The recent death of teenager Thomas Kelly in Sydney's King's Cross has reignited debate on the extent of drug and alcohol use in Australia and its effects. NDARC deputy director A/Prof. Anthony Shakeshaft wrote an opinion piece for The Sydney Morning Herald explaining the three things we can do to positively change Australia's drinking culture.
The handwringing over the tragic death of 18-year-old Thomas Kelly has so far produced the usual buckpassing and calls for more of almost everything, including police, CCTVs, transport and punishment.
But strategies that try to contain alcohol-related violence without attacking its root causes are likely to reduce street offences but not assaults or drink-driving deaths and injuries. We know this now because we have just tested them in rural communities in NSW, where the same alcohol-related violence and needless deaths occur.
So, what would work? The drivers of excessive drinking are availability, advertising and price, and we need changes to all three together to make a lasting difference. If a proposed strategy does not impact on one or more of those three, then it won't work for long, if at all. Increasing police numbers or zero tolerance policing are unlikely to be effective precisely because they do not impact on availability, advertising or price.
Availability should not need much explanation. The more bottle shops, pubs and bars there are, and the longer they are open, the more people will drink. We are all susceptible to our environment. If you want direct evidence, look at the Newcastle example: shutting pubs at 3am instead of 5am seems a small price to pay for a 37 per cent reduction in assaults.
Next up is advertising. Alcohol advertising is insidious - everywhere and essentially self-monitored. Compliance with the alcohol advertising code is not mandatory and is difficult to monitor effectively because what does or does not comply is really subjective. The simpler solution is to follow the path of tobacco and just ban alcohol advertising and sponsorship.
And finally, price. The more expensive alcohol is, the less we buy. But we have also shown that when price goes up, our inclination is to drink on fewer days during the week to preserve our financial ability to binge drink on the weekend. So price alone is unlikely to reduce binge drinking significantly: that's why restricting availability and banning advertising are also important. And we don't have to drink a lot less to get a positive impact: the British clinical epidemiologist Geoffrey Rose estimated that if everybody drank just two standard drinks a week less, there would be about a 15 per cent reduction in the number of high-risk drinkers.
So we have a fairly simple choice: reduce alcohol availability, ban alcohol advertising and increase its price - or continue to live with ongoing alcohol-related violence at its current rate or worse. It's really that simple.
Any public health changes that make a difference are painful, slow and resisted by both the community and vested interests. Think smoking, seatbelts and speed limits. But those examples are also cause for optimism: I hope in 10 years time we will see a very different drinking culture and will look back and wonder what were we thinking.
Implementing changes to availability, advertising and price to make a sustained difference requires all levels of government to work together because each has a different jurisdiction: the Australian government can most efficiently control advertising, price and standardise laws such as opening hours, while state and local governments control planning and development.
We need a taskforce with the sole mandate to determine how to most efficiently implement these reforms: not a review and not a scoping exercise, just a determination of how to implement what we know will work.
There are some unpalatable truths in here. What we do is influenced by our environment. Even the best reforms will only reduce, not eradicate, alcohol-related violence, in much the same way that seatbelts did not eradicate car deaths. We will have to pay a bit more for our alcohol. We will all have to drink a bit less. Change will be unfair on the many people who have a drink or two, perhaps even a few drinks, and never cause any harm to anybody. But that is the price we pay for living in a community: as the great Russian writer Dostoevsky once said, we are all responsible for all.
Here is another choice: we could create a lasting legacy to the memory of Thomas Kelly and at the same time save and improve the quality of thousands of future lives, or we can continue to write these articles, over and over again.