Preventing Alcohol-related Harm in Australia - Department of Health

The study also examined the relationshipbetween each country’s score and per capitaalcohol consumption, and found a strongnegative correlation that implied a decreasein consumption of 1 litre of alcohol per yearfor each 10-point increase in the score. Inother words, as alcohol policies increasedin strength (i.e. effectiveness), alcoholconsumption decreased.Since the late 1980s, Australia has adoptedseveral national strategies to tackle the harmfulconsumption of alcohol. Australia’s first nationalalcohol strategy was completed in 1989 [95]followed by subsequent inerations in 1996, [96]2001, [97] and most recently in 2006.[6] If thesuccess of these strategies is to be measured onthe basis of any change in rates of overall percapita drinking, rates of adult binge drinking,rates of underage drinking, and outcomessuch as hospitalisations and crime, then thesestrategies appear to have had only modestsuccess. One Australian commentator hassaid that ‘while these documents provide thebasis for a coherent and legitimate nationalapproach to alcohol there has been poorfollow-through on implementation’.[98]A recent summary of the state of alcohol policyin Australia reported that ‘what is needednow is not so much an understanding of whatworks, but an appreciation of how to makeit work in the various contexts in which it isimplemented’[43] [emphasis added]. Essentially,even the most effective strategies in the worldwill not be effective if they are not properlyimplemented as intended.5.2 The best mix of interventionsWhile some interventions are more effectivethan others, there is no single strategy thatcan offer a ‘quick fix’ or ‘silver bullet’ to theprevention of harmful consumption of alcohol.The review undertaken by Babor et al. (2003)[13] concludes that an integrated approachis required that includes a combination ofthe strategies that are known to be effectiveand suitable for the particular context inwhich they are to be implemented. The NDRIemphasises[36] that it is important to considerthe quality, rather than the quantity, ofinterventions. For example, ‘a single targetedrestriction (for example, hotel closing atmidnight) may be more effective than anentire suite of half-heartedly implemented,watered-down or ill-considered restrictions’.[36]Importantly, choosing high-quality interventionsdoes not mean choosing the most expensive. Infact, many of the most effective strategies arethe cheapest.A recent analysis of studies into the costeffectiveness of various alcohol-preventionmeasures found that there are very substantialdifferences in costs and effects, both betweeninterventions and between world regions.See Table 10.[99] Random breath testing (dueto the need for regular sobriety checkpointsadministered by police) and brief advice inprimary care (the intervention itself, plus costsassociated with training) are the most costlyinterventions to achieve equivalent savings inyears of health, expressed as disability-adjustedlife years (DALYs) With regard to taxation, costeffectiveness appears to depend in part on theefficiency of the tax system and the degree ofanti-drinking sentiment. In the Americas andEurope, where like Australia, the prevalence ofheavy drinking is high, taxation was the mosteffective and cost-efficient strategy. However,by contrast, tax is actually least effective andleast efficient in South East Asia, where lowrates of heavy drinking appear to favour moretargeted approaches such as random breathtesting and brief physician advice.[99]38