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).3The 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.11Table 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

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).3The 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.11Table 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