National Preventative Health Taskforce Research Articles

Estimated impacts of alternative Australian alcohol taxation structures on consumption, public health and government revenues

To examine health and economic implications of modifying taxation of alcohol in Australia. Economic and epidemiological modelling of four scenarios for changing the current taxation of alcohol products, including: replacing the wine equalisation tax (WET) with a volumetric tax; applying an equal tax rate to all beverages equivalent to a 10% increase in the current excise applicable to spirits and ready-to-drink products; applying an excise tax rate that increases exponentially by 3% for every 1% increase in alcohol content above 3.2%; and applying a two-tiered volumetric tax. We used annual sales data and taxation rates for 2010 as the base case. Alcohol consumption, taxation revenue, disability-adjusted life-years (DALYs) averted and health care costs averted. In 2010, the Australian Government collected close to $8.6 billion from alcohol taxation. All four of the proposed variations to current rates of alcohol excise were shown to save money and more effectively reduce alcohol-related harm compared with the 2010 base case. Abolishing the WET and replacing it with a volumetric tax on wine would increase taxation revenue by $1.3 billion per year, reduce alcohol consumption by 1.3%, save $820 million in health care costs and avert 59 000 DALYs. The alternative scenarios would lead to even higher taxation receipts and greater reductions in alcohol use and harm. Our research findings suggest that any of the proposed variations to current rates of alcohol excise would be a cost-effective health care intervention; they thus reinforce the evidence that taxation is a cost-effective strategy. Of all the scenarios, perhaps the most politically feasible policy option at this point in time is to abolish the WET and replace it with a volumetric tax on wine. This analysis supports the recommendation of the National Preventative Health Taskforce and the Henry Review towards taxing alcohol according to alcohol content.

What should be done about policy on alcohol pricing and promotions? Australian experts’ views of policy priorities: a qualitative interview study

BackgroundAlcohol policy priorities in Australia have been set by the National Preventative Health Task Force, yet significant reform has not occurred. News media coverage of these priorities has not reported public health experts as in agreement and Government has not acted upon the legislative recommendations made. We investigate policy experts’ views on alcohol policy priorities with a view to establishing levels of accord and providing suggestions for future advocates.MethodsWe conducted semi-structured in depth interviews with alcohol policy experts and advocates around Australia. Open-ended questions examined participants’ thoughts on existing policy recommendations, obvious policy priorities and specifically, the future of national reforms to price and promotions policies. All transcripts were analysed for major themes and points of agreement or disagreement.ResultsTwenty one alcohol policy experts agreed that pricing policies are a top national priority and most agreed that “something should be done” about alcohol advertising. Volumetric taxation and minimum pricing were regarded as the most important price policies, yet differences emerged in defining the exact form of a proposed volumetric tax. Important differences in perspective emerged regarding alcohol promotions, with lack of agreement about the preferred form regulations should take, where to start and who the policy should be directed at. Very few discussed online advertising and social networks.ConclusionsDespite existing policy collaborations, a clear ‘cut through’ message is yet to be endorsed by all alcohol control advocates. There is a need to articulate and promote in greater detail the specifics of policy reforms to minimum pricing, volumetric taxation and restrictions on alcohol advertising, particularly regarding sporting sponsorships and new media.

Advocates, interest groups and Australian news coverage of alcohol advertising restrictions: content and framing analysis

BackgroundLegislating restrictions on alcohol advertising is a cost-effective measure to reduce consumption of alcohol. Yet Australia relies upon industry self-regulation through voluntary codes of practice regarding the content, timing and placement of alcohol advertising. Ending industry self-regulation was recommended by the National Preventative Health Taskforce; a suggestion contested by the drinks industry. Debates about emerging alcohol-control policies regularly play out in the news media, with various groups seeking to influence the discussion. This paper examines news coverage of recommendations to restrict alcohol advertising to see how supporters and opponents frame the debate, with a view to providing some suggestions for policy advocates to advance the discussion.MethodsWe used content and framing analyses to examine 329 Australian newspaper items mentioning alcohol advertising restrictions over 24 months. All items were coded for mentions of specific types of advertising and types of advertising restrictions, the presence of news frames that opposed or endorsed advertising restrictions, statements made within each frame and the news-actors who appeared.ResultsRestrictions were the main focus in only 36% of 329 items. Alcohol advertising was conceived of as television (47%) and sport-related (56%). Restrictions were mentioned in non-specific terms (45%), or specified as restrictions on timing and placement (49%), or content (22%). Public health professionals (47%) appeared more frequently than drinks industry representatives (18%). Five supportive news frames suggested the policy is a sensible public health response, essential to protect children, needed to combat the drinks industry, required to stop pervasive branding, or as only an issue in sport. Four unsupportive frames positioned restrictions as unnecessary for a responsible industry, an attack on legitimate commercial activities, ineffective and ‘nannyist’, or inessential to government policy. Support varied among news-actors, with public health professionals (94%) more supportive than the public (68%), community-based organisations (76%), the government (72%), and the sports (16%), drinks (3%), or advertising (4%) industries.ConclusionRestrictions on alcohol advertising currently have low newsworthiness as a standalone issue. Future advocacy might better define the exact nature of required restrictions, anticipate vocal opposition and address forms of advertising beyond televised sport if exposure to advertising, especially among children, is to be reduced.

Prevention No Cure: A Critique of the Report of Australia’s National Preventative Health Taskforce

Australia's National Preventative Health Taskforce baulks at the economic approach to public policy that weighs up costs and benefits, and instead adopts a 'healthist' perspective, with an open-ended and unconditional commitment to maximising health and a jumbling of private and external costs. The result is to overstate the benefits, and ignore the costs, of proposed policies. While this is predictable given the interests and agenda of preventative health advocates, it is not desirable. Not only is the economic approach mandated for regulatory reform, it has a number of advantages in determining the likely effects of policies and identifying unintended consequences. Although the Taskforce emphasises the irrationality of consumers, it is not clear whether a preventative health bureaucracy will improve the efficiency of health spending.

Vested interests in addiction research and policy. Alcohol industry use of social aspect public relations organizations against preventative health measures

It has been proposed that alcohol industry 'social aspects/public relations' organizations (SAPROs) serve the agenda of lending credibility to industry claims of corporate responsibility while promoting ineffective industry-friendly interventions (such as school-based education or TV advertising campaigns) and creating doubt about interventions which have a strong evidence base (such as higher taxes on alcoholic beverages). This paper investigated whether submissions to Australia's National Preventative Health Taskforce (NPHT) from alcohol industry bodies regarding the Australian SAPRO, Drinkwise, have used this organization to demonstrate corporate responsibility while promoting industry-friendly interventions. Submissions to the Australian National Preventative Health Taskforce (NPHT) discussion paper Australia, the healthiest country by 2020 (n = 375) were examined to identify those with primary alcohol content. A thematic analysis of the resulting 33 submissions was conducted to determine which organization, institution or individual discussed Drinkwise. Australia. Nine of the 33 submissions discussed Drinkwise; all were submitted by the alcohol industry or its affiliates. Every industry submission referred to Drinkwise either as providing evidence of social responsibility or by suggesting the industry-friendly actions of Drinkwise as alternatives to those recommended by the NPHT report. Drinkwise has been used by the alcohol industry to create an impression of social responsibility while promoting interventions that maintain profits and campaigning against effective interventions such as higher taxes on alcohol.

Rebecca Ivers: driving down the toll of injury

Rebecca Ivers: driving down the toll of injury

Are the national preventive health initiatives likely to reduce health inequities?

This paper examines commitments to address health inequities within current (2008-11) Australian government initiatives on health promotion and chronic disease prevention. Specifically, the paper considers: the Council of Australian Governments' 'National partnership agreement on preventive health'; the National Preventative Health Taskforce report, 'Australia: the healthiest country by 2020'; and the Australian Government's response to the taskforce report, 'Taking preventative action'. Arising from these is the recent establishment of the Australian National Preventive Health Agency. Together, these measures represent a substantial public investment in health promotion and disease prevention. The present paper finds that these initiatives clearly acknowledge significantly worse health outcomes for those subject to social or economic disadvantage, and contain measures aimed to improve health outcomes among Indigenous people and those in low socioeconomic status communities. However, we argue that, as a whole, these initiatives have (thus far) largely missed an opportunity to develop a whole of government approach to health promotion able to address upstream social determinants of health and health inequities in Australia. In particular, they are limited by a primary focus on individual health behaviours as risk factors for chronic disease, with too little attention on the wider socioeconomic and cultural factors that drive behaviours, and so disease outcomes, in populations.

Forecasting future tobacco control policy: where to next?

Effective tobacco control policies include price increases through taxes, restrictions on smoking in public and work places, adequately funded mass media campaigns, bans on advertising, health warnings on packages and cessation assistance. As these policies have been largely implemented in Australia, what next should the country do in tobacco control? Ninety-one Australian tobacco control stakeholders took part in a web-based survey about the future of tobacco control policies. The policy deemed most important in decreasing smoking was to increase excise and customs duty by 30%. Other policies receiving high support included: funding mass media campaigns through tax hypothecation; introducing retail display bans; plain packaging of tobacco products; and banning smoking in outdoor dining areas. Reintroducing the sale of smokeless tobacco products received the least support. Countries that have largely implemented the provisions of the Framework Convention on Tobacco Control must maintain commitments to proven tobacco control measures, but also provide global leadership through the adoption of innovative policies. The release of the Australian 2009 National Preventative Health Taskforce's report presents an opportunity to translate these ideas into action.

Australia, the healthiest nation: death, hospital and cost savings of the Preventative Health Taskforce target reductions for alcohol, 2007 to 2020

Background - The National Preventative Health Taskforce has set a 30% target reduction in the proportion of risky and high risk drinkers by 2020. This study estimated the potential saving in deaths, hospitalisations and associated economic cost savings to premature mortality and health of achieving the target. Method - Past national estimates of alcohol-attributable hospitalisations and deaths were used to forecast trends from 2007 to 2020. Estimated potential savings in deaths and hospitalisations were based on incremental decline in the prevalence of risky/high-risk drinking reaching a total of 30% by 2020 (about 2.3% per year). Associated economic costs of premature death were estimated using the Value of Statistical Life method (willingness to pay). Hospital costs were estimated from known trends in annual national costs for recent past years and taking inflation into account. Results - A 30% reduction in risky/high-risk drinkers would avoid an estimated 7,200 deaths and some 94,000 person-years-of-life lost due to premature death by 2020. The estimated benefit to the health sector would include 330,000 fewer hospitalisations and 1.5 million associated bed days. The net present value of these benefits is AUD 22.7 billion from deaths avoided and AUD 1.7 billion from fewer hospital separations totalling AUD 24.4 billion. Conclusion - The potential savings in premature deaths, health and associated financial costs of a 30% reduction in risky and high-risk drinking by 2020 across the Australian population are considerable.

What Do the Bingers Drink? Micro‐Unit Evidence on Negative Externalities and Drinker Characteristics of Alcohol Consumption by Beverage Types*

The recent debate on alcohol tax reform, recommendations from the national preventative health task force and from the Henry Tax Review in Australia have highlighted the need for quantifying externalities of excessive alcohol consumption by beverage types. This paper presents microlevel information from the Australian National Drug Strategy Household Surveys to examine the association between risky drinking behaviour, drinker characteristics, health and labour market status, and types of alcohol beverages consumed. Drinkers of regular‐strength beer (RSB) and ready‐to‐drink spirits in a can (RTDC) have the highest incidences of heavy bingeing, whereas low‐alcohol beer, fortified wine or bottled wine drinkers are least likely. Bottled spirits, RSB and RTDC are most likely to be linked to risky behaviour such as property damage, stealing, and verbal and physical abuse under alcohol influence. All three spirit products are overwhelmingly the favourable drinks for the underage and young drinkers. Risky drinking behaviour is not found to be associated with the alcohol strength of the products.

Jim Bishop: The Chief Medical Officer of Australia

Jim Bishop: The Chief Medical Officer of Australia

Alcohol policy reform in Australia: what can we learn from the evidence?

Alcohol consumption is a major risk factor contributing to the burden of disease in Australia. The National Preventative Health Taskforce recommends the long-term goal of reshaping Australia's drinking culture to produce healthier and safer outcomes. A study of the cost-effectiveness of interventions to reduce alcohol-related harm in Australia suggests that policymakers could achieve over 10 times the health gain if they reallocated the current level of investment. The optimal package of interventions identified in the study comprises, in order of cost-effectiveness, volumetric taxation, advertising bans, an increase in the minimum legal drinking age to 21 years, brief intervention by primary care practitioners, licensing controls, a drink-driving mass media campaign, and random breath testing. Australia has a window of opportunity to significantly expand activities to reduce alcohol-related harm. It is important that federal and state governments take this opportunity to reform alcohol policy in Australia.

Critical questions we should ask in a changing Australian preventative health landscape: competing interests, intervention limits and permissible health identities

The national health reform reviews conducted recently in Australia ('Henry Review', National Preventative Health Taskforce, National Health and Hospitals Reform Commission) have seen significant energy invested in articulating a new vision for health promotion and disease prevention in this country. This is an opportune time to think critically about the underpinning frameworks that we want to guide our decisions and actions in public health policy, practice and research. The purpose of this piece is to raise questions for debate in relation to the issues of competing professional interests and perspectives, intervention limits, permissible health identities; and what these might mean for the justification of health promotion and prevention interventions in a changing funding and policy environment.

Editorial – Time to get tough on unhealthy sponsorships

Health is everybody?s business, and the Bangkok Charter placed health promotion firmly in a global context, calling for an integrated policy approach where health is central to global development and a key requirement for good corporate practice. The Charter recognised the potential harms associated with marketing strategies1 and there is a growing recognition that advertising and marketing of unhealthy food and drinks, including alcohol, have a negative impact on children?s knowledge, attitudes, preferences and consumption. A recent New Zealand study also found links between alcohol industry sponsorship and higher levels of alcohol consumption among sport participants. In Australia, the National Preventative Health Taskforce placed advertising and marketing of unhealthy products firmly on the national health agenda and concluded that the weight of evidence is now sufficiently compelling to recommend action to control what remains an overwhelmingly self-regulated industry.

Nicola Roxon: Australia's Minister for Health and Ageing

Nicola Roxon: Australia's Minister for Health and Ageing

For the record

In Canada, broadcasters would declare it a national crisis. Such is the apoplectic state that has ensued in Australia after a national preventative health task force floated the proposition that Vegemite — a paste comprised of brewer's yeast, salt and other additives that is typically spread on

Editorial – Health promotion: essential to a national preventative health strategy

April 2008 the Australian Government announced the establishment of a National Preventative Health Taskforce (NPHT) with the primary function of developing a national preventative health strategy. In October 2008 a discussion paper and three technical reports1 were released with a call for input from individuals and organisations, professional and consumer groups. This editorial outlines four key issues from the Australian Health Promotion Association’s (AHPA) submission: • the importance of a broad social determinants of health approach; • clear explanations of ‘prevention’ and ‘health promotion’; • establishing health promotion high on the political agenda; and • building the capacity of Australia’s highly skilled health promotion workforce to strengthen health promotion action across Australia.

Australia: the healthiest country by 2020

In April 2008, the Australian Government established the National Preventative Health Taskforce to develop a National Preventative Health Strategy by June 2009. The Strategy will provide a blueprint for tackling the burden of chronic disease currently caused by obesity, tobacco and excessive consumption of alcohol. The Taskforce has produced a discussion paper, Australia: the healthiest country by 2020. It presents a wide range of options, some of them contentious, to achieve this ambitious target.