FOREWORD. However promising these signs are, they represent only tentative first steps. NSW must now complete the job that it started last January.

FOREWORD Not one more. As we head into summer and brace for the unwelcome, but expected increase in alcohol harms, the upcoming New South Wales (NSW) State Election in March provides the people of NSW with an opportunity to ensure that their next Government continues to work towards a comprehensive plan that addresses alcohol harms. The Coalition Government deserves credit for the action it took in January 2014 to prevent alcohol-related violence, adopting some of the measures long advocated by the NSW and ACT Alcohol Policy Alliance (NAAPA). So too, the Labor Party deserves recognition as the first party to commit to evidence-based policies to tackle the State s heavy alcohol toll. However promising these signs are, they represent only tentative first steps. NSW must now complete the job that it started last January. Not one more unsafe community. All of the people of NSW deserve and demand safe and healthy communities, regardless of postcode. Alcohol harms exist beyond the infamous Kings Cross precinct and the streets of the inner Sydney CBD. The NSW Government must also acknowledge those harms and aspire to improve the lives of all communities within their jurisdiction. Not one more disempowered community. So too, we must ensure all communities have a voice and that their voice is being heard. We know communities want a say in how alcohol is made available in their communities and we also know that the complexity of the current legislative and regulatory environment, which places the onus of proof on communities, all but ensures they are prevented from doing so. Not one more industry driven policy measure. Government action on alcohol must prioritise the health and safety of the people of NSW, ahead of alcohol industry interests. That requires political parties to be free of vested interests and be willing to demand that alcohol policy be evidence-led and not industry-driven. It also requires that the alcohol industry, which profits so excessively from its products, be compelled to pay for the alcohol harms it causes. Not one more preventable disease. Alcohol contributes to more than 200 health conditions including heart disease, cancer and liver cirrhosis, and exacts a heavy human and financial toll on the people of NSW. This costs more than $575 million in providing hospital, ambulance and aged care services annually. While it is important to acknowledge the measures announced in January 2014; the introduction of a Sydney CBD precinct with 3am last drinks, a 1:30am lockout and a freeze on new liquor licenses, together with State-wide measures including a 10pm close for takeaway alcohol sales and the introduction of risk-based licensing fees; effective alcohol harm reduction does not begin and end with those measures. Not one more. Each day in NSW alcohol is responsible for 66 assaults, 27 of which are domestic assaults, 28 emergency department presentations, 142 hospitalisations and three deaths. It is a staggering and frightening toll, a roll-call of unacceptable and preventable harms that can only be fully addressed by a comprehensive plan of action. NAAPA s election platform provides such a solution, and contains five key policy priority measures: protecting children and families, putting communities first, reducing disability and disease, preventing street violence and building a robust alcohol harm prevention framework. The plan recognises the absolute need to develop an evidence-based state-wide alcohol plan; one that acknowledges this is an issue impacting on all communities throughout the State and one that ensures government efforts are coordinated, comprehensive and cost effective. NAAPA s election platform calls for the creation of a Community Defenders Office, a service that would support and assist communities throughout NSW in having a say in how alcohol is made available in their communities. 2

FOREWORD It would also see the continued funding of the dedicated Fetal Alcohol Spectrum Disorder (FASD) clinic at the Children s Hospital in Westmead, ensuring children can not only be correctly diagnosed, but subsequently receive access to a range of health and support services that will improve their quality of life. NAAPA s election platform calls for the protection of children and families. There were almost 10,000 cases of alcoholrelated domestic violence in NSW in 2013-2014, and the evidence makes clear that the density of alcohol outlets and alcohol promotions contribute to these harms. NAAPA wants the density of outlets be a consideration when granting a new liquor licence and for the Government to ban the promotion of alcohol on public transport, bus stops, and other state property. NAAPA also wants $600,000 to be made available over four years for domestic violence services and alcohol and other drug services to develop shared models of care. NAAPA also recommends the expansion of the successful Magistrates Early Referral into Treatment (MERIT) program which currently provides adult defendants with substance abuse problems the opportunity to access treatment as part of their bail conditions. Currently the program is largely limited to defendants with issues with illicit drugs, but should be expanded so that all local courts offering the MERIT program would also offer alcohol services. NAAPA is also calling for measures to ensure the alcohol industry is not involved in alcohol policy development, beginning with maintaining the ban on political donations from the alcohol industry to NSW political parties, and the development of a code of conduct that would ensure the alcohol industry does not play any part in the development of alcohol policy or health promotion programs in line with World Health Organization (WHO) recommendations. These eight demands along with the other 11 that comprise this comprehensive plan are only the beginning. The plan recognises there is much more to be done to reduce alcohol harms. The alcohol industry and its apologists will argue that the work is done. They are wrong. Alcohol harms, alcohol kills, and one preventable death from alcohol is one too many. This summer, NAAPA says Not one more. NAAPA s NSW Election Platform lays out a clear roadmap to prevent and to reduce alcohol harms across NSW, and we call upon the Government and Opposition, State MP s and future political candidates from all parties to declare their commitment to our election platform and towards a safer and healthier NSW. SCOTT WEBER PRESIDENT JIM L ESTRANGE CHIEF EXECUTIVE OFFICER DR SAXON SMITH PRESIDENT MICHAEL THORN CHIEF EXECUTIVE POLICE ASSOCIATION OF NEW SOUTH WALES CANCER COUNCIL NSW AUSTRALIAN MEDICAL ASSOCIATION NSW FOUNDATION FOR ALCOHOL RESEARCH AND EDUCATION 3

ABOUT NAAPA The NSW ACT Alcohol Policy Alliance (NAAPA) aims to reduce alcohol-related harms by ensuring that evidence-based solutions inform alcohol policy discussions in New South Wales (NSW) and the Australian Capital Territory (ACT). NAAPA currently has 45 member organisations from a range of fields including health, community, law enforcement, emergency services and research organisations. The following are the NSW members of NAAPA: > > Network of Alcohol and Drug Agencies (NADA) > > Pedestrian Council of Australia > > Darlinghurst Resident Action Group > > Salvation Army NSW > > Newcastle Community Drug Action Team (CDAT) > > Awabakal Newcastle Aboriginal Co Operative Ltd > > Police Association of NSW > > The Royal Australasian College of Physicians (RACP) > > Australian Medical Association (AMA) NSW > > Hello Sunday Morning > > The Royal Australasian College of Surgeons (RACS) > > Byron Bay Youth Service > > Public Health Association of Australia NSW Branch > > Law Enforcement Against Prohibition (LEAP) > > Cancer Council NSW > > NSW Nurses and Midwives Association > > National Drug and Alcohol Research Centre (NDARC) > > 2011 Residents Association > > Centre for Health Initiatives - University of Wollongong > > Bondi Beach Precinct > > Australasian College for Emergency Medicine (ACEM) > > Last Drinks in Byron > > Jewish House Limited > > Mental Health Association of NSW > > Inspire Foundation > > Bondi Residents Association > > Noffs Foundation (NSW) > > Health Services Union (HSU) > > University of Newcastle > > St Vincent s Hospital > > Ulladulla Community Drug Action Team (CDAT) > > Australian Drug Foundation (ADF) > > Drug and Alcohol Research and Training Australia (DARTA) > > The Asia Pacific Centre for Crime Prevention Griffith University (Sydney) > > The Royal Australian College of General Practitioners (RACGP) For further information about NAAPA, visit www.naapa.org.au. Contact the NAAPA secretariat at info@naapa.org.au or 02 6122 8600. 4

CONTENTS 2 FOREWORD 4 ABOUT THE NSW ACT ALCOHOL POLICY ALLIANCE (NAAPA) 6 INTRODUCTION 7 FIVE KEY PRIORITY AREAS 8 PROTECTING CHILDREN AND FAMILIES 11 PUTTING COMMUNITIES FIRST 13 REDUCING DISABILITY AND DISEASE 16 PREVENTING STREET VIOLENCE 18 BUILDING A ROBUST ALCOHOL HARM PREVENTION FRAMEWORK 20 REFERENCES 5

INTRODUCTION In January 2014 the NSW Government announced a number of reforms to prevent alcohol-related violence. These measures included the development of a Sydney CBD precinct with 3am last drinks, a 1:30am lockout and a freeze on new liquor licenses. Other measures were introduced across the state, including a 10pm close for takeaway alcohol sales and the introduction of risk-based licensing fees. These policies provide the foundation for the systemic change needed to keep our communities safe, healthy and free from alcohol harms. But there is more work to do. The human toll from alcohol is significant and the financial cost in addressing these harms puts a considerable strain on the community, amounting to $1,565 per household. This is $3.87 billion per year. 1 The people of NSW are well aware of the harms that result from alcohol. The alcohol-related violence occurring on our streets has become all too common. This violence has lifelong effects on individuals, families and whole communities. Alcohol-related violence also puts a great strain on our police officers, ambulance workers, emergency department physicians and nursing staff. The harms from alcohol do not just occur from consuming alcohol in and around pubs, clubs and bars, but also in our homes. Families are affected by alcohol in a number of ways. Alcohol is involved in 34 per cent of all reported domestic violence cases. 2 Alcohol use also impacts on children in a range of ways, including being subject to abuse and neglect. There are also long-term health impacts from alcohol consumption. Alcohol contributes to more than 200 diseases. 3 These diseases include cancers of the mouth, throat and breast, as well as cardiovascular disease and cirrhosis of the liver. Alcohol use during pregnancy can also lead to Fetal Alcohol Spectrum Disorders (FASD), which are lifelong conditions that include brain damage, birth defects, developmental delay, as well as cognitive, social, emotional and behavioural deficits. While the impacts of alcohol are far reaching and significant, this is not a problem without solutions. There is a sound evidence-base on policies and programs that work to prevent alcohol harms. We know that lower prices, increased availability and extensive promotions, increase alcohol consumption and harms and that we need to address these environmental levers if we are to reduce levels of harms. We also know that we need to raise awareness of ways that people can reduce their risk of harms from alcohol, through evidencebased public education campaigns and brief intervention programs. The NSW community is ready for change. An overwhelming majority of people in NSW (80 per cent) believe that Australia has a problem with alcohol and 80 per cent also think that more needs to be done to reduce alcoholrelated harms. 4 The time for action on alcohol is now. Through NAAPA, emergency workers, health professionals, community members, community sector workers, researchers and advocates have come together to present a comprehensive plan that addresses alcohol harms. The plan is outlined under five key priority areas: 1. Protecting children and families 2. Putting communities first 3. Reducing disability and disease 4. Preventing street violence 5. Building a robust alcohol harm prevention framework. NAAPA s election platform presents this plan. 6

NAAPA S 2015 NSW ELECTION PLATFORM PROTECTING CHILDREN AND FAMILIES > > Require the density of outlets to be a consideration in granting a new liquor licence in both planning and liquor licensing legislation. > > Introduce saturation policies that allow for areas to be deemed saturated with both on and off-licence premises. > > Provide $600,000 over four years for support for domestic violence services and alcohol and other drug services to develop shared models of care. > > Replace the grossly inadequate Liquor Promotion Guidelines with robust legislation and regulations on alcohol marketing. > > Ban the redemption of alcohol shopper docket promotions, as recommended by the Office of Liquor Gaming and Racing (OLGR). > > Ban promotions of alcohol on state property, such as public transport and bus stops. PUTTING COMMUNITIES FIRST > > Provide $800,000 over four years to develop and fund a Community Defenders Office based on the successful Alcohol Community Action Project (ACAP) pilot. > > Review the flawed Community Impact Statement scheme by ensuring onus of proof does not sit with the community. > > Maintain the ban on political donations from the alcohol industry. > > Introduce a code of conduct on the engagement with the alcohol industry that reflects the World Health Organization (WHO) recommendation that the industry not be involved in policy development. REDUCING DISABILITY AND DISEASE > > Provide $10 million over four years to develop and fund an ongoing public education campaign on the health impacts of alcohol consumption. > > Provide $1.2 million over four years to establish a Fetal Alcohol Spectrum Disorder (FASD) clinic at the Children s Hospital at Westmead in Sydney. > > Provide $2 million over four years to fund a brief intervention program for alcohol in primary care and emergency department settings. > > Expand the Magistrates Early Referral Into Treatment (MERIT) program to include alcohol. PREVENTING STREET VIOLENCE > > Limit extended trading venues to a 3am close and introduce 1am lockouts. > > Provide a formal mechanism for communities to request precinct-wide measures that are appropriate for their local areas. > > Abolish all existing 24 hour liquor licenses and maintain the current policy of not granting new 24 hour licenses. BUILDING A ROBUST ALCOHOL HARM PREVENTION FRAMEWORK > > Develop a state-wide alcohol harm prevention plan. > > Mandate the collection of alcohol sales data across all of NSW. 7

FIVE PRIORITY AREAS PROTECTING CHILDREN AND FAMILIES 1 > > 34 per cent of reported domestic violence incidents involve alcohol. > > There were almost 10,000 cases of alcohol-related domestic violence in NSW in 2013-14. > > In NSW alcohol results in a $113.5 million cost to child protection and intensive family services. > > For every 10,000 additional litres of pure alcohol sold at a packaged liquor outlet, the risk of violence experienced in a residential setting increases by 26 per cent. > > Alcohol outlets in Sydney have an average of 30.2 point of sale promotions per outlet. > > 71 per cent of Australians believe that alcohol advertising and promotions influence the behaviour of people under 18 years. Children and families are affected by alcohol in a number of ways. Alcohol is implicated in a large number of domestic violence incidents, with alcohol increasing both the likelihood of the violence occurring as well as the severity of the incidents. The latest data from the NSW Bureau of Crime Statistics and Research (BOCSAR) show that of all the domestic violence incidents reported to NSW Police in 2013-14, 34 per cent were alcoholrelated. 5 This equates to 9,939 alcoholrelated domestic assaults in NSW between July 2013 and June 2014. The impacts of domestic violence on women and children are numerous and devastating. For women they include premature death and injury, poor mental health, and the development of alcohol use disorders. 6 A report by VicHealth found that compared to common risk factors such as high blood pressure and smoking, intimate partner violence is responsible for more preventable ill-health and premature death in Victorian women of reproductive age. 7 Children who live with domestic violence, whether they are witnesses of the violence, or experience the abuse directly, are likely to experience mental health issues, 8 are at particularly high risk of being perpetrators or victims of abuse themselves, and are likely to develop their own alcohol and drug problems. 9 In NSW the cost of alcohol through child protective services was $91.1 million in 2010. An additional $22.4 million was spent on family support services due to alcohol. 10 Children under 18 years of age are also particularly susceptible to alcohol harms from their own consumption, such as risky or antisocial behaviour, adverse impacts on brain development and a higher likelihood of developing alcohol problems later in life. 11 Young people under the age of 18 years are also disproportionately represented in acute alcohol emergency department presentations. In 2013, 15-17 year olds presented to emergency departments for alcohol at a rate of 202.9 presentations per 100,000 population, compared to the general population rate of 159.9 presentations per 100,000 population. 12 THE EVIDENCE We know that women and young people are disproportionately affected by the drinking of others. We also know that the broader drinking environment such as the density of alcohol outlets and alcohol promotions contribute to these harms. Research has consistently found an association between alcohol outlet density (i.e. the number of active liquor licenses in an area) and negative alcohol-related outcomes such as assaults, adolescent drinking, domestic violence, drink driving, homicide, 13 14 15 suicide, and child maltreatment. An Australian study from Melbourne has found that there is a strong association between domestic violence and the concentration of off-licence liquor outlets in an area, in that a 10 per cent increase in off-licence liquor outlets is associated with a 3.3 per cent increase in domestic violence. Increases in domestic violence were also apparent with the increase in general (pub) licenses and on premise licenses. 16 A study in Western Australia, found that for every 10,000 additional litres of pure 8

PROTECTING CHILDREN AND FAMILIES alcohol sold at a packaged liquor outlet, the risk of violence experienced in a residential setting increased by 26 per cent. 17 Children and adolescents are also exposed to unprecedented levels of alcohol marketing and promotions and this exposure influences young people s 18 19 20 drinking. Studies consistently demonstrate that the volume of alcohol advertising exposure is the strongest predictor of future consumption patterns in young people, including initiation of alcohol consumption, and heavier consumption among people who already drink. 21 The NSW Government has responsibility for both point of sale (POS) promotions and promotions on public property, such as promotions on public transport. POS are promotions found within or on the exterior of licensed premises at the point where an alcohol purchase is made (e.g. happy hours, free gifts with purchase, prominent signage, competitions, price discounts for bulk purchases, and sale prices). POS have been found to be particularly effective in encouraging the purchase of 22 23 increased volumes of alcohol. Both POS and other forms of outdoor advertising are prolific. Alcohol outlets in Sydney have an average of 30.2 POS promotions per outlet. 24 A study in Sydney and Wollongong found that alcohol promotions made up 22 per cent of all of the outdoor advertising surrounding schools. For each square kilometre there were 25 alcohol advertisements. 25 The majority of Australians (71 per cent) believe that alcohol advertising and promotions influence the behaviour of people under 18 years. THE SOLUTIONS Require the density of outlets to be a consideration in granting a new liquor licence in both planning and liquor licensing legislation. The WHO has identified the importance of considering alcohol policies in the prevention or mitigation of domestic violence. 26 The density of liquor licensing should be included as part of the planning and liquor licensing processes by developing cumulative impact polices. Cumulative impact policies take into consideration impact additional liquor licenses will have on a community, particularly in areas where there is a large number of liquor licenses. These policies should be included in both the planning and liquor licensing legislation to ensure areas do not become saturated with liquor licenses. Introduce saturation policies that allow for areas to be deemed saturated with both on and offlicence premises. Policies that target the availability of alcohol include saturation policies where areas can be deemed to be saturated with both on and off-licence premises, resulting in no further licenses being granted. When an area is deemed saturated, policies should be in place to impose limitations on the provision of new liquor licenses. Since 2005, local authorities in England and Wales (typically a council or borough) have been able to establish saturation zones within their licensing policies where no new licensed premises are permitted. 27 These saturation zones are determined on the basis of existing outlet density levels and crime data including domestic violence statistics. Provide $600,000 over four years for support for domestic violence services and alcohol and other drug services to develop shared models of care. Work is needed to develop best practice strategies for collaboration between domestic violence and alcohol and other drug services. A no wrong doors approach to support services should be provided by both domestic violence sectors and alcohol treatment sectors so that victims are not turned away from services. For example, a woman seeking refuge from domestic violence should not be turned away because of problems with alcohol. A state-wide model of care is needed, whereby domestic violence and alcohol treatment services work together to determine the most appropriate support mechanisms for the victim, whether based in the alcohol treatment service or the domestic violence service. Funding should also be provided to organisations to implement the model of care and include resourcing for activities such as agency cross training. Replace the grossly inadequate Liquor Promotion Guidelines with robust legislation and regulations on alcohol marketing. The current Liquor Promotion Guidelines fail to appropriately regulate promotions within the contemporary advertising market. The Liquor Promotion Guidelines do not adequately address harm minimisation in the promotion of liquor, nor do they adequately address on- and off-licence venues and public health concerns regarding liquor promotions. Most Australians consume alcohol in a domestic setting 28, with 80 per cent of all alcohol purchased from off-licence venues. However off-licence promotions are not included in the Liquor 9

PROTECTING CHILDREN AND FAMILIES Promotions Guidelines. Price based promotions which results in alcohol being made available for as little as 22 cents a standard drink are also not regulated under the current promotion policy. This is problematic because lower prices are associated with increased consumption and harms. The Liquor Promotion Guidelines should be replaced with robust regulations that address both on and off-licence premises, including price based promotions. Consultation with the community and public health experts should occur to ensure harm minimisation is the key objective in the development of the regulations. Ban the redemption of alcohol shopper docket promotions, as recommended by the Office of Liquor Gaming and Racing (OLGR). Shopper dockets are coupons or vouchers for free or discounted alcohol printed at the bottom of supermarket shopping receipts. Shopper dockets have been a concern for the NSW regulator over the past year. Following a six month investigation into shopper dockets by OLGR in 2013, the agency found shopper dockets were likely to encourage the misuse and abuse of liquor. As a result of these findings, OLGR recommended that shopper dockets promoting discounted alcohol should be banned. Despite the finding, the Director General of the Department of Trade and Investment did not support his Agency s recommendation. 29 OLGR found that shopper dockets are likely to encourage the misuse and abuse of liquor. In light of this finding, the redemption of shopper dockets promoting discounted alcohol should be banned. Ban promotions of alcohol on state property, such as public transport and bus stops. One of the ways in which children and young people are being exposed to alcohol promotion is on public transport, such as buses, trains and at bus and train stops. The NSW Government has a role to play in protecting children from being exposed to alcohol promotions by removing alcohol advertisements from state property such as at train and bus stations, and on and in public transport. Women and young people are disproportionately affected by the drinking of others... We also know that the broader drinking environment such as the density of alcohol outlets and alcohol promotions contribute to these harms. 10

FIVE PRIORITY AREAS PUTTING COMMUNITIES FIRST 2 > > 48 per cent of Australians feel they do not have enough say in the number of licensed venues in their local area. > > Over half (56 per cent) of Australians believe that alcohol industry donations influence governments decision-making. > > 64 per cent of Australians believe that political parties should not be able to receive donations from the alcohol industry. Communities know about the impact that alcohol has on their local area and the challenges they face when dealing with decision makers. Communities are affected by alcohol in a number of ways. They endure the noise and disruption from licensed venues, they avoid areas where alcohol use and misuse has led them to feel unsafe, they live alongside and are affected by alcohol-related violence and their children are witnesses of alcohol fuelled violence. Only five per cent of Australians have made a complaint about a licensed venue and almost half feel they do not have enough say in the number of licensed venues in their local area. 30 The communities of NSW are also concerned about the undue influence that results from political donations by private entities. Over half (56 per cent) of Australians believe that alcohol industry donations influence governments decisionmaking, and almost two thirds (64 per cent) of Australians believe that political parties should not be able to receive donations from the alcohol industry. 31 Prior to the ban on alcohol industry political donations which came into effect on 1 January 2011, the alcohol industry were significant donors to NSW political parties. In the financial year ending June 2011 the Australian Hotels Association (AHA) NSW made donations of $546,797 to NSW political parties, including $79,850 to the Labor Party, $318,955 to the Liberal Party and $147,992 to the Nationals. 32 This funding was greater than the funding provided in the two financial years prior ($418,011). It is clear from these figures that members of the alcohol industry have been very supportive to political parties in the past through donations. THE EVIDENCE We know that communities want a say in the way alcohol is made available in their communities. We also know that navigating the liquor licensing and planning systems is complex for community members. In the NSW, there is limited opportunity for community engagement with liquor licensing and planning decisions. The complexity of the legislative and regulatory environment for liquor in NSW poses a range of barriers to community members who seek to navigate this legislative and regulatory landscape. The hurdles that community stakeholder are confronted with are threefold, and concern the legislative, regulatory and resource challenges. These challenges discourage community participation; limit the ability of stakeholders to present consequential objections or complaints; and exclude some stakeholders from the process altogether. The concern here is that warranted complaints and objections may be overlooked, or never made to the regulatory authorities. It is now well accepted in public health literature that the alcohol industry should not be involved in the development of alcohol policy and programs. The WHO s Expert Committee on Problems Related to Alcohol Consumption recommends that Any interaction [with the alcohol industry] should be confined to discussion of the contribution the alcohol industry can make to the reduction of alcoholrelated harm only in the context of their roles as producers, distributors and marketers of alcohol, and not in terms of alcohol policy development or health promotion. 33 The alcohol industry is currently involved in the development of alcohol policy in Australia, despite their significant vested interests. An example of this, was the 2013 review of the Liquor Promotion Guidelines by OLGR. This review occurred in 11

PUTTING COMMUNITIES FIRST consultation with members of the alcohol industry. NAAPA requested involvement in this review but was denied. Documents obtained following a subpoena in the NSW Upper House by Member Dr John Kaye revealed that the final Liquor Promotion Guidelines had been significantly watered down from their original version as a result of the extensive consultation with members of the alcohol industry. The changes made as a result of the alcohol industry s engagement effectively made the Liquor Promotion Guidelines irrelevant to off-licence premises, which is where 80 per cent of alcohol is purchased, demonstrating the significant influence of vested interests in this process. THE SOLUTIONS Provide $800,000 over four years to develop and fund a Community Defenders Office based on the successful Alcohol Community Action Project (ACAP) pilot. There is no targeted support for communities to interact with the liquor licensing or planning systems. This results in unsuccessful objections and complaints or community members not engaging with these systems at all. The development and funding of a Community Defenders Office based on the Alcohol Community Action Project (ACAP) pilot would help individuals and communities in navigating and interacting with the liquor licensing system. The ACAP, was a pilot project funded by the Australian Rechabite Foundation and administered by the Foundation for Alcohol Research and Education. The purpose of ACAP was to assist individuals and organisations who wanted to interact with the liquor licensing and planning systems with the aim to reduce alcohol harms in their community. The pilot project consisted of two key resources; a community adviser and a website. The ACAP project successfully assisted numerous communities within NSW to lodge objections to liquor related development applications and liquor licences applications and provided advice to individuals who were not aware of their rights when dealing with licensing applications. The demand experienced by the ACAP project during the pilot demonstrates the need within the community for such a service. Funding of $800,000 over four years would establish a service to support and assist communities in the having a say in how alcohol is made available in their communities. Review the flawed Community Impact Statement scheme by ensuring onus of proof does not sit with the community. There is limited opportunity for community members to have a say in liquor licensing decisions. The current system that is intended to assess the impact that new liquor licenses have on communities is flawed and heavily biased towards the applicant. The Community Impact Statement (CIS) process includes a requirement for new liquor licence applicants as the main reporter of the social impacts of the proposed licence. Relying on the licence applicant as the primary source of social impact evidence raises the issues of the potential for information presented in the CIS to be biased in favour of the applicant. Communities have a right to have an informed and fair say in decisions that have the potential to negatively impact their area, reforming the CIS process will provide opportunities for greater community input. Maintain the ban on political donations from the alcohol industry. In NSW the Election Funding, Expenditure and Disclosures Act 1981 prohibits donations from property developers, tobacco, liquor or gambling industries. This is an essential policy that assists in limiting vested interests influence in policy decisions. In order to achieve meaningful change and reduce alcohol harms, the alcohol industry should not be involved in alcohol policy development. This should begin by maintaining the ban on political donations from the alcohol industry to NSW political parties. Introduce a code of conduct on the engagement with the alcohol industry that reflects the World Health Organization (WHO) recommendation that the industry not be involved in policy development. It is clear that the alcohol industry is involved in alcohol policy development in NSW. As a result of this engagement, policies are developed and implemented that are not evidencebased and that have been proven to be ineffective. A code of practice on Government engagement with industry should be developed in line with the WHO recommendation that the alcohol industry not participate in the development of alcohol policy or health promotion programs. 12

FIVE PRIORITY AREAS REDUCING DISABILITY AND DISEASE 3 > > Alcohol contributes to more than 200 health conditions. > > The healthcare costs of alcohol in NSW is $575.7 million including hospitalisations, ambulance and aged care. > > There are 1,261 alcohol attributable deaths in NSW in one year. > > There are 51,981 alcohol attributable hospitalisations in one year. > > Few Australians are aware of the link between alcohol and mouth and throat cancer (29 per cent) and breast cancer (17 per cent). > > Fewer than one in five (18 per cent) of NSW adults have been asked by their doctor about their alcohol use. According to the WHO, there are established causal relationships between alcohol consumption and more than 200 health conditions, including gastrointestinal diseases (e.g. liver cirrhosis and pancreatitis), cancers (e.g. mouth, throat and breast cancers), injuries and cardiovascular diseases. 34 The WHO has estimated that 80 per cent of all heart disease, stroke and diabetes cases and 40 per cent of all cancers, are preventable. 35 The latest available data shows that in 2011, there were 1,261 deaths and in 2012/13 there were 51,981 hospitalisations attributable to alcohol. 36 This equates to three deaths and 142 hospitalisations per day. Alcohol use during pregnancy can also have devastating lifelong impacts. Fetal Alcohol Spectrum Disorders (FASD) is an umbrella term for a range of disabilities resulting from prenatal alcohol exposure. FASD are lifelong conditions that include brain damage, birth defects, developmental delay, as well as cognitive, social, emotional and behavioural deficits. The majority of Australians are unaware of the full extent of alcohol s contribution to long-term health conditions. Most Australians associate illnesses such as cirrhosis of the liver (80 per cent) and liver cancer (74 per cent) and heart disease (56 per cent) with alcohol misuse. 37 However, fewer Australians are aware of the link between alcohol misuse and stroke (47 per cent), mouth and throat cancer (29 per cent) and breast cancer (17 per cent). 38 In addition to the human toll of alcoholrelated health harms, there are also significant financial costs. The annual health costs of alcohol in NSW in 2010 equated to $575.7 million including hospitalisations, ambulance and aged care. THE EVIDENCE We know that alcohol contributes to a large number of health conditions from birth. We also know that few Australians are aware of the link between alcohol and many of these health harms. In Australia, 47.3 per cent of women consume alcohol when they become pregnant and one in five continue to consume alcohol after their pregnancy is confirmed. 39 Alcohol use in pregnancy can lead to FASD, which is the leading preventable cause of non-genetic, developmental disability in Australia. 40 Despite this, little or no action has been taken on the prevention of FASD, its diagnosis and in supporting people with FASD and their carers. The most current data available suggests that prevalence for Fetal Alcohol Syndrome (FAS), one of the conditions within the spectrum, is between 0.06 and 0.68 per 1,000 live births in the general Australian population and between 2.76 and 4.7 per 1,000 births among Aboriginal and Torres Strait Islander peoples. However, these figures are likely to be significant underestimates due in part to low diagnosis rates. 41 Since 1988 alcohol has been classified by the WHO as a Group 1 Carcinogen. This classification is only given to products that have been proven to cause cancer in humans. This is the same classification given to 13

REDUCING DISABILITY AND DISEASE tobacco smoke and asbestos. Cancer Council Australia estimates that anywhere between 2,182 and 6,620 new cases of cancer in Australia in 2009 were attributable to long-term chronic use of alcohol. 42 Public education campaigns can increase awareness of FASD and other health harms, which when implemented as part of a comprehensive campaign can lead to behaviour change. Screening and brief intervention programs (SBIs) are an efficient way for health professionals to assess harmful alcohol consumption. SBIs involve health professionals asking consumers questions about their alcohol use and providing advice to motivate risky drinkers to reduce their alcohol consumption. The use of an SBI to treat early stage problem drinking can save health system resources in the long-term because it can ameliorate the need for later stage treatment which may be more intensive and costly. The effectiveness of SBIs in the primary care context is well established and there is emerging evidence of their efficacy and importance in emergency and general 43 44 45 hospital settings. A study on the how much crime is drug and alcohol related found that nearly half of all police detainees attributed their current offending to alcohol or drugs, with alcohol being attributable to 30 per cent of offences. 46 Diversion programs are an efficient tool to provide offenders who use drugs and alcohol the opportunity to undertake education and/or treatment aimed at reducing the likelihood of alcohol and/or drug use and committing further crimes. THE SOLUTIONS Provide $10 million over four years to develop and fund an ongoing public education campaign on the health impacts of alcohol consumption. In Australia and internationally public education campaigns have been effectively used to raise awareness of public health issues such as the harms associated with tobacco use and risks 47 48 associated with drink driving. However, alcohol-related social marketing campaigns in Australia, with the exception of those relating to drink driving, have been ineffective and had little impact. 49 This has been because they are too often ad hoc, not sustained and have had ambiguous messaging. A comprehensive and coordinated public education campaign that communicates the messages of the health harms that result from alcohol and ways to reduce risk of these harms is needed. This campaign should focus on the often overlooked long-term health harms from alcohol, such as chronic disease and cancer. The campaign should focus on communicating messages on how people can reduce their risks from consuming alcohol, by drinking within the Australian Guidelines to Reduce Health Risks from Drinking Alcohol. These Guidelines specify that people should limit their alcohol consumption to no more than two drinks per day to reduce their risk of long-term harms. Provide $1.2 million over four years to establish a Fetal Alcohol Spectrum Disorder (FASD) clinic at the Children s Hospital at Westmead in Sydney. There are two dedicated FASD diagnostic clinics in Australia; one on the Gold Coast, funded by Queensland Health and one based at the Children s Development Unit within The Children s Hospital at Westmead in Sydney, for which FARE provided one year of pilot funding. The funding is due to end on 30 June 2015 and further long-term funding is needed to ensure the continuation of this valuable program. The clinic is run by Professor Elizabeth Elliott AM, Professor in Paediatrics and Child Health at the University of Sydney and Consultant Paediatrician at the Children s Hospital at Westmead. Children (aged 0 to 16 years) who are referred to the clinic undergo a comprehensive assessment consisting of full history and medical checks as well as assessments in developmental and/ or neuropsychology issues, speech and language, as well as occupational and physiotherapy developmental issues. 50 The child is initially seen by a paediatrician and then referred to the other specialists for further tests. To make a diagnosis the multi-disciplinary team reviews the results from all of the assessments and recommends a final diagnosis. This allows for specialist teams to focus on the diagnosis of FASD and would result in teams of health professionals specifically trained in the diagnosis of FASD. Funding of $1.2 million over four years will ensure that the clinic at Westmead Hospital employs a part-time paediatrician who can coordinate access to allied health services needed by the child. The funding will also provide opportunities for the clinic to continue to build capacity for health professionals to diagnose FASD. Provide $2 million over four years to fund a brief intervention program for alcohol in primary care and emergency department settings. Despite the evidence supporting their effectiveness of SBIs only 18 per cent of NSW adults had been asked by their doctor about their alcohol use in the past 12 months. 51 A structured SBI program is needed to support health professionals to routinely talk to people 14

REDUCING DISABILITY AND DISEASE about their consumption. SBIs are inexpensive, take little time to implement (as little as five to 10 minutes), and can be undertaken by a wide range of health and welfare professionals. The uptake of SBIs and the identification of people with alcohol use problems are low and health professionals list a range of barriers when undertaking SBIs including a lack of financial incentives, time constraints, lack of confidence and concerns about achievement of results. 52 53 54 Funding of $2 million over four years to the development and implement a SBI program in primary care and hospital settings would see a preventive focus on alcohol harms. Expand the Magistrates Early Referral Into Treatment (MERIT) program to include alcohol. The Magistrates Early Referral Into Treatment (MERIT) program provides the opportunity for adult defendants with substance abuse problems to work towards rehabilitation as part of the bail process. The program is usually limited to defendants whose primary concern is illicit drugs, however, at selected courts the program is available to defendants with a primary alcohol issue. A MERIT treatment plan is tailored to match the defendant s individual needs. This may include detoxification, residential rehabilitation, pharmacotherapies and counselling. The program allows defendants to focus on treating their drug or alcohol problem separately from legal matters, although a Court may also make their involvement in MERIT a condition of bail. 55 Initial evaluations of the MERIT program have found that there is significant improvement in health and wellbeing of defendants and associated with a reduced risk of criminal reoffending. 56 Nine of the 65 local courts with MERIT programs in place offer alcohol services. This should be expanded so all local courts offering the MERIT program should also offer alcohol services. The majority of Australians are unaware of the full extent of alcohol s contribution to long-term health conditions. 15

FIVE PRIORITY AREAS PREVENTING STREET VIOLENCE 4 > > 38 per cent of people in NSW have experienced alcohol-related violence. > > Each day in NSW there are 34 alcohol-related assaults on our streets. > > 67 per cent of people in NSW feel unsafe in the city or the centre of town on a Saturday night, with 94 per cent of these people saying this is because of alcohol. > > The estimated cost to NSW taxpayers of policing, courts and prison as a result of alcohol was $915 million in 2010. > > 82 per cent of NSW adults support a closing time for pubs, clubs and bars of no later than 3am and 70 per cent support a 1am lockout. Alcohol-related violence occurs all too often in our streets, resulting in long lasting effects for the people involved in the incident, their families and the broader community. In NSW more than one third (38 per cent) of people in NSW have experienced alcohol-related violence. 57 In 2013-14 there were 12,494 incidents of non-domestic alcohol-related assaults and 1,644 alcohol-related assaults on police. 58 The financial cost of responding to alcohol-related violence in NSW is significant. In 2010 the cost was $915 million, including the cost of policing, courts and prisons. 59 Policing alone accounts for more than one third (36 per cent) of the direct costs of alcohol for the NSW Government and courts and prisons together account for a further 10 per cent. The prevalence of alcohol-related street violence in NSW has resulted in people feeling that the city is unsafe. Polling in 2014 revealed that 67 per cent of NSW adults think it is unsafe in city CBD or town centre on a Saturday night. Of these people, 94 per cent said they felt unsafe because of people affected by alcohol. 60 While alcohol-related violence can occur at any time of the day, it is now well established that alcohol-related assaults increase significantly after midnight. 61 62 A study by BOCSAR found that the percentage of alcohol-related assaults increased substantially between 6pm to 3am, with the highest rates of alcoholrelated assaults occurring between midnight and 3am. 63 THE EVIDENCE We know that alcohol-related street violence occurs too often and that much of this violence happens after midnight. We also know that reducing trading hours of pubs, clubs and bars reduces the number of alcohol-related assaults. Even modest reductions in the trading hours of licensed venues can substantially reduce alcohol-related harms. This has been demonstrated in Newcastle, where in 2008 the NSW Liquor Administrated Board introduced restrictions to 14 hotels, including a 3 am close time and 1 am lockout (which were later amended to 3.30 am and 1.30 am following a legal challenge by the licensed premises). An evaluation carried out in the 12 months following the introduction of these restrictions found that there was a 37 per cent reduction in night time assaults between the hours of 10pm and 6 am after 18 months. 64 A further evaluation was undertaken five years after the restrictions were introduced. This evaluation found that there was a sustained reduction in alcohol-related assaults in the Newcastle Central Business District with an average of a 21 per cent decrease in assaults per hour. 65 This is consistent with findings from Norway where an average 20 per cent decrease in assaults per hour of restriction was also observed in 15 cities where trading hours were restricted. 66 In February 2014 in response to growing community concern about alcoholrelated violence, the NSW Government introduced 3am last drinks and a 1:30am lockout for licenses within the Sydney Central Business District (CBD) precinct. While these measures have only been in place for less than a year, emergency services have indicated that they are seeing fewer cases of alcohol-related 16

PREVENTING STREET VIOLENCE violence 67 and residents in and around these areas are reporting improvements in public amenity. People in NSW support measures to reduce trading hours. The majority of NSW adults (82 per cent) support a closing time for pubs, clubs and bars of no later than 3am and 70 per cent support a lockout for 1am. THE SOLUTIONS Limit extended trading venues to a 3am close and introduce 1am lockouts. The NSW Government s introduction of 3am last drinks and 1am lockouts in the Sydney CBD have now been in place for nine months. While it is too soon for a formal evaluation, initial reports from police and health professionals working on the front line, suggests that the policy is having an effect in reducing the number and severity of alcohol-related assaults. This is consistent with the experience in Newcastle. Trading hours across NSW should be limited to no later than 3am across the state, with a 1am lockout to allow all people in NSW to have safer streets and fewer harms. Provide a formal mechanism for communities to request precinctwide measures that are appropriate for their local areas. There are many communities outside the Sydney CBD precinct that experience high levels of alcohol harms. These communities should also be able to experience the reductions in alcohol harms and improvements in public amenity that result from reductions in trading hours. The experiences of these communities will differ depending on their current licensing environment. For example in the CBD, or centre of town for regional areas, there may not be venues that trade past 3am, but there may still be a strong community desire to reduce trading to 2am, or the community may want to introduce an earlier lockout of midnight. They may also want to introduce restrictions on the purchase of high alcohol content products or energy drinks after midnight. Communities should be able to introduce precinct-wide measures that suit their particular environment and assist to prevent alcohol-related harms in their local area. Abolish all existing 24 hour liquor licenses and maintain the current policy of not granting new 24 hour licenses. In November 2008, a ban on new 24 hour liquor licenses was introduced in NSW. However existing licenses were able not cancelled. In Sydney alone there are 286 24 hour liquor licenses. 68 Given what we know about the link between the availability of alcohol and harms, 24 hour liquor licenses should be removed from the liquor licensing system. Alcohol-related violence occurs all too often in our streets, resulting in long lasting effects for the people involved in the incident, their families and the broader community. 17