Preventing Alcohol-related Harm in Australia - Department of Health

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These changes have resulted in major shifts indrinking patterns across Australia, particularly inrelation to brown spirit pre-mixed drinks (mostlyaround 5% alcohol by volume in 375ml cans)and white spirit pre-mixed bottled drinks (mostlyaround 5% alcohol by volume in 375ml bottles).With each price change, sales of these RTDshave increased or decreased quite significantly.While there is considerable evidence that theseincreases and decreases in sales representshifts in product preferences (market share)rather than shifts in per capita drinking, thepatterns of consumption have clearly beendirectly influenced by taxation and pricing.There is substantive evidence that the higherthe price, the lower the consumption of theseproducts, and the lower the price, the higherthe consumption of these products. Perhapsjust as importantly, the shifts in consumptionpatterns are more marked amongst the youngand lower social-economic groups.[2, 68, 74]The principle of alcohol taxation reform mostoften discussed by public health advocatesis usually that of applying excise taxes to allcategories of alcoholic beverages. That is,taxing the beverages on their alcohol content,as a mild discouragement of consumption.Along with taxation reform of this kind, therehave been calls to raise the price of thecheapest forms of alcohol. This is referred toas the floor price of alcohol. Given that priceis being used as the lever, it is the floor pricethat should be given more attention in order toachieve a real shift in per capita consumption,rather than just product preference. Within thiscontext, it is important to acknowledge thatthe impact of any increase in the floor pricefor alcohol will impact more on young people,Indigenous communities, heavy drinkers andlower socio-economic groups.It appears that the most likely model thatcan effectively reduce alcohol-related harmwould be based on an across-the-boardexcise model that also includes regulating thefloor (minimum) price, especially with regardto small containers. The excise tax couldbe scaled within different product types toensure there were strong financial incentivesfor the production of lower alcohol products(for example, low-strength beer, wine andRTDs), and so that the highest-risk alcoholproducts (i.e. spirits, which can more easilycause overdose) are taxed at an appropriatelyhigher rate. In combination with a volumetrictaxation system, in which all products are taxedaccording to alcohol content, all productscould effectively have a floor price based ontheir alcohol content in a 300ml container.Modelling this alcohol taxation system would bea very challenging exercise, particularly whenhealth advocates have very limited access toactual sales data. As noted above, competingin the alcohol market requires extensive markettesting and monitoring. This generates a levelof detailed information that is not availableto health researchers and policy makers.Perhaps just as importantly, this model wouldhave a negative impact on some segments– particularly cask wine and cider – whileadvantaging other market segments – spiritsand spirit-based RTD products. It would be verydifficult to gain broad political support for sucha model, given the level of public and politicalopposition from powerful alcohol producers.There has been some modelling undertakenthat considered a range of alcohol taxationscenarios that would move the alcohol exciseand taxation system closer to a true volumetricbase, while remaining revenue neutral withineach market segment. These models are publiclyavailable, but have attracted limited supportas they increase the price of cask wine andciders while more expensive wines are reducedin price.[36] Until public health researchers andadvocates have access to accurate sales data,and economic modelling can be implementedon the combination of floor price and a morevolumetric approach to alcohol taxation, itis difficult to strongly put forward a particularmodel. At the same time, there is a substantivehistory in Australia that illustrates the danger ofchanging taxation levels of particular productswithout considering the implications both onconsumption patterns and the developmentand marketing of alternative alcohol products.26
4.4 Drink-driving countermeasuresDrink-driving laws and the associated programsof enforcement and social marketing areconsidered to be one of the great publichealth success stories of the late 20th century. InAustralia, state and territory laws allow a BloodAlcohol Content (BAC) of up to 0.05% whiledriving for full licence holders, 0.00% for learnerdrivers and 0.00 per to 0.02% for provisionaldrivers, depending on the state or territory. Thosewho operate commercial aircraft, public orheavy vehicles, commercial vessels, machineryand mobile plant or farm equipment mustobserve the BAC restrictions required by theiremployer, as well as those required by law. Formost adults, drinking no more than two standarddrinks on an occasion will maintain their BACbelow 0.05%. The evidence for the deterrenteffect of such laws is strong, although the effectscan erode over time and hence some countrieshave continued to lower BAC limits.[13] From the1970s, Australian states world leaders in drivingdown rates of drink-driving through randombreath tests and other means.There is some evidence, albeit tentative, thathaving lower BAC limits for young driversreduces the risk of road fatalities, especially ifthe BAC limit is 0.00%.[7] More broadly, there isgood evidence that lower BAC limits, delayedaccess to full licence and curfews for youngdrivers can be effective in reducing drink drivingamong young people; graduated licensingschemes can potentially incorporate all of thesemeasures within a single system.[13]Random breath testing (RBT) has been shownto be effective in several countries, includingAustralia, in reducing road crashes, injuries andfatalities.[7] The defining feature of RBT is thatany motorist at any time may be required totake a breast test, and there is nothing theycan do to influence their chances of beingtested.[13] Research suggests that there is astrong tendency for motorists to comply withdrink-driving laws in jurisdictions that use RBTprograms because of the uncertainty aboutthe real risk of detection.[13] Herein lies part ofthe impressive cost effectiveness of randombreath testing. RBT is considered a superiormethod of enforcing drink-driving laws thansobriety checkpoints, which only check driverswho are judged to have been drinking.[13] InAustralia, creating the public perception thatthere is a high chance of being caught drinkdriving through RBT has been achieved by acombination of high-visibility policing (roadblocks, ‘booze buses’) and frequent socialmarketing campaigns that emphasise thelikelihood of drink drivers being detected.[7]Among the range of punishments for drinkdriving, the penalty that appears to havehad the most consistent impact is licencesuspension.[13] Increasing the severity of finesand imposing penalties such as imprisonmentfor drink driving have not been shown to result inreduced rates of drink driving or car accidents.[13] However, it is estimated that up to 70% ofpeople who lose their licence continue to drivewhile unlicensed, as the risk of apprehensionis relatively low.[43] The major concerns withdisqualified drivers continuing to drive arethat it undermines the effectiveness of licencesuspension and is also linked to a range ofother high-risk behaviour such as repeateddrink driving and speeding.[43] Court diversionof drink drivers to educative and mandatorytreatment interventions and the incapacitationof vehicles using ignition interlock devices areregarded as effective means of increasingcompliance with licence suspension andreducing recidivism.[7, 13]While there is no evidence that on-premisedesignated driver programs produce negativeeffects, the impact of such programs is verymodest and even with concerted promotionsthey only produce a small positive effect.[13]An Australian review of these schemes wassomewhat more supportive, pointing to researchfindings that the programs do have somepositive influence on the behaviour of youngpeople in selecting a sober driver, and thatgiven the cost of such programs is usually borneby licensed premises, there is no opportunitycost in recommending such schemes.[7]27
Page 1: Preventative Health TaskforceNation
Page 4 and 5: Contents1 Introduction: changing th
Page 6 and 7: 1. Introduction:changing thedrinkin
Page 8 and 9: ModifiableDeterminants:Cultural Pla
Page 10 and 11: 2. Key trends in alcoholconsumption
Page 12 and 13: Figure 3: Drinking at risky/high ri
Page 14 and 15: 2.4 Alcohol prices andconsumer spen
Page 16 and 17: More males than females died from b
Page 18 and 19: Families and childrenIt is a realit
Page 20 and 21: Young AustraliansRates of risky dri
Page 22 and 23: Table 5: Key to the rating scales s
Page 24 and 25: 4.2 Regulating the physicalavailabi
Page 26 and 27: The distinction is important becaus
Page 28 and 29: While increasing the price through
Page 32 and 33: 4.5 Treatment and early interventio
Page 35 and 36: number of RSA training programs hav
Page 37 and 38: Table 8: Alcohol advertising in Aus
Page 39 and 40: nThe effectiveness of the current s
Page 41 and 42: 5. Policy imperatives5.1 The state
Page 43 and 44: Table 10: Cost-effectiveness (avera
Page 45 and 46: There are some specific challenges
Page 47 and 48: thousands of Australians at the ear
Page 49 and 50: 21. Chikritzhs T, Catalano P, Stock
Page 51 and 52: 63. Gruenewald P, Freisthler B and

Preventing Alcohol-related Harm in Australia - Department of Health

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