This paper presents an evaluation of the impact of an alcohol harm reduction program initiated in the Northern Territory (NT), a thinly populated though geographically substantial part of central and northern Australia. The total resident population of the NT is slightly less than 250,000 persons. There were several unique features of both the program and the manner of its evaluation which may make it of special interest for policy makers and researchers concerned to develop more effective strategies for reducing alcohol-related harm. The NT has for many years had the highest levels of hazardous alcohol consumption and of related problems such as violence and road trauma both in Australia and world-wide. The Living With Alcohol program (LWA) was established with the aim of being a comprehensive public health strategy to address alcohol related harm in the NT. It was originally funded by an additional levy on alcohol products containing more than 3% alcohol by volume. Other funding mechanisms were developed following a High Court ruling in 1997 which disallowed States and Territories to use licensing fees to raise tax revenue. The period of this evaluation covers four financial years prior to that High Court ruling when the LWA levy of 5 cents per standard drink was in effect.
There is growing interest in international alcohol epidemiology in the development of national systems for monitoring alcohol-related harm as a tool for guiding the development of effective public policy (WHO, 2000; WHO, in press). In Australia, national indicators of a range of key alcohol-caused harms are being developed with funding from the National Drug Strategic Framework. Early outcomes of this project include the publication of annual state-by-state estimates of alcohol-caused deaths and serious alcohol-related road injuries (Chikritzhs et al, 1999; Chikritzhs et al, 2000a,b; Chikritzhs et al, in press). The present evaluation represents an early opportunity to refine and apply indicators of serious alcohol-related harms to the evaluation of a major prevention initiative.
The LWA program followed a general increase in community concern about alcohol in the late 1980s which led to an influential report of a Select Committee being presented in 1991 to the Legislative Assembly. In this report it was estimated that the financial cost to the NT Government and the community from problems associated with the use of alcohol in 1988 was A$150 million, or approximately $1000 per adult resident (Legislative Assembly of the NT 1991). Other evidence presented to the Select Committee emphasised the high levels of alcohol-related harm in the Territory, as indicated by per capita alcohol consumption being approximately 70% higher than elsewhere in Australia, one in two road deaths being alcohol-related (50% higher than the national average, in 1989/1990 there were over 30,000 incidents of people being taken into protective custody by police for public drunkenness, in 1991/1992 three-quarters of sentenced prisoners reported that alcohol was a factor in their offending and it was estimated that rates of alcohol-related deaths were three times the national average (Crundall, 1994a)
The present study employed a range of official data sources to create alcohol harm indicators as well as control indicators of cases unlikely to be alcohol-related. Hospital, mortality, road crash and alcohol consumption data were used. Hospital morbidity data were incomplete for the four years prior to this study and so are not reported here (see Chikritzhs et al, 1999 for analyses of these data). The available harm indicators were then applied to address the question as to whether the four financial years following the introduction of the LWA levy were associated with a significant reduction in alcohol-related harm. It was also necessary to control for other significant initiatives during that time including the introduction of a lower permitted BAC for drivers and a special levy on cask wine both introduced towards the end of the study period. A wide range of alcohol initiatives were introduced during the before and after LWA periods as summarised below.