Ask An Expert: Nicki (Alcohol Healthwatch)

Today’s expert is Dr Nicki Jackson, the Executive Director of Alcohol Healthwatch – a charitable trust which promotes evidence-based policies and practice to reduce alcohol-related harm in Aotearoa New Zealand.

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Mrs D: Alcohol Healthwatch is all about reducing alcohol-related harm in NZ, how bad is it right now? What are the latest trends in hazardous drinking?

Nicki: Every year since 2011 the prevalence of hazardous drinking has increased. Currently, 20.8% of New Zealanders are classified as hazardous drinkers. That equates to 778,000 adults. Strikingly, the largest increases in hazardous drinking are amongst those aged 35-54 years.

Mrs D: Crickey that’s a lot of adults drinking at dangerous levels! What about younger kiwis?

Nicki: Although there are promising signs that fewer adolescents are choosing to drink (or are drinking on fewer occasions), among adolescent drinkers the amount of alcohol consumed remains very high. This is of particular concern given the long-term impacts of alcohol on adolescent brain development and the high levels of harm that young people experience from their drinking. For example, the more alcohol-related harms a young person in New Zealand experiences, the less likely they are to complete high school. I am sure we all agree that this is not the outcome we wish for our future generations.

Mrs D: No indeed not. We’re often told most people drink responsibly… do you agree?

Nicki: That’s the belief that I hear constantly – that only a minority drink hazardously; most drink responsibly. However, even moderate drinkers, on occasion, drink heavily and therefore place themselves and others at risk of harm. In one New Zealand survey, 50% of all drinkers had drunk to intoxication in the past year; clearly not a minority. In reality, we are all affected, directly or indirectly, by the heavy drinking culture in our country.

Mrs D: What are we talking about when mention ‘harms’? Is it just accidents and incidents when drunk?

Nicki: Yes, let’s be clear about this. The harms from alcohol aren’t just associated with drunkenness. The risk of many cancers begins at very low levels of alcohol consumption. For example, more than a third of breast cancers among women are attributable to drinking less than 2 standard drinks per day on average. Our role at Alcohol Healthwatch is to support New Zealanders who choose not to drink, and for those who drink, to do so at limits within the low risk drinking guidelines.

Mrs D: So Alcohol Healthwatch has rather a massive job. How can it be done? What works?

Nicki: Firstly, we need to acknowledge that alcohol is a drug that causes more harm to individuals, families, communities and society than any other drug in New Zealand. As such, it deserves serious attention. We all have a role to play in changing our drinking culture by holding our decision-makers to account – so that they take action using strong, evidence-based measures. This means addressing the cheap price of alcohol and restricting its advertising and promotion. This could make a huge difference to our drinking culture and reduce inequities in alcohol-related harm.

Mrs D: If raising the price is so effective why aren’t we doing this? 

Nicki: The Ministry of Justice in 2014 made a decision to wait until 2019 before looking at price strategies, despite their own research showing that price increases would result in net savings to the New Zealand society in the realms of hundreds of millions of dollars per year. If we, as the public, allow important decisions to be put on hold, hundreds of people will continue to die as a result of their alcohol consumption every year, and many more will be harmed from their own or other’s drinking. Society will continue to foot the staggering bill. Is it acceptable in our country that we can buy an RTD, which contains the equivalent of almost 2 drinks of alcohol, for as little as $1.50?

Mrs D: Um when you put it like that…. no. What are other countries doing about this?

Nicki: Many countries that have similar drinking cultures to New Zealand are currently addressing the ubiquity of cheap alcohol – and this is despite vehement opposition by the alcohol industry. Scotland, Wales and Ireland have drafted legislation which would combat the very cheap price of alcohol (favoured by heavy drinkers and young people).

Mrs D: Hopefully we’ll follow suit soon. In the meantime we did get some new liquor laws recently that are supposedly designed to give local communities more power over things like alcohol availability in their areas. Are they working?

Nicki: One of the priority objectives of the new liquor laws was to increase community input into local alcohol policy making. When the new laws were introduced, the Minister of Justice at the time said that “Licences will be harder to get and easier to lose.” Unfortunately, this has not been the reality. For many reasons, community wishes for reduced availability have not been upheld. Communities continue to shoulder the burden of having to remain aware of licence applications in their neighbourhood, collect evidence relating to their likely effects, and take time out of their busy lives to attend licensing hearings where they may be cross-examined by legal counsel regarding their concerns. The outcome of this substantial burden placed on communities? Outlets are permitted to open despite opposition, and communities are disempowered.

Mrs D: That’s depressing.

Nicki: The new laws also allow each local Council to develop their own alcohol policies, so that they can tailor their decision-making to the local conditions and needs of their communities. Almost 20,000 submissions on local policies have been put forward to date, with communities expressing a strong desire for reduced availability of alcohol in their local neighbourhoods. However, all but one of the local policies have been appealed by the alcohol industry, resulting in a final policy which is watered down in its ability to reduce availability and consequential harm. These legal challenges by the alcohol industry have cost Council, Police and Health authorities (and therefore tax payers and local ratepayers) hundreds of thousands of dollars in legal fees. So much for their ability to defend community wishes and ensure that the strong research evidence is incorporated into decision making.

Mrs D: Everyone talks about how powerful the liquor industry is and what a tough opponent they are to fight. Is this true? How do they prevent these changes being made?

Nicki: High quality research has clearly demonstrated the similarities between the tobacco and alcohol industry in influencing policy making. New Zealand is no different in this regard. The alcohol industry strongly opposes evidence-based measures (such as price increases or advertising restrictions), preferring to focus on ineffective strategies which promote personal responsibility among the so-called minority of the population who drink hazardously. As described above, they are well-resourced to appeal any policies, with Local Government New Zealand noting that “I don’t think people understood the lengths people in the alcohol industry would go to defend their commercial position.”

Mrs D: It seems crazy that we’re so powerless against the liquor industry! How can this power imbalance be shifted? What needs to happen so that the alcohol-industry lobbyists don’t always get their way?

Nicki: Good question!! Firstly, I believe that we need an increased awareness of the role of the liquor industry in policy making. I strongly believe that part of the successes of the smoke-free sector in reducing the prevalence of smoking has been as a result of highlighting the role of the tobacco industry in political decisions. Secondly, we need to be unified in our stance to take stronger, evidence-based action to reduce alcohol harm. New Zealand was a leader when it removed tobacco advertising, increased the price of tobacco, and put in tough environmental measures related to smoking – let’s take the same concerted action around alcohol. I want to be hopeful that New Zealand can also lead some change in this important area.

Mrs D: Should other leaders in our society start speaking out to get things changed? Who could/should be doing that? How could they help improve our heavy drinking culture?

Nicki: I would love to see all sectors united in a call to action around alcohol. The harms from alcohol reach into so many sectors: Education, Justice, Employment, Vulnerable Children, etc. For example, Fetal Alcohol Spectrum Disorder (which arises from drinking during pregnancy) is considered internationally to be the leading preventable cause of intellectual and developmental problems. Many sectors are working with children and young people affected by FASD; they can also be advocates for stronger alcohol policy. I would also support concerted action from the business sector, given the huge impact of alcohol on productivity. Let’s see some champions for strong alcohol policies from leaders across society! I am happy to assist them!

Mrs D: Let’s talk about supermarkets. I’ve always said if I could do one thing I’d take alcohol out of the supermarkets. Partly because it’s very tricky for people in early sobriety to have to be faced with booze when they’re gathering necessities, but also because having it sitting there next to the cheese and dips sends an overt message that alcohol an ordinary grocery item, and it’s not! How have we got to this place where a destructive, addictive drug is being treated so casually?

Nicki: Many communities agree – in 2010 when the Law Commission called for submissions on the laws surrounding alcohol, a strong sentiment in favour of removing alcohol altogether from supermarkets was expressed. Many people believed that the aggressive promotion of alcohol within supermarkets and the cheap prices in which beer and wine were sold played a major role in our heavy drinking culture. I live in an alcohol trust area where alcohol is not sold in supermarkets and it brings me great relief that my two four year-old boys can go shopping with me whilst not being exposed to alcohol marketing at an early age. I wish every New Zealand parent had the same opportunity. We need to ask ourselves: why should the most-used recreational drug in New Zealand be so widely available in our day-to-day shopping environments?

Mrs D: One of the big problems is that so many kiwis are hard-wired to see alcohol as an ordinary and necessary part of life (I know I was), the best way to relax, have fun, host friends, commiserate etc etc. Shifting this entrenched way of thinking takes a huge amount of work for one individual, let alone large population groups. Are you hopeful we’ll ever turn this boozy ship around?

Nicki: Yes, if I wasn’t hopeful I wouldn’t be in my role. I am passionate about a New Zealand where everyone can reach their potential. But for this to happen, we need to be willing to make sacrifices for the common good. This means supporting an increase in price, for example. Paying a little more for less harm has to be good thing. We also need to take a serious look at our relationship between sport and alcohol. In December 2014, a Ministerial Forum on Alcohol Advertising and Sponsorship provided its recommendations to Government on whether further restrictions on alcohol advertising and sponsorship were needed to reduce alcohol-related harm. Here we are, in 2017, still awaiting the Government to respond to their report.

Mrs D: That’s crazy! 

Nicki: Meanwhile, young people in New Zealand are exposed to up to 777 alcohol brands during televised sports events. The association between alcohol and sport is a good place to start to turn this boozy ship around.

Mrs D: It does seem to me that there are more kiwis speaking out now about the benefits of living alcohol free, do you think we’re moving ahead even slightly with shifting the narrative?

Nicki: I strongly support New Zealanders who choose not to drink; the impact they are having on normalising alcohol-free situations is tremendous. I acknowledge the challenges they face in the normalised heavy drinking culture. Our young people are increasingly choosing not to consume alcohol; let’s do everything to support them in this decision! And meanwhile, take action so that their environment is not saturated with alcohol when they reach 18 years of age.