Alcohol Healthwatch welcomes the opportunity to comment on the draft of the New Zealand Injury Prevention Strategy and commends the work that has obviously gone into creating it already.
Alcohol Healthwatch is funded by the Ministry of Health to provide expertise on alcohol-related issues. We are a charitable trust that works to reduce alcohol-related harm in the Auckland region and throughout New Zealand. Our goal is to “achieve sustained reduction of alcohol related harm in New Zealand/Aotearoa”. We involve ourselves in development and debate around alcohol-related policy and provide information, support and co-ordination for professional and community groups.
Summary of Submission
- Internationally the use and the abuse of alcohol has been identified as a major contributor to the burden of injury. As the summary below shows, alcohol is a major contributor to injury in New Zealand
- Alcohol contributes to all six of the priority areas identified in Objective 9 of the New Zealand Injury Prevention Strategy
- The significant contribution of alcohol consumption to injury in New Zealand is not acknowledged in the New Zealand Injury Prevention Strategy. Alcohol Healthwatch believes that the contribution of alcohol to injury must be included in the New Zealand Injury Prevention Strategy in order for action to reduce alcohol-related injury to occur.
- The goal of the National Alcohol Strategy 2000-2003 is ¡§to minimise alcohol-related harm to individuals, families and society¡¨. This goal is clearly linked with the vision of the draft New Zealand Injury Prevention Strategy. We strongly urge that the Injury Prevention Strategy makes explicit this link and provides the guidance to ensure that alcohol is considered in the implementation of the strategy. The suggested actions under objectives 4 and 9 are will be of particular importance.
- Alcohol Healthwatch strongly calls for appropriate information collection systems to be put in place to gather and monitor data on alcohol-related injuries in New Zealand.
General Comments on the New Zealand Injury Prevention Strategy (NZIPS)
- Vision and Goals - We commend the intention of the vision "Injury Free" and the inclusion of both culture and environmental goals. We do note however, that it will be important to be able to communicate these to those outside the Injury Prevention fields where the terms used may need clarification to ensure the widest possible engagement.
- Objectives and Actions - The NZIPS is identified as a framework for injury prevention activity and while it provides the necessary direction for action (what) it is very light on implementation and co-ordination (how). We believe that what are referred to as 'actions' would be better described as 'strategies'. While we acknowledge that an implementation plan is to be developed we feel it is important to provide some guidance as to how the actions/strategies could be implemented at the various levels - e.g. national, regional, local and across and between sectors.
- Priority and Timing - What is also missing in the Strategy is a sense of timing and priority for the suggested actions/strategies. Some wording suggests that they are the being of a process e.g. 'investigate the...' Others suggest an ongoing process e.g. 'ensure..' It is important to acknowledge that we are not starting from scratch and that many of the suggested actions may be already in action. So some guide to priority, timing/progression would be useful.
Social Determinants- Alcohol Healthwatch supports the Injury Prevention Network of Aotearoa New Zealand submission in that social and economic determinants of injury need greater consideration in the Strategy. Alcohol use, poverty and poor housing are risk factors for injury and the Strategy could include a stronger advocacy role around these issues.
Alcohol and Injury in New Zealand
Internationally the use as well as the abuse of alcohol has been identified as a major contributor to the burden of injury. Although information on the contribution of alcohol to injury in New Zealand is not routinely available, it is clear that alcohol is a major contributor to injury in New Zealand.
In order to inform action to reduce the contribution of alcohol to injury and death in New Zealand accurate data needs to be available.
Recommendation:The appropriate information collection and systems should be put in place in order for this information to be collected and disseminated.
The goal of the National Alcohol Strategy 2000-2003 (Alcohol Advisory Council and Ministry of Health. 2001) is “to minimise alcohol-related harm to individuals, families and society” which links with the vision of the New Zealand Injury Prevention Strategy (NZIPS).
Recommendation:The NZIPS include the New Zealand Alcohol Strategy in one of the strategies in Objective 9: “Develop, implement and monitor national injury prevention strategies for priority areas”.
The NZIPS identifies six priority areas in Objective 9, these are motor vehicle crashes; suicide and deliberate self-harm; falls; workplace injuries; assault; and drowning and near drowning. Alcohol is a major contributor to all of the six priority areas, yet the contribution of alcohol to injury in New Zealand is not outlined in the Strategy.
Recommendation:That the NZIPS clearly states the role of alcohol to injury in New Zealand.
The following is a brief summary of the evidence of the role that alcohol plays in the six priority areas outlined in Objective 9:
Motor Vehicle Crashes
Alcohol is one of the biggest contributing factors to many deaths and injuries on New Zealand’s roads. In 2001 alcohol contributed to 26 percent of all fatal crashes, and 14 percent of all injury crashes (Land Transport Safety Authority. 2002). However this has improved, at our highest, drink driving was a contributing factor in almost 44 percent of crash casualties in 1988.
In 2001 drinking and driving contributed to:
- 118 deaths
- 502 serious injuries
- 1272 minor injuries (Land Transport Safety Authority 2002)
Suicide and Deliberate Self-harm
A New Zealand study identified alcohol and/or drug abuse as one of the factors that predisposes young people to suicide. Many overseas studies have also had similar findings. (Summarised in Ministry of Youth Affairs et al. 2001).
National data for youth suicide attempts shows that alcohol, cannabis and other drug abuse is present in over a third of suicide attempts (Ministry of Youth Affairs et al. 1998). A recent New Zealand review indicated that 29 percent of young people had evidence of alcohol consumption at the time of their suicide attempt or at the time of presentation (Bennett S. 2002).
The Canterbury Suicide Project (Beautrais A. 1998) is a case control study of suicide and medically serious non-fatal suicide attempts in people of all ages. A subset of this data was used to explore the extent to which substance abuse contributes to suicidal behaviour. This analysis found that among those who made serious but non-fatal suicide attempts almost one third met the criteria for alcohol abuse or alcohol dependence at the time of their suicide attempts compared with 16 percent of the control group.
Searches for information on alcohol and self-harm have found no New Zealand data or studies in this area. Clearly this is an area where information should be gathered to determine the relationship between alcohol and self-harm.
Falls among young people have been identified as an injury problem in New Zealand (Injury Prevention Research Centre. 2002), however national data on the role of alcohol to falls is not readily available.
The Auckland Young Person’s Alcohol and Falls Study (Injury Prevention Research Centre. 2002) examined the role of alcohol in serious fall-related injury among people aged 16-29 in the Auckland region over a 7 month period. The study found that alcohol played a role in 23 percent of fall-related hospitalisations. Alcohol was also associated with an increased likelihood of falling from a height. Fifty four percent of falls from a height greater than one metre involved alcohol, whereas only 36 percent of non-alcohol falls were from a height greater than one metre.
Alcohol is thought to play a part in many injuries and deaths related to assaults in New Zealand. Total hospitalisations data from 1997 and 1998 showed that alcohol contributed to 2461 male assaults, and 604 female assaults (Alcohol Advisory Council. 2002). Evidence shows that alcohol is a major contributor to injury through interpersonal violence, especially assaults, violence against partners, and child abuse (Reviewed in Alcohol Advisory Council and Ministry of Health. 2001).
One of the effects of alcohol is the lowering of people’s inhibitions; this often means that people who are aggressive become more aggressive after they have been drinking. Alcohol can also trigger violent, aggressive and confrontational behaviour in normally quiet people. Alcohol is the most common trigger of family violence, estimates suggest that alcohol contributes to between 25 and 50 percent of physical assaults against partners and child abuse. (Reviewed in Alcohol Advisory Council and Ministry of Health. 2002). People who have consumed alcohol are also more likely to become victims of violence and sexual assault.
The Drinking in New Zealand survey from 2000 (Habgood et al, 2001), found that 10 percent of men and 5 percent of women had been physically assaulted in the past year by someone who had been drinking. The same survey found that 5 percent of males and 3 percent of females got into a physical fight more than once in the past year after they had consumed alcohol.
Research from 1984 found that 75 percent of violent offenders report drinking at the time of, or 30 minutes prior to the incident (Veale R. 2002).
Drowning and Near Drowning
Nationally, testing rates for alcohol and drowning are low. Alcohol was known to be involved in 11 percent of drownings in 2001 (Water Safety New Zealand. 2002). However studies have shown that the true involvement of alcohol may in fact be much higher.
A review of coroners files of people ten years or older who drowned in New Zealand between 1992 and 1994 found between 17-24 percent had a blood alcohol concentration of 100mg/100ml or higher; between 30-40 percent of cases were estimated to have a positive blood alcohol concentration (Warner et al. 2000).
A retrospective study examined drownings of people aged 15-64 years old in the Auckland area between 1988 and 1997. Over 80 percent of drowning victims had their blood alcohol levels tested as part of the post mortem. The researchers found that 30 percent had a blood alcohol level above that of the legal limit to drive (80mg/100ml), and over 40 percent of people had positive blood alcohol levels. Based on the findings from this study the researchers concluded that the role of alcohol in water-related fatalities is just as important as, if not more important, than the role that alcohol plays in deaths on the roads (Smith et al. 1999).
An ALAC sponsored study of all boating deaths in Auckland for the years 1980-1997 (Smith et al. 1999) found 27 percent of boating deaths for people aged 15-64 years old had a blood alcohol concentration greater than 80mg (the present legal blood alcohol limit for driving in New Zealand), 43 percent had evidence of drinking or had a positive blood alcohol concentration.
Alcohol can impair work performance in two main ways (Institute of Alcohol Studies UK):
1. Raised blood alcohol levels at work impair both efficiency and safety. Any deviation from a zero blood alcohol level causes impairment.
2. Alcohol dependence may be associated with drinking or being under the influence of alcohol at inappropriate times and places and can cause deterioration of skills and injuries. In safety sensitive occupations such as forestry even small amounts of alcohol could have a significant impact on performance and serious implications for safety.
Data in New Zealand is not routinely collected about the role of alcohol in workplace accidents. However the inappropriate use of alcohol has been highlighted as one of a number of preventable causes of workplace accidents (In Alcohol Advisory Council and Ministry of Health. 2001).
Overseas research has shown that alcohol is a factor in a high percentage of alcohol-related workplace injuries. A study in Scotland showed that of 35 industrial fatalities 20 percent involved blood alcohol levels in excess of the legal blood alcohol limit for driving (80mg/100ml) (Beaumont and Allsop. 1983). In the UK accidents with alcohol as a contributory factor are estimated to comprise 20-25% of all workplace accidents (Alcohol Concern).
New Zealand research and statistics are required to identify the role of alcohol in workplace injuries in order to inform action to reduce workplace injuries. Alcohol Healthwatch strongly calls for appropriate information collection and systems to be put in place to collect this information.
Although New Zealand data on the role of alcohol in injury and death is not comprehensive, the summary above clearly shows the contribution of alcohol to injury in New Zealand. To achieve the vision of the New Zealand Injury Prevention Strategy – “a safe New Zealand – injury free” the role of alcohol in injury needs to be acknowledged in order for action to be taken to reduce the role of alcohol to harm in New Zealand.
Alcohol Healthwatch wants the New Zealand Injury Prevention Strategy to acknowledge the harm that alcohol causes to New Zealanders, particularly in the six priority areas – motor vehicle crashes; suicide and deliberate self-harm; falls; assault; drowning and near drowning; and workplace accidents.
Alcohol Healthwatch would also like the New Zealand Injury Prevention Strategy to mention the New Zealand Alcohol Strategy as one of the strategies in Objective 9.
Alcohol Advisory Council. 2002. Factpack: Health and Social impact of drinking. Accessed 14/01/03. www.alcohol.org.nz
Alcohol Advisory Council and Ministry of Health. 2001. National Alcohol Strategy 2000-2003.
Alcohol Concern. Workplace – Drugs and alcohol in the workplace. Accessed 13/01/03. www.alcoholconcern.org.uk
Beaumont P, Allsop S. 1983. Beverage Report, Occupational Health & Safety October 1983. p25-27
Beautrais A. 1998. The Role of substance abuse in serious suicidal behaviour: The Canterbury suicide project. Alcohol Advisory Council - Say When. November 1998.
Bennett S. 2002. The Risk and Resistance Project: Explorations of Pakeha/New Zealand European young people’s suicide behaviour. PhD Thesis. University of Auckland
Habgood R, Casswell S, Pledger M, Bhatta K. 2001, Drinking in New Zealand: National surveys comparison 1995 and 2000. Alcohol and Public Health Research Unit, University of Auckland.
Injury Prevention Research Centre. 2002. Alcohol and fall safety. The Auckland young persons and falls study. Retrieved 07/01/03. www.auckland.ac.nz/ipc/
Institute of Alcohol Studies UK. Fact Sheet, Alcohol and the workplace. Retrieved 07/01/03 www.ias.org.uk
Land Transport Safety Authority. 2002. Drinking and driving statistics. Retrieved 07/01/03. www.ltsa.govt.nz
Ministry of Youth Affairs, Ministry of Health, Te Puni Kokiri. (1998). New Zealand Youth Suicide Prevention Strategy
Smith G, Coggan C, Koelmeyer T, Patterson P, Fairnie V, Gordon A. 1999. The role of alcohol in drowning and boating deaths in the Auckland region: An updated report to ALAC. Injury Prevention Research Centre. Auckland.
Veale R. 2002. Violence. Alcohol Advisory Council Partnerships Conference Queenstown
Warner M, Smith GS, Langley JD. Drowning and alcohol in New Zealand: What do the coroner's files tell us? Australia and New Zealand Journal of Public Health, 2000, 24 (4): p387-390
Water Safety New Zealand 2002. 2001 drowning statistics – record low. Media 3 January 2002. Retrieved 07/01/03. www.watersafety.org.nz
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