Alcohol consumption during COVID-19 significantly impacts vulnerable communities: The case study of Miller

by Andrew Reid

A national YouGov poll commissioned by The Foundation for Alcohol Research and Education (FARE) found one in five (20 percent) Australian households buying more alcohol than usual since the COVID-19 outbreak in Australia. Within these households, 70 percent are drinking more, with 34 percent drinking now daily. This is  likely to be a result of job loss, financial stress, family pressures, social isolation, declining mental health and a loss of structure and routine during the pandemic.

While we are waiting on further research and study results to uncover the full extent of the impact caused by alcohol consumption during COVID-19, it is highly likely those Australians who are already poor, unemployed or underemployed, with high levels of existing debt, suffering homelessness, or facing existing difficulties with access to health and social services, will be most affected. This is supported by available evidence that suggests disadvantaged communities have more significant alcohol-attributable harms compared with individuals from advantaged areas for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity, and smoking status at the individual level.

Community profile of Miller

Miller is a suburb within the Liverpool Local Government Area (LGA). In 2016, Miller had a population of 3,237 people, an unemployment rate of 15.5% more than double that of NSW (6.3%), 3.9% of the population were Aboriginal and/or Torres Strait Islander, 43.4% of Miller residents were in social housing, many with multiple and complex needs. Miller remains one of the most socio-economically disadvantaged suburbs in the state with the SEIFA Index of Relative Social Disadvantage (IRSD) score of 701 in 2016.

Alcohol Related Assault

Figure 1: Incidents of Alcohol Related Assault, July 2018 – June 2020, Miller

(Source: New South Wales Bureau of Crime and Research Statistics (BOCSAR), 2020)

The latest figures for incidents of alcohol-related assault from New South Wales (NSW) Bureau of Crime and Research Statistics (BOCSAR) show incidents of alcohol-related assault in Miller in May 2020 increased to 58.5 compared to 13 for NSW (see Figure 1). 

A breakdown of the data reveals incidents of alcohol-related assault (non-domestic assault) in Miller in May 2020 also increased to 58.5 compared to 4 for NSW. Compared to this time last year (May 2019), incidents of alcohol-related assault (non-domestic assault) in Miller was 0 compared to 8.5 for NSW

Incidents of Assault (Domestic Assault)

BOSCAR data for the same period (May 2020) showed incidents of assault (domestic assault) in Miller increased to 117 compared to 30.3 for NSW. While this may be due to several factors, existing evidence has found this could be linked to alcohol consumption. In 2010, research revealed alcohol was “present” in 41% of domestic assaults in NSW. Other studies since have found alcohol was involved in up to half of partner violence in Australia and 73% of partner physical assaults. The same studies also pointed out that alcohol features prominently in police data, although not all jurisdictions keep consistent records.    

Significant factor – access and availability of alcohol

There currently are 2 packaged liquor outlets and 1 hotel in Miller.

While the NSW Government COVID-19 restrictions forced the pubs and clubs to close between March 23, 2020 and 1 June 2020, Miller residents were still able to purchase alcohol from packaged liquor stores. The normal trading hours for one of these outlets in the area includes Monday to Saturday, 8:00am to 9:00pm and Sunday, 10:00am to 8:00pm. These alcohol outlets in Miller are in a Statistical Areas Level 1 (SA1) quadrant of approximately 280 households belonging to the lowest 1 percent of the most disadvantaged quantile in NSW.

In addition to this, Miller residents also had the option of buying alcohol online. In April 2020, Retail Drinks Australia reported one national retailer’s deliveries were up 300% from December 2019 to March 2020, while the size of the average order had increased by 50%. Around the same time, the Commonwealth Bank data showed a 34 percent increase in spending on alcohol over a week from March 27, 2020, compared to the same week in the previous year.

Despite no locally available data, Miller residents may be subject to the unsavoury and illegal delivery practices of some of the most popular online alcohol retailers in Australia. A study in January 2020, found 69 percent of these retailers advertised that they were willing to leave alcohol unattended at an address without verifying the purchaser’s age.

Conclusion

Alcohol consumption during the COVID-19 pandemic has the potential to impact all Australians. However, it can potentially further affect vulnerable communities. More research is needed to understand the full extent of the impact on these communities. In the case of Miller, preliminary data shows alcohol has contributed to an increase in incidents of assaults (non-domestic) and, most likely, incidents of assault (domestic assault). Access and availability of alcohol is a major contributing factor. Therefore, there needs to be more action taken around managing the economic and physical availability of alcohol, as well as provision of support for disadvantaged communities. We must remember this is an avoidable burden on our communities.  Let’s act now before it is too late!

Adequacy of the NSW LiveData site for evidence-based liquor licence decisions

By Andrew Reid, Dr Alison Ziller and Dr John Crozier

This commentary examines the adequacy of the NSW Liquor and Gaming LiveData website in providing evidence to assist decision making about liquor licences and trading hours.

Introduction

On 4 May 2020, Liquor and Gaming NSW [L&GNSW] invited feedback on the draft Liquor Amendment (24-hour Economy) Bill. The aim of the Bill, once COVID-19 restrictions are eased, is to ‘create a vibrant and safe 24-hour economy with risk-based liquor laws that support business’. Among the proposed changes is ‘a refined evidence-based approach to help manage the density of licensed premises, and associated risks of alcohol-related violence and anti-social behaviour, in areas of high venue concentration’. The draft Bill says that the Authority may prepared an ‘evidence-based’ cumulative impact assessment.

In December 2019, L&GNSW introduced a trial version of its LiveData site, which ‘is an online tool that allows you to search the latest liquor licence information alongside demographic, alcohol-related crime and health data for every suburb and Local Government Area in NSW’. There are, however, a number of significant flaws in the LiveData tool. We showcase several of these here with reference to the NSW suburb of Miller.

The Live Data evidence profile and the Miller suburb
The community of Miller

Miller suburb is located in Liverpool LGA. In 2016, Miller had a population of 3,237 people, an unemployment rate of 15.5% more than double that of NSW (6.3%), 3.9% of the population were Aboriginal and/or Torres Strait Islander, 43.4% of Miller residents were in social housing, many with multiple and complex needs. Miller remains one of the most socio-economically disadvantaged suburbs in the state with the SEIFA Index of Relative Social Disadvantage [IRSD] score of 701 in 2016.

The LiveData profile

The LiveData site does not provide the SEIFA IRSD score, preferring instead the SEIFA Index of Relative Advantage and Disadvantage.  It notes that Miller is in the bottom 1% of NSW households but Liverpool LGA is in the top 38% . Presenting this information suggests that the LGA is not too badly off and the suburb score is unusual. However, Miller is one of a cluster of highly disadvantaged suburbs in the relatively large Liverpool LGA.

Alcohol outlet density in Miller

The suburb of Miller has 2 packaged liquor outlets and 1 hotel. These are located in Miller town centre in a Statistical Areas Level 1 (SA1) quadrant of approximately 280 households belonging to the lowest 1 percent of the most disadvantaged quintile in NSW.

The LiveData profile

Alcohol outlet density is described on the LiveData site as outlet saturation and outlet clustering. Overall alcohol outlet saturation (number of outlets per 100,000 residents) is reported as lower in Miller suburb (61.8) compared to NSW as a whole (201.9) and Major Cities of Australia (NSW) (176.8) averages. However, the overall rate conceals the fact that for each of the years shown the alcohol outlet saturation rate for the licence types actually present in Miller presents a quite different profile. For example, in 2019 the saturation rate for hotels in Miller, major cities and NSW as a whole was 30.9, 19.1 and 28.5 respectively . The saturation rates for outlets authorised to sell packaged liquor was virtually the same for Miller 61.8 as for major cities (62.3) and significantly higher than the rate for Liverpool as a whole (34).

Public health profile in Miller

Since 1999, hazardous drinking in public spaces in Miller has been a significant concern. The last Miller Household Survey (2010) found 70.6 percent of the 301 people surveyed felt that drug and alcohol problems divided people in their neighbourhood a bit or a lot.  While most of the respondents reported good health overall, average scores on standardised physical and mental health assessments showed the sample was well below other Australian norms (CHETRE, 2010).

This issue has taken on a new urgency with the arrival of COVID-19 and the reporting of differential incidence of the virus, with residents of low-income areas at greater risk. There is concern that lockdown restrictions are associated with increased drinking, gambling and domestic violence.

LiveData health profile

The LiveData site reports alcohol attributable deaths in Liverpool LGA for the two years to 2015/16 and alcohol attributable hospitalisations to the two years to 2017/18. While alcohol attributable deaths declined in the reported period, alcohol attributable hospitalisations rose. The two charts (9 and 10) on the LiveData site have a similar format and would be easy to misread as being on the same scale (vertical axis) whereas the number of deaths is on a scale of 17.5 – 21.0 per annum while the number of hospitalisations is on a scale of 350 – 600 p.a.. Alcohol-attributable hospitalisations are increasing in Liverpool as well as NSW as a whole.

Risk of gambling related harm in Miller

Environmental factors, such as locational disadvantage, significantly influence gambling outcomes. In one US study, neighbourhood disadvantage was linked to a 69% increased odds of exhibiting a gambling problem and eight additional gambling occasions. Australian research has found gambling increased with risky alcohol consumption for all gamblers during a single visit to a gambling venue. That is, gambling is part of the health profile of hotels.

The LiveData gambling profile

LiveData does not provide information about gambling. However, gambling is a significant source of profit for hotels in NSW and the late trading hotel in Miller has its full complement of 30 gaming machines. There are 345 gaming machines in venues in Liverpool LGA. Data available to Liquor and Gaming NSW and provided in part on another L&GNSW site (reveals that in 2019, each machine was making an average $227,127 profit per annum. On this basis, the hotel in Miller would have made [$227,127 x 30 =] $6,813,820 in gaming profit in 2019. A particularly significant loss for the local community.

Assault and violence in Miller

The non-domestic assault rate in Miller for the year to December 2019 was 1462.0 per 100 000 population. NSW as a whole had a rate of 403.2.  The domestic assault rate in Miller for the year to December 2019 was 877.2, while the NSW rate was 390.4. All three alcohol establishments in Miller are located within a ‘hotspot’ for these incidents of assault which has persisted for many years.

The assault and violence LiveData profile

The LiveData site has charts (5 & 6) for alcohol-related domestic and non-domestic assault for Miller, Liverpool LGA, major cities and NSW as a whole . Both charts show significant declines in these crimes in Miller in the last two years while the rates for the LGA, major cities and the State show small changes. These charts do not present the significantly adverse data available on the BOCSAR website and summarised above. This is because, the charts use only those assaults recorded by police as alcohol-related. BOCSAR notes these rates cannot be relied on. The net effect of using these unreliable data is to present a misleading picture of these crimes in a suburb where their incidence is significant.

Discussion

LiveData is presented as a useful source of information for liquor licence applicants and members of local communities alike. However, these are unlikely bedfellows. The information on the site appears more favourable to licence applicants than to local residents, as shown above for the suburb of Miller, namely:

  • The community profile fails to report the most relevant measure of social disadvantage – a measure known to correlate with alcohol-related harm.
  • Outlet saturation is presented in aggregate concealing concerning rates of density for the licence types actually in the suburb.
  • Crime data is treated selectively, minimising the number of domestic and non-domestic assaults in the suburb by reporting only those assaults recorded as alcohol related — notwithstanding the known limitations to the data presented and the high rates of assault actually occurring.
  • Data on gaming machine losses in the local hotel is omitted entirely.
  • Health data for the LGA is presented in visually similar charts with such different scales as to render them non-comparable.

Conclusion

There is growing evidence to suggest the adverse impact of increasing liquor licenses and extended trading hours in disadvantaged communities. It is of significant concern that the LiveData site being trialled by Liquor and Gaming NSW fails to signal these risks. A data source that cannot signal risk in the case of a community as disadvantaged as Miller, cannot be relied on.

Authors’ information

Andrew Reid is a Research Officer at The Centre for Health Equity Training Research and Evaluation (CHETRE). Andrew is also the Chair of the Liverpool Community Drug Action Team (CDAT).

Dr Alison Ziller is a Lecturer in the Department of Geography and Planning, Macquarie University.

Dr John Crozier is a vascular and endovascular surgeon. He is appointed as Visiting Medical Officer to Liverpool Hospital. Dr John Crozier is the current Chair of the Royal Australasian College of Surgeons’ national trauma committee.

References

Centre for Health Equity Training, Research and Evaluation. (2010). Miller Household Survey (pp. 1-72). Liverpool, NSW: CHETRE

Social Infrastructure and health

The issue

Liverpool City Council is planning for the redevelopment of social infrastructure in Miller, South Western Sydney. Social infrastructure includes the delivery and maintenance of public services such as libraries, parks, swimming pools and community spaces. Social infrastructure planning is an opportunity for SWSLHD Population Health to collaborate with Liverpool City Council with a focus on the connections between health and wellbeing. The planning work provides an opportunity to build planning collaboration and research capacity, potentially centred around a Health Impact Assessment. The dual purpose of the collaboration is to provide evidence and information to inform the planning for Miller and to influence decisions within the Council about what to focus on in planning and investment.

The project

The project involves the development of a report describing the health impacts of social infrastructure/links between social infrastructure and health and wellbeing. This will be achieved through a literature review and grey literature analysis. 

Contacts 

Patrick Harris or Karla Jaques 

Community STaR event with Joan Silk (10:30-11:30 22 Nov, 2019)

Community STaR presents…

Doing more with less:
Observations about community development in Cuba

Can lessons learned from the Cuban experience
improve health disparities in Australia?

Speaker : Joan Silk

Cuba is the largest island in the Caribbean Sea. Despite limited funding and supplies, Cuba’s adult and youth literacy rate stands at 100%, and it has consistently managed to keep its population of 11 million people healthy into old age with a health system recognized worldwide for its excellence and its efficiency.

Joan Silk visited Cuba in 1997 and again this year. Her presentation will draw on those experiences and reflect on what we can learn from the Cuba experience.

Joan Silk is a health worker with a special interest in the relationship between inequality and health, both on a community and an international level. She has worked in the printing, retail, hospitality and creative industries, as a secondary school teacher, a research assistant, and for the last 20 years as a health equity worker in various communities. She has a BA Honours in Economic History and Politics and a Diploma of Education.

  • When : Friday, November 22, 2019
  • Time : 10:30am – 11:30am
  • Where : Miller Community Centre,
    18A Woodward Crescent, Miller, NSW 2168
  • RSVP by 18 November
  • Register here via Eventbrite
  • For more information, contact: E: Andrew.Reid@health.nsw.gov.au  or T: 02 87389310
  • See flyer

Preventing Alcohol-Related Harm: What’s Changed?

By Andrew Reid and Joan Silk

 

Second Forum: Friday, March 23, 2018

The Centre for Health Equity Training Research and Evaluation (CHETRE) through Community StaR in partnership with Liverpool Community Drug Action Team (CDAT), recently held our second public forum on Preventing Alcohol-Related Harm. It was almost five years on from our first forum, Alcohol-Related Harm in Our Community, also held in Miller, New South Wales (NSW). We wanted to discuss the changes since 2013 and provide an information update and further insight into preventing alcohol-related harm. Several important changes had happened in the past five years including the introduction of the ‘lockout laws’ in Newcastle and parts of Sydney after several alcohol-fuelled one-punch killings including that of Thomas Kelly in 2014.

Uncle Malcolm Maccol, a local Aboriginal Elder, performed the Welcome to Country, and the Honourable Paul Lynch M.P., NSW state member for Liverpool, officially opened the event at Miller Community Centre. The forum was facilitated by Norman Booker, an experienced health professional and consultant. The sixty people in attendance at the forum shared concerns, questions and comments throughout the event.

 

Not all good news

The good news is that there have been some positive (and hard-fought) changes. Since the ‘lock-out laws’ came into effect, serious injuries from alcohol-fuelled violence have significantly reduced in the Kings Cross and Sydney Central Business District (CBD) Entertainment Precincts. Stricter restrictions on access and availability including on the sale of packaged liquor have been shown to work. However, the NSW Government has not implemented changes in other areas of the state. A highlight of the event was the comprehensive and inspiring Northern Territory plan for addressing alcohol-related harm.

 

More needs to be done

The forum’s three keynote presentations by Emeritus Professor Ian Webster AO, Dr. John Crozier, and Dr. Criss Moore generated knowledge, inspiration, insight and a strong desire to work together closely and effectively to reduce alcohol-related harm in our community. We look forward to a broad implementation of the evidence based measures discussed by our speakers and thank them for generously sharing their expertise and encouragement.

 

Key Issues:

Mental health and Alcohol-Related Harm

Professor Ian Webster‘s keynote presentation discussed the nature of alcohol-related harm and the crucial link between mental health, suicide and alcohol. This highlighted the urgent and growing need for health and related services to address dual mental health and alcohol and other drug (AOD) presentations. For example, in the period 2011–2015, forty percent of male suicides and thirty percent of female suicides were attributable to alcohol use. More national attention on the issue is required, and governments at all levels must work together to prevent such tragedies. The most marginalised and disadvantaged groups are often the most severely impacted. In many parts of Australia, this includes, but is not limited to, the homeless and Indigenous communities. For instance, the overall rate of suicide among Aboriginal and Torres Strait Islander people in 2015 is more than two times higher than the rest of the population.

 

Marketing and supply of alcohol

As well as detailing the daily economic and horrific health costs of alcohol-related harm, Dr John Crozier’s presentation provided shocking examples of the cynical and sophisticated strategies the alcohol industry uses to widen access and entice customers, including the promotion of online shopping and home delivery. He also covered the blatant tactics alcohol companies use to attract young people. He highlighted the detrimental effects on communities of the increasing availability of alcohol and the ever-expanding range of beverages and alcohol outlets. For every 10,000 litres of alcohol sold through Australian outlets, domestic violence increases by twenty-six percent.

He concluded that private industry profits while the public purse ‘picks up the pieces’.

 

Community Power

Despite the ‘mighty and powerful’ alcohol industry, there have been some significant community victories. Dr. Criss Moore spoke about a group of Casula residents who successfully managed to win a three year battle with a prominent hotelier wishing to establish a late night hotel and gaming venue in their residential suburb. She highlighted the power of community – people power, and gave examples of the organisational methods of a diverse community that stands together to challenge the powerful. Residents held street corner meetings, door knocks, rallies, letters and petitions to raise awareness and action. Tony Brown, chair of the Newcastle CDAT and key activist for the successful Newcastle ‘lockout laws’ and Dr. John Crozier gave much assistance and support to the residents. Dr Moore emphasised the critical importance of building and maintaining relationships with those in the neighbourhood, and beyond.

 

Tackling the availability of alcohol – the ADF toolkit

Damian Dabrowski from the Alcohol and Drug Foundation (ADF), the funding body of this forum, was also present to demonstrate a toolkit that community and others can use to assist in having their voices heard in the decision-making process of regulating the availability of alcohol. See the ADF website at https://adf.org.au/

 

Next steps: Where to from here?

The Q&A panel following the keynote addresses and discussions at the forum suggested that having stronger restrictions on the availability and advertising of packaged liquor is one important way forward in reducing alcohol-related harm. A number of participants also applauded and were inspired by the action of the NT government in addressing alcohol-related harm in a comprehensive, innovative and evidence-based plan. As well as a national response, local action is needed. Local Community Drug Action Teams (CDATs) such as the Liverpool CDAT can help facilitate this and we invite interested community members and service workers to join us.

CHETRE, through Community STaR will continue to work with Liverpool CDAT and others to address critical issues in the AOD space to help improve the health and general well-being of the community.