The swinging pendulum of alcohol policy in the Northern Territory

The Northern Territory (NT) of Australia has a longstanding reputation for enduring the highest rates of alcohol-related harm in the country, and possibly the world. For a country which counts itself among the wealthiest of democracies, our (Australia’s) status as a world leader for alcohol-related harm ought to be a cause of urgent ameliorative and restorative action at all levels of government. But, as we explore here, vested commercial interests appear to maintain a firm grip on how alcohol policy plays out in practice. And like most forms of preventable disease, disability and premature death, socially and economically vulnerable populations pay the highest price. Aboriginal people make up about 30% of the NT population, suffer significant social disadvantage, and endure high levels of harm from alcohol misuse. On the other hand, Aboriginal Territorians are more likely than their non-indigenous counterparts to abstain completely from alcohol, and if all Aboriginal drinking was subtracted from total consumption, per capita alcohol use in the territory would still be approximately 50% higher than the national average. The general public, media, policymakers and even health professionals could all benefit from realising that heavy or risky drinking is not just something that other people do. Central Australia is a good testing ground for alcohol policy effects, as alcohol-related harms are very high, and in the midst of a pandemic which has demonstrated its potential to wreak havoc on frontline healthcare services, the focus of the study by Wright et al. on alcohol-related intensive care unit (ICU) admissions to Alice Springs Hospital is timely. That alcohol’s toll on human life and society at large can be ameliorated by policy is good news in unsettling times. In more concrete terms, the message that lies at the core of the study’s findings is that policies aimed at reducing alcohol’s availability—whether by way of reduced physical access or increased price—can be relied on to save lives, save hospital beds and save dollars. In this respect, the study by Wright et al. is in concert with decades of scientific evidence and theory supporting the crucial role that alcohol availability plays in driving problematic alcohol consumption and its consequences. Australian governments and their agencies are relatively well informed of the evidence concerning the range of supply, harm and demand reduction strategies at their disposal to address alcohol-related problems and their enormous human and economic costs. This is evidenced by the many federal-level expert committees, frameworks, inquiries and guidelines that have emerged over past decades. Current initiatives, for instance, include the 2019–2028 National Alcohol Strategy, the draft National Preventive Health Strategy (alcohol and other drug-related harm listed among six focus areas), a senate inquiry into fetal alcohol spectrum disorder (FASD) and the newly minted Australian guidelines to reduce health risks from drinking alcohol. A past initiative of particular note was the Henry Tax Review, published in 2009. The review strongly recommended reform of the national alcohol taxation system, and prioritised the cessation of preferential tax treatment bestowed on the Australian wine industry by the wine equalisation tax (WET). That recommendation was never enacted, and to this day the WET props up the very large bottom end of the wine industry by taxing its products at a flat 29% of wholesale value while all other beverages (beer, spirits, cider) are taxed according to their pure alcohol content. This means that per unit of alcohol, wine generally attracts a lower tax compared to other beverage types, and the cheaper the wine at wholesale, the lower the tax. This has created a perverse incentive for wine producers to oversupply the market with the tremendous assortment of cheap, low quality, cask wines, cleanskins and home