Title: Alcohol Policies in Australia: Indigenous Activism and International Blueprints

A significant dimension of the WHO definition of alcohol policy is the suggestion that such “authoritative decisions” and measures to limit health or social harm may be made, not just within the government sector, but by any societal sector and non-government group. To be effective, alcohol policies must be relevant to the history and culture of each particular country and, in some instances, must be tailored to fit the patterns of harm and the needs of particular groups to adopt a coordinated response that also allows for local flexibility. Attention to these nuances is often best managed at the sub-national, regional, or community level, not necessarily from within the government sector.

In 2016, Australia had a population of 23 million, of which around 3 percent identified as Indigenous Aboriginal or Torres Strait Islander people. There are higher rates of abstention from alcohol in the Indigenous population—around 22 percent, compared with 16 percent among non-Indigenous Australians. This higher rate of abstention suggests that some Indigenous Australians were previously drinking problematically and have since stopped. Among the Indigenous people who do drink, the hazardous patterns of consumption result in especially high rates of alcohol-attributable deaths and other harms⁠—between five and nineteen times higher than for non-Indigenous Australians in some states and territories. There is also a notable regional variation in Indigenous alcohol-related mortality; the highest rates are in the central Australian region of the Northern Territory, and the lowest in Tasmania). The leading causes of alcohol-related deaths are suicide and liver cirrhosis.

These disparities strongly suggest that certain regions require special attention. Accordingly, some of the WHO’s alcohol policy recommendations have been put into practice by both government and non-government actors, with varying degrees of success and controversy. For example, in October 2018 the government of the Northern Territory became the first in Australia to introduce minimum unit pricing (MUP) to combat what it considered to be disastrous incidence of alcohol-related harms. MUP is the practice of  mandating a lowest retail price, or “floor price,” at which alcohol may be sold based on the alcohol content. Highly endorsed by the WHO as an effective policy to reduce demand, MUP targets the heaviest drinkers who typically consume the strongest, cheapest alcoholic beverages. Scotland, with some of the highest cirrhosis mortality rates in Western Europe, introduced MUP as a national policy in May 2018, reporting its first encouraging results in August 2019.

The WHO locates alcohol policies within the realm of public health and health policies that are broadly-based, rather than narrowly disease-focused. This means that alcohol policies can be employed flexibly at a smaller scale as well as at the national level in both public and private settings. They can also be activated at the grassroots to target specific licensed premises or even households. It is here, closer to the lived experiences of daily life, that Indigenous Australians have engaged most energetically with the options presented to them by alcohol policies.

Since Australia is a federation of five states and two territories that make their own liquor laws, in practice, states or territories and local governments, rather than by the national government, enact alcohol policies. For example, Indigenous groups often support regional agreements that limit sales from a number of liquor outlets in order to deal with harms affecting a defined area. Additionally, if state laws have retained a “local veto” provision, particular neighbourhoods or communities may be declared “dry.” An additional local option survives in many discrete Aboriginal communities on Indigenous-owned land, whereby residents vote for local bans on the importation of alcohol. In cases where this is not wholly effective, individual households sometimes put up a bold sign to declare their own home and yard a “dry area,” thus enacting their own local, grassroots alcohol policy.

In the Northern Territory, where per capita consumption is highest and alcohol-related harms are greatest among all Territorians, localized policies have been tailored for specific circumstances. This has often happened with Indigenous councils, women’s organizations, and peoples’ alcohol action groups in the lead. Despite the earlier “prohibition” for Indigenous Australians, Indigenous groups have embraced one of the WHO’s key recommendations, which is to regulate and restrict the physical availability of alcohol. This includes having a minimum drinking age, restricting hours and days of sale, and regulating outlet density.

Stemming the physical availability of cheap and high alcohol-content beverages in or near remote Indigenous settlements and rural towns has been the goal of numerous interventions spearheaded by Aboriginal groups. They are often assisted by legal aid lawyers, public health physicians, and anthropologists employed in Indigenous organizations who have collated supporting evidence of harm to set before liquor licensing agencies. Interventions have included banning the sale of alcohol in large containers; experimenting with different hours and days of sale, like not opening takeaway outlets until midday or closing them altogether on social security paydays; and disallowing takeaway sales to all residents (both Indigenous and non-Indigenous) of certain remote communities. In some cases, Indigenous associations have attempted to regulate alcohol sales by purchasing the nearest licensed hotel or roadhouse near their settlements. This gives them a monopoly over sales and greater leverage to make local rules covering serving practices and hours of opening. A small number of remote communities have on-site licensed clubs with limited hours of opening and selling only medium-strength beer. These initiatives have had mixed success in minimizing harm, but they do allow local people to create their own policies for licensed premises and have a voice in hotel or club committees.

In order to earn ongoing support from Indigenous citizens, however, governments must be careful not to introduce too many “top-down” approaches, or else risk crushing small-scale, community initiatives. The Northern Territory, for example, has introduced several controversial policies, such as individualized controls over drinkers through point-of-sale interventions (including a register of banned drinkers to whom alcohol should not be sold); in Alice Springs, police officers are stationed at off-license establishments to check on where purchasers intend to consume their alcohol. Strategies that target individuals in this way provoke resentment in the community, may be successful only in limited remote settings, and are congenial to liquor industry approaches to alcohol abuse.

One of the most notable examples of Indigenous grass-roots activism in recent years has been among women who, in a modern Indigenous version of the women’s temperance campaigns of years past, have mobilized to complain about rampant sales of takeaway or off-premises alcohol by demonstrating outside liquor stores and organizing public marches against “grog,” or strong alcohol. Their demonstrations have focused on violence against women and the effect abusive drinkers have on whole communities, families, and future generations. Their petitioning and political lobbying have at times produced tangible alcohol policy outcomes.

Coincidentally, in recent years, the WHO has redirected attention to alcohol’s harm to others, reminding governments that citizens have the right to a family, community, and working life protected from the negative consequences of others’ drinking such as violence, accidents, and harm to children. Reducing harm to others is now a guiding principle of the WHO Global Strategy to Reduce the Harmful Use of Alcohol. Without knowing about these international agenda-setting declarations, these Indigenous women were already incorporating such ideas into their lobbying and activism, realizing that they provide incontestable reasons to reduce alcohol-related harm.

Alcohol misuse and its associated social and physical harms present a persistent challenge for Indigenous Australians, whether they live in urban, rural, or remote communities. They need governments at the state, territory, and national levels to situate their alcohol policies firmly within the realm of public health and social policy in order to serve the public good. If this is the case, then Indigenous communities experiencing alcohol-related harms will have a comprehensive framework within which to work locally. As discussed previously, Indigenous Australians are particularly aware of the environmental determinants of alcohol-related harm, and, as a result, have concentrated their efforts on restricting the physical availability of the product in and around their communities. This strategy is a key element in the “toolkit” created for the WHO to inform policymakers and empower grassroots movements.

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Maggie Brady is an Honorary Associate Professor with the Centre for Aboriginal Economic Policy Research at the Australian National University. She is an anthropologist with a focus on health, alcohol, and other drug use among Indigenous peoples. She has produced several books based on original fieldwork in different parts of Australia concerning issues including volatile solvent use, voluntary remission from drinking, and alcohol policy. She has worked on community development projects in Australia and South Africa and contributed to World Health Organization programs, and she has also researched, tested, and published resources for use by frontline workers.