New Zealand's drinking culture has come under fire following a new study which shows a link between alcohol consumption and trips to the emergency department.
Experts are linking the result to New Zealand's binge drinking culture and easy access to cheap booze.
The study, recently published in Addiction, shows data from 62 emergency departments in the 28 countries, and includes more than 14,000 patients.
It ranks New Zealand second out of 28 countries for the proportion of injury cases presenting to emergency departments where the person had consumed alcohol in the preceding six hours...
[Alcohol Healthwatch director Nicki] Jackson said such injuries were costing New Zealand billions of dollars.
If we want to improve mental health, reduce suicides and shorten hospital waiting lists, government needed to start making changes around accessibility to alcohol, she said.
"We haven't taken any strong measures against the most harmful drug in our society. We will keep paying this cost until we take strong action."
There were issues around easy access to alcohol, increasing affordability, and marketing.
"We need to raise excise tax on alcohol," she said, adding taxes were "nowhere near the level they should be" when it comes to drinking.I tracked down the research paper mentioned in the article (sorry I don't see an ungated version). It was written by Cheryl Cherpitel (Alcohol Research Group in the U.S.) and others (including Bridget Kool of the University of Auckland). [*]
In the paper, they use a measure called the International Alcohol Policy and Injury Index (IAPII) as an omnibus measure of the policy environment with a range from zero to 100. Higher values of this measure represent a stricter policy environment, and lower values represent a more permissive environment. Based on the 33 studies included in Table 1 of the paper (and treating them all as independent observations [**]), the average value of the IAPII is 59.8. New Zealand's IAPII was 76 in 2000, and 78 in 2015-16. In fact, only Sweden (91 for two observations), Canada (80 for three observations), and Ireland (79 for one observation) have stricter alcohol policy environments than New Zealand. Australia's IAPII in 1997 was also 78.
That doesn't strike me as particularly bad. But equally, I'm not sure that we want a permissive alcohol policy environment, so I would want to know how the policy environment relates to harm. There's another measure in the paper that will help with that question: the detrimental drinking patterns (DDP) measure. DDP is "an indicator of the ‘detrimental impact’ on health and other drinking-related harms at a given level of alcohol consumption", and is measured on a 1-4 scale, "from 1 (the least detrimental pattern of drinking) to 4 (the most detrimental)." New Zealand rates as a 2 on the DDP score, equal with Canada, but better than Sweden or Ireland (both have DDP scores of 3). Only Australia and Switzerland rate a 1 on the DDP measure.
I graphed the relationship between DDP and IAPII for the observations from the Cherpitel et al. paper, and that graph is shown below. The IAPII is on the vertical axis, and the DDP is on the horizontal axis (there are only four values of the DDP). Each blue dot represents on study site from Table 1 of the paper. The two red dots are the observations for New Zealand (the lower dot is the observation for 2000, and the higher dot is the observation for 2015-16). The dotted green line is a linear regression line showing the relationship between the two variables. As you might expect, the relationship is negative, meaning that countries with more permissive alcohol control policies (lower IAPII) have worse detrimental drinking patterns (higher DDP).
One thing to note from this diagram is that the dotted line essentially shows the 'average' IAPII for sites at that level of DDP. Observations above the line are under-achieving - their DDP is higher than would be expected, given the strictness of their alcohol control policies. New Zealand fits into that category.
All of that suggests to me that the problem isn't our alcohol control policies. If we have high alcohol-related emergency department admissions, as the Cherpitel et al. paper contends, then the solution is unlikely to be found in stricter alcohol control policies. At least, based on the comparison with other sites in this study. Our policies are already one of the strictest, and are stricter than would be expected given our level of detrimental drinking patterns.
One notable aspect that isn't covered in the IAPII measure is pricing, and that could be a fruitful policy avenue to explore. If we want to reduce alcohol-related harm, we might get more value out of pricing interventions (e.g. minimum pricing, higher excise taxes) than stricter policy controls.
*****
[*] I haven't written too much about the Cherpitel et al. paper itself in this post, because that wasn't my focus. They show that IAPII and DDP have independent and statistically significant relationships with the chance of a person presenting at ED for an injury having consumed alcohol in the previous six hours. In other words, higher IAPII is associated with a lower proportion of injuries that are alcohol-related, and higher DDP is associated with a higher proportion of injuries that are alcohol-related. That isn't unexpected. However, when they include both variables in the same model, only IAPII is statistically significant. This is because of multicollinearity - two of their explanatory variables are closely correlated, so that reduces the chance that either of them show up as statistically significant when they are both included in the same model, because they are trying to explain the same part of the variation in the outcome variable. Notice the close relationship between IAPII and DDP in the diagram above.
[**] Strictly speaking, we should down-weight multiple observations from the same country (e.g. two observations from New Zealand, and three from Canada). However, I don't think it would make much difference in this case.
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