outlets, with confiscation of alcohol purchased for consumption in prohibited areas.
This package combines what that we know works well, in one town at one time, and it produced a moment to celebrate and be proud of for the whole town.
It shows it is really possible to make a very big difference with supply reduction measures that most people would live with quite easily. It shows that addressing alcohol as a key social determinant of health in its own right is critical to Aboriginal health and the reduction of violence.
• Thanks to NACCHO for assistance with organising this article. Previously at Croakey: What are the priorities of Aboriginal people and communities in alcohol control in the NT?
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