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Nov 19, 2012

Dear preventative health wowsers: stop taking the piss

Some persistent themes run through campaigns by the preventive health lobby to ban and tax things. But should these taxpayer-funded elites be allowed to crack down on what they disapprove of?

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Bucket full of beer

The medical profession and the growing, taxpayer-funded preventive health industry are engaged in a constant campaign against basic rights in the name of forcing Australians to become healthier. Media coverage of the campaign is episodic and sporadic. But pieced together, the nature of the campaign becomes clear — even when confined to the recent past.

In September, the taxpayer-subsidised Australian Drug Foundation called for alcohol consumption to be banned on school grounds because drinking at fetes or BBQs “undermines the alcohol education programs for young people in schools”.

The same month, the Australian Medical Association called for the legal drinking age to be lifted to 25 (presumably because prohibition has worked so well in the past). In June, the AMA demanded a complete ban on alcoholic energy drinks.

Last week, Sandra Jones, director of the Centre for Health Initiatives at the University of Wollongong, attacked online wine sites for selling at “ridiculously low prices”, declaring (without evidence) “it’s typically young people who are more likely to be on social media and on these group buying sites”. Jones wants a minimum price for alcohol. Her comments are part of strengthening campaign from public health types to impose additional taxes on alcohol.

The new headquarters of the preventative health industry, the $9 million Australian National Preventive Health Agency, recently released a discussion paper proposing an increase in wine taxation and more research for a minimum alcohol price, including the localised imposition of a minimum price in some areas.

The call to make alcohol more expensive is propped up by some interesting maths about the alleged economic cost of alcohol. The taxpayer-subsidised Foundation for Alcohol Research and Education has released a commissioned report arguing not merely for a shift to volumetric alcohol taxation, but a lift in all alcohol taxes. The basis for the argument was the extraordinary claim that alcohol causes $15 billion per annum in “harm to others”, including nearly $8 billion pa in “loss of quality of life” (the basis for these numbers was disputed by Access Economics, on behalf of the alcohol industry).

The persistent demonisation of alcohol is a core driver of preventive health campaigning (Chris Berg pointed out one of the more absurd examples). In 2009, The Australian prised from the Commonwealth Department of Health a report that proposed to force employers to discourage alcohol consumption on the basis that “in some work settings, workers who do not normally drink in their own leisure time may find it expected of them by their colleagues or workplace” and that Australia’s drinking culture was “calculated hedonism”.

Another report from the National Drug Research Institute this year supported workplace breath-testing. This is despite the fact that as FARE itself admitted in a Senate inquiry submission, Australian alcohol consumption had fallen by nearly a third since 1975. The submission also claimed Australia’s level of consumption was “high by world standards”, a claim that only holds when non-developed countries are counted. Australia’s level of consumption is below that of virtually every European country, and often far below.

Demonisation of young people is another persistent feature. This time last year, Sandra Jones was joining the annual schoolies hysteria by warning “almost two-thirds will have more than 10 drinks a night and ‘hook’ up s-xually with a stranger”, presumably on the basis that no previous generations have ever engaged in binge drinking or casual s-x. A WA parliamentary committee wanted to lift the drinking age to 21, though the Barnett government knocked them back.

As two liquor outlets last week posted guards at stores in order to somehow divine that adults were buying alcohol for people under 18, we were warned of the evil genius of young people: “you’ll see four or five down the road or across the road in the park pooling some money and that one who is 18 will come in.” FARE has demanded the NSW government institute sting operations to catch out any retailers selling alcohol to under-18s and the removal of legal defences against doing so. Then there’s the proposal to ban young people from smoking from 2018.

This approach accords neatly with traditional media narratives about uncontrolled youth and their unprecedented violence/drug use/s-xual activity/poor taste in music/hair styles; all the better if the internet (which is of course distorting the brains of young users) can be added to the mix.

Yes, the internet, too, worries the preventive health industry. It is still valiantly fighting to have alcohol advertising banned altogether from traditional media but it has been looking at the internet and warning of disaster for a while. “Anecdotal evidence suggests online social networking sites, such as MySpace and Facebook, may hold a range of potential risks in facilitating social interactions involving alcohol that my have potentially harmful repercussions,” warned a 2008 report (the fact that no one used MySpace after about 2006 suggests how on the ball the report’s authors were).

And last year ANPHA gave more than $250,000 to a University of Sydney academic to examine “how the rapid emergence and mass adoption of new media tools, including social networking websites, may be promoting unhealthy foods, influencing dietary choices and contributing to excessive weight gain” and how “effective marketing regulations” could be used to deal with it.

A fortnight ago a workplace relations lawyer called for the banning of access to gambling sites from work for health reasons, comparing them to p-rnography and race hate sites.  Croakey’s Melissa Sweet has also covered the rather censorious tone toward social media adopted by the Australian Health Practitioner Regulation Agency in its draft social media policy. Sydney University researchers recently demanded the banning of what they called “pro-smoking apps” for mobile devices.

The instinctive urge of preventive health advocates is always to ban us, to tax us, to use surveillance. This doesn’t merely apply to companies, but to individuals. Only yesterday, two medical professionals made the astonishing proposal that everyone in the country currently using opioid pain relief should be regularly drug tested to make sure they were consuming them rather than selling them. A German study on alcohol consumption in effect infantilised all women when it suggested GPs start interrogating their female patients about how much they drink.

Veteran anti-smoking campaigner and respected health academic Simon Chapman recently proposed licensing and smartcard sales-tracking of smokers, although commendably he had enough intellectual rigour to invite a critic of the proposal to respond. Licensing, and the control and surveillance that it enables, is a popular tactic for public health advocates — former NT administrator and anti-alcohol campaigner Ted Evans has called for licensing of alcohol consumption.

Sometimes there’s nothing overly sinister about demands for regulation — they’re just a cover for old-fashioned gouging: the AMA has joined with a pharmacy chain in demanding that supermarkets be banned from selling panadol because “you can buy 100 tablets for hardly any money”.

There’s little new in all this. Last year, a coalition of preventive health groups demanded the Victorian government move to curb the number of liquor licences. Between trying to reduce the number of alcohol retailers and using taxation to increase the price, the preventive health industry has moved precisely nowhere in over 250 years since the Gin Craze of 18th century England. In what has been called the first drug scare in history, mid-18th century British governments, spurred by an outraged middle class, used exactly the same tactics to attack the prevalence of gin consumption among poorer English people who, it was felt, drank too much and didn’t work hard enough.

It’s fascinating how little the justification for such crackdowns has changed. Attempts to regulate and tax gin out of the reach of poorer people were justified by not merely by moral righteousness but on economic grounds: gin was damaging the capacity of English women to produce children, and consumption of gin caused poverty and idleness in an economy struggling to compete with its European rivals.

The economic justification is no longer couched in such melodramatic terms. Instead, it relies on QALYs — Quality Adjusted Life Years, and AWE-based calculations of lost productivity. But the motivation remains the same: social élites anxious to impose control on what they disapprove of. The big difference now is that nearly all of this is taxpayer-funded: we are paying these élites to rationalise banning, taxing and using surveillance over what they disapprove of.

Bernard Keane — Politics Editor

Bernard Keane

Politics Editor

Bernard Keane is Crikey’s political editor. Before that he was Crikey’s Canberra press gallery correspondent, covering politics, national security and economics.

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48 comments

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48 thoughts on “Dear preventative health wowsers: stop taking the piss

  1. Konrad Reardon

    As a qualified pharmacist, while I firmly agree with Crikey’s correspondent that there is a precedent demonstrating the futility of drug prohibition, there is a wider angle to preventive healthcare which this article misses completely.

    There has been little appreciable change to the drug usage patterns of Australians in the decades since control of certain substances began. The main changes have been the types of drugs used with a new worrying trend towards the usage of prescription and over-the-counter medications. This was the subject of a recent forum – Australia21.

    However, to condemn the entire preventive approach to healthcare simply on a small number of policies is incorrect, and as a keen student of rhetoric, Crikey’s correspondent should be aware that it is often unwise to make absolute statements (ie The instinctive urge of preventive health advocates is always to ban us). Preventive health policy does not just concern medical professionals – it includes sanitation, civil engineering projects, public transport, parks and wildlife and even occupational health and safety. The more specifically medical areas, according to the McKeown hypothesis, contribute relatively little to overall public health (although there has been a drop in infectious disease rates since the introduction of antibiotics and vaccination; hopefully a similar positive effect may be seen with breast and cervical cancer screening).

    “Prevention is better than cure” is a favourite saying – and overall it is definitely cheaper – yet the outcomes are difficult to account for because they often concern intangibles. For example, smokers contribute enough through the excise charged to more than cover their direct health costs. However, there is a much higher indirect cost of smoking which includes health risks to people inhaling the smoke, transport/work days lost for friends/family caring for people with chronic smoking-related illnesses and the long-term effect on children of women who smoke while pregnant. Please note that I do not intend to vilify smokers with this example – it is an illustration used because smoking is one of the more publicly noticeable health risks. There less obvious, but far more dangerous health risks than smoking.

    Crikey’s correspondent characterises the use of QALYs as being wholly negative – a justification of the policies of wowsers. In truth, the QALY is a crude measure of health risks and benefits. In this capitalist society where everything is measured in terms of money spent/saved, what else is going to be the yardstick of healthcare. We would like to be able to measure pain, happiness, suffering and dignity but this may not yet be possible. If it suits Crikey’s correspondent better, it might be useful to think of the QALY as a measure of life wasted unnecessarily.

    The argument for freedom from Nanny State regulation is well worth mentioning – though only a brief comment is needed. The home of personal freedom is said to be United States of America. I need not go into too much detail about the state of individual health in that country. Personal freedom comes with personal responsibility – if it is up to the marketing boards of cigarette, alcohol, food and other luxury goods manufacturers to emphasise personal freedom, then someone must be left to at least help people become aware of the consequences of their actions. I don’t like being labelled as a “wowser” simply because I might advocate for people to enjoy life as far as possible without hurting themselves and others too much.

    Finally, as wars and natural disasters displace many hundreds of thousands of people across the world, the value of preventive health should become much more obvious as the spread of physical and mental illness can hopefully be alleviated by brave and selfless aid workers on the ground.

  2. tonyfunnywalker

    An excellent article Bernard. The History of the control of alcohol is fascinating. Alcohol control was fashionable in the 19th and early 20th century and in Australia the six O’clock swill was finally repealed in the 1960’s. Driven bt the Temperance movements globally they culminated in Prohibition in the US and the evils of prohibition was well illustrated in the recent SBS series – Broad Walk Empire and included Al Capone. Liquor control is still practised in Canada and Scandinavia. It is interesting that alcohol related disease increased during Prohibition as a result of a lack of quality monitoring ( alcohol is a foodstuff) and the production of moonshine. It is estimated that moonshine and Bootlegging in Scandinavia represents over 40% of consumption.
    Minimum pricing will in the same way not curtail consumption and as has occurred in Canada where there is a high taxation regime home brewers and winemakers will flourish.
    I agree there needs to be a curtailment of binge drinking but price is not the answer as for those readers who purchase alcohol at entertainment venues realise they are paying well over the odds for their tipple of choice.
    The tax hike on Alcopops is said to be effective but the consumer has switched to substitutes such as recreational drugs which are a much better ” bang for your buck”.
    There is a need for greater education of the consumer and the resellers a campaign that the alcohol industry is engaged. The History of Alcohol use and abuse is measured in millennia and the success of regulation is sparse if not counter productive and will not be solved by simplistic measures such as minimum pricing.
    In Australia Liquor marketing is strictly regulated pays

  3. edumf

    All things in moderation Bernard.

    The issue is not the opposition to alcohol consumption per se, but rather the gross abuse of alcohol that is so culturally systemic and socially destructive in sections of Australian culture.
    Take a trip to the public hospital emergency wards on a Saturday night in any of Australia’s major cities fully to appreciate the poignancy the ‘ vomiting class’ mostly young people exercising their freedom to clog up the hospitals and, to verbally and physically abuse medical staff. Oh, its a great laugh ! And so moving because people are expressing their god- given freedom to binge drink.
    Or Bernard, why not enjoy the spirited revelry of King St Melbourne on a Saturday evening, where alcoholic abandon generates all sorts of lovely outcomes. Like someone I know, who pissed at the time, got into a altercation with another ‘liberated’ aggressive drinker, was king hit and has now lost his sight for life. Too bad ! They were all just having fun !.
    Exploring the economic argument, who pays for that. Well the Australian community does, not the bloke who swung his hay-maker. I could go one, but I think the point is made.

    No man or woman is an island in Australian society, and rights and freedoms need to be balanced with responsibilities (accepted) . While I can appreciate that some folk dislike what they see as ‘ the nanny state’ , my take is a little different. Personally I get throughly sick of the ‘in your face’ slick advertising for alcohol consumption everywhere. This is perhaps another form of the ‘ nanny state’, which suggests we should take every opportunity to self medicate ( self soothe ) with copious alcohol, whatever the occasion.

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