Addressing inequities in alcohol consumption and related harms

Abstract

Social determinants, or the conditions in which individuals are born, grow, live, work and age, can result in inequities in health and well-being. However, to-date little research has examined alcohol use and alcohol-related problems from an inequities and social determinants perspective. This study reviewed the evidence base regarding inequities in alcohol consumption and alcohol-related health outcomes in Australia and identified promising approaches for promoting health equity. Fair Foundations: the VicHealth framework for health equity was used as an organizing schema. The review found that social determinants can strongly influence inequities in alcohol consumption and related harms. In general, lower socioeconomic groups experience more harm than wealthier groups with the same level of alcohol consumption. While Australia has implemented numerous alcohol-related interventions and policies, most do not explicitly aim to reduce inequities, and some may inadvertently exacerbate existing inequities. Interventions with the greatest potential to decrease inequities in alcohol consumption and alcohol-related harms include town planning, zoning and licensing to prevent disproportionate clustering of outlets in disadvantaged areas; interventions targeting licensed venues; and interventions targeting vulnerable populations. Interventions that may worsen inequities include national guidelines, technological interventions and public drinking bans. There is a need for further research into the best methods for reducing inequities in alcohol consumption and related harms.

Case study of a decolonising Aboriginal community controlled comprehensive primary health care response to alcohol‐related harm

“…As well as the medical, clinical and alcohol services, the Table indicates the activities in other sections of the service that contribute to addressing alcohol‐related harm. For example, there is a strong link between healthy early childhood development and later alcohol consumption, 36 so Congress’ activities in early childhood are likely to reduce future alcohol‐related harm. Similarly, social determinants of Aboriginal health, including employment, education, housing, cultural determinants of health and self‐determination, are all associated with increased health, and Congress’ efforts in improving these determinants through collaborations with housing and other government sectors, and health promotion strategies, such as addressing job skills in the Men’s health branch, are likely to reduce the burden of alcohol‐related harm in the community 1…”

Effectiveness of the YourCall™ text message intervention to reduce harmful drinking in patients discharged from trauma wards: protocol for a randomised controlled trial

“…Acknowledging the structural determinants that influence and sustain inequities in alcohol consumption and related harm in many populations [24], we also aim to assess the equivalence of the effectiveness of the intervention among Māori and non-Māori participants in the trial. There is an increasing body of research attesting to the possibility that some alcohol-related interventions may inadvertently increase inequities in alcohol consumption and alcohol-related health outcomes [24].…”

“…There is an increasing body of research attesting to the possibility that some alcohol-related interventions may inadvertently increase inequities in alcohol consumption and alcohol-related health outcomes [24]. …”

“…Social determinants can strongly influence alcohol use with more impoverished groups at significantly greater risk of experiencing related harms [24–26]. This is of particular concern in New Zealand, where Māori (indigenous people) have disproportionately high rates of injury and less access to health and rehabilitation services compared with non-Māori [27].…”

The association between alcohol outlet accessibility and adverse birth outcomes: A retrospective cohort study

“…Although very little research has been conducted on alcohol outlet density and drinking behavior among pregnant women per se, considerable research has investigated the association between proximity and density of alcohol outlets and health outcomes in general. In a recent systematic review, [12] Roche et al found positive associations between alcohol outlet availability and alcohol consumption, and SES and drinking frequency, and found that maternal alcohol use during pregnancy increased the odds of physical, developmental, learning and behavioral problems in children. Similarly, Brenner et al [13] found that women living near the highest density of alcohol outlets had significantly higher alcohol consumption than women who lived in areas with low density, and that female drinkers above the 75th percentile were more likely to have high education and income.…”