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Standing Committee on Indigenous Affairs - 28/08/2014 - Harmful use of alcohol in Aboriginal and Torres Strait Islander communities

CRANE, Ms Meredythe, Senior Policy Officer, Foundation for Alcohol Research and Education

GIORGI, Ms Caterina, Director, Policy and Research, Foundation for Alcohol Research and Education

THORN, Mr Michael, Chief Executive, Foundation for Alcohol Research and Education

Committee met at 11:38.

CHAIR ( Dr Stone ): I now declare open this public hearing of the House of Representatives Standing Committee on Indigenous Affairs inquiring into the harmful use of alcohol in Aboriginal and Torres Strait Islander communities. I would like to acknowledge the Ngunnawal and Ngambri people, the traditional custodians of the Canberra area, and pay our respects to the elders past and present of all Australia's Indigenous peoples.

Please note that these meetings are formal proceedings of parliament. Everything said should be factual and honest and it can be considered a serious matter to attempt to mislead the committee. The hearing is open to the public. It is being audio broadcast live by the internet, which is a standard procedure on ParlInfo net. A transcript of what is said will be placed on the committee's website. You will also be given a transcript to check for accuracy at the end of this hearing. As we mentioned just before we began this public hearing, we do have filming going on for in-house departmental documentation.

We will ask for an opening statement from either or all of you, followed by questions from the membership. Perhaps we can begin by introducing our members. We have a coming-in-late apology from our deputy chair, Warren Snowdon. I am the chair, Sharman Stone, member for Murray in northern Victoria. I am very familiar with FARE. We probably do not need much further introduction. It is just an accident that we have the opposition and the government on opposing sides of the table! We are a bipartisan team, to use an overworked expression of the minute, and many of us have served in Indigenous affairs as well as the family and legal studies committees in the previous parliament, where we particularly took up foetal alcohol spectrum disorder. You will recall a lot of these Indigenous issues. We welcome you most sincerely. Mr Thorn, are you leading off with a statement?

Mr Thorn : I am happy to do that, and thank you for the opportunity to appear before the committee today. I thought I would just put on the record a few comments to shape one aspect of what we think the committee's inquiry should focus on. I do not need to impress upon any of you the importance of this inquiry, and I think it has been a welcome development by the government in commissioning these terms of reference.

We all know that Aboriginal and Torres Strait Islanders are disproportionately affected by harms from alcohol. This committee has heard from others about the extent of those harms: the impacts of alcohol related violence, domestic violence, the unacceptable impacts on health and the social costs of this devastating issue. The problem is grave; the need of an inquiry absolute. However, an inquiry of itself is not enough. This inquiry must be informed by the countless well-intentioned reviews that have come before but distinguished by the questions this committee chooses to ask and the issues it chooses to explore.

This is not an academic exercise. An examination of the tragedy is not enough. Preventing the tragedy from continuing must be the one true objective of this committee. A bushfire inquiry looks beyond property loss and examines the fire's origins—where a fire began, how it started and what fuelled it—in a bid to prevent a similar tragedy. An inquiry into flooding does not begin and end where the riverbanks burst, but rather upstream, taking rainfall and water management into account in a bid not only to understand what happened downriver but to understand why and to prevent its recurrence.

Past inquiries and reviews into the harmful use of alcohol in Aboriginal and Torres Strait Islander communities have been distinguished not only by what they have examined but by what they have overlooked. Those inquiries examined the role of government and examined the responsibility of drinkers, but none have examined the alcohol industry's responsibility for the alcohol related violence, injury and death that this committee is investigating. Too little is known about the supply of alcohol; after all, it is the access and availability of its supply that lies at the heart of alcohol related harms.

It is the foundation's view that we need to shine a light on this chain of supply in order that the alcohol industry's culpability is exposed, and that they can then be made to shoulder their part of the responsibility for stopping harm caused by alcohol.

The only way to fully gauge to what extent the alcohol industry is deliberately targeting, and exploiting, Aboriginal and Torres Strait Islander drinkers is for the data about marketing and the supply of alcohol to be publicly revealed: What is the supply chain of alcohol from producers, distributors, wholesalers and retailers to Aboriginal and Torres Strait Islander communities? How does this differ from communities with limited restrictions, when compared with those that are dry? How much alcohol, and what type of alcohol, is being supplied? How frequently is alcohol being supplied to these communities, and what is the timing of the provision of this alcohol? How is the alcohol priced and promoted in and around these communities? And what is the role of the alcohol industry in mitigating the risk of harms that result from the consumption of alcohol?

Only with these questions answered can we fully explore the alcohol industry's culpability. Today I ask the House of Representatives Standing Committee on Indigenous Affairs to begin the process of understanding the extent of the alcohol industry's knowing contribution to the tragedy in Australia's Indigenous communities. This committee should demand information and data on supply practices from producers, distributors and retailers. As a nation, if we are sincere about addressing this national shame, we need to first acknowledge that there is an alcohol industry that profits every day from misery and suffering. If the industry has nothing to hide it will not resist this call. Thank you very much.

CHAIR: Thank you, Michael. We appreciate that introduction. I will ask the first couple of questions. You make it clear in your submission that you do not believe—and I think you were referring mostly to the Northern Territory, perhaps other parts of Northern Australia—that moving to, in a sense, recriminalise public drunkenness is necessarily the best way to go. You prefer a health focused treatment, a strategic treatment type focus, rather than just simply removing people and mandating their placement in a facility that they cannot leave for three months, as is the case in the Northern Territory. Is that based on anecdotal evidence of that not producing any great benefit, or is it a philosophy of yours in FARE, or is it based on international practice? Can you tell us why you are arguing that there are better ways to deal with alcoholism, or harm associated with alcohol, through those practices now in the Northern Territory?

Mr Thorn : There has obviously been a long history about how to deal with what I regard as, or is euphemistically known as, problem drinkers. Certainly, in my involvement in public health issues in this sector, we have moved away from the criminalisation of drunks, as it were. And of course the apogee of this was the royal commission into black deaths in custody. None of that, of course, goes to actually solving the particular problems, and I think that the former Northern Territory government's efforts to take a different approach on this was nothing short of courageous. They were definitely getting out into new territory.

CHAIR: Are you talking about the banned drinkers register?

Mr Thorn : The banned drinkers register and all that went with it. And social controls on individuals has had a chequered history around the world. I am the first to concede that there were risks, and we would not be entirely confident that it was going to work and what was going to happen over time. But it seemed to me that in the Northern Territory's case, and I think this probably applies in some of the other regional parts of Australia, it was worth a try. I think the disappointing thing was really the way that so much of the banned drinkers register approach was cut off before it really had an opportunity to demonstrate that maybe there was something worthy in the approach.

My concern about all of it, though, is that the enormous efforts put in by governments and communities to institute things like the banned drinker register, and even the current Northern Territory government's approach—what has been happening in Queensland and other parts and in South Australia more recently—is being done in the face of the gross oversupply of alcohol. Until we accept that that is at the root of the problem, all our other efforts are going to, at best, make a marginal difference.

I think at this point it is worth acknowledging that we are an organisation that largely promotes population-wide measures. We look at the price and we look at its availability and we look at the way it is marketed and advertised to people. All the evidence in terms of how that reduces harms is such that it is spread across the entire population and there are specific instances, communities, localities et cetera that are not likely to be perhaps as advantaged by those sorts of policy measures as the population at large. I acknowledge that. I think we need to start with the big picture first before we then focus on the specifics—be they the individuals or very localised communities—because you very quickly lose the focus on solving the bigger problem.

CHAIR: Given that alcohol is a legal substance and you are saying the core of the problem is—I think your words were 'gross oversupply'—isn't it a case of 'gross overdemand' fuelling that supply or are you saying it is the means of promoting it, like the hours of availability to buy, the number of outlets, the use of internet, Facebook and all those other ways of advertising, and now the sports sponsorship in association with alcohol drinking? Are you alluding to all of those ways that alcohol is more likely to be put in front of younger and older people? But isn't there at the core of all of this too the fact that Indigenous people drink at harmful, risky levels because of their need to have something to do with their time or their colonial history of disempowerment and continuing disadvantage, even the new notion of epigenetics now? Can you just balance that out and say 'gross oversupply' but in response to 'gross overdemand', perhaps?

Mr Thorn : Let me put it this way: alcohol is not an ordinary commodity, as we all know. It is not toilet paper, it is not soap flakes and it is certainly not cornflakes. It is a regulated product and has been really from the time of white settlement of Australia. It is regulated for very good reasons—it is because it is a harmful product. There is this line that is worked up in defence of the availability of alcohol that alcohol is just this other commodity, another commodity, and the use of this term 'a legal product' I think is really a clever way, or at least an effort, to circumvent the issue of its capacity to harm.

Yes, it takes two to tango, but I think that societies throughout history have recognised that the difference about alcohol means that as part of our civil society we need to regulate its supply. And that is what we do; we do not regulate demand, by and large. The first thing is you have to have a licence to sell this stuff. You have to have a licence to manufacture it. I think that, if you just follow that simple logic, you get to a point where this question of supply becomes more than moot. We need to look at the entire chain and what actually transpires as a consequence of the supply of alcohol. We need to accept that some people will drink in harmful ways and that maybe one of the solutions to dealing with that is to focus not just on the drinker but on the provision of that alcohol.

Mr RAMSEY: I think I am driven to the point of saying that alcohol restrictions are the only way to deal with this issue. I am the member whose electorate covers the APY Lands. APY is alcohol free—at least, legal alcohol free—but the supply, even there, is consistent if not constant. Communities that surround them have more and more restrictions in the area of supply. APY residents cannot buy alcohol at Marla or at Coober Pedy now, which is 300 kilometres to the south. Other communities have actually given up some of their rights, I guess, to allow for these laws to be enacted. This is more about the reactions to what happens in their local communities than concern, probably, for the Aboriginal communities far away. But, with all those restrictions, we still have, I would say, plenty of alcohol. When the restrictions do work, we have seen a move to drugs—the outbreak of drugs there. The petrol situation is pretty good. But, certainly, drugs are causing all the same problems that alcohol is causing and, of course, the drugs are illegal as well; they are banned.

I do not know what else to do. I recognise what you are saying about the Northern Territory restrictions and I wish they had been given more time to work as well. But I am just not confident that restrictions are going to do the job. Could you just comment on that; that is all.

Mr Thorn : It seems to me that we have to look at this in a different way, through a different lens. Professor Peter d'Abbs has appeared before you. I have read his submission. He is a former director of the foundation—one of the inaugural directors. I think that his very worthy submission is an important part of trying to understand or to think about how we solve this problem. At the bottom of it is accepting that alcohol is not a symptom of this disadvantage; where we are at today is that it is, by and large, the cause of most of these problems. Following the very short logic around this, the absence of alcohol, we know, does make a difference in the lives of people—not only the drinkers but also the families and their associates.

What is new, I think, and what the foundation is arguing today is that we look at this issue through another lens, and that is through this supply lens. I do not know how it all comes together. We do not know what all the drivers are that lead to the illegal provision of alcohol into APY Lands, for instance, or all those other 'dry' communities throughout Australia. We know a little about it. We know it gets there. We know that somebody is profiting from it. We know that somebody has manufactured the product. We know that an appetite has been built up for particular types of product. We know a little about the sorts of products that are sold. You only have to drive down the Stuart Highway to see the sea of green cans to know it is the favoured product. There are some terrific images that people like Maggie Brady have gathered over the years that show mountains of empty casks of cheap bulk wine and only one brand featuring in that. So somebody has got that product to those drinkers. If all these other efforts around targeting the drinker are not amounting to a change in the wellbeing of Aboriginal communities, it seems to me we need to do something different. Let us have a look at the alcohol industry's responsibilities in this quarter—and it has got to go beyond them arguing for better public awareness campaigns, because that surely ain't the answer.

Mr RAMSEY: Yes. Thank you.

CHAIR: Warren.

Mr SNOWDON: Michael, thank you for your very comprehensive submission. I was attracted to a number of elements of it, I must say, not least of which were your observations on evaluations of existing restriction programs. I was particularly attracted to the one which I think has been probably the most successful—that is the Groote Eylandt and Bickerton Island one—which is explained in part because it is an island, I suspect. I was also interested in the recommendations that you proposed on evidence-based informed treatment and rehabilitation services and I would not mind you making some comments about that.

On the supply side, we cannot get the industry to talk to us. With regard to the marketing of the products, I have seen a liquor store in the Northern Territory—a supermarket in fact owned the liquor store; that might give a hint as to which one of the two it might be!—where they were selling bulk wine cheaper than orange juice. That is just hideous. It is targeted at a particular group of people. I have actually spoke to representatives of the wine industry and said, 'Why are you selling this crap?' They say, 'Because the people who sell the stuff want it.' I said, 'Well, you have the capacity not to give it to them. Just don't provide it. Do other products. Do high-end products that aren't going to cause the same issue.'

I think we have to talk seriously about the supply chain. We really have to talk about marketing, to try and get some idea of how we can control—if that is not the right word, it is probably not the best word—or have an impact upon people's use of alcohol. But there has to be a matrix of things. It is supply and marketing, but we also have to look at the restricted sale of alcohol in particular places. I am not sure if we can go back to the six o'clock swill or the 10 o'clock opening. I have to admit—I do this hesitantly; nevertheless, I need to tell the truth—I used to visit the early-openers in Sydney. We lived here in Canberra and we would belt up to Sydney on the weekend and we would be in the six o'clock-openers on Manly wharf because we knew we could get a beer. We were bits of lads, by the way—well, I was not; I was looking after their interests! But this is what happens. That behaviour is little different from the behaviour of other people today.

If you could just comment for me on the funding for informed treatment and rehabilitation services, I would be very grateful.

Mr Thorn : Groote Eylandt is a terrific example. It is a case study, plainly, and it has been operating there for a long time. We can learn a lot about what happens when you can manage the availability of alcohol in the way that community has. It has been remarkable that they have managed to sustain that environment, despite the chopping and changing of other policies and laws in the Northern Territory. Meredythe, you might want to comment specifically on the treatment issues that the member has just raised.

Ms Crane : There are a number of issues around treatment for Aboriginal and Torres Strait Islander people and for the whole population. The specific issues for Aboriginal and Torres Strait Islander people are related to having culturally appropriate treatment. That does not mean it has to be an Aboriginal and Torres Strait Islander run service, but it does mean that the service needs to be culturally informed and have support for Aboriginal and Torres Strait Islanders. So it is not necessarily that the treatment services need to be different, although there are some treatment options that are available that I suspect are better suited to Aboriginal and Torres Strait Islander groups. I am not an expert, but there are things like going back to country and getting back in touch with their roots—those sorts of things have been shown to be effective where they have occurred. It is really important to have those options available.

The issues are about having access to the treatment, having a range of options available, having security of funding, and having certainty about their situation so that they can plan and provide opportunities for staff as well as for the people they are serving. The big issue is about options being available, because one sort of treatment does not fit all people. Security of the service being available and having access to the services—and those services being culturally appropriate—are also important.

Mr NEUMANN: For my sins, I was on a parliamentary committee looking into gambling during the last term of parliament. One of the things that struck me during that inquiry—and I say this as a Brisbane Broncos tragic—was the normalisation of gambling associated with major sporting events. In various iterations between the XXXX Maroons and the Toohey's Blues in State-of-Origin, you will see a lot of alcohol being sold—and not just sold but advertised frequently in association with the NRL, the AFL and other major sporting events. That is picking up what you were saying, Michael, when you talked about how a certain kind of can or a certain kind of wine was being sold in a certain community. I am interested in your comments about what we should do. We have made restrictions with tobacco and other types of things. Would you recommend we look at restrictions to marketing and the like?

Mr Thorn : This is the multidimensional nature of the problem. Caterina is wont to ask, in our efforts to make changes to drinking cultures, what chance we stand while we are being overwhelmed by all these marketing messages about different sorts of alcohol products—and products that are very carefully tailored to particular market segments. I think that, if we want to change drinking culture, we are definitely going to have to restrict the way that alcohol is advertised and marketed, the way particular drinking groups—be they young people, women or Indigenous people—are targeted by the liquor industry. That should be done either at the packaged liquor level or with unlicensed liquor. They all have their own techniques. The alcohol market is obviously highly competitive, which drives innovation across the entire industry—product development, advertising approaches, marketing efforts and so on. It is what you would expect from open competition. I think that, in acknowledging that that is the environment in which we are operating, the totality of this drives us towards a certain norm around the use of alcohol. Things like its association with big sport are classic examples of that.

Mr NEUMANN: You see it in junior sport, even, Michael. In that committee I was talking about, we saw brands—I will not name them—on jerseys of football teams for 10-year-olds on the Gold Coast. We saw those sorts of things.

CHAIR: And they are shown during children's television time—the live sport, the matches, the car racing.

Mr Thorn : This is not about banning all of that outright, but it is about trying to get things back into some sort of proportionality—

Mr SNOWDON: Balance.

Mr Thorn : or into balance. My line about the State of Origin is: is it a game between Queensland and New South Wales, or a contest between XXXX and VB, or Carlton & United and Kirin breweries? You can pick and choose, really, depending on which part of the game you are watching at any one time!

CHAIR: Michael, Warren mentioned how very cheap some of the casks, the Fruity Lexia and so on, were. Do you want to comment on the capacity to raise the price of alcohol through a different tax regime, whether through a minimum price or a volumetric tax?

Mr Thorn : Australia's tax system for alcohol needs to change, and it needs to begin with a reform of the way that wine is taxed. The way that wine is taxed simply encourages the production of cheap bulk wine, and these Indigenous communities are ready markets for that. We should move to a complete overhaul of the tax system. We should move wine onto a volumetric based system—and I am not saying that should be done overnight; there would need to be industry adjustment packages to facilitate the economic impacts of that. And the tax rates need to be differentiated, I think, to reflect the various risks of the different types of products.

CHAIR: The alcohol content.

Mr Thorn : So that we do not have just one volumetric rate. There needs to be a recognition—and I think history has demonstrated the reasons for this—that spirits, for instance, should be treated in a different way from wine and from beer, because I think there is an argument to show that what we call this issue of speed to intoxication is something that we need to be conscious of.

CHAIR: Indeed, we have the recent history of the different tax treatment of alcopops. Mr Van Manen.

Mr VAN MANEN: You comment in your submission, in your summary of policy options, on trading hour restrictions. Have you got some evidence or examples of where and how that has worked? Warren's example from earlier is probably not a good one!

Mr SNOWDON: No!

Mr Thorn : It is the obverse of what I think we are looking for!

Ms Giorgi : There is some really strong evidence—

Mr SNOWDON: It would have been good for me at the time had it not been the case!

Ms Giorgi : to demonstrate that even modest changes in trading hours result in reductions in harms. In Australia, we have Newcastle, where there was a reduction in trading hours from 5 am to 3.30 am. It is a really small change. We have to talk about this for what it is. We are not talking about winding back to 6 pm; we are talking about an hour and a half. An evaluation of that now, five years on, has shown that there has been a sustained 20 per cent reduction in assaults for every hour trading hours were reduced, and that actually reflects international studies. An example is in Norway, where, for every hour of reduction in trading hours, there was a 20 per cent reduction in assaults. So there is a really strong evidence to support that, and it is definitely a measure that FARE supports.

Mr VAN MANEN: You also talk about outlet density controls. There are not too many places you can go these days where you cannot find a bottle shop or other alcohol. Would you care to comment on that a little bit further?

Mr Thorn : Absolutely. Queensland is bit of a tail-end Charlie on this issue, and I have to say that I am bit concerned that the move towards less regulation there is going to see even an increase in the number of outlets. But, again, there has been some terrific work on this. Dr Michael Livingston, who is one of our researchers at our Centre for Alcohol Policy Research, has produced a number of reports showing that the higher the number of outlets in a community, the more domestic violence incidents there will be. We also know that there is a correlation between the locating of those outlets in lower socioeconomic demographic areas as opposed to higher socioeconomic—

Mr VAN MANEN: In terms of a higher density in lower socioeconomic areas?

Mr Thorn : Yes, so there is a higher number of them, and a higher number of harms as a consequence, in lower socioeconomic areas.

CHAIR: Like gambling venues.

Mr VAN MANEN: In that research, is there any commentary on—for want of a better term—an acceptable level of density per head of population? That is probably not the right word.

Mr Thorn : There is not a lot of work that has been done, it has to be said. We wait for the New South Wales government to release the work that ACIL Allen were commissioned to do for them. They produced, out of all that, a tool called EVAT, which stands for—

Ms Giorgi : Environment and venue assessment tool.

Mr Thorn : Very good, Caterina; thank you for that. That has really been in response to analysis of harms data by Don Weatherburn's BOCSAR about the relationship between violent incidents and the location of liquor outlets. So that might be an inquiry, perhaps, that you ask of the New South Wales government, but I think that at least there has been an attempt to try to understand what these relationships are. I do not think there is an ideal. As a society we have a choice. At the moment we are choosing to have these levels of harms, which we estimate to be at $36 billion a year, which means about 20,000 child protection cases and 24,000 cases of domestic violence. That is where we are at at the moment. From our organisation's perspective, that is a level of harm that is too high and that we need to reduce. I think that then we need to make decisions about whether we ratchet up or ratchet down on that front.

Ms Giorgi : Can I just add that it is not about having a ratio of venues to population; it is about the considerations before approving a licence, so having a look at what the levels of violence are—the levels of hospitalisation, the levels of emergency department representation—and then using that to inform whether you approve a new licence, whether it be off licence or on licence. And, at the moment, there are not those checks and balances in place as well as they could be across the country in different states and territories.

CHAIR: We do restrict pharmacies, for example, in terms of numbers of kilometres between pharmacies, which is interesting. It has nothing to do with the harm they do, but rather the commercial competition.

Mr SNOWDON: And a very strong guild.

CHAIR: A very strong guild. But it is interesting that, while we restrict the number of pharmacies per square kilometre, it is not the same. I think newsagencies have a similar situation, so it is not unknown in Australia to be looking at the spatial dispersal of a certain sort of enterprise.

Mr PERRETT: Just on that, I think the difference is they have their union, or their collective, that does that to prevent competition, whereas obviously pubs and clubs are all in competition.

Mr Thorn : Can I just pick up on that, because this is the economics of alcohol. I do not think anyone really imagined what the move to a more market orientated economy was going to do in the alcohol space when we started to deregulate or at least reduce regulation in the 1980s. Clearly competition policy has been a significant benefit to Australian society: groceries are cheaper; a whole raft of things have been terrific for consumers. I would argue that it has also been terrific for drinkers, but there has been a price to pay for that, and that the framing of regulation that really has come out of national competition policy has reduced the public health consideration in all of that regulation. It has really been a system that prefers competition ahead of public interest, or market interests ahead of public health interests.

CHAIR: And these are price based interests?

Mr Thorn : Indeed, and so the liquor acts of all the jurisdictions are largely biased towards an outcome that leads to more competition, and more competition manifests itself in longer trading hours and more outlets. We published this book, Stemming the tide of alcohol: liquor licensing and the public interest, last week. It is an academic research book that Caterina and myself and Professor Robin Room and Dr Liz Manton edited. It is a collection of research papers and essays. It is not quite in the vein of the member for Moreton's literary outputs, but nevertheless it is worth a read.

Mr PERRETT: If you'd like to mention my books on the record!

CHAIR: Can I suggest you submit that to us as evidence?

Mr Thorn : This is the printer's proof. I will not be submitting this, but we can—

CHAIR: Can you supply us when you do have some?

Mr Thorn : I think we are getting them next week.

CHAIR: We have not asked Mr Perrett to give us any of his literature.

Mr Thorn : I hope he doesn't ask me to read it into the Hansard! I would argue that the pendulum has swung right out to one side in terms of a competition policy orientated regulatory system. It has probably gone about as far as it is going to go. Western Australia, for instance, in its liquor act now has really reversed the onus of proof. It actually is asking any applicant for either a new licence or a variation to their licence to demonstrate the point that Caterina was making—that their licence is not going to further contribute to harms in a community. I think that that is where all jurisdictions need to get to.

CHAIR: I think that is an important recommendation.

Mr PERRETT: That was actually where I was going with my question. I think I have actually asked you in another committee the question about how the real cost can be attached to the players in the market, because obviously, at the moment, all the cost is borne by the individual and the state, not the other participants. The individual is responsible for their own health. The cost associated with that is either met by their private health insurance or the state—the Medicare levy that everyone pays. I was wondering if there are any emerging similar jurisdictions where there have been attempts to attach that cost, like tobacco did 20 or 30 years ago, saying that this is not a transaction that is without cost.

Mr Thorn : We can design a system—and I am sure that there are hundreds of economists that would be willing to leap in and help design a model—to address that. One of the ways that that can manifest itself is through the introduction of what we call risk based licensing systems. In other words, the fees that a licensee pays to operate are related to the risks of their operations. That is slowly being introduced around Australia, so Queensland, Victoria, the ACT and now New South Wales—and New South Wales have probably got the most up-to-date—

Mr PERRETT: This is all at the retail side not the production side?

Mr Thorn : This is at the retail level, yes. I just use it as an illustration.

CHAIR: Is that demonstrated risk or theoretical risk?

Ms Giorgi : They vary depending on the states and territories, but they look at things like trading hours, occupancy and also a lot of the systems have compliance built within them, so your compliance with the existing legislation.

Mr PERRETT: Do they look at the type of alcohol?

Mr Thorn : The type of outlet, so off-licence versus on-licence issues.

Mr PERRETT: Can they drill down further so that, if you are selling full-strength beer rather than light beer or spirits versus—

Mr Thorn : I think inevitably, if you put enough variables into your model, you can get to that point. I think we need to be sensible in terms of what is manageable. For instance, we have got a crazy situation in Sydney at the moment where, after the Thomas Kelly killing, the New South Wales government implemented a number of controls specifically around Kings Cross. One of the things they wanted to do was to collect sales data. This is something which the public health sector has been on about for year and years.

Mr PERRETT: I am from Queensland. We have not even started.

Mr Thorn : They have gone to such an extreme position where they want to know what type of alcohol is sold within each hourly window. Not unsurprisingly, that has received enormous push-back from the industry. I support them. It is just too onerous.

Mr PERRETT: It is a red tape nightmare.

Mr Thorn : We need to keep these things proportionate. Prior to the introduction of the risk based licensing system that New South Wales adopted from 1 July, they had no annual licence fee system. So once you got a licence it was in perpetuity.

Mr PERRETT: What was the revenue stream?

Mr Thorn : They were getting no money. The only fees that were paid were for applications for a licence, and they were paltry, to say the least.

Mr PERRETT: So with that licence you could have been selling light beers at your bowls club at 10 o'clock on a Sunday morning to a couple of old bowlers versus 17 shots per hour at 3 o'clock in the morning with the same licence.

Mr Thorn : I think they had different types of licences but there was no fee attached to the risk of that operation. So now what they have—

CHAIR: The deputy chair has to go.

Mr SNOWDON: My apologies. I have to go to another committee which is finalising their report. Thank you.

Mr PERRETT: Chair, just to tease this out: there have been steps taken. Anything comparable? Are there any other countries where they have tried to put a price on the risk—the costs associated with the consumption of alcohol, which obviously varies from person to person, age to age and community to community. You are saying that we have all but had it unpriced.

Mr Thorn : Yes, the right to trade—that social licence to trade has been unpriced.

Mr PERRETT: So it was not directly linked to the excise or anything like that?

Mr Thorn : For instance, with the Queensland government system, all it does is really pay for the regulatory system itself. It makes no further contribution to the harms. It does not pay for police; it does not pay for ambulance. The ACT system was introduced the last time the Liquor Act was changed here. I think part of the political deal to get it through was that some of the additional funds that were raised from the risk based licensing system went to additional police officers to police some of the night-time entertainment areas. These are really baby steps in terms of the issue that you are getting at and linking the harms to the right to trade element. I think we have got a long way to go to get to that position. A more efficient way, of course, for the administration is using the tax system. In my view, even though we raise in excess of $6 billion worth of taxes on alcohol, that is well short of the total harm caused.

CHAIR: The usual estimation is that it is about half, isn't it? One of our terms of reference, which you will be aware of, is the extent to which the outcome for pregnant women drinking is that they have an intellectually or cognitively disabled child through FAS or FASD. In Australia, a few incidence studies have been done and one in particular showed we have the highest incidence of this in the world. Through your work, have you got any comments to make about how we ensure that the issue of women drinking during pregnancy is better understood? Have you got any ideas of international best practice or, indeed, Australian best practice on how to make sure that women of child bearing age and their partners are more conscious of the damage they do, or do you think it is just a case of, 'Look, women are often such heavy drinkers that, without treatment, they are not going to be able to regulate their drinking without help?'

Mr Thorn : Again, I think FARE's view on this is that dependent drinkers are a special case, and we need programs and services that deal with that. The first thing is being able to identify who they are. At the other end of the continuum, I think that until we do the Australia-wide prevalence studies and understand what the level of prevalence of the spectrum of the disorders is, we really are just groping around in the dark. In the end, dealing with the FASD risks is an issue where more information is the pathway towards a solution. That then allows us to develop the sort of public awareness campaigns that are plainly needed to encourage health professionals, pregnant women, their families and their partners to all put their shoulder to the wheel to ensure there is no drinking during that pregnancy. It is as simple as that.

CHAIR: I presume you mean well-communicated information. There is information out there, but it is not understood or communicated.

Mr Thorn : The Commonwealth funded the foundation to develop a program which we have calledWomen Want to Know, which is specifically targeting health professionals to raise their level of awareness about FASD and, secondly, what the National Health and Medical Research Council recommends. In developing that campaign, we did some research about health professionals' understanding of the risks. Do you want to comment on what we found?

Ms Giorgi : We found that we asked them, 'Do you talk to women about alcohol during pregnancy?' we had a high proportion who said 'yes' across the different health professional groups. Around 80 per cent said 'Yes, we talk to women about alcohol.' When we asked what the message was, and whether it was consistent with the guidelines, that varied depending on health professionals, but it was much lower. In some cases it was one-third of people who were aware of the guidelines, or one in five health professionals who were aware of the guidelines. While that conversation is maybe being had in saying 'Are you drinking?' and the woman may say 'No', that is not followed up by 'I wanted to let you know that this is what the guidelines say', which would be consistent with tobacco.

CHAIR: I guess if you had asked the supposed recipients of the information from the medical practitioner, 'Did you receive any information about alcohol when you first presented as pregnant or wanting to become pregnant', you would get a different set of statistics as well.

Ms Giorgi : We have asked that in our annual alcohol poll, and fewer than one in five said they had had that question asked of them.

CHAIR: That is right, exactly. Not 50 per cent.

Mr PERRETT: Only one in five actually had that conversation?

CHAIR: Only one in five of the pregnant women said, 'Yes, we had a conversation' or said that they were asked or told about alcohol by their medical practitioner, or whatever. Whereas 50 to 80 per cent of medical practitioners said, 'Yes, we talked to them about alcohol.'

Ms Giorgi : Through the Women Want to Know campaign, that was something that we developed over 18 months. When we were talking to health professionals about talking to women about alcohol, we were surprised at how much they were saying things like, 'We do not want to shame the woman', 'We don't want to bring it up', 'We don’t want to have an uncomfortable conversation' or 'We need this reinforced by public awareness campaigns'. Considering all of the possible uncomfortable topics you could speak about with your health professional, we thought alcohol was relatively low on the list. So we worked through that with different health professional bodies to get these resources developed and these training modules so then we can have a more consistent message during pregnancy.

Mr PERRETT: Tell them about how uncomfortable it is to tell a child that they have got Foetal Alcohol Spectrum Disorder.

CHAIR: 'The reason why they are as they are is because I drank while I was pregnant'?

Mr PERRETT: Yes.

Ms Crane : They will ask about smoking, diet and exercise—those other things.

Mr SNOWDON: Most of them do not smoke, therefore they are happy to ask that question. But they have a guilt complex about their own drinking habits.

CHAIR: Yes.

Mr PERRETT: They will be having an uncomfortable conversation with their medical negligence lawyer, I think.

CHAIR: Are there any further questions from the panel? We have gone a little over time, and we appreciate your generosity with the time you have given us, representatives of FARE. We also have a number of pieces of the report itself that you are going to provide when you are able to, which we will then admit as evidence.

Resolved that these proceedings be published

Committee adjourned at 12 : 35