To weep with them that weep doth ease some deal,
But sorrow flouted at is double death
Titus Andronicus, Act three,
Scene one.
The House of Representatives Standing Committee on Health,
Aged Care and Sport has recently released a report titled Issues paper
relating to the health impacts of alcohol and other drugs in Australia (link
here). The report is effectively an interim report and is designed to form
the basis of a more comprehensive report assuming the next Government is
prepared to renew its terms of reference. While the terms of reference span
mainstream society, the report unsurprisingly addresses Indigenous issues at
various points.
Like most Parliamentary reports of this nature, this Issues
Paper carefully navigates its way through what is a complex and at times
prickly thicket. Its value in the Indigenous policy context is to remind
readers of the multitude of ways in which AOD, the report’s acronym for alcohol
and other drugs, impacts indigenous people and communities. Thus, there is
mention of Foetal Alcohol Syndrome (FASD), criminal justice, numerous health
impacts and in passing the potential influence of poor social and environmental
infrastructure in driving AOD use and abuse. It is not my intention to seek to
summarise the report, but rather I intend to cherry pick a number of
propositions as a stepping stone to further discussion.
The report provides an excellent introduction to the
overwhelming numbers of research activities, advocacy NGOs and treatment and
service providers all operating across the mainstream system.
In the Chapter on AOD services, at paras. 4.19 to 4.36, the
report provides an extended discussion of Indigenous issues related to AOD use,
relying in large measure on submissions from NACCHO and the Queensland based
Institute for Urban Indigenous Health.
These submissions were largely premised on arguments for
community-controlled service provision based on evidence that Indigenous people
are over-represented in the statistics depicting the adverse impacts of AOD
abuse. At para 3.58, the Committee records this plea:
The Institute for Urban
Indigenous Health submitted that Aboriginal and Torres Strait Islander-led
research and evaluation of AOD services must be recognised as a separate,
dedicated stream of research and evaluation component of the AOD system. Such
an approach would recognise that AOD has a disproportionate effect on
Indigenous communities. According to the Institute, more Aboriginal Australians
die due to drug and alcohol-related causes than any other disease group,
including suicide and cardiovascular illnesses. Among young Aboriginal people
aged 15 to 24, alcohol is the number one contributor to the burden of disease.
In a discussion of the links between AOD use and the prison
population generally, the report notes (para 459):
People entering adult prison
are more than four times as likely to report recent illicit drug use than
people in the general community, and seven times more likely to drink to
excess, according to the Legal Aid Commission of New South Wales (Legal Aid NSW).
Mental health conditions also tend to be over-represented in the prison
population.
Given the over-representation of Indigenous citizens in the
prison system, these correlations are likely to apply to that subset too.
Chapter Five of the report deals with preventing and
reducing harm caused by alcohol and other drugs. This strikes me as the crucial
set of issues for policymakers. At para 5.18, the report notes a submission
arguing:
there is growing evidence to support a
shifting of focus away from the law enforcement response, ‘especially with
regard to communities disproportionately impacted by policing, including LGBTQ+
people, but also First Nations communities and people experiencing complex
mental distress’.
The crucial issues for reducing the harm of
alcohol across the community are somewhat buried within the
report. At para 5.18 and following, there is a discussion of regulatory
oversight policy issues including product labelling. At para 5.100, there is an
important point made by the Foundation for Alcohol Research and Education regarding
the extent to which the current regulatory regime in Australia is out of date
and in effect unfit for purpose. At para 5.97, the report notes:
Multiple submissions, … drew
the Committee’s attention to the World Health Organization’s three key
strategies … in the regulation of alcohol beverages to reduce health harms from
drinking: • restricting exposure to alcohol advertising • increasing excise
taxes on alcohol beverages, and • restricting the physical availability of
retailed alcohol.
There is discussion in the report in relation to each of
these points, albeit largely anodyne and descriptive. There is no criticism of
the fact that advertising of alcohol appears to be largely based on industry
formulated schemes. As is the way with these reports, the views of diverse
interests are laid out without detailed analysis or critique. It is largely an
exercise in ‘He said / she said’…. Perhaps we are meant to be reassured by the
Committee’s observation (para 5.123) that:
In their submissions to the
inquiry, industry representatives highlighted that the majority of Australians
were drinking responsibly and in moderation.
The Committee’s final commentary (para 5.131) is carefully
framed to acknowledge the range of points raised, but it assiduously steers
clear of suggesting that there may be a role for government in controlling alcohol
advertising, and crucially in limiting access to alcohol or in raising taxes to
reduce demand and to remove inconsistent volumetric rates for tax on alcohol.
The Opposition members’ addendum goes further making very clear that the
current report has no status whatsoever and is merely an issues paper. They go
on to make crystal clear that commercial interests must be engaged before reaching
any substantive policy positions:
In chapter two, in relation to
the regulation and effects of alcohol there is a need to hear from both sides
before coming to any concluded views. In chapter three there are a range of
controversial observations that have been made about harm minimisation and the
approaches of law enforcement—these need to be tested with evidence from state
and territory police. In chapter five, a range of highly contested policy
responses are raised. It will be important that the Committee receives
submissions and takes evidence from a much wider range of stakeholders to test
the evidence, on all matters contained in that chapter, before reaching any
conclusions.
For Indigenous interests, this report provides
a case study which should cause them to rethink their advocacy strategy in
relation to alcohol. The advocacy voices representing Indigenous prison
inmates, Indigenous victims of family violence, Indigenous families of
individuals suffering acute health issues, Indigenous children growing up in
alcohol induced poverty and trauma are either non-existent or severely muted. Instead,
the Indigenous interests making submissions to this inquiry are service delivery
organisations with a particular focus on accessing the resources necessary to
ensure service delivery is effective. These are important and legitimate
interests, but they are not the whole picture. The consequence is that the report
is able to effectively ignore these hidden or muted perspectives in favour of a
focus on service delivery. This amounts to a structural blind spot that will
only be filled when Indigenous interests adopt a broader advocacy strategy. In
my view, the Coalition of Peaks (which I acknowledge is fundamentally under-resourced)
should make addressing these systemic issues a priority for its advocacy
efforts. The absence of such a broader systemic perspective in Indigenous
advocacy leaves the field open to those mainstream interest groups arguing against
reform.
The clear if implicit message from the major parties is
that they do not wish to upset the apple cart vis a vis the major alcohol
industry interest groups. Instead of policy reforms aimed at reducing access to
alcohol and other drugs, the major parties will focus on the provision of
health services and other supports. The report made no attempt to address the
particular issues facing remote Indigenous communities (but see para 6.4) notwithstanding
that they arguably bear the brunt of lax regulation and encompass the most
vulnerable subset of the Indigenous population. The submissions to the
Committee by NACCHO and the Institute for Urban Indigenous Health (available on
the Committee website link
here) were premised on making the case for community-controlled service
delivery and largely ignored the importance of institutional reforms to reduce
easy and cheap access to alcohol, and the issues associated issues around
incarceration and domestic violence. The NIAA submission ( #140 at this
link but not available on its website) focusses on its financial support
for AOD treatment:
Through the IAS, the NIAA
provides approximately $70 million annually to deliver around 90 AOD activities
across Australia. IAS AOD funding is supplementary to Health and state
government funding and prioritises treatment that is culturally safe and tailored
to First Nations clients. These services offer evidence based, and trauma
informed models of care for First Nations people and their families. This
includes individual and group based therapeutic care, client-based family
support, case management, referrals, and AOD prevention and education
activities.
In relation to regulation, the NIAA states:
There are various regulations,
laws and restrictions that aim to reduce alcohol related harms in jurisdictions
around the country. While some laws, such as the legal drinking age, are in
place across Australia, the majority of alcohol regulation is the responsibility
of the states and territories. The weight of evidence suggests measures to
reduce the availability of alcohol through strengthened controls on price and
promotion can contribute to reducing harm and improving public safety.
The submission’s conclusion states:
While substance use impacts
all Australians, it disproportionately affects First Nations people. The NIAA
emphasises the importance of working in partnership and taking a
strengths-based, trauma informed, culturally safe and holistic approach to
addressing harmful AOD use. It is critical that First Nations voices are
elevated throughout the Inquiry, and that the Committee’s recommendations are
informed by the unique histories, cultures and experiences of First Nations
people.
The subliminal message from the NIAA then is don’t look to the
Commonwealth to drive institutional policy reform, its someone else’s
responsibility. See this page on their website too (link
here). For what it’s worth, I just don’t buy that argument.
The appendix to the NIAA submission (
#140 at this link) which
I strongly recommend readers seek out and read very usefully provides a
comprehensive and powerful snapshot of the impacts of alcohol on various
sectors. Here are a few data points I have cherry picked from the NIAA
submission appendix:
… First Nations people were
4.2 times as likely to die from alcohol-related causes as non-Indigenous
Australians. They were also 3.8 times as likely to die from alcoholic liver
disease, and 4.7 times as likely to die from mental and behavioural disorders
due to alcohol use….
AOD are involved in more than
half of all police-reported family and domestic violence incidents in
Australia, and are likely to be involved in a substantially greater proportion
of all family and domestic violence…. For homicides in the period from 1989–90
to 2016–17, 72% of First Nations offenders were under the influence of alcohol
at the time of the incident, as were 71% of First Nations victims…
If those data points don’t make the case that a national
crisis exists and is ongoing for Indigenous communities in relation to the use
of alcohol, then what will?
For those still unpersuaded or just interested in exploring
the issues further, the following posts deal with various aspects of alcohol
policy in remote Australia (link
here, link
here, and link
here). The consistent theme of these posts has been to point out the
excessive influence of the alcohol industry in shaping remote alcohol policy, to
encourage the Commonwealth to engage proactively in driving reforms including in
relation to the accessibility of alcohol.
Conclusion
If Australia was serious about reducing Indigenous
incarceration, we would implement significant policy reforms in relation to
alcohol advertising, taxation and retail availability.
If Australia was serious about reducing family violence
within Indigenous contexts, we would implement significant policy reforms in
relation to alcohol advertising, taxation and retail availability.
If Australia were serious about improving Indigenous
health status, we would implement significant policy reforms in relation to
alcohol advertising, taxation and retail availability.
If Australia were serious about improving socio-economic
status within the Indigenous community, we would implement significant
policy reforms in relation to alcohol advertising, taxation and retail
availability.
If Australia was serious about closing the gap, the Commonwealth
would step up and lead, and one of its first steps would be to implement
significant policy reforms in relation to alcohol advertising, taxation and
retail availability.
Unfortunately, it is quite clear from a close reading of this
report that neither the Government nor the Opposition are serious about any of
these issues.
18 March 2025
