The Public Health Association of Australia is celebrating the passing of the alcopops tax legislation in the Senate today as “a significant victory for prevention and public health in Australia”.
Meanwhile, health policy analyst Jennifer Doggett has been humming some old tunes, and contemplating Todd Harper’s recent Croakey post calling for health warnings on alcohol labels. She writes:
“Elvis Presley almost certainty wasn’t thinking about public health when he sang his 1968 hit ‘A little less conversation, a little more action”. However, the song has a message for Health Minister, Nicola Roxon, reported to be contemplating the introduction of alcohol health warnings, as recommended by the Preventive Health Taskforce.
Todd Harper, CEO of VicHealth, makes a case for more conversation about alcohol health warnings. He argues that we need to talk more to drinkers about how we communicate alcohol and health information to them.
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Certainly such conversations have their place. Conversations can help governments considering the introduction of health warnings to gauge the response from the media, public health groups and the general community. This is an important part of public health policy development.
However, what conversations won’t tell us is whether or not alcohol health warnings actually work. For this we need data – independent, robust, replicable and measurable data. No amount of consultation with consumers, engagement with public health groups or advice from experts can substitute for this.
From the limited available evidence, the case for alcohol health warnings isn’t strong. A comprehensive review of research into the impact of alcohol warning labels was undertaken by Professor Tim Stockwell (Director of Australia’s National Drug Research Institute) for the Canadian Government in 2005. After examining a large number of studies he concluded that “….there is little or no measurable change in drinking behaviour and related harms as a result of the introduction of alcohol warning labels”.
In fact, there is a danger that warning labels could have unintended negative effects on those most at risk of alcohol-related harms. This is because they could increase the attractiveness of alcohol consumption among people seeking to undertake risky behaviours. In 2000 when the Australian and New Zealand Food Authority looked at this issue, it found that “there is considerable scientific evidence that warnings statements may result in an increase in the undesirable behaviour in ‘at risk’ groups.”
Of course, all this research has limitations. In particular, the fact that most of the studies in this area have been conducted outside Australia makes it difficult to assess their relevance to the current debate. Given these constraints and the lack of robust data from the Australian context, those advising the government on alcohol health warnings can only guess at their impact.
If we want more than guesswork from our public health policies we need to demand that they are based on evidence rather than opinion. In the case of alcohol health warnings, this means we need a properly conducted, Australian-based trial.
Unlike many public health interventions, alcohol warning labels are a good candidate for a policy trial. It’s hard to randomise exposure to quarantine laws or food safety standards, but relatively easy to control exposure to alcohol health warnings.
For example, we could take two cities of comparable size, say Sydney and Melbourne or Brisbane and Perth, introduce alcohol warning labels in one of them and not the other. After a decent interval – 12 months at a minimum – we could measure whether there has been a change in the level or nature of alcohol-related harms in each city. This would involve selecting a few measurable indicators, for example, alcohol-related admissions to hospital emergency departments and motor vehicle accidents involving alcohol, and measuring them both before and after the health warnings are introduced. The impact on specific at-risk groups, such as young people, should also be measured to determine whether they respond differently to health warnings, compared with the general population.
Such a trial would not be perfect but it would give us more information about the impact of alcohol health warnings than we would get from any number of consumer focus groups, conducted around a table and a bowl of Minties.
If the Government is serious about promoting evidenced-based health policy, it should fund such a trial on alcohol health warnings. After the trial’s completion, the data could be used by government, health groups and other interested parties to argue for or against their introduction. Either way, this would be a conversation worth having.”
•Jennifer Doggett has previously worked on a youth alcohol campaign, partly funded by the alcohol industry