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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 27-August-2010, Vol 123 No 1321

Is New Zealand lagging behind other OECD countries in measures to reduce alcohol-related harm?
The need to improve measures to reduce alcohol consumption and hazardous drinking in New Zealand has become particularly topical in New Zealand following the release of a report by the Law Commission1 and Government’s response to this report, announced on 23 August 2010. This concern is appropriate given the high burden of harm to health (and particularly for Māori health)2 in New Zealand. Indeed, alcohol is second only to tobacco as a cause of lost disability-adjusted-life-years (DALYs) in high-income countries according to recent global burden of disease work by the World Health Organization (WHO).3
The public and taxpayers should particularly welcome measures which aim to reduce alcohol-related harm given that some of the interventions may be cost saving to government (e.g. alcohol taxation and advertising restrictions)4,5 or at least be relatively cost-effective.6 The measures that may be implemented include increasing the age of alcohol purchase at off licences (including supermarkets) to 20 years, banning the sale of premixed drinks with high alcohol content that appeal to youth, and giving more power to local communities to influence the location, density and opening hours of alcohol outlets. However, the Government has missed opportunities to reduce harm from alcohol by delaying or ruling out the introduction of evidence-based measures such as lowering the legal blood alcohol limit for all drivers, introducing restrictions on alcohol advertising, promotion and sponsorship and increasing alcohol taxation.
Methods—To put the current New Zealand discussions into a wider context, we examined how current policies compare with other OECD countries. Data were obtained from the WHO Global Information System on Alcohol and Health (GISAH) (see http://apps.who.int/globalatlas/default.asp) and the World Health Organization Global Status Report on Alcohol Policy.7 For comparison purposes we used data only from OECD countries with fairly complete data on key indicators.
Results and discussion—Table 1 shows alcohol polices in 19 OECD countries for which data are available. Besides New Zealand, only three other countries in this table have a high blood alcohol limit of 80mg for drivers, although in the UK a report by NICE recently recommended lowering the limit to 50mg.8 In Canada, all provinces except Montreal had a limit of 50mg up until this year (2010). As might be expected, opposition to the change was intense, with the bar industry in Quebec being quoted as concerned at dropping beer sales and bar closures.9 The Nordic countries (Finland, Norway, Sweden, Iceland) have historically had stronger alcohol policies, although their inclusion into the European Union has meant freer access to alcohol and higher alcohol consumption,10 although deaths from liver cirrhosis (except in Finland) remain much lower than the rest of Europe.11
Table 2 shows restrictions on advertising, promotion and sponsorship of alcohol in 19 OECD countries, many of which have introduced voluntary and/or statutory regulation of advertising. Here we rank New Zealand as having the weakest restrictions—except for Belgium.
Table 1. Age limits for serving alcohol, blood alcohol level driving limits and off license restrictions in 19 OECD countries (2008 data)
OECD country
Blood alcohol level limit (in mgs†) for all drivers
Age limit for on premise alcohol purchase*
Age limit for off licence alcohol purchase*
Off licence restrictions on alcohol sales‡ by outlet density
Austria
50
16
16
No
Australia
50
18
18
No
Belgium
50
16 (18)
0 (18)
No
Canada
80
18
18
No
Denmark
50
16
16
No
Finland
50
18
18 (20)
Yes (s, w)
France
50
16 (18)
16
Yes (w, b)
Germany
50
16 (18)
16
No
Iceland
50
20
20
Yes (s, w, b)
Ireland
80
18
18
No
Italy
50
16
0
No
Netherlands
50
16 (18)
16 (18)
No
New Zealand
80
18
18
No
Norway
50
18 (20)
18 (20)
Yes (s, w, b)
Portugal
50
16
16
No
Spain
50
16
16
No
Sweden
20
18
18 (20 + wine)
No
Switzerland
50
16 (18)
16 (18)
No
United Kingdom
80
16 (18)
18
-
Data from World Health Organization Global Information System on Alcohol and Health (GISAH) (“-” means data not given)
*Age for service of spirits given in brackets if different to that for beer and wine; †Blood alcohol is the amount of alcohol present in a 100mL sample of blood, therefore 50mg is 0.05g of alcohol in 100mL (also 0.05% or 50mg/dL); ‡ Sales of beer (b) wine (w) and/or spirits (s);
A causal link between alcohol advertising and consumption is hotly contested but advertising does influence the drinking patterns and attitudes of young people12 and advertising restrictions are widely considered to be one strand in a range of measures that can reduce alcohol-related harms.13
Table 3 shows excise taxes for beer, wine and spirits in 2004 (on countries for which data are available). New Zealand has below average taxation rates compared to many other OECD countries, particularly for its preferred national beverage, beer.
This analysis is very brief and many additional details would improve the quality of such international comparisons. Nevertheless, the results indicate that New Zealand is lagging behind the OECD laws on most of a range of evidence-based measures to reduce the harm caused by alcohol consumption.
Table 3. Taxes on beer, wine and spirits (2008), ordered from highest overall average tax to lowest
OECD country
Tax as a percentage of retail price
Beer
Wine
Spirits
Finland
47.7
37.3
59.9
Iceland
40.1
35.4
52.7
Norway
14.5
42.1
71
Belgium
23.9
33
53.5
New Zealand
59.4
12.8
33.8
Sweden
11.7
34.6
50.1
Ireland
21.5
25.7
44
Denmark
31.9
15.4
42
Netherlands
25
16.8
45.4
Switzerland
46
0
38.7
United Kingdom
7.7
42.2
11.9
Australia
38.1
0
15.7
Hungary
21.6
0
28.4
France
3.8
1.2
22.5
Portugal
0.4
0
24.9
Austria
13.9
0
10
Canada
3.2
2.1
12.7
Data from World Health Organization Global Information System on Alcohol and Health (GISAH).
A recent report to the European Commission on evidence-based policies that would be effective and cost-effective in reducing social, economic and health harms from alcohol included:
  • Lowering blood alcohol limits for driving,
  • Increasing alcohol taxes,
  • Reducing the volume of alcohol advertising in all media (acknowledging that self-regulation was not effective),
  • Restrictions to alcohol sales (acknowledging that these were only effective if adequately enforced), and
  • Encouraging brief advice interventions in primary care.13
Some steps towards achieving these policies have been made by the recent announcement of the New Zealand Government to review the liquor laws, but much more can be done to better protect public health from alcohol-related harm.
Fiona Imlach Gunasekara
Senior Research Fellow
fiona.gunasekara@otago.ac.nz
Nick Wilson
Associate Professor
Richard Edwards
Professor
Department of Public Health, University of Otago, Wellington, New Zealand
References:
  1. New Zealand Law Commission. Alcohol In Our Lives: Curbing the Harm (NZLC R114). Wellington New Zealand Law Commission., 2010. http://www.lawcom.govt.nz/ProjectReport.aspx?ProjectID=154
  2. Connor J, Broad J, Rehm J, Vander Hoorn S, et al. The burden of death, disease, and disability due to alcohol in New Zealand. NZ Med J 2005;118(1213):U1412.
  3. World Health Organization. Global Health Risks: Mortality and burden of disease attributable to selected major risks. Geneva: The World Health Organization, 2009.
  4. Cobiac L, Vos T, Doran C, Wallace A. Cost-effectiveness of interventions to prevent alcohol-related disease and injury in Australia. Addiction 2009;104:1646-55.
  5. Chisholm D, Rehm J, Van Ommeren M, Monteiro M. Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis. J Studies Alcohol 2004;65(6):782-93.
  6. WHO Regional Office for Europe. Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm. Copenhagen: WHO Regional Office for Europe, 2009. http://www.euro.who.int/document/E92823.pdf
  7. World Health Organization. Global Status Report: Alcohol Policy. Geneva: Department of Mental Health and Substance Abuse, 2004.
  8. Killoran A, Canning U, Doyle N, Sheppard L. Review of effectiveness of laws limiting blood alcohol concentration levels to reduce alcohol-related road injuries and deaths. Final Report. London: Centre for Public Health Excellence (NICE), 2010.
  9. Lefebvre S-M. New Quebec blood-alcohol limit worries bar owners. Toronto Sun 2010;(18 February). http://www.torontosun.com/news/canada/2010/02/18/12937466.html
  10. Holder H. Border trade and private import in Nordic countries: Implications for alcohol policy. Nord Stud Alcohol Drugs 2009;26:232-6.
  11. OECD. Health at a glance 2009: OECD indicators. Paris: Organisation for Economic Co-operation and Development, 2009.
  12. Anderson P, et al. Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies. Alcohol Alcoholism 2009;44(3):229-43.
  13. Anderson P, Baumberg B. Alcohol in Europe. London: Institute of Alcohol Studies, 2006.
     
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