Emerging alcohol policy innovation in the Northern Territory, Australia

The costs and harms of alcohol consumption in Australia are well documented.1 While the National Health and Medical Research Council are currently reviewing the Australian Guidelines to Reduce Health Risks from Drinking Alcohol,2 the latest global evidence suggests there is no safe level of alcohol consumption.3 The negative effects on the health and wellbeing of our society far outweigh its benefits.1,3–5 Harmful levels of alcohol consumption—both binge drinking and sustained high and moderate levels of drinking—increase the propensity for risk taking associated with violence, crime, drinkdriving, unsafe sex, alcoholic poisoning, drinking while pregnant and a wide raft of antisocial behaviours.1,3–5 Alcohol’s harm also extends beyond the drinker to those around the drinker and arguably the totality of this harm is more than that which accrues to the drinker. This harm includes family and domestic violence, child neglect, diminished industry productivity and other third–party harm.6 The Australian Institute of Health and Welfare reports that the proportion of people drinking in excess of the recommended Australian risk guidelines has been declining since 2010.1 Generally speaking, this is good news. However, there is reason to be cautious7 with population demographics changing and the decline being marginal given current average per capita drinking level is more than double those in the 1930s.8 For example, we know that around one in three Australians continue to binge drink, and that alcohol also remains the most common principal drug of concern for which Australians seek treatment.1 Also, we know that alcohol is an addictive drug. Dependence upon alcohol requires expensive therapeutic and treatment options to minimise harms to the individual, their family and the broader community.9 The chronic impact of alcohol consumption on population health in Australia is also well documented.1,10 That is, excessive alcohol consumption exacerbates health issues associated with chronic conditions such as diabetes, cardiovascular disease, mental illness and cancer.10 Furthermore, excessive alcohol consumption is positively associated with pathological gambling,11,12 spending more money while gambling13 and other psychiatric disorders.14 As such, it adds a layer of complexity to the way in which policy and program interventions are, and continue to be, designed. The health promotion community has been active in the planning, implementation and evaluation of alcohol harm minimisation strategies for decades.15 These have often reflected a comprehensive approach to health promotion16 and have been supported by respective state and national alcohol harm minimisation strategies and policies.5,17 While this has contributed to strengthening the evidence base about what works and why, concern has also been raised about the policy rhetoric and lack of tangible action. When compared with other wicked public health problems, such as tobacco control, we have not yet seen an equivalent trajectory of health improvement.4 A notable area of difference between alcohol harm minimisation and tobacco control measures has been the relative emphasis placed on sustained policy and legislative reforms. In spite of a comprehensive evidence base,18 there remains significant room for improvement in this regard in Australia. In this editorial, we provide examples of two promising alcohol policy and legislative interventions currently being implemented in the Northern Territory (NT), Australia.