A+review+of+alcohol+related+violence+and+prevention+strategies+in+remote+Indigenous+communities.

Student Number: 8297126
Tutor: Colleen Niland

//"Until that is tackled it will be impossible to deal with other social issues". - Tennant Creek resident//
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__** Cultural Artefact **__ This artefact is a news segment that was aired on the ABC’s //7.30 Report// on 27 April 2011. Filmed in the Northern Territory at a time approaching the 4th anniversary of the Howard Government’s Northern Territory Emergency Response Intervention (NTER), ABC Political Editor Chris Uhlmann interviews residents about their opinions of issues such as alcohol restrictions and their implications. The NTER was developed as a five year plan in response to the 2007 ‘Little Children are Sacred’ report, commissioned by the Government of the Northern Territory, which outlined shocking sexual abuse of children in remote Northern Territory Indigenous communities. The report identified that excessive alcohol abuse results in serious physical and social harm (Northern Territory Government, 2007), leading to an Emergency Response legislation which in part “prohibits the sale, consumption or purchase of alcohol in prescribed areas, and enacts new penalty provisions for those activities. It also makes new laws in relation to liquor sales in the Northern Territory, making the collection of information compulsory for purchases over $100 or 5 litres of alcohol” (Australian Human Rights Commission, 2007).

__** Public Health Issue **__ The public health issue central to my analysis is alcohol abuse, primarily in remote Indigenous communities. It is difficult to reconcile the extent of this problem within remote Indigenous communities given that on a population level Indigenous Australians drink less frequently, if at all, in comparison to the non-Indigenous Australian population (Northern Territory Government, 2007). While the effects of alcohol abuse are far reaching and may include issues such as neglect and abuse of children, long term ill health and family breakdown (Northern Territory Government, 2007), I will consider recent research with a focus on rates of alcohol use in comparison with alcohol related violence. Various methods of intervention will also be considered along with some of the research that discusses their merits, primarily in regard to Indigenous community consultation and acceptability.

__** Literature Review **__ Studies conducted between 2000-2011 regarding the issues surrounding alcohol abuse and its flow-on effects illustrate a complex social phenomena, as is the relationship between alcohol and violence (Morgan & McAtamney, 2009). A study published by the Australian Institute of Health and Welfare (2011) from data collected in 2008 states that 29% of Indigenous Australians had not consumed alcohol in the preceding 12 months of the study, compared to just 15% of non-Indigenous Australians and the percentage of Indigenous and non-Indigenous Australians who consumed alcohol at long-term, chronic levels were comparable at 15% and 14% respectively. This data is difficult to reconcile with the statistics provided by the Department of Families, Housing, Community Services and Indigenous Affairs (2010) in relation to, for example, homicide as spouse or partner homicides involving an Indigenous offender are 13 times more likely to be alcohol related than non-Indigenous homicides of the same nature. 70% of Indigenous homicides involve alcohol use by both the offender and the victim compared to just 22.5% of homicides involving non-Indigenous individuals. The statistics regarding the likelihood of an Indigenous person being hospitalised due to assault related injuries or spouse or partner violence are 11 times and 34 times that respectively than for the non-Indigenous population (Department of Families, Housing, Community Services & Indigenous Affairs, 2010). While it is clear that alcohol plays a significant role in these situations, it is unclear why the risk factors are so much higher in Indigenous communities. The Australian Institute of Criminology (as cited in Department of Families, Housing, Community Services & Indigenous Affairs, 2010) stated that “alcohol is now regarded as one, if not the, primary risk factor for violence in Indigenous communities” and that “alcohol use was one of the strongest predictors of Indigenous people’s contact with the justice system”. Shore and Spicer’s (2004) study had the main objective of identifying the relationship between alcohol and violence. Research was conducted over 3 consecutive months in a remote, unnamed Indigenous community and utilised a combination of ethnographic data and informal surveys with the participants aware of the purpose of their participation. The study concluded that increased recognition of the interactions between circumstance, community and the individual will facilitate the development of more effective alcohol related interventions to reduce the rate of alcohol mediated violence. The conclusions drawn from this study illustrate the stark disparity between the comparative numbers of Indigenous Australians using alcohol coupled with their heightened risk of being affected by incidents of alcohol related violence, both as offenders and victims, but is unable to offer an explanation as to why. Recent research has identified not only some of the key problems resulting from alcohol abuse, but has also attempted to identify the policy approaches that may be more effective than those implemented to date. Supply restrictions have been implemented as part of the NTER, but also by other states such as Queensland which implemented restrictions in some remote Indigenous communities in 2002 (Queensland Government Office of Liquor & Gaming Regulation, 2011). Supply restriction is a policy which studies suggest may be effective (Spicer, 2010) and are widely supported, particularly by Indigenous leader Noel Pearson (Cape York Institute for Policy & Leadership, 2007), but is also critisied as a denial of basic human rights (Martin & Brady, 2004). This issue was raised in the creation of the Little Children Are Sacred Report and the authors state that they saw the safety, and indeed lives, of children as being more important than an individual’s right to drink (Northern Territory Government, 2007). A study conducted by Czech (2010) suggested merit in the success of ‘whole of community’ interventions based on the results of community acceptability of various options. This study utilised a large-scale randomised control project of participants in New South Wales. The age range was restricted to 18-62 and included 3,017 participants from 20 rural communities. While the results of the surveys suggested that whole community interventions were widely acceptable at 85.5%, and were notably more acceptable than increased random breath testing (80.7%) and increasing job based education (77%), the highest rating was given to high school based education at 96.2% (Czech, 2010). The large-scale randomised control mechanism gives this study credibility as it is representative of opinions from a range of both ages and communities. Midford et al. (2010) aimed to identify the benefits of the restriction of container size and hours of take-away alcohol available for sale, similar to that introduced via the NTER, to identify the results in the community. An experimental design was used, and a town of similar size and demographic features was used as the control while multiple methods of data collection including surveys as well as consumption and related harm data. The restrictions were implemented through voluntary and mandatory phases and while the whole outcome indicated that the restrictions had been successful in terms of a reduction in both consumption and associated harm (e.g: police call outs, hospital admittance etc), these findings were mainly attributed to the voluntary phase. This study is presented as a 42 page report which includes extensive detail about time frames, methodologies, research parameters and supporting data, lending it great credibility. The community involvement in both the initiation and implementation of the restrictions was paramount to their success (Midford et al., 2010). These findings support the study conducted by Gray, Saggers, Sputore, and Bourbon (2000) which utilised the Australian National Centre for Research into the Prevention of Drug Abuse database to evaluate the efficacy of a number of alcohol related interventions in Indigenous communities. The authors state their most important finding to be the requirement for more cooperation with the Indigenous community in question in order to achieve more successful outcomes along with noting that most interventions to date seem to be inadequately funded (Gray et al., 2000). The authors note both the limitation of the method of data collection and that their findings are tentative only. One of the key themes to emerge from these studies has been the importance of community consultation and involvement in any interventions that are being designed for Indigenous communities and the relationship between community consultation and improved outcomes. Further study with a focus on improving education is required to continue to develop policies which are acceptable to communities and sensitive to cultural differences between Indigenous nations, as opposed to a ‘one size fits all’ approach (Northern Territory Government, 2007).

__** Cultural and Social Analysis **__ Numerous researchers have attempted to explain in a social and/or cultural context the reasons for the disparities between the rate of alcohol abuse in Indigenous and non-Indigenous communities and flow on effects such as alcohol related violence. In 2007, alcohol was recognised as having a significant negative impact on social and cultural fabric (Northern Territory Government, 2007). A study conducted by Gray and Saggers (2002) states that rates of alcohol abuse in Indigenous communities through Canada, New Zealand and Australia all tell remarkably similar stories. The authors contribute these findings to a ‘loss of personal power’, particularly for men, following colonisation whereby their ability to provide for their families and communities was diminished, as was their position within the labour market. Alcohol may provide comfort in the absence of the opportunity to participate in meaningful employment and recreation along with relief from boredom or an escape to deal with psychological issues (Gray & Saggers, 2002). The authors also considered an explanatory approach called ‘political economy’, the recognition of the social and cultural impact that complexities between politics and economy produces and argues that the difference in the ‘power’ relationship between Indigenous and non-Indigenous people is a powerful factor in determining social behaviours (Gray & Saggers, 2002). In his paper, // Alcohol, communities and researchers: Theorizing the relationships in an unstable mixture //, D’abbs (2002) discusses the relevance of French sociologist Pierre Bourdieu’s concept of ‘social fields’ and how this concept affects the outcome of both research and policy implementation by discussing economic, social, political and symbolic/cultural capital in terms of the particular interests that each ‘agent’ (e.g. researcher, politician, local business owner etc) in the field has in determining outcomes. This relationship, presented as ‘inner and outer domains’ can be illustrated as below:

(d’Abbs, 2002) Since the 1970’s, Indigenous policy has aimed for self determination – a shift to increased accommodation of Indigenous social values from the push for assimilation into Western ways (Kowal, 2008) - and while it can be argued that self determination had not failed completely, in 1999 the Government moved to a policy framework which emphasised “equality of rights, opportunities, and acceptance of responsibilities for all Australian citizens” (Martin & Brady, 2004). Kowal (2008) suggested that the 2007 NTER may signal the end of self determination based policy. The NTER was a Liberal Government policy, which has since been continued largely in its original form by the current Labor Government. While both parties share the objective of achieving equality in Indigenous health, the statistics that I've presented don't suggest substantial gains to date. Noel Pearson, Director of the Cape York Institute for Policy and Leadership, calls for a framework built on the concept of the political ‘third way’, emphasising a change towards a political philosophy that promotes personal responsibility and zero tolerance towards drug and alcohol abuse (Martin & Brady, 2004). A paper published in Just Policy, A Journal of Australian Social Policy, critiques the arguments both in favour of and against the theory of the third way and notes Anthony Gidden’s comments that this philosophy offers the best of both the right and the left and creates increased means of social inclusion (Gibilisco, 2009). Further in-depth analysis would be required to ascertain if this would be supportive of improved public health outcomes. __** Analysis of Cultural Artefact and Learning Reflections **__ My artefact represents the human face of just one facet of the Indigenous health crisis. Media reporting can often be unbalanced and biased, however, Chris Uhlmann has presented a balanced, well reported story which presents a range of views and opinions not just from stakeholders or politicians, but from the people who these issues have a direct impact on. Having spent a short amount of time in the Northern Territory within the last 12 months, I recall the feelings I experienced at seeing the ‘No Alcohol, No Pornography’ signs on the roadside. I was confused, and frankly embarrassed, at the double standards applied to Indigenous and non-Indigenous people in regard to the purchase of alcohol near restricted areas. I believe that for the most part, policy is developed by people who are trying to do the best they can with the information and resources available to them at the time. I don’t believe, however, that a meaningful, inclusive way forward on the path to equality has yet been found and think it will take a new approach in order to do so. This assessment piece has presented an opportunity to try to further understand the complexities of effective policy creation and implementation along with the multifaceted web that lies behind the reasons for alcohol abuse and its related effects, such as alcohol related violence. In terms of going forward, we need to be cognisant of the previously mentioned factors of individual interest and understand that this is not just an abstract, theoretical issue, but a real situation that is affecting a huge number of real people every single day. media type="youtube" key="yJYamd9bKzA" height="442" width="442" align="center"
 * LEARNING ENGAGEMENT AND REFLECTION TASK**

//A Culture of Excess - How Consumerism and Individualism has Shaped Generation Y's Health Behaviours// http://healthculturesociety.wikispaces.com/A+Culture+of+Excess+-+How+Consumerism+and+Individualism+has+shaped+Generation+Y’s+health+behaviours Name: Breanne Hosking

Great piece, I’ve really enjoyed reading this. As a Nutrition student, the data on excessive food and alcohol consumption was really interesting as I think it’s an issue that is going to develop into major problems for individuals in the short, medium and long term, when we will be the health professionals confronting it. I also found the third paragraph of your Social and Cultural Analysis really thought provoking. What do you think it will take the change this attitude shift back from consumerism – or is this just the way of the future? It reminded me of an article written by The Barefoot Investor recently about the mentality of the ‘silent generation’ around the 1930’s and 40’s and how things have changed – here’s the link if you’re interested: []

//Chlamydia, MTV and Pornography - Generation Y's Sexual Revolution// http://healthculturesociety.wikispaces.com/Chlamydia%2C+MTV+and+Pornography+–+Generation+Y’s+Sexual+Revolution Name - Samuel Kevin Bianchi Wow, great assignment. You’ve gone straight for the nitty gritty of an issue that tends to get swept under the carpet a bit. You’ve identified some really valid limitations of the current research such as the asymptomatic nature of Chlamydia and lack of diagnosis may distort the data. In this age of information being available more than even before, do you think that further education in school sexual health curriculum as mentioned in the last paragraph of your Social and Cultural Analysis is the answer to reducing the STI rates? Or do you think that perhaps it’s not lack of education and awareness, but the ‘risk taking’ culture so often associated with Gen Y that encourages the mindset of ‘it won’t happen to me’? Your mention of 90.5% of TV programming being of a sexualised nature was pretty scary too – it’s worry to think about the future flow-on effects for the kids of today who are currently exposed to it.

**References** Australian Human Rights Commission. (2007). // Social Justice Report 2007. // Retrieved from Australian Human Rights Commission website [|http://www.hreoc.gov.au/social_justice/sj_report/sjreport07/chap3.html#part2]

Australian Institute of Health and Welfare. (2011). // Substance use among Aboriginal and Torres Strait Islander people. // Retrieved from the Australian Institute of Health and Welfare website []

Cape York Institute for Policy and Leadership. (2007). //Position on alcohol (grog).// Retrieved from Cape York Institute for Policy and Leadership website [] Czech, S. (2010). Whole-of-community approaches to reducing alcohol-related harm: what do communities think? //Journal of Public Health//, //18//(6), 543. doi: 10.1007/s10389-010-0339-5

d'Abbs, P. (2002). Alcohol, communities and researchers: Theorizing the relationships in an unstable mixture. //Contemporary Drug Problems//, //29//(4), 657. Retrieved from []

Department of Families, Housing, Community Services and Indigenous Affairs. (2010). //Indigenous family safety agenda – 2010//. Retrieved from the Department of Families, Housing, Community Services and Indigenous Affairs website []

Gibilisco, P. (2009). The third way. //Just Policy//, (50), 46. Retrieved from []

Gray, D., Saggers, S., Sputore, B., & Bourbon, D. (2000). What works? A review of evaluated alcohol misuse interventions among Aboriginal Australians. //Addiction//, //95//(1) 11. doi: 10.1046/j.1360-0443.2000.951113.x

Gray, D., & Saggers, S. (2002). // Preventing harmful drug use in Australia ////. Indigenous Australian alcohol and other drug issues: //// Research from the National Drug Research Institute. // Retrieved from the Curtin University of Technology website [|http://ndri.curtin.edu.au/local/docs/pdf/publications/M38.pdf#page=163]

Kowal, E. (2008). The politics of the gap: Indigenous Australians, liberal multiculturalism, and the end of the self ‐ determination era. //American Anthropologist//, //110//(3), 338. doi: 10.1111/j.1548-1433.2008.00043.x

Martin, D., & Brady, M. (2004). Human rights, drinking rights? Alcohol policy and Indigenous Australians. //The Lancet (British edition)//, //364//(9441), 1282. Retrieved from []

Midford, R., Young, D.,Chikritzhs, T., Playford, D., Kite, E., & Pascal, R.(2010). The effect of alcohol sales and advertising restrictions on a remote Australian community. //Drugs//, //17//(1), 21. doi: 10.3109/09687630802145271

Morgan, A. & McAtamney, A. (2009). //Key issues in alcohol-related violence//. Retrieved from the Australian Institute of Criminology website []

Northern Territory Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse, Northern Territory Government. (2007). //Little Children are Sacred.// Retrieved from the Northern Territory Government Board of Inquiry into the Protection of Aboriginal Children from Sexual Abuse website []

Queensland Government Office of Liquor and Gaming Regulation. (2011). //Alcohol restrictions.// Retrieved from the Queensland Government Office of Liquor and Gaming Regulation website []

Shore, J., & Spicer, P. (2004). A model for alcohol-mediated violence in an Australian Aboriginal community. //Social Science & Medicine//, //58//(12), 2509. doi: 10.1016/j.socscimed.2003.09.022