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IN THIS EDITION
Strong evidence counters the protective effects of alcohol on mortality
Select Committee Report: Local Alcohol Policies & renewals
Alcohol control policies remain cost-effective

Tax Working Group: Interim Report
FASD Awareness Month
Submission opportunities
Conference Overview: Who should pay for all the harm from alcohol?
International news
Watch: Useful videos to share
Focus on research
Conferences and events
Research update

As we turn the corner to warmer weather, we typically also enter the heaviest drinking quarter of the year. This newsletter highlights the recent literature demonstrating effective and cost-effective strategies to minimise the harm that arises from alcohol use and the findings that health harms can begin from one drink per day. 

STRONG EVIDENCE COUNTERS THE PROTECTIVE EFFECTS OF ALCOHOL ON MORTALITY

Few would have missed the world-wide attention on the latest Global Burden of Disease study into the harms from alcohol. Coverage was vast, with excellent debate on the implications of the study.

The main points from the study were:
  • Globally, alcohol use was the seventh leading risk factor for both death and disability-adjusted life years;
  • Among those aged 15-49 years, alcohol use was the leading cause of death (we know this is true for New Zealand also);
  • Cancers accounted for a large proportion of alcohol-attributable deaths in those aged 50 years and over. The risk of cancer increased with every drink – from any amount of alcohol use;
  • The only significant protective effects of alcohol were for Ischaemic Heart Disease, occurring at 0.83 standard drinks per day for men and 0.92 standard drinks for women. There was also a significant J-shaped curve for diabetes among women with protective effects at low levels of alcohol use; and
  • For total mortality across 23 health outcomes, the level of alcohol use that minimised harm was zero.
For an excellent synopsis of the study and its implications for those working to reduce the harm from alcohol, we recommend the commentary by Alcohol Concern entitled “Confusing research: is moderate drinking safe”  
SELECT COMMITTEE REPORT: LOCAL ALCOHOL POLICIES & RENEWALS

On August 16, the Governance and Administration Select Committee reported on Louisa Wall’s Private Members’ Bill - the Sale and Supply of Alcohol (Renewal of Licences) Amendment Bill (No 2) and Supplementary Order Paper.

The Committee had received 254 submissions on the Bill, of which 47 submitters presented at oral hearings in Auckland and Wellington.

The outcome:
The Select Committee was unable to agree on whether the bill should proceed, and recommended that the House take note of this report.

Most notably, they commented that for the bill to have any effect, a local alcohol policy would have to be in place, and many local councils do not have local alcohol policies. Many of the submitters raised wider issues about the process for implementing local alcohol policies under the Sale and Supply of Alcohol Act, particularly the ability to appeal local alcohol policies. Some commented that the current appeals process adds unreasonable costs and delays to the development of policies.

Alcohol Healthwatch noted that in the same week that the report was released, the Parliament website listed a Briefing on the Sale and Supply of Alcohol Act 2012 to be conducted by the same Select Committee. We will keep you posted when we have more information on this.
 
Following a number of high-quality papers examining the effectiveness and cost-effectiveness of alcohol control interventions, recent research has provided an up-to-date assessment.

In a nutshell, the picture has not changed.

Effective policies that achieve the greatest impact on health at minimal cost are:
  • Alcohol excise tax increases
  • Restrictions on alcohol advertising
  • Reductions to off-licence trading hours 
Whilst screening and brief interventions for hazardous drinking were deemed effective and achieved significant health gain, the implementation costs were extremely high. 

Whilst effectiveness and cost-effectiveness are important, it is important that we also think about the equitable distribution of benefits. Tax increases show the strongest potential to achieve social justice.

Alcohol Healthwatch used the data from the paper to illustrate the differences in costs and health gain between policies. We believe that the figure speaks for itself.

On September 20, the Tax Working Group released its Interim Report. The inconsistency in the tax rates across products was highlighted (see wine as an example in the figure below).

In relation to alcohol, the following was reported:

The appropriate rates of alcohol excise will depend on an assessment of the health effects of alcohol consumption, and of the externalities associated with alcohol abuse. Accordingly, the Group believes the rates would be best decided with appropriate input from the public health community.

It is evident, though, that the current rate structure is unnecessarily complex. It is difficult to understand why the rates of excise per litre of alcohol should vary so much across different products. A case could be made for applying a consistent rate per litre of alcohol across all products – which would increase rates for some products and decrease them for others – but little can be said in favour of the current approach. The Group recommends that the Government review the rate structure with the intention of rationalising and simplifying it.


As a member of the public health community, Alcohol Healthwatch looks forward to future discussions and debate with the Tax Working Group on the appropriate rates of excise tax.

Sunday 9th September was FASD Awareness Day. The 9th minute of the 9th hour of the 9th day of the 9th month traditionally marks the moment of FASD reflection as it makes its way around the world’s different time zones. That means Aotearoa is always the first to kick it off.  We have been the first country to do so since inception in 1999. That’s 20 years!

Our first ever event introduced Diane Yates, Member of Parliament for Hamilton East, whose Private Members' Bill sought to require alcohol products to display pregnancy warnings. The Government in 2003 agreed, but through loop holes and red tape, we still wait for that promise to be fulfilled. Australian and New Zealand Government Ministers are expected to vote on whether to mandate these before the end of this year. Alcohol Healthwatch and other health organisations support visible and consistent messaging which can only be achieved through Government regulation.  

“This product damages the brains of unborn babies. Any other food product causing that much harm would not be on supermarket shelves and yet we can’t even manage a simple warning label for alcohol. That still astounds me”, says Health Promotion Advisor Christine Rogan, whose petition in 2000 set the ball rolling. 

Fast forward to 2018, and it has been a mad dash to get RED SHOES ROCK! happening for Aotearoa for the first time this year but rock they did!  Why Red Shoes? In 2013 RJ Formanek (photo), an adult with FASD, decided to wear RED SHOES to stand out, be noticed and have some fun starting the FASD conversation with strangers. It was all about:
•    Turning invisibility into visibility
•    Creating conversation
•    Changing stigma into understanding and acceptance

The countdown has begun toward FASD Awareness Month next year. We encourage you to go to the FASD ActionPoint website and pledge to ‘Start the Conversation’, post pics or tell a story. You are also encouraged to join other champions for public health and 'Sign the Petition' launched by FARE (Foundation for Alcohol Education and Research) in Australia to support mandatory pregnancy labels for alcohol products in both countries.  

                                                                                           (Image: RJ Formanek)   
Indicators Aotearoa New Zealand – Ngā Tūtohu Aotearoa

Stats NZ is developing Indicators Aotearoa New Zealand to track New Zealand’s progress. The set of indicators will go beyond economic measures, such as gross domestic product, to include well-being and sustainable development.
Have your say by 30 September 2018.

Health Research Council priorities

The Health Research Council of New Zealand (HRC), Ministry of Health and Ministry of Business, Innovation and Employment invite your feedback on the Strategic Investment Areas (SIAs) - also known as the overarching 'framework' that the new research priorities will fit into.
Have your say by 12 October 2018.

A stimulating conference hosted by Alcohol Action NZ and SHORE & Whariki Research Centre (Massey University) showcased a range of presentations on the economic costs of alcohol harm, the Treaty of Waitangi claim on the harms from waipiro, the role of alcohol in suicide, the impact of alcohol on health and police services, and the importance of raising alcohol taxes.

Key take home messages were:
  • Estimated costs of harm in 2018 = $7.85 billion (3% of GDP);
  • After depression, alcohol is the strongest risk factor for suicide (alcohol increases suicide risk 6-fold);
  • Māori continue to suffer the greatest inequities in alcohol-related harm and are seeking immediate redress through the Waitangi Tribunal; and
  • Inaction on alcohol taxes effectively subsidises the alcohol industry and penalises New Zealanders that don’t drink or drink at low-risk levels.
Alcohol Healthwatch will be using the information from the conference as we develop our evidence-based submission on the Wellbeing Budget of 2019. Alcohol harm is a key driver of inequalities and reduced well-being (for the drinker and for others), and we should all demand fairness when it comes to who pays the cost of alcohol harm in our society.
Ireland

Ireland’s Public Health (Alcohol) Bill has now passed 1000 days in debate. There has been some good reporting on the tenacity of the alcohol industry to protect its profits at the expense of public health.

However, this week it was pleasing to read that politicians are holding steadfast against intense alcohol industry lobbying and will continue to debate the need for cancer warning labels on alcohol products. This element has been, by far, the most controversial in the debate.

Northern Territory Minimum Unit Pricing kicks off

From Monday October 1, 2018, one standard drink in the Northern Territory will cost a minimum of A$1.30. This is great news for a region that experiences disproportionately more harm compared to other parts of Australia.

Minimum Unit Pricing is a pro-equity approach; the evidence shows that the most vulnerable to alcohol harm experience the greatest benefits from the setting of a floor price of alcohol.

Declines in adolescent drinking in Europe

There has been a lot of publicity this week on the decline in adolescent drinking across many EU countries. Adolescents are less likely to drink, those that do drink begin later, and the prevalence of binge drinking has decreased. Importantly, they are not turning to other drugs to replace alcohol use.

Drinking in China and India continues to increase 

In contrast to many countries, per capita consumption has been rising in China and India. In China, per capita consumption was 4.1 litres in 2005, 7.1 litres in 2010, and 7.2 litres in 2016. In India, it rose from 2.4 litres in 2005 to 4.3 litres in 2010 and 5.7 litres in 2016. Read more in the World Health Organisation Report "Global status report on alcohol and health 2018". 

Wales

Today, it was announced that Welsh Ministers are opting for a minimum alcohol price of 50p per unit.

Drink, drank, drunk: what happens when we drink alcohol in four short videos 
 

Check out the new short videos created by the online media platform - The Conservation. The videos cover topics including the effects of alcohol in our body and brain; what happens after that first sip of alcohol; and what happens when we drink too much. 

Alcohol brands and sponsorship are found everywhere – looking through the eyes of kiwi kids 

A recent study showed that New Zealand kids are exposed to alcohol marketing on average 4.5 times per day. Māori and Pacific children had rates of exposure that were 5 and 3 times higher than New Zealand European children, respectively.

The Kids’ Cam project, led by the University of Otago, captured images taken by kids in the Wellington region as they go about their daily lives. Kids were found to be exposed to alcohol marketing in many settings, including the home, liquor stores and sports venues. Of particular concern, they were exposed to alcohol sports sponsorship every day. 

“Alcohol companies’ sponsorship of sport led to the exposure of children to alcohol marketing in their homes, on their clothing, and in traditional health promoting environments such as sports venues,” says lead researcher Tim Chambers, from the University of Otago, Wellington.

Dr Chambers said that the research provided further evidence of the need for legislative restriction on alcohol marketing. This includes banning alcohol sport sponsorship and ending industry self-regulation of alcohol marketing. 
FASD Forum from an International and Local Perspective
5 October 2018, Manurewa Marae

Fetal Alcohol Spectrum Disorder and the Criminal Justice System
11 October, 4:00pm - 6:15pm, Auckland District Law Society Chambers

Australasian Professional Society on Alcohol and other Drugs
4 - 7 November 2018, Pullman Auckland Hotel, Auckland

2nd Australasian Fetal Alcohol Spectrum Disorder Conference (FASD2018)
21-22 November 2018, Perth
RESEARCH UPDATE

Hot off the press is a wealth of high-quality alcohol research. Email Alcohol Healthwatch if you do not have access to any of the full-text versions below. Some papers may not be directly relevant to reducing alcohol harm; we have also chosen high-quality papers on other public health issues that can greatly inform our work.
 
New Zealand

Why is alcohol in the government’s’ too hard basket’?

Alcohol consumption in New Zealand women before and during pregnancy

Prenatal alcohol consumption and infant and child behaviour

The alcohol industry, the government and the alleged defamation of public health advocates: A New Zealand case study

Children’s Real-time Exposure to Alcohol Marketing in Their Everyday Lives

Students Who Limit Their Drinking Are Stigmatized, Ostracized, or the Subject of Peer Pressure

International

Alcohol industry

Trouble brewing: Making the Case for Alcohol Policy

Public Health England’s capture by the alcohol industry

How dependent is the alcohol industry on heavy drinking in England?

Proliferation of ‘healthy’ alcohol products in Australia: implications for policy

Global studies

WHO Global status report on alcohol and health 2018

Are the “Best Buys” for Alcohol Control Still Valid?

Alcohol use and burden for 195 countries and territories, 1990–2016 (Global Burden of Disease Study)

Adolescent drinking 

Parent characteristics associated with approval of their children drinking alcohol

Advertising & Marketing 

Youth perceptions of alcohol advertising: are current advertising regulations working? 

The marketing of sugar-sweetened beverages to young people on Facebook 

Unhealthy sponsorship in sport: a case study of the AFL

Licensed premises

Alcohol outlet density and alcohol related hospital admissions in England

Underage alcohol sales in community sporting clubs in Australia

Other 

Alcohol must be recognised as a drug

Association between changes in lifestyle and all-cause mortality
 
The Mutual Relationship Between Men’s Drinking and Depression: A 4-Year Longitudinal Analysis

Effective advocacy strategies for influencing government nutrition policy

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