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Summit a chance to end nation’s decades-long drinking binge

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I had heard about but not seen the Todd River in Alice Springs, with its small encampments of quiet and inactive Indigenous people in its dry bed. But about 30 years ago I had my chance.

I was, irony of ironies, attending a meeting of Australian health ministers in a nearby comfortable motel to discuss health goals and targets for Australia. In the dust of the Todd I saw innumerable discarded empty casks of Coolabah wine, and discarded people. You can guess the rest.

Whatever goals we set as a nation back then for alcohol have not been met, and the shambles associated with its misuse – violence, road crashes, liver disease, mental chaos, cardiovascular disease and diabetes, impaired pregnancy and so on – continues pretty much unabated.

Full marks to the AMA for convening a summit about alcohol.

Summit may seem an odd word to use in relation to alcohol, but it is the right word. Alcohol is at the top of current public health problems in Australia, especially in our Indigenous communities, and deserves the quality debate that occurs at international meetings convened to resolve wars and prevent major threats such as Ebola and economic collapse.

That there are many interested parties when discussion and decisions are made about alcohol is a good reason for such a summit. All voices need to be heard, and conflicting arguments for and against an uncontrolled market need to be considered.

But the medical nature of this summit moves it well beyond a talkfest: the health problems to which alcohol contributes are multiple and devastating, especially in our Indigenous communities. 

The National Health and Medical Research Council has moved in an increasingly conservative direction in the past two decades in determining the risks posed by alcohol. A little bit of radiation, a touch of small-particle air pollution, a small amount of asbestos were all once regarded as no bad thing. We now know that one cigarette a day increases the risk of heart disease to the same extent as all the modern genetic markers put together. That’s the direction we are moving in with regard to alcohol.

Many and varied are those interested in alcohol. We should not expect harmony, and consensus is an unlikely outcome.

Like the problems that necessitate international summits, ideology will probably trump facts most of the time. There will be those who will argue that any form of limitation on the availability of alcohol in any of its many forms needs to be targeted only to vulnerable groups. Others will seek more radical control through taxation, following its demonstrable success in cutting smoking rates wherever it has been applied worldwide.

Yes, of course, tobacco and alcohol are different, but the same arguments about individual freedom and not wanting a nanny state interfering with the market will probably be heard at the summit on alcohol.

The summit may well hear good-news stories that should serve to encourage others to action. Indigenous communities that have taken control of the availability of alcohol point to the importance of community education and community development. In our richly multicultural society, we can easily find national and religious groups who exemplify healthy behaviour in relation to alcohol from which lessons can be drawn.

But the environment also matters, and availability of alcohol deserves attention.  

A year ago I met with a senior planning politician to discuss how new housing estates might be designed with health in mind. He asked expressly about shops. I suggested, based on depressed communities we both knew, that it would be great if there were more outlets for fresh food than there were for alcohol. The door closed. I was told this would need to be determined by the market.

The summit will contribute to a continuing conversation. We should not expect Harry Potter will to turn up with his wand and convert all present to a lasting preference for non-alcoholic butter beer.

But if recommendations emerge that focus less on individual responsibility and more on creating a disciplined and supportive environment that decreases the health risk of alcohol, then it will have served a useful purpose.