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Memo to Perth’s mayor: get with the evidence on public health and alcohol

During a debate with Tony Abbott at the University of Sydney last year, public health advocate Professor Mike Daube took us on an historical tour of “the Nanny State”.

He told us that while a Spectator column by conservative British MP Ian Macleod is credited for coining the pejorative term, Nanny’s spirit was around long before then.

In 1851, when the great sanitary revolutions of the nineteenth century were being debated, the London Times thundered in an editorial that the public was being “bullied into health by Mr Snow” and that “every man is entitled to his own dungheap”.

Dr John Snow is, of course, now revered as one of the fathers of modern epidemiology for showing the link between contaminated water and cholera outbreaks, and was once voted “the greatest doctor of all time”, out-ranking even Hippocrates.

In modern times. Nanny most often finds employment whenever new public health measures are mooted. Her biggest employers, Daube said, have been the tobacco, alcohol and junk food industries and their friends, who ensure Nanny is invoked whenever policies are proposed that might affect their interests.

Croakey is thinking of beginning a campaign to put Nanny to rest.

And it seems there may be at least one person ready to help with this: Sarah Jaggard, the Community Mobilisation Policy Officer at the Australian Drug Foundation, is suffering a bad case of “Nannyitis”.

Sarah Jaggard writes:

If I hear the term ‘wowser’ or the phrase ‘nanny state’ again, I’m going to scream.

Last week in The West Australian (and as a former West Australian, yes, I am equipped to comment), Perth Lord Mayor Lisa Scaffidi claimed that liquor licensing restrictions are “strangling the city” and inhibiting its growth.

“I cannot believe the fact there are now restrictions on the sale of energy drinks!” Ms Scaffidi said.

Ms Scaffidi, that would be because a recent US study found that patrons consuming alcohol mixed with energy drinks are at greater risk of harm through drink driving, violence, and unsafe sex.  This study contributes to a growing body of literature indicating that mixing energy drinks and alcohol has negative health and safety consequences in young adults.

There’s more though.

Ms Scaffidi also says that steps to force some Northbridge pubs and clubs to close early could contribute to antisocial behaviour, rather than curb it.

Well, that’s easily refuted. 

Australian research has shown that extended trading hours for licensed premises (from as little as one to two hours) can increases violent assaults in and around premises by up to 70%.

The article goes on to say that “In WA’s nanny state, there is no having a quiet drink on Australia Day.”

Let’s face it – WA’s drinking culture is not one of ‘quiet drinks’.  Who can forget the mini riot on South Perth’s foreshore back in 2004?

But why are we punished, people bleat, for the actions of a few?

That would be because the bulk of alcohol-related harm can be attributed to the majority of the population who are moderate drinkers whom binge drink on occasion.  It can not be attributed to heavy drinkers who constitute a distinct minority.

The evidence is clear:  the most reliable and cost effective way reduce alcohol related harm, including violence, is to reduce the supply of alcohol.

If anyone has evidence to the contrary, I’d love to hear from you.

***

PS from Croakey: If anyone has a catchy pitch for the “Bury Nanny” campaign, please speak up…


Comments 14

  1. WeBe says:

    Sorry, but I can’t agree with Sarah Jarrard’s POV here.

    You can’t just simplify the debate to a “consumption of alcohol increases the risk of harm, therefore we must reduce the supply of alcohol” argument — if it’s that simple then ban alcohol full-stop.

    When you don’t take quotes in isolation, you will see that Lord Mayor Scaffidi is especially supportive of WA’s burgeoning small bar scene. These venues provide a vastly superior environment in which to indulge in a beverage with friends, as opposed to the “beer barn” culture upon which us Perth-ites have previously relied.

  2. Margo says:

    A comment on a croakey piece in May 2010 suggested: “Personally, I say full steam ahead for the canny state (vs the nanny state).”

    Yes, it should be about the canny state, as explained in the article ‘A tentative step towards healthy public policy’ by Michael Joffe, Jennifer Mindell (J Epidemiol Community Health 2004;58:966–968, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732660/pdf/v058p00966.pdf).

    In their commentary on the Wanless Report, which explored ways of improving population health in the UK, Joffe and Mindell note:

    “In summarising the roles and responsibilities of different agents, the report rejects the view that all decisions should be left completely up to each individual, as people may not have sufficient scientific information, may be unable to accurately balance risks and benefits,and may lack a supportive social context.”

    They conclude that what is required is:

    “…more emphasis on making healthy choices easier…. This would require a state that is clever, prudent, capable, and shrewd, in other words a ‘‘canny state’’. It is more promising than simply re-iterating the healthy living messages.”

  3. Patrick Bateman says:

    I think you (and Sarah) are missing the point. Lots of things cause harm, whether directly or as a statistical average outcome. By applying Ms Jaggard’s logic, those things should be stopped so long as there is any evidence that they cause any harm. A more appropriate question is, at what point is it up to the individual to take the risk, versus up to the state to minimise the risk?

    Example, you could reduce road fatalities to zero by mandating that all vehicles have a maximum speed of 5km/h. But that would also massively interfere with our ability to do what we want. So a balance is struck: by having speed limits of 50 and 110km/h, we are basically saying as a society, “ok, a few of us will die, but the other 24,999,500 or so will get to work on time and have nice holidays every year”.

    In other words, I think you’re missing the point. Those who oppose the nanny state aren’t saying that interventionist measures are useless. They’re saying that they are a bad trade off between personal freedom and social benefit. I prefer a slightly higher, but miniscule, risk of terrorism to living in a surveillance society, for example. And I prefer to be able to have a drink when I choose over a small reduction in alcohol related stupidity.

  4. JamesH says:

    “Only Conservatives Have Nannies”?

  5. J G says:

    I agree with WeBe above – Scaffidi has done a lot to move Perth away from the beer barn attitude (and mini riots) towards a more varied drinking experience. The new-to-Perth small bars she’s helped through the system mean you can grab a glass of wine or a cocktail with a bite to eat, get to know the staff and you won’t be harrassed by drunken yobbos. It’s a more grown-up attitude and one long overdue in Perth. The restrictions Scaffidi is against aren’t stopping the beer barns from operating (more’s the pity), they’re stopping smaller, more intimate venues from being set up, and preventing restaurants from providing more varied service.

  6. Jon Hunt says:

    I agree in general that the higher the availability, the higher the risk of harm. If we had any sense we would ban alcohol (and for that matter, ciggies) all together, but we don’t because that would annoy many of us and there is always the black market to get around it. There is little sense in banning cannabis, amphetamines et al when statistically most harm is associated with those which are not banned. Alcohol is a poison, it is carcinogenic, neurotoxic, hepatotoxic, cardiotoxic and probably more yet we seem to love the stuff. Work that one out.

  7. Bill Parker says:

    I up for putting Nanny to rest. There is no answer to a situation where the streets are awash with money. Don’t forget, we do have a mining “boom”. That means money. But wait.

    One well known Perth publican has a good idea. Shut down the booze barns and permit small street corner bars. In line with the Lord Mayor obviously.

    Carcinogenic? Where did that nonsense spring from? Check the MSDS data and you’ll find warnings but a carcinogen it ain’t.

  8. Yuwalk says:

    Patrick Bateman

    For one who talks about missing the point you go out of your way to create a straw-man. It seems pretty clear to me that no one is arguing to stop things with any evidence of harm. To do so would be stupid and impossible to even try.

    I agree with your question “at what point is it up to the individual to take the risk, versus up to the state to minimise the risk?”. In 2004/2005 there was an estimated 15 billion dollar cost of alcohol abuse in Australia. It seems to me that at 15 billion dollars the point has well and truly been reached

  9. Sarah.Jaggard says:

    That’s just it – this isn’t a point of view. It’s fact, pure and simple. And there’s a good thirty years of evidence to back it up: if you decrease the availability of alcohol, you decrease consumption and therefore alcohol related harm.

    Show me the evidence that says otherwise!

    I’m not saying people shouldn’t be able to drink – far from it! And I’m all for personal freedom. But as Yuwalk says – alcohol related harm costs the community dearly – latest estimates from the Alcohol Education Rehabilitation Foundation put it at $36 billion! Don’t you think we need to do all we can to reduce that?

    And PS Bill Parker: Since 1988, alcohol has been recognised as a Group 1 carcinogen (highest rating for carcinogens) by the International Agency for Research on Cancer (IARC), for cancers of the mouth, pharynx, larynx, oesophagus and liver.

  10. Patrick Bateman says:

    But then surely you have to either advocate prohibition, or accept that people are going to drink and cause themselves and others harm?

  11. Sarah.Jaggard says:

    Well no, because prohibition doesn’t work. And yep, I totally accept that people are going to drink and cause themselves and others harm.

    But all we want to try and do is minimise that harm. Less suicides, less violence, less car crashes. How can you argue with that?

  12. WeBe says:

    Sorry @SarahJaggard, but it’s not a “fact, pure and simple” when you rely on another critically flawed assumptive ‘leap of faith’…

    Fewer outlets does not of itself decrease the availability of alcohol and nor does that, of itself, decrease the consumption of alcohol.

    Do 10 small bars or 10 restaurants pump their customers with the same volume of booze as 10 “beer barns”? Heck no!
    Even on a per head basis, is the harm caused by consumption of alcohol in 10 small bars of 120pax each, greater than (or even the same as) one “beer barn” with a capacity of 1200?Again, heck no!
    Why, because they provide an entirely different drinking environment.

    What Scaffidi is pushing (quite rightly) is that Perth needs increased flexibility when it comes to our liquor licensing regulations. And ,as someone who has owned and run liquor outlets (including one of the “beer barn” scale) in a past life and someone who has visited most of the small bars that have opened in Perth in the past couple of years, I support Lord Mayor Scaffidi’s efforts 110%.

  13. Bill Parker says:

    Sarah,

    If I claim that “alcohol” is not a carcinogen, I am referring to ETHANOL, and I get the MSDS data from one of the world’s leading repositories of such data at Oxford. The metabolites maybe what you are talking about, and in any case, most alcoholic drinks (with the possible exception of vodkas) are a complex array of alcohols. The following is from Nature Reviews Cancer 7, 599-612 (August 2007) |

    “Approximately 3.6% of cancers worldwide derive from chronic alcohol drinking, including those of the upper aerodigestive tract, the liver, the colorectum and the breast. Although the mechanisms for alcohol-associated carcinogenesis are not completely understood, most recent research has focused on acetaldehyde, the first and most toxic ethanol metabolite, as a cancer-causing agent. Ethanol may also stimulate carcinogenesis by inhibiting DNA methylation and by interacting with retinoid metabolism. Alcohol-related carcinogenesis may interact with other factors such as smoking, diet and comorbidities, and depends on genetic susceptibility.”

    In English, that is saying, very cautiously, that “alcohol” ( without defining WHICH alcohol) may be a problem. If it is a Class I carcinogen then show me chapter and verse of where that claim/observation is made. I am not wanting a list of chemicals, I already found that, I want at least a peer reviewed article and better still actual data.

  14. Yuwalk says:

    WeBe

    The below report shows that there is good evidence that the number of venues is linked to increased harm from alcohol.

    http://ndri.curtin.edu.au/local/docs/pdf/publications/R207.pdf

    Pg xiii
    “Restrictions on the outlet density of licensed premises ✓
    Only a handful of studies relate specifically to outlet density in an Australian context. Most research evidence for the impact of licensed outlet density has been collected internationally. Nonetheless, taken together, international and national evidence indicates a particularly strong and consistent relationship between increased numbers of licensed premises and increased levels of violence. Planning and licensing decisions should be based on careful consideration of the likely benefits of restricting outlet density of licensed premises and equal consideration to the possible negative outcomes of unrestrained proliferation of licensed premises.”

    If you read the report a bit further you get to the bit below, which is probably what you are trying to say.

    pp 32
    A study of licensed premises in Perth, Western Australia demonstrated that – after adjusting for levels of alcohol sales – patrons of hotels, taverns and nightclubs were at higher risk of being involved in drink-driving offences, drink driver road crashes and violent assaults than the patrons of restaurants/cafes and social clubs. In other words, drink-for-drink, the patrons of hotels, taverns and nightclubs were more likely to become involved in alcohol-related problems (Stockwell et al. 1992)

    But, the very next paragraph says

    “Finally, the somewhat distinct concept of ‘bunching’ as opposed to general outlet density has been considered recently by some reviewers. Babor et al. (2003) describe this as the concentration of many licensed premises within short distances of each another creating a high density of licensed premises within a distinct location – for example, as occurs in late-night entertainment precincts. A small number of cross sectional studies suggest that, where licensed premises are bunched in such a way, alcohol-related road crashes, (Jewell & Brown 1995; Gruenewald et al. 1996), pedestrian road injury (LaScala 2001) and violent assault (Stevenson 1999) are more likely to occur”.

    Essentially smaller cafes, restaurants and wine bars may be better than massive nightclubs, but you make an environment where you get a lot of them and you still get increased negative outcomes. Maybe you need to define “increased flexibility when it comes to our liquor licensing regulations” a bit more clearly, but it appears what you and Scaffidi are arguing for has been linked to increased harm.

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