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Position Paper - Alcohol and other Drugs
August 2013
The Inner South Community Health Service (ISCHS) is a major provider of primary health care services including alcohol and other drug (AOD) services, and has been for over 20 years. The service model is based on the social model of health. Principles of harm minimization are adopted in relation to all AOD work.
1. Purpose
This paper outlines ISCHS’s positions in relation to alcohol and other drugs (AOD). It includes positions on:
- Reducing consumption through greater control of access and availability
- Education and information provision
- Access to quality treatment services.
- The use and misuse of pharmaceutical products.
The overriding principles of the paper relate to advocating for health and social approaches to reduce harms including a right to access treatment and harm minimization strategies for the whole community with a focus on strategies that are effective for marginalized groups. All policy and reform positions adopted by ISCHS will be evidenced based.
Public health interventions are deliberately designed to maximize their effect by appealing to large but relatively lower risk population groups- which means that public health success increases health inequities (Bambra et al, 2010). Although ISCHS supports a public health approach, it equally recognizes the inadequacy of some policies to fully benefit many of our marginalized clients.
2. Background
Thirteen percent of the Australian Burden of Disease and Injury in 2003 is directly accountable to the consumption of alcohol, tobacco and other drugs. Alcohol alone accounts for 60 deaths and 1500 hospitalizations weekly in Australia’ (NAAA 2011).
ISCHS’s role as community health service incorporates health promotion. This includes working directly with local communities, in conjunction with influencing public health debates.
Influencing the public health debates is crucial as there is a significant lobby within Australia who oppose effective public health debate and actions by attempting to categorize any such attempts as promoting a ‘nanny state’. The reality is those behind such campaigns normally stand to benefit from existing patterns of consumption which legislation, regulations, and education are seeking to change.
As a public health organisation ISCHS provide an alternative view and seek to influence legislation and regulation, promoting a harm minimization approach, in line with recommendations of peak AOD groups, public health bodies and the needs of the local community.
This position paper will provide a clear framework for the Board of Directors, management and staff, students and volunteers of ISCHS.
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3. Context
Government
The National Drug Strategy 2010-2015 and the Victoria Whole of Government Strategy “Reducing the Alcohol and Drug toll: Victoria’s Plan 2013-2017’ set the agenda for alcohol and drug management. (See Appendix 1).
National and State health budgets are under considerable financial pressure and this pressure will increase over the next 20 years. All levels of Government policy are framed on the effective provision of prevention and harm minimization strategies to reduce the demand on health services and costs on future budgets.
It is well recognized that AOD use is a major contributor to Australia’s ‘burden of disease’.
The ability to change drug use culture has been demonstrated through tobacco legislation, regulation and education. This has proved to be an effective long term method for supporting prevention and reducing harm.
ISCHS Context
The ISCHS service model is based on a harm minimization approach.
It is recognized that current National and State Strategies to regulation AOD have not had the same benefit for all parts of the community. While rates of smoking have dramatically reduced among the population, among disadvantaged groups smoking rates are up to 5 times higher than the population average (Australian Preventative Health Agency 2013 p.2).
ISCHS has a strong commitment to delivering primary healthcare services, complimented by advocacy on issues that influence the health and wellbeing of disadvantaged groups within the community.
ISCHS is a member of peak organisations focusing on AOD advocacy.
The focus of ISCHS advocacy will be in supporting the advocacy of member bodies. However, ISCHS will advocate independently on relevant local issues, especially where more tailored strategies are required to support change within disadvantaged groups.
ISCHS operates within the Social Model of Health (VHA)
ISCHS operates under the principles embodied in the Ottawa Health Promotion Charter (WHO).
4. ISCHS Position
4.1 Alcohol
4.1.1 Supporting health, social and planning approaches to reduce harm related to alcohol use including
- Taxing alcohol products according to the level alcohol they contain (volumetric alcohol taxation);
- Phasing out of alcohol promotion from times and placements which have high exposure to young people aged up to 18 years;
- Reduction in the availability of alcohol through more effective control of new outlets, and through reduced trading hours.
4.1.2 Increased awareness through education of what constitutes harmful drinking and binge drinking, and increased understanding of the harms. 4.1.3 Increased awareness of the risk and protective factors for foetal alcohol syndrome.
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Appendix 1. Evidence
There is a body of local and international research that both identifies the harm caused by illicit and licit drugs including alcohol, along with a broad range of evidence supporting the effectiveness of treatment and prevention strategies.
Alcohol
Facts
Alcohol consumption accounted for 3.3 per cent of the total burden of disease and injury in Australia in 2003; 4.9 per cent in males and 1.6 per cent in females. (NHMRC)
Most Australians who drink alcohol do so at levels which have few adverse effects. However, any level of drinking increases the risk of ill-health and injury. (NHMRC)
Alcohol is second only to tobacco as a preventable cause of drug-related harm in Australia. Risky use of alcohol has serious personal, social and economic consequences (ADF).
The AERF (Alcohol Education Rehabilitation Foundation) estimates the toll from the use of alcohol at $36 billion annually in Australia (Danny Rose, The Age 24th^ August 2010), including 70,000 victims as a result of alcohol related assaults, 24,000 of these related to domestic violence (FARE.org.au)
The consumption of alcohol was estimated to cost Australian society $15.3 billion, in 2004–05 (Collins & Lapsley 2008a).
In relation to our Community Health catchment, estimates derived from the 2008 Victorian Population Health survey indicated alcohol consumption at levels considered to be at high risk to health across the ISCHS catchment compared to the Victorian average (Social Health Atlas of Australia, 2013).
Positions
Alcohol pricing and taxation (NAAA website) International scientific evidence consistently shows that alcohol consumption and harm are influenced by price. Alcohol taxation, as a means of increasing the price of alcohol, is one of the most effective policy interventions to reduce the level of alcohol consumption and related problems, including mortality rates, crime and traffic accidents.
Alcohol marketing and promotion (NAAA website) Alcohol marketing and promotion contributes to young peoples’ attitudes to drinking, starting drinking and drinking at harmful levels. Much of this marketing has the effect of reinforcing the harmful drinking culture in Australia. We urgently need comprehensive reform of the alcohol advertising regulatory arrangements. The National Preventative Health Taskforce recently recommended that in a staged approach, alcohol promotions should be phased out from times and placements which have high exposure to young people aged up to 25 years.
Alcohol availability (NAAA website) There is heightened concern in communities across Australia about the increased availability of alcohol, primarily caused by the deregulation of liquor control laws. In many of our major cities and regional centres, the link between high densities of alcohol outlets and alcohol related violence has been the focus of significant public attention and concern. Similarly, there is strong evidence that extending the trading hours of alcohol outlets results in increases in alcohol-related problems. Other evidence indicates that a reduction in these hours can contribute to a reduction in these same problems.
In this context, there is a need to reassess approaches to alcohol availability and enforcement of legislation. NAAA considers that treating alcohol like an ordinary commodity and prioritising market competition over public health will continue to exacerbate Australia’s harmful drinking culture. Additionally, there is a need for national guidelines on alcohol outlet density and opening hours.
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Tobacco
Facts
Smoking is a leading cause of preventable death and disease in Australia (National Tobacco
Strategy). In Australia in 2003, tobacco use was responsible for 7.8% of the burden of disease.
Smoking was the cause of 15,551 deaths (42 a day) in 2003. It was responsible for 20.1% of the disease burden due to cancer, and 9.7% of the disease burden due to cardiovascular disease (AIHW).
Collins and Lapsley (health.gov.au) estimated that in 2004–05 the total cost of smoking in Australia was $31.5 billion. It was considered that this study underestimated the actual costs.
In 2007/2008, 23% of males aged over 18 years, and 19% of females smoked. Smoking rates for men and women are continued to drop (down from a peak of 72% for men, and 31% for women).
However, people living in the most socioeconomically disadvantaged areas were twice as likely to smoke as people living in the most advantaged areas (AIHW). This is supported by the data from the ISCHS client survey in 2009, which indicated 35% of clients interviewed smoked daily (nearly twice the Australian average).
Bonevski and Baker (2012) give current rates of smoking in high prevalence communities as: 50% of Aboriginal Australians, 37% of single parents, 73% of homeless people and people with other drug disorders, 66% of people with a mental illness and 60% of people accessing welfare aid from non- government agencies such as Anglicare and the Salvation Army and 85% prisoners smoke.
Positions
ISCHS advocacy builds on a continuation and strengthening of the current successful National and State Strategies, to ensure we further reduce the percentage of people still smoking, with a focus on strategies that will be effective with marginalized groups and communities.
Illicit Drugs
Facts
Illicit drug use accounted for 2.0% of Australia’s total burden of disease in 2003. Much of this harm is related to unintended outcomes of drug use or public policy. For example, twenty five percent of this burden of disease is related to Hepatitis (AIHW), which can be contracted by risky injecting practices, particularly the sharing of injecting equipment. Continued and improved access to injecting equipment is critical to reduce harms associated with drug use.
The social cost of illicit drug use in Australia was estimated at $8.2 billion in 2004–05, including costs associated with crime, lost productivity and healthcare (AIHW).
Positions
Our advocacy approach to illicit drugs is driven by the understanding that often the harm associated with illicit drug use is a direct result of the environment in which drug use occurs, as well as the harmful effects of the actual drugs. Our advocacy focuses on the health needs of people using illicit drugs, rather than the illegal nature of their drug use. This response should not be interpreted in any way to support illicit drug use, but as a health service, our focus is on reducing harm, rather than law enforcement. The paper supports decimalization of drugs to reduce criminal behavior and allow greater support and engagement of people engaged in drug use.
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References
Australian Preventative Health Agency (2013). Promoting a healthy Australia.
Bambra et al. (2010) Reducing health inequalities in priority public health conditions: using rapid review to develop proposals for evidence based policy.
Billie Bonevski and Amanda Baker JUL 23, 2012 Smoking is a social justice issue. Crikey. Retrieved from http://blogs.crikey.com.au/croakey/2012/07/23/will-social-change-help-reduce-smoking-rates- amongst-disadvantaged-australians/
Collins & Lapsley (2008a). The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. Australian Department of Health.
Commonwealth of Australia. (2012). National Tobacco Strategy.
Lawn. S. (2008) Tobacco control policies, social inequality and mental health populations: time for a comprehensive treatment response Australian and New Zealand Journal of Psychiatry; 42:
NAAA. (2011). Alcohol tax reform is a major public health and social policy issue
Nicholas, R., Lee, N., & Roche, A. (2011). Pharmaceutical Drug Misuse in Australia: Complex Problems, Balanced Responses. National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide.
Public Health Association Australia (2010). Pharmaceutical Drug Misuse Policy
