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Standing Committee on Social Policy and Legal Affairs - 31/05/2012 - Foetal alcohol spectrum disorder

CRANE, Ms Meredythe, Senior Policy Officer, Alcohol and other Drugs Council of Australia

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

LITTLE, Mrs Jeannie Aileen, Chair of the Alcohol and other Drugs Council of Australia Aboriginal and Torres Strait Islander Peoples Working Group

TEMPLEMAN, Mr David, Chief Executive Officer, Alcohol and other Drugs Council of Australia

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

WALKER, Ms Melanie Jayne, Deputy Chief Executive Officer, Public Health Association of Australia

WARD, Ms Sarah, Senior Policy Officer, Foundation for Alcohol Research and Education

WEBSTER, Professor Ian W, Patron, Alcohol and other Drugs Council of Australia

Committee met at 08:34

CHAIR ( Mr Perrett ): Welcome. I declare open this public hearing of the House of Representatives Standing Committee on Social Policy and Legal Affairs inquiry into the incidence and prevention of foetal alcohol spectrum disorder. I would like to acknowledge the Ngunnawal and Ngambri people, the traditional custodians of this land, and pay our respects to the elders past, present and future. The committee also acknowledges the present Aboriginal and Torres Strait Islander people who now reside in this area and thanks them for their continuing stewardship of this land—and, when I say 'present' I mean people living here currently, not just those who are present in front of us.

Please note that these hearings are formal proceedings of the parliament, which means that whilst we are quorate parliamentary privilege applies, which I will refer to later. Everything said before the committee 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 and is being broadcast live. A transcript of what is said will be placed on the committee's website, and Hansard may contact you to verify names and terms you use.

I welcome representatives from the Public Health Association of Australia, the Foundation for Alcohol Research and Education, and the Alcohol and other Drugs Council of Australia. I wanted to touch on some information we received late yesterday. We were ccd on a letter from Corrs Chambers Westgarth, the lawyers for the Distilled Spirits Industry Council, who have given a message to the Foundation for Alcohol Research and Education. So you had this letter—

Mr Thorn : Yes.

CHAIR: We are not here to give you any legal advice, obviously, even though the committee is full of lawyers! I just wanted to be sure that you had the letter and you were aware of its contents, and you have made your own decisions about what you say. As I said, what you say before the committee today is protected by parliamentary privilege, as long as we are quorate—but we will let you know if we are not quorate.

Mr Thorn : Yes, we have read the letter and we are aware of those conditions.

CHAIR: I have not had a chance to read it but I will pass it around for the rest of the committee to be aware of. Do you have any comments on the capacity in which you appear?

Prof. Webster : I am a physician and Emeritus Professor of Public Health and Community Medicine, at the University of New South Wales, as well as patron of the Alcohol and other Drugs Council of Australia.

Mrs Little : My name is Jeannie Little. I call myself the black version because there are two of us in Australia! I am a life member of ADCA and chair of our deaths in custody/suicide watch group in Cairns.

CHAIR: And you did a very good interview on Radio National this morning.

Mrs Little : Thank you.

CHAIR: Would any of you like to make a brief introductory statement before we move on to questions—any and/or all of you?

Mr Templeman : Thanks, Chair. Good morning, everybody. ADCA really appreciates the opportunity to appear today and to further emphasise the need for a national strategic approach to foetal alcohol spectrum disorder. As already indicated, with me today are ADCA's patron, Professor Ian Webster, and the chair of ADCA's Australian Indigenous people's working group, Jeannie Little. Jeannie will make a brief statement after me. I have also brought along a mannequin of a foetal alcohol spectrum baby, which I will pass around shortly. ADCA supports the sentiments expressed by you, Chair, and the Hon. Dr Stone in your statements to the House of Representatives on 13 February. A national strategy for prevention, intervention and management of FASD is required. Such a strategy should incorporate a national public health campaign, development and adoption of an effective and reliable national diagnostic tool, and the recognition of FASD as a disability to allow people with FASD and their carers access to disability pensions and support services. People with FASD and their carers will need support to manage its effects for the rest of their lives. I am not sure whether the committee has seen one of these before, but this mannequin—which Meredythe will pass around—has the distinctive physical features of foetal alcohol spectrum syndrome.

CHAIR: Some of us that were in Cairns saw it. I cannot pronounce the name of the group that brought it down.

Mr Templeman : We just thought that today it would be helpful for the rest of the committee if they have not had the opportunity. It is very small for its gestational age. You can see the short palpebral fissure, which is the opening between the upper and lower eyelids; the short nose; the flat mid-face; the smooth philtrum, which is the groove in the middle of the upper lip; and the thin upper lip. I also have some diagrams to pass around. You can see that it also has the low nasal bridge. What you cannot see, of course, is the host of mental, behavioural and learning difficulties that become evident across the range of spectrum for FASD as these children develop.

In developing a national strategy on FASD, one of the biggest issues that need to be addressed is the Australian drinking culture. This will not be easy, since alcohol is the most widely used drug in Australia. Approximately 3,000 people die annually and there are 75,000 hospitalisations each year as a result of alcohol consumption. The total cost of alcohol-related harm to the Australian community is estimated at about $36 billion a year annually. Things will not change when you can buy alcohol more cheaply than water. Last year you could buy wine for approximately $2 a bottle. While I no longer have the ALDI advertisement, I do have an advertisement from a national liquor outlet which was issued yesterday and which advertises six 750-millilitre bottles of wine for $20. That is roughly $3.30 a bottle. Just to show that I am not making things up, I also have an online advertisement for Perrier water from a different liquor outlet at $3.49 a bottle, demonstrating that we do have a really serious issue to deal with.

CHAIR: I would suggest that you can get water more cheaply than that.

Mr Templeman : It is water. I am talking about water.

CHAIR: I know. I understand your point.

Mr Templeman : ADCA is not anti-alcohol, as the alcohol industry portrays us, but we are against the harmful use of alcohol. Until we see a change in attitudes towards alcohol, it will be difficult to give women the support they need to prevent FASD or at least minimise the risk. I will now hand over to Jeannie. Thank you.

Mrs Little : First I would like to say that, having spiritual tribal links with the lands of my three tribes in Queensland and the Northern Territory, I wish to acknowledge the ancestors of this land who once lived freely, culturally and with dignity and pride, and their descendants who continue to carry on this spiritual traditional knowledge. May the guiding spirit of the ancestors and their descendants past, present and future be reflected within the purpose for which we are here, in the words we all speak and in the way we interact with one another to achieve important win-win outcomes for those for whom we care. I concur with what the ADCA CEO has said and with the papers I have read, but from my point of view there is a pyramid representing important people in our world who are part of all of us at this important gathering. Their excellent skills lie in different areas within the alcohol and drug use and abuse arena and include those who are researchers, clinically skilled people, government and non-government bodies, reference groups who have the responsibility to provide a diverse support framework for human beings and their struggles, and business people. I look at where the links are between this pyramid of important people and those who live in isolation from services throughout our country. To those who are the focus within the pre- and post-diagnosis and treatment of the new issues which come up, when and what are the links of the three levels of prevention? We focus a lot on the secondary and tertiary level, but primary prevention, which is stopping something before it starts, is very seldom happening. I feel that the link between the pyramid of important people and communities where people are vulnerable needs to be aware of those three levels. Who makes up the links in the chain of support on a continuous basis? Within that chain, a link is the father of the child, but often the focus is on mum and the baby and the father gets left out, and they have an important role to play as a family member.

What is the outcome for all stakeholders? I wonder whether longitudinal studies have ever been done to follow up on important issues like this so that we can assess the success that has been achieved and where the gaps are—the failures, the things that are not happening. There are negative issues like stigmatism and bullying within the schoolyard. Kids with foetal alcohol disorder who I have met in the Aboriginal and non-Aboriginal world are bullied on a daily basis. Often these kids, because of their mental issues, have stored negative tapes within their heads, within their brains, and these have never been erased. They can only been erased between the ages of five and six, according to a psychologist in America who has seen this. So we need these links and this framework.

The other thing that should stop is the blame game of one to the other. The blame game takes up a lot of energy, and it is negative energy. We need positive energy to be able to provide a link so that people can get education. We do not have a formal education to teach parents to be parents, hence we see babies having babies. Often there is no formal procedure and mental health is missing from the provision of services, along with the skills to counsel in alcohol and other legal and illegal substance abuse. In health centres in the isolated areas there are no mental health workers, just physical clinical health workers.

CHAIR: Thank you, Mrs Little. Mr Thorn?

Mr Thorn : I will hand up this document, which I will very briefly speak to. Let me start by thanking the committee for undertaking this important work. I endorse the comments of my colleague Mr Templeman. I will not go over those again. I have just a couple of quick points before I speak to this document. FASD has been overlooked by governments in too many respects, and it is really fantastic that we are currently having a good close look at the issue. FARE knows this issue quite well. Most recently we have invested more than half a million dollars in seven projects to address foetal alcohol spectrum disorders. I think that work is aiding our knowledge and also the community's more general knowledge.

There are a couple of things about why we are involved. One of them is that we love working with an extremely committed bunch of researchers, doctors, carers and communities and families around Australia. It has been an amazing journey for us working with people the likes of Sue Miers and Anne Russell, who are at the pointy end of this; June Oscar, who has been a truly fantastic leader in her community in the Kimberley; and the professors Elliott, Latimer and Bower, who are great, world-renowned researchers doing really important work.

FARE sees its role in all of this—because it has certainly become quite a cluttered field—as being to try and provide some focus on the public policy needs that come out, and that is really what I want to address today. I suppose we see our role in more recent times as being about trying to coordinate some of that public policy discussion. I think we have reached a tipping point in the prevention of FASD and the provision of services in Australia. We have done great work around research in the sorts of things going on at Westmead Hospital and at the Institute of Child Health Research in Perth, for instance. It is world-class and informing our knowledge significantly. A lot of that work is starting to translate into concrete action. We have a better understanding about some of the tools that we need to manage this issue. We are starting to see programs being put in place—a combination of government funding and FARE funding, for instance. The first diagnostic clinic is about to be established at Westmead with FARE funding. We have prevention programs and education programs in place. This week we announced some funding that we have put into a training program in Tasmania. These are all of the sorts of concrete things that are needed in the community.

Finally, there has been fantastic advocacy around the issue. There is a growing awareness—a better understanding of the problem that we are dealing with—but it is a complex issue, and it does need really good precision and coordination in the way we deal with this. As we know, FASD does not occur in isolation; it is part of the wider and complex issue of alcohol in the community. As Professor Webster is wont to say, the way alcohol is served, marketed and sold in our community contributes to this drinking culture. The consumption of alcohol during pregnancy is merely one aspect of that but a really important aspect. What we have learned though is that we need a whole-of-government approach to bring together all those aspects with the sectors that are involved in addressing foetal alcohol spectrum disorders—across education, justice, health, community and housing.

This sounds a bit bureaucratic and process oriented, but FARE believe we have arrived at the point where we need a concrete national foetal alcohol spectrum disorder action plan so that all those things can be brought together. I think there are four elements that we need. One is around understanding what FASD is, and that is about improving our diagnostic ability. The second is a clear prevention strategy, and this is one of those issues where prevention is undoubtedly the best way forward. The third is services for those who are affected by foetal alcohol spectrum disorders. I think the way to deal with that in a coherent way is to replicate what has happened on the disability front more generally and what governments have done, and I think this is supported by all parties. The lessons we have learned about autism, for instance, are really instructive here. Finally, we need to continue to monitor what is going on. We need to gather data and keep an eye on what is happening and to feed that into our research processes.

CHAIR: As there is a division in the House, some of us will be away for five minutes or so, but the committee will keep going.

Mr Thorn : I wrote to the chair of the committee recently with a thought about how this committee might continue this momentum and the good work that is being done. My suggestion was that the committee issue an interim report. I suggest that because we understand that the committee is not likely to report until either late this year or early next year, and we all know what—

CHAIR: Definitely this year.

Mr Thorn : Perhaps the most important part of government cycles is the budget cycle. If we miss that, we could well delay the opportunity to act on a number of crucial fronts until the following budget year. I think there are four things that need to be done to maintain this momentum.

CHAIR: Mr Thorn, I am about to leave. When I do, the committee will continue but it will not be protected by parliamentary privilege.

Mrs MOYLAN: We do not have a quorum.

CHAIR: So just be careful what you say!

Mr Thorn : That should not be too difficult in these circumstances. At least this will go on the record. The first thing that we need to do is continue progressing the work around diagnostic tools. We are obviously at the critical point in getting that done, and further funding will be required to land that. The second is to pilot and test that tool. We have a clinic about to start and we need to make sure the resources are there to finish that process. The third is, we believe, to expand a Better Start initiative to include FASD.

Finally, there are two fronts where there are major issues. Firstly, we need a much better public education campaign, and part of that is to follow through on the decision to mandate pregnancy-warning labels on more alcohol products. I will briefly touch on the trajectory of health-warning labels on alcohol products over recent years—the last half-dozen years. It has been a fairly tortuous process, and even today we are struggling to ensure that governments commit to the sort of decision that we understand they made last December, and that was to ensure that there would be mandatory pregnancy-warning labels on all alcohol products two years from that time. I am aware that the alcohol industry has written to the ministers participating in that process, I think putting pressure on governments to persist with a voluntary, not mandatory, regime around alcohol warning labels.

I will sum up where I see this process going. I think we can land some of the really good work that is being done if the committee is sensitive to my suggestions around the need for an interim report to bring together some of the early findings you have made. That can then be received by government and federal parliament in the next budget process. Secondly, after completing this inquiry, we would like the main finding in the final report to parliament to be a clear national plan. Thirdly, we suggest that one of your recommendations be to reinforce what we understand to be the situation, and that is that there should be a mandatory alcohol warning label scheme introduced from December 2013. Finally, we would be urging government, having received your report, to develop that national action plan and, hopefully, fund what is needed in the 2014 budget.

Ms Walker : Obviously, I support all the very sensible things that my colleagues have already said in relation to this matter, but I would like to make a few broader comments with regard to our perspective as the Public Health Association and in that broader context of public health.

Obviously, FASD is a significant public health problem and one that we believe should—at least theoretically—be entirely preventable. It is also a problem where those affected are not only the drinkers themselves and not just the babies but families and communities, as evidenced by what my colleagues have touched on already. We also want to make the point that foetal alcohol spectrum disorder cannot be taken in isolation. It is part of a broader community alcohol problem, and measures that prevent and reduce alcohol problems in the community will have a flow-on effect in relation to FASD. We think that is important to note.

Given that context it is hardly surprising that we are seeing FASD, given the way that young people are drinking, with the evidence saying that they are drinking to get drunk and with cheap alcohol readily accessible, as David has already spoken to. We note as well, related to some of the comments that Jeannie has already made, that there is a related need for consideration of complementary sexual and reproductive health programs within the context of what we are talking about here. Similarly, there is no magic bullet; we do need a broad and comprehensive approach as outlined, including action in all the key areas we have identified as priorities and also those that are touched upon a bit further on in the joint submission that we provided to the committee earlier in the piece.

We do think it is very important to get across that we need action on FASD, but this will not happen or succeed if it occurs in isolation. It does need to be part of that broader, comprehensive approach. We also want to see appropriate services but, again, part of a comprehensive approach, not just in isolation but also taking into account the importance of prevention in this regard. The Public Health Association has long been making the point that at the moment only two per cent of the health budget—and that is at the national level and within jurisdictions—is spent on prevention activities. Particularly in this area, it is really important that there is a very strong focus on prevention as part of the plan.

On the prevention front here, as in so many other areas, we know a lot about what needs to be done, and the Preventative Health Task Force report set out the recommended broader strategy for action on alcohol. This should be the starting point and the context to be complemented by specific action and programs on FASD.

We are also keen to ensure that the committee notes and considers that, while there is a need for a proper focus on issues for Aboriginal and Torres Strait Islander peoples and communities, we would be very worried if this was typecast as an issue only in Indigenous communities. The statistics that we have talked about and provided in our submissions indicate that it is an issue for the broader community. Those are just some comments we would like to make about the context.

CHAIR: Certainly our approach, and I apologise for missing part of that presentation.

I am not sure if you have had a chance to look at the transcript or to hear any of the evidence we received last week from the alcohol industry groups—the people who produce the material that is on the table now. They certainly argued that broad public education initiatives, such as referred to by you, Ms Walker, and labelling generally, are ineffective. Instead they claimed that education should be targeted at at-risk groups. Would anyone like to comment on this?

Ms Walker : I am happy to start, and I will allow my colleagues to elaborate; but, Ian, would you like to start and I will follow up after you?

Prof. Webster : Clearly, right across the world, if you look at alcohol problems in a population, the relationship between alcohol and the harms it causes is related to consumption in the general population. When you reduce the consumption in the general population, you reduce the harms. If you look at some of the countries in Central Europe, at Russia and at other countries which have massively high rates of alcohol consumption, there are notable harms like mental health problems, diseases and illness and massively high suicide rates that are related to alcohol.

CHAIR: Just to be clear, in the literature review there is a clear correlation?

Prof. Webster : There are clear correlations. If you operate at a large population level you alter the impact on the whole population. One of the dominant factors which affects this is that where societies have great inequalities these patterns are in fact worse, whether you take drug use or alcohol use. That is true in Australia. There are regions and communities in Australia where there are wide inequalities. In those local regions the alcohol problems are worse and the harms from alcohol are worse.

CHAIR: Inequalities as in living?

Prof. Webster : Social inequalities. Living inequalities. So there are broad social and cultural factors which lead to the overall patterns of alcohol consumption, and they generate the extent of the problems in communities. Many people point to the person who is a dependent alcohol drinker as being the problem we have to deal with.

CHAIR: The ones who are not at risk?

Prof. Webster : No, not the ones at risk. They are the ones who are really damaged by it, and they are the ones who we used to call, in the past, 'alcoholics'. They represent five per cent of the population. I mean the 20 per cent of the population who are drinking in ways which they think are socially acceptable but who are at high risk. Of course they are at high risk for road traffic accidents, suicide events, mental health problems, personal violence, assaults and so on. So it is a wrong perception to think that you can deal with the problem of alcohol in the population by focusing on those only at high risk. However, of course, the people at high risk are a very special problem.

In relation to foetal alcohol syndrome, the Aboriginal population is one group but impoverished populations are another group. My thoughts about that are that it is not only the foetal alcohol syndrome itself or the birth of a child with this problem that we should be focusing on but the early childhood development area, both prenatally and postnatally. As Jeannie Little was saying, it is not just the woman drinking. It is the environment in which this child is born, and the fact that there is a father present and there ought to be a family structure.

There are very good attempts being made right now. I have worked out in south-west Sydney, at Liverpool, where there are massive population needs and socially disadvantaged populations. There are two programs being funded by the Commonwealth government through the National Health and Medical Research Council and the ARC, which are cohort studies, which Jeannie was arguing should be done. One is a cohort study of home visiting of mothers with newborn children in an impoverished suburb, Miller, of south-west Sydney. They have been followed up for five years now, so the kids are now in school. It shows that that sort of intervention improves the outcome for those kids and there are fewer childhood problems of development. But within that group if alcohol continues as a problem in a family those kids to not do so well.

The other project which is being done is a cohort study where Aboriginal children born to mothers in the Campbelltown-Liverpool area are similarly being home visited and followed up, I think for about three years now. It shows the sort of pattern that Jeannie was talking about. Where alcohol is being used prenatally and certainly during the nurturing period of the child those children do not do so well. In all these things, it is not one or the other. Clearly you have to have national population approaches, and that is what you, as members of parliament, are bound to deal with—the broad policy. But then there are much more focal issues which have to be dealt with at a community level.

Ms Walker : If I can add to what Professor Webster said—and of course I agree totally with everything he said—I would like to address the point made in the question about public education campaigns not being an effective measure. I think the evidence is in that they are a very, very important part of a comprehensive approach to dealing with any public health problem. Tobacco is a great example of a comprehensive approach over the last 50 years or so creating a situation where we have gone from a majority of people smoking to it being a minority issue. It is really clear that population-level campaigns over time can make a real difference.

CHAIR: There are similar characteristics of Aboriginality and wealth in smoking patterns as well.

Ms Walker : Absolutely. It is a really salient example too in terms of things like warning labels that have been so effective. There is no one measure or magic bullet, but as part of a bigger picture they certainly can make a very big difference. I would like to put that to bed to start with.

On targeted programs, yes, as Professor Webster said, it is very important to have targeted programs, but it also important to have broader population-level measures. To say that this is only a problem in small components of the population is really a bit of a myth. When you look at the figures, one in five women continues to consume alcohol after knowledge of pregnancy. That is not a small group—one in five women. Clearly it is important that we have those broader public health messages as well as targeted programs looking at particular communities.

Prof. Webster : There is a publication which FARE funded called First Taste: How Indigenous Australians Learned About Grog. It was written by Dr Maggie Brady who is an anthropologist. It is a description of the way in which Aboriginal people came into contact with alcohol. The important lesson in it is that Aboriginal people are not genetically predisposed to developing alcohol problems; they have learnt that from their contact with the white, Anglo-Saxon and other societies. Maggie Brady says in her book that the first medical report about the abuse of spirits came in 1734 when it was said that 'gin-drinking mothers in England gave birth to unusually small, odd-looking babies'. She goes on to say: 'We know this was describing foetal alcohol syndrome. Despite people knowing for so long about the damage that alcohol can do to babies, it is only recently that the message has begun to reach out.'

CHAIR: What year was that?

Prof. Webster : That was back in the 1700s.

CHAIR: Did you say 1730?

Prof. Webster : It was 1734.

Mrs MOYLAN: Alcohol consumption was a huge problem.

CHAIR: Do you mean 1834?

Prof. Webster : I might have to check that date.

Ms Walker : It was a long time ago, anyway.

CHAIR: Would FARE like to make a comment?

Ms Giogi : Population-level initiatives are really important, because we know from being in the community that 80 per cent of Australians drink alcohol. We also know from the international experience that even when warning labels are applied to products in an inconsistent manner—they are small or hidden away—they have been shown to raise awareness. For example, in America where labels have been in place since 1989, it has been the same small label that is quite difficult to find, but it has still been shown to raise awareness. Where labels are applied optimally—for example, in the case of tobacco—and accompanied by a public education campaign they have been shown to change behaviours.

CHAIR: In targeting the at-risk groups, you are suggesting the shotgun approach is more effective than the targeted approach?

Ms Giogi : We are suggesting that both need to occur. You need general messages for the general community to target all the people who are drinking and also the one in five women who continue to drink after knowledge of pregnancy. You also need targeted approaches that are culturally appropriate to different communities.

Mrs Little : I would just like to say that public health issues are okay but that it does not happen in isolated areas and that it is not just the Aboriginal population but also the pastoralists who live out in the bush and that they have mothers and fathers. What has been taken, and this is my experience, is the cheaper approach to stop alcohol—rather than to give a $75,000 fine or prison it is more expensive to put in health services that can help people prevent, particularly at the primary prevention level.

CHAIR: Obviously we are the Commonwealth government here, not the state government; but we will pass on that concern to them.

Mrs Little : It is in the Northern Territory—

CHAIR: I beg your pardon; sorry.

Mrs Little : Punitive approaches do not do anything. It was proven in America.

CHAIR: Do you have data on alcohol consumption that it has not had any impact on alcohol consumption in communities that have had the intervention?

Mrs Little : The only impact it has had is that more people have been put in prison for breaking the law.

CHAIR: So there has been no decrease in alcohol consumption?

Mrs Little : No.

Dr STONE: But surely where there has been a community consensus around cutting back alcohol or even perhaps leadership driving that issue like at Fitzroy Crossing and Halls Creek, you have a massive reduction in consumption. So I think what you are implying is that it doesn't work if it is imposed on a community without their understanding the real problems of alcohol and if it is from above—someone says 'no more grog in that settlement' though it might be just that the grog is five kilometres down the road instead—but if you have a community saying, 'no more grog', like at Fitzroy Crossing and Halls Creek and so on, then you have fantastic results.

Mrs Little : But what our communities are calling for is: why do we have a health centre in every community and why does that health centre just have physical-help professional people but no mental health people and why are the health workers not trained to look at counselling for their people or to work with mothers and fathers? We have to own our problems and the solutions of those problems, but how do we do that if that link is not made from the wider government approach? In Canada it worked, and I was so proud of the Canadian government. They worked with the natives to say, 'How can we facilitate but not control what you're doing?'

Ms Walker : I think it is a very important point that Jeannie is making—the need for legislative measures to be supported by appropriate resourcing within communities and the provision of services to enable people to make those changes. I think a lot of people think, 'everyone needs to stop drinking', but, if you have a serious drinking problem, that is a clinical issue and you need to be managed through that. People can have seizures and die within alcohol withdrawal, and they need to be appropriately supported by services and enabled to make those changes. I think that that is a really important point too.

Dr STONE: One of the things you do not seem to be mentioning out loud about alcohol labelling, though I am sure it is subliminal in your message, is that it is also about price. You mentioned that there is alcohol which is cheaper than water, but surely part of the tobacco solution was the massive increases in the price of cigarettes. With alcohol we have that price issue, so would you also be seeing a relationship with the alcohol labelling? It is not really featured in your diagrams or your dot points, this issue of pricing of alcohol. Do you agree with our forum of alcohol related industry sector people last week when we met with them that, if we priced alcohol according to its alcohol content, that could be some way to go. Would you recommend that?

Mr Thorn : I was conscious of limited time today and thought we would focus on a couple of particular issues, but it is very clear that in managing the risky consumption of alcohol the issue can be triangulated around price, availability and promotion. In Australia and around the world, that is an extremely well-understood concept. There is increasing economic modelling that shows exactly what the demonstrated effect is from increasing the price. The most sophisticated work is going on in the UK at the moment and, as a consequence of that, the Scottish government and the British government have all signed up to minimum pricing regimes. That is a direct link back to that evidence that shows that price is the most important determinant in the amount that people consume. There has been research here in Queensland—

CHAIR: Mr Thorn, could you make a comment. I thought they had changed their opening hours, so that the other factor was availability in the UK. I thought there had been quite a deregulation of opening hours. Are they responding by now changing price?

Mr Thorn : What research has been done—there have been some cost-effectiveness studies led by some researchers in Queensland, for instance—shows that price is the No. 1 factor, followed by availability issues. It is obviously a complex thing.

CHAIR: I just wanted to be clear that you can draw a parallel between cheap alcohol and problem behaviour.

Mr Thorn : Yes.

CHAIR: It is not complicated economics, obviously, but I just wanted to make sure that that dotted line is quite a dark line.

Mr Thorn : Australia's pricing of alcohol is affected by the current alcohol taxation regime, in particular the fact that wine is taxed on a wholesale basis, an ad valorem basis, whereas all the other products are taxed on their volume. As you know, the foundation has been campaigning fairly hard to try and get government to deal with that issue. It is not the only thing. Clearly, the really aggressive marketing of alcohol and the promotion of alcohol to young people is another factor. We have seen that the availability of alcohol—across all sorts of communities, if you make it more available you will increase the problems that a community has to suffer, ranging from long-term problems like foetal alcohol spectrum disorders and increases in cancers through to the short-term issues around increased violence and crime et cetera. On the latter, for instance, Newcastle has a living social experiment going on where the liquor authorities brought the closing hours back from 5 am and 6 am to 1 am and 3 am. A sustained 35 per cent reduction in violent assaults in that community is the result. It has been four years in the making.

CHAIR: Is there Queensland data on that yet? Because they changed their hours.

Mr Thorn : I am not aware of any research where that has been tracked. The good thing is that Newcastle University got in early with the population health people from the New South Wales health department. They have been following that for some time now.

Mr Templeman : Just to add to that, Chair, there has been some work done by Tanya Chikritzhs, from Western Australia, in relation to outlet density and the increase in violence and assaults. That is very recent data in terms of, if you grow the number of outlets, you end up with an increased number of assaults.

CHAIR: That has been the case in Perth, hasn't it?

Mr Templeman : Certainly. In certain areas around Perth. In order to assist the committee, there is some data around which we can draw attention if you want to access it and talk to the researcher who was actually involved. I think it would be very worth while for the committee to get that.

To add to Mr Thorn's earlier comments, I think that this discussion about price, access and availability and marketing advertisement are the three core things that we see fundamentally as possibly having a huge impact in addressing the whole alcohol and harm question. This is embraced not just by one or a few organisations. There is now the National Alliance for Action on Alcohol, the NAAA, which now has over 70-plus organisations which are fully supportive of those three core issues. That includes organisations like mine and the AMA—all those sorts of organisations. It is a very powerful body of people that all joined up in terms of having a much more holistic approach to this overall problem.

CHAIR: I think we might be hearing from them in Melbourne.

Mrs MOYLAN: Thank you very much for your presentation. I do not need a lot of convincing on this because I had the privilege of sitting on this committee, or its equivalent, in the previous parliament. We had the inquiry into youth and violence. I think one of the really shocking pieces of evidence was taken in the roundtable in Melbourne with youth groups and individuals. Some of those young people had been in the juvenile detention system as a direct result of their alcohol consumption and drunkenness.

One of the things that really concerned me about that, and you have just touched on it, Mr Templeman, is the availability of alcohol now. What many of the young people told us in the inquiry was that, since the Productivity Commission made the recommendations to deregulate the alcohol market, a lot of little bars have set up. I think we can see a proliferation, certainly in Melbourne and Perth, and they called them 'vertical drinking holes' because many of them do not serve much by the way of food. A lot of cocktails and hard liquor is being sold there, not just beer and wine but spirits like vodka. They drink until they drop, basically. This not just a problem for Indigenous communities; it is a problem right across the community.

I am wondering what comment you would like to make about the recommendation by the Productivity Commission, or whether you have thought about that, and how governments might approach that? On the face of it it probably, to many people, looks like a fair enough approach to the marketing or to the sale of alcohol. It seems to me that there is a very large national cost attached to that for all the reasons you have all given and that is that there are major health issues, major social issues including domestic violence and major productivity issues and, of course, the issue that we are looking at here, thanks to Dr Stone, of the increasing number of children who are born with very serious disability because of alcohol consumption.

Prof. Webster : May I start with responding to that? The problem with the Productivity Commission was that it was treating alcohol as if it was a good, like selling ice-cream, whereas in fact alcohol has other capacities. Of course, state governments were penalised if they did not implement the policy.

Mrs MOYLAN: I would like to see this matter dealt with very rigorously by the parliament, but you just said about goods and you mentioned ice-cream. I have just come from talking to Danish and British authorities about diabetes in the community. The Danish parliament has just put a tax on fat in prepared food. It raises €200 billion or million a year. Where do governments draw the line on this? The arguments that we hear all the time in this parliament are that we do not want a nanny state, we do not want government interfering with everything. There really is a tension, for many of us who think we should have more responsible policies, in how we deal with this.

Dr STONE: There is too much regulation.

Prof. Webster : I should not have mentioned ice-cream; I should have mentioned shoes or something.

Mrs MOYLAN: You know what I mean. I think it was good that you mentioned that.

Prof. Webster : I agree that it is a dilemma. For some areas there is clear evidence that there is damage being caused. In the alcohol area there is a lot of evidence that damage is caused. You can look at it from many different levels. I am a physician. Alcohol damages every organ in the body in some way. Two hundred years ago we used to say, 'If you knew syphilis you knew medicine'. In other words, it was a disease which affected every part of the body. I say today, as a medical person, 'If you know alcohol you know medicine,' because it affects every part of the body. Not only does it affect every part of the human body, it affects the brain and it affects behaviour. One of the areas I am concerned about—and I chair the Australian Suicide Prevention Advisory Council—is that we often do not talk about alcohol in relation to mental health. It is a very dominant factor in mental health. It is a very strong factor in suicide. In the reports in the newspaper from the Kimberley where that community had the high rate of youth suicide recently, all those young people were intoxicated. So alcohol affects people's immediate judgments and risk-taking behaviour. It causes road traffic accidents, violence of the type you described, senseless injury of other young people in the streets getting beaten up with little provocation and, as I have just been speaking about, it has an impact on mental health. So there are clear harms.

The job of politicians is to strike the consensus between competing interests and outcomes. But certainly with alcohol the evidence of harm is clearly apparent. Seventy per cent of the police force work in Sydney is alcohol related, 45 per cent of the assaults that police go to are alcohol related and the emergency department at St Vincent's Hospital in Sydney on Thursday, Friday and Saturday nights is almost totally alcohol driven.

Mr Thorn : I do not want to get into a political philosophy argument but it seems to me that one of the ways to approach this is that the role of parliaments is to deal with issues that cause harm. That is when government intervenes. Alcohol clearly causes harm and not just to the drinker.

CHAIR: So does skateboarding, rugby league and driving a car.

Mr Thorn : Indeed. Driving a car is a very good example. But there are a plethora of laws around driving—'Thou shalt not speed, do not drink and drive, and drive on the left-hand side of the road.' These are the sorts of things where government has intervened in order to protect citizens. And I think this is the way you need to frame consideration of alcohol. We are talking specifically about babies here. If we are to accept the evidence that suggests one in five mothers continue to drink after they know that they have become pregnant you are talking about not an insignificant proportion, let alone their partners and what they are doing and the effect that they have on the drinking of a young pregnant women, for instance. This is not a small target as the drinks industry would have us think.

CHAIR: The at-risk target and the health professionals' focus, which is a question I will come to you later—

Mr Thorn : We can talk about the deficiencies there. In talking to some GPs in this space, for instance, a number of them have said, 'Our profession does not do well.' But back to the reason why governments would make laws in this space: it is about the capacity of a product or an act to cause harm. It is quite a simple proposition.

Dr STONE: You just mentioned health professionals. We have taken evidence or seen research about the number of women or girls who are not asked by their midwife, GP, obstetrician or gynaecologist, 'By the way, what are your drinking habits? Do you drink? Have you got a drinking issue?' In private hospitals you are offered alcohol on your menu in the maternity area even during breastfeeding times, if you have already given birth. Part of the publicity for that private hospital is a menu including wines or other alcohol. So we have this whole issue with health professionals. One of the biggest problems I have had in going around talking about this is gynaecologists and obstetricians telling me that there is no such thing, that this is a bit like attention deficit syndrome where you invent a term and invent another problem to get people out of jail. There has even been a hideous suggestion—

CHAIR: Were they were saying that they were not aware—

Dr STONE: They were saying that there is no clinical proof or evidence of it.

Prof. Webster : Obstetricians would not know, would they?

Ms Walker : In the joint submission we put in, we actually talked about the importance of embedding information on FASD into the curricula of health and medical university courses, and I think you are illustrating the importance of that one right there.

Dr STONE: Absolutely. I have been to places like the University of Melbourne, which has an excellent medical school with virtually no emphasis on alcohol.

Prof. Webster : That is right.

Dr STONE: It is a very serious problem. This morning on the radio I heard your interview, Jeannie, and it was very important that you spoke to the ABC. You mentioned obesity and foetal alcohol syndrome. Would others like to comment from a medical position? We have not had that evidence before that obesity is linked to people suffering from FAS or FASD.

Prof. Webster : I do not know if there is a direct link. If Jeannie was saying that people who suffer from it become obese, that is probably true, because they cannot make the sorts of judgements that the Hon. Judy Moylan was making about complex choices. If you look at people with persistent intellectual disability, if you look at people with mental illness, they have the problems that the rest of the population suffer from, but to a far greater degree.

CHAIR: Everything is exaggerated.

Prof. Webster : They are exaggerated because they cannot make the same sorts of decisions. Their sense of gratification of their needs and desires is not as sophisticated if there is some impairment, and very often they get poor advice because people do not give it to people who have got some impairment and they get neglected. In the mental health area, the rates of death in people with severe mental illnesses are equivalent to the rates of death of Aboriginal populations, and it is from all the common diseases the rest of us suffer from but to a much greater extent. Obesity is a hell of a problem, a very big problem, in that group. If Jeannie was saying that there is that association, it would be on the basis of that impaired capacity to make proper judgements or get care.

Ms Walker : I think there would be a link too in terms of social determinants of health in enabling people to make good decisions. PHAA, in some of its broader work, is highlighting the issue of food security and ensuring that people are able to access healthy foods and that these are affordable. Obviously, if healthy foods are out of your reach from a financial perspective and cheap alcohol is available, that cannot be a good thing, can it?

Dr STONE: I will just follow up very quickly with the other thing that concerns me, which is: if there is a father around, then the man needs to be very much a part of assisting the woman not to drink alcohol and understanding the problems. In the ACT now, with tobacco, you cannot smoke in a car or a room with a child, and there are laws about that in cars—but we have not yet extrapolated that with the alcohol story. My problem with young people in my part of the world where FAS and FASD are serious issues is that there are no dads around. Very often, there is no recognised father of the child, and certainly they are not around, when the child is born, to offer any support to the mother. I think we need to keep that in mind: often the mother is alone. Saying that, often my young mums do not go to the doctor for four or five months before the birth of a child. That is another problem if the mother is drinking all the way through that and probably beyond that as well.

Finally, in relation to this area—I am just thinking about strategies for all of that—one of the problems in my part of the world, for both Indigenous and non-Indigenous young people, is that contraception for girls with FAS and FASD is a serious issue because, very often, girls and women with this brain damage and associated problems become pregnant very young. We have taken a lot of evidence about people who have foster children with this condition who know that the mother has the condition and so on. One of you—I did not take note of which person gave the evidence—mentioned reproductive health issues in relation to all of this.

Ms Walker : That was me.

Dr STONE: Would you like to comment on this issue? How do we assist girls and women with FASD, in particular with reproductive health issues and contraception?

Ms Walker : It is a very important link that you make there in terms of the need for access to a range of complementary sexual and reproductive health programs. It is not just about preventing FASD but, as you have pointed out, ensuring that those services and programs are readily available to all people, particularly those target populations where there is a real issue. I know that sexuality, sexual and reproductive health and the provision of services are issues in the disability sector. I think it just goes to further illustrate the point about how important access to those complementary services is in the population more generally, particularly among those targeted populations who are vulnerable—whether they be young people or people with intellectual impairment, FASD or another disability that makes them particularly vulnerable. That is really important and good to note in the context of this broader discussion around alcohol.

Mr Templeman : If I could pick up on the earlier remarks by the deputy chair concerning issues raised earlier about who else might need to be spoken to about some of the evidence around some of these harms. I am thinking out loud here. I do not know to what extent the committee is talking to police, paramedics or emergency departments about this. I know you would normally ask the questions, but I would like to put a question in that context. The Australian New Zealand Policing Advisory Agency, ANZPAA, has every police commissioner on its board. Police have been very strong and very positive on community policing. They will tell you that 50 per cent of policing time on a daily basis is related to alcohol and you can track it right back, and that that ratchets up to about 85 per cent on a Friday and a Saturday night. And that is mirrored in emergency departments and with what paramedics have to put up with on the streets.

I strongly advocate that the committee also needs to talk to ANZPAA and involve them; the Council of Ambulance Authorities, for the particular perspective of ambulatory personnel; and emergency departmental people, so that a whole picture is presented with regard to the problem that is happening out there on a daily basis. Commissioner Scipione from New South Wales has made some strong statements about alcohol, as have some other commissioners. I just make the suggestion.

CHAIR: The particular focus of the alcohol industry seems to be on health professionals talking to pregnant women in their rooms.

Prof. Webster : They are advocating that.

CHAIR: That seemed to be the focus of their prevention cause.

Prof. Webster : Obviously that should happen but I do not think it does happen very much.

CHAIR: Okay. We have certainly had some suggestions about it. Obviously you are suggesting that it needs a much broader social approach.

Mr Templeman : As Professor Webster said before, there are many impoverished and many marginalised in the community who do not even have access to a general practitioner or never get the opportunity to get that sort of professional advice.

Mrs Little : I just want to make a comment about holistic approaches. Capacity building for our people in isolated areas is not happening in terms of health workers and RNs. We have 10 cultures living in four communities. It is about people on the ground who can provide that support from primary prevention—

CHAIR: You are suggesting that health professionals are not working in your community?

Mrs Little : No they aren't, particularly with mental health and substance abuse counselling. The government needs to look at that with a holistic approach and say, 'Let's not just focus on the issue but on the source and find out what is happening to the people who can give that advice and support'—and cover the three levels of prevention.

Mrs MOYLAN: Thank you, Jeannie, for your contribution today. You mentioned Canada as having developed a good model, and I think that was in relation to the kinds of health services—

Mrs Little : and substance use and abuse.

Mrs MOYLAN: Are there other countries with models we can draw on regarding the pricing, marketing and sales generally of alcohol, and the general community campaigns as to the harm it can do?

Prof. Webster : Canada is another example. They have just done some major evaluations in British Columbia on the effectiveness of minimum pricing of alcohol. It showed that the consumption of alcohol across all groups fell. It is often said by the alcohol industry that those who are heavy drinkers are not affected by these pricing policies. That particular study, which was led by Tim Stockwell—he is from Australia and is now in Canada—showed that the heaviest drinkers also changed their patterns of drinking as a result. So the notion that these broad population approaches, such as pricing, do not have an impact at all levels is wrong. Canada has good pricing. Scotland has just introduced, as Michael has said, minimum pricing, and they are evaluating that. It came from an economic study which was done in Sheffield, England.

Mrs MOYLAN: I travelled to Norway quite a bit before I came into parliament, and I noticed there that you could only buy alcohol from what they called 'bin monopolies'.

Prof. Webster : Sweden too.

Mrs MOYLAN: People would line up down the street, especially at festive times. I observed that it did not stop the heavy binge drinker, who was prevalent in Norway.

CHAIR: A lot of road trips to Sweden, I would think.

Mrs MOYLAN: In fact, the young people used to get on the ferry to Denmark and they would just obliterate themselves. Clearly, just limiting the sale of alcohol is not the answer in itself.

CHAIR: Mr Thorn—

Mr Thorn : You want to wrap up.

CHAIR: No, no. It is all right.

Mr Thorn : I just want to introduce into evidence the paper that we released last year, which was our analysis of the alcohol industry's submissions to this inquiry, in case time escapes us. There is a copy of it for everyone. I think our approach in this has not been to take on big alcohol. I think I have been careful—

CHAIR: As we said earlier, they are quite protective from the tone of that letter.

Mr Thorn : And there are other ways of dealing with that. The terms of reference of this inquiry were around foetal alcohol spectrum disorders, and we have approached it in that way. The committee should think about the sorts of empirical needs in order to try and understand what the problem is. As I said, we have started that. We need better capability to diagnose, and so work is being done there. We need to be able to diagnose in order to work out what the prevalence is. It seems to me that we should be dealing with the facts.

The evidence should drive what the public policy response should be. What we are arguing is that there is a need to do the prevalence studies so that we can better understand it and then we can move to the sorts of public policy responses that are required. Clearly, people who are already damaged need the sorts of services that people with a disability or a rare disease generally have.

On the prevention side, the evidence about people's drinking behaviours in this country suggest that most people drink; too many women who are pregnant drink; and too many of their partners drink. We cannot have a public education or awareness raising program that is driven through the medical fraternity. It will not get to everyone, it will not get to them in a timely way and it will not get to them in an effective way. We do need population-wide measures.

CHAIR: I might touch on the promotion in my next question. I am particularly interested in the idea about the safe periods during pregnancy to drink or immediately post the birth, as Dr Stone has already touched on. Can we have some of the medical information about that.

Prof. Webster : I do not think there is any evidence that there are safe periods during pregnancy.

CHAIR: So that is a myth?

Prof. Webster : That is my opinion. I think you ought to go to people with more biological knowledge than I have. Clearly, there are peak periods during the early parts of development when the particular characteristics of the foetus are developing Some of the diagrams in front of you demonstrate that at certain periods in intra-uterine development the facial characteristics are becoming evident and the nervous system is becoming developed very early on in the pregnancy. My reading of it is that there is no stage in pregnancy where alcohol does not have a potential to cause some harm to the foetus.

CHAIR: And post pregnancy, with breastfeeding?

Prof. Webster : It depends on—

CHAIR: We have got hospitals who give alcohol—

Prof. Webster : Well, that is wrong. Again, the Foundation for Alcohol Research and Education funded a major study on the relationship between drinking and breastfeeding, which was done in Western Australia. I cannot remember the details of it, but it did advise in the end—and the government took this up—that alcohol should be avoided while breastfeeding.

CHAIR: So hospitals, be they public or private—certainly I know of a private hospital in Brisbane, where my children were born, where there was alcohol. So there is a disconnect between the care—

Prof. Webster : There is an absolute disconnect, yes.

Ms Walker : For Hansard I should reinforce that the NHMRC guidelines are very clear that the safest option is no alcohol, both during pregnancy and breastfeeding, and there is a really good reason for that.

CHAIR: I wanted to touch on promotion. I am 46. I remember tobacco ads, I remember the Marlborough man, I remember billboards, I remember the Winfield Cup—

Mrs MOYLAN: You are showing your age.

CHAIR: I am showing my age. In my lifetime, now you would not find a football competition sponsored by tobacco. It would be hard to find a tobacco product advertised in public spaces and the like. Obviously the government of the day saw the promotion of tobacco as being one of the things, along with price and availability. Would you like to comment, especially in the context of two per cent of the health budget being spent on prevention—

Ms Walker : No, no, it is pretty well solid across.

Mr Templeman : The minister mentioned it the other day at a specific launch in relation to money for sports programs.

Ms Walker : Two per cent is generous. In some jurisdictions it is less than that. Two per cent is the average. The AIHW has a study that I think is done biannually and it looks not just at Commonwealth government spending but at the jurisdictional governments.

Mr Templeman : The minister also made a comment that most of the two per cent goes on immunisation.

CHAIR: I vaguely remember the economic arguments about tobacco, because obviously governments were receiving a percentage of every smoker's habit. But I guess there was an economic argument about whether or not the costs were there, because lung cancer and hospital patients' time, because of tobacco consumption, economically just did not add up. So could you comment on alcohol? We have had comments about the number of deaths and assaults and time spent in emergency departments. Has there been a balance sheet of alcohol cost to society? There are two questions there.

Mr Thorn : We were talking about how pregnant women should not drink. That is what the independent experts say—the NHMRC. We have a clear label on all tobacco products that say, 'Do not smoke' or 'Smoking will harm the unborn baby'. That is a nice segue to alcohol promotion. The whole experience with the way tobacco has been managed out is very instructive around alcohol. The issue was triangulated. We did talk about price, we did talk about promotion and we are increasingly talking about its availability. We certainly do not talk about alcohol and tobacco as the same sort of product, but in terms of trying to mitigate the harms that alcohol causes, yes, you can adopt exactly the same sorts of strategies. The evidence is strongly supportive of applying a number of those approaches to alcohol. Our foundation's funded research would suggest that, on a cost of illness basis, alcohol costs the community around about $36 billion per annum.

CHAIR: That is deaths, lost productivity, hospitalisation, assaults?

Mr Thorn : A whole gamut of things.

CHAIR: Looking after people with FASD.

Mr Thorn : About $15 billion of those costs are attributed to the drinkers themselves. The balance, the majority of it, is what we call harm to others—in other words, the other people. The unborn child is a classic 'harm to others' victim. That child did not have a choice about their mother's drinking and they live with the consequences of that.

CHAIR: So that is a lost productivity type of analysis.

Dr STONE: Incarceration, suicide.

Mr Thorn : In terms of a child, they are unlikely to ever hold down a job. They will be in the justice system.

Mrs MOYLAN: Indeed, it is a cost.

Mr Thorn : Yes, there will be costs for their entire lives.

CHAIR: What is the government collecting?

Mr Thorn : The government collects about $6 billion in revenue.

CHAIR: So that is $36 billion to $6 billion, you said?

Mr Thorn : They are not exactly comparable. What we need to do—as a community, not just government—is to get a better handle on what the precise tangible costs are to government. Our knowledge needs to be improved in order to assess the precise costs to our health services, to our justice system, through the loss of productivity to employers.

Mrs MOYLAN: Perhaps we should refer it to the Productivity Commission.

Dr STONE: Heaven help us!

Mr Thorn : It has been suggested in the past.

CHAIR: I want to go back to these figures. They are rubbery figures. There is a rigour there—

Mr Thorn : There is a plus and minus. There is an error factor.

CHAIR: Yes. Does the $6 billion of government revenue include income tax?

Mr Thorn : No. That is just excise and the wine equalisation tax.

CHAIR: So it does not include the income tax of all the people who work in the alcohol industry, the service of alcohol industry and all those other things?

Mr Thorn : No.

Dr STONE: Because Mrs Little is here, I just want to spell out the issue we were talking about just now of the costs to the community as a consequence of alcohol consumption or abuse and FASD. One of the problems with Indigenous communities is that when people are trying to retain traditional languages, or indeed traditional knowledge, lore and culture, if a baby is born without the capacity to remember or learn then we have lost the culture with that child. It is another form of cultural genocide, someone has suggested. Do you want to comment on that, for the record?

Mrs Little : In our area there would probably be three communities that have retained their language, because the missionaries punished people for speaking it. So in most of the communities English is the first language. What I see happening is that the children are learning, particularly in one committee of Aurukun. Every child is speaking their language. So to me it did not look as though there was anything stopping the children doing that.

Dr STONE: I suppose I was talking about the individual child who was born with brain damage as a consequence of alcohol consumption. That child will have difficulty learning anything, much less the traditional culture, or retaining memory.

Mrs Little : Absolutely. It is the mental health as well as FASD that would prevent them learning.

Dr STONE: We also took evidence about the initiation of young boys, in particular in Western Australia. It was a difficulty for the community to decide whether they took those boys who had FAS or FASD through initiation. That was a very serious cultural issue for those communities.

Mrs Little : That is the blockage and that is what is happening. What I am proud of is that some of our communities have said: 'This is our business. What is your business is to work with us to stop it happening in the future.' That is what they are doing to prevent that, particularly the elders of those communities. They are working with the young mothers and fathers. But FASD has an impact on those children, and that is for the future as well.

Prof. Webster : I really want to just follow up something that Mr Michael Thorn was speaking about. You were discussing with him the costs of alcohol in dollar terms, and some work that FARE had costed that at $36 billion in a year. But one of the key elements of that study—and Mr Thorn has said this—was that alcohol harms not only the person that is drinking but harms others and it harms strangers. In the context of children, I want to make the point that, in one-third of child protection cases, the person that has perpetrated the abuse upon the child—a parent, an adult, someone who was there to protect the child—had been drinking. This goes back to the notion that not only is it the mother we should be talking about with alcohol and being concerned; there are other members of the family whose drinking can be harmful to children in that environment which should be nurturing the child.

CHAIR: As in they were intoxicated at the time?

Prof. Webster : Alcohol affected their judgment so that they behaved in such a terrible way.

CHAIR: I think you are drawing a bit of a long bow to suggest that you become a paedophile because you—

Prof. Webster : I have not used the word 'paedophile'.

CHAIR: No, but you said, 'assaulted children'.

Prof. Webster : Child protection cases are about assaults to children, whatever it is, whether it is psychological or whether it is physical or whether it is deprivation.

Mr Thorn : Most of these cases are not about sexual abuse. Overwhelmingly it is about neglect, harm and assault.

Prof. Webster : Some of them were sexual abuse.

CHAIR: I think we will have to wrap up there, guys.

Ms Walker : If I could say one more thing very quickly, I would like to go back to our ice cream analogy and the issue of rationale for government intervention. From a public health perspective, with FASD we are really talking about the pointy end of risk and harm. While eating too much ice cream might be bad in terms of your waistline, it is not going to cause your baby to look like that one over there. I think that is a really important point to make.

CHAIR: I do not think there is any medical evidence to suggest that one ice cream cone will affect your child, but you have evidence that one drink could harm your child.

Dr STONE: At the wrong time.

CHAIR: Yes, at the wrong time in the pregnancy. I just want all consumers of ice cream to calm down. It was only a metaphor! Before closing the public hearing: we received a submission from FARE and I ask a member to move that it be received as evidence and authorised for publication as a supplementary submission.

Mrs MOYLAN: So moved.

CHAIR: For and against—I declare that carried. We also received a document from FARE and ADCA, and I ask that it be received as an exhibit.

Dr STONE: So moved.

CHAIR: For and against—I declare that carried. I thank everybody for their attendance today.

Resolved (on motion by Dr Stone):

That this committee authorises publication, including publication on the parliamentary database, of the transcript of the evidence given before it at public hearing this day.

Committee adjourned at 10:03