To reduce alcohol‐related harm we need to look beyond pubs and nightclubs

Much of the focus of alcohol policy in Australia in recent years has been on the late-night inner-city entertainment precincts. Around the country we've seen lock-out trials, caps on late-night licences, restrictions on certain products and practices in late-night venues and a range of policing interventions focused on reducing alcohol-related problems in the night-time economy. As Lancaster et al. 1 noted recently, the framing of alcohol problems as problems of young people late at night is a common and recurrent one, and one that obscures as much as it illuminates. The impacts of alcohol are felt much more broadly, with chronic diseases like liver cirrhosis, stroke, alcohol dependence and some cancers contributing to substantially more of the alcohol-attributable disease burden than assaults 2. Furthermore, while estimates are not particularly robust, Victorian police data suggest that alcohol-related violence in the home is probably at least as prevalent as the late-night public assaults that often trigger policy responses 3. Thus, while policy interventions in the night-time economy can dramatically reduce the rates of public alcohol-related violence 4, the ongoing focus on late-night entertainment precincts overlooks a broader range of opportunities. In particular, this focus overlooks the critical role of packaged liquor outlets (outlets that sell alcohol only for take away consumption, often referred to as bottle shops or off-licences). In the last few years, I have led a series of studies examining the impact of liquor licensing reform in Victoria at the local level 5-8. These studies specifically examined the relationship between the density of alcohol outlets and a number of alcohol-related harms. Three types of licences were examined: general licences (pubs and most nightclubs); packaged licences (standalone bottle shops); and on-premise licences (restaurants and bars). The results are summarised in Table 1, with the significant relationships represented by arrows (all positive, with the larger arrows representing stronger associations). Packaged outlet density was positively associated with rates of assault, domestic violence, chronic disease and very heavy episodic drinking. In contrast, the density of pubs and nightclubs was only linked with assault rates. These findings are supported by work that identifies packaged liquor as a key driver of harm rates in other Australian jurisdictions 9 and by a large international literature 10-12. An evaluation of recent restrictions to the number and trading hours of packaged liquor outlets in Switzerland suggest that policies aimed at this segment of the market can reduce alcohol-related harm 13. These findings are particularly problematic given the evidence that packaged liquor outlets tend to cluster disproportionately in socioeconomically disadvantaged neighbourhoods 14-17. Further, the growth of packaged liquor outlets in Victoria far outstrips that of pubs and nightclubs. Between 2001 and 2011, the total number of active general licences (pubs and nightclubs) was stable, while the number of packaged liquor outlets rose from 1354 to 1954 (an increase of about 44%). This expansion of the retail market has primarily been driven by the two major Australian grocery chains 18. It has been facilitated by deregulation specifically aimed at reducing restrictions on these chains 19 which has led to a sharp increase in the number of new outlets opening and a struggle for market domination that has meant routine discounting of alcohol below wholesale price 20. While the previous Victorian policy approach of capping the proportion of the market that any one company could own at 8% was considered anti-competitive by the National Competition Council, it did at least limit the escalation of the market, which has been unleashed since it was removed. Recent attempts to curb this growth via changes to planning regulations have thus far had little impact, and more wide-ranging approaches to limiting packaged liquor outlet growth are necessary. These problems are not limited to Australia, with expansions of the packaged liquor market occurring widely, even in jurisdictions with a tradition of retail monopolies 21. More generally, the tendency for media and policy-makers to react to the high-profile and visible harms that occur in the night-time economy has led to an emphasis on alcohol restrictions aimed at young people's drinking. By virtue of their public nature, these acute and dramatic harms tend to drive the alcohol policy debate in Australia, and researchers and policy-makers should encourage a more wide-ranging account of alcohol-related harm when advocating for alcohol policy reform. The recent discussion of volumetric taxation by the Australian National Preventative Health Agency is a sign that a broader focus is emerging. However, it is worth noting that the only major alcohol tax reform in recent years, the increase in the ‘alcopops’ tax, was largely driven by concerns over young people and binge drinking 22. This emphasis on youth needs to be supplemented by a more wide-ranging view of alcohol policy, recognising that alcohol-related harm is prevalent across the Australian population and that youth-focused policies will only have marginal impacts on overall rates of harm.