Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012
Why is it important?:Excessive consumption of alcohol is associated with health and social problems in all populations. It is a major risk factor for conditions such as liver disease, pancreatitis, diabetes and some types of cancer. Alcohol is also a frequent contributor to motor vehicle accidents, falls, burns, and suicide. It has the potential to lead to anti-social behaviour, domestic violence and family breakdown. Where mothers have consumed alcohol during pregnancy, babies may be born with Foetal Alcohol Spectrum Disorders (FASD). Estimates of the burden of disease and injury for Indigenous Australians attribute 5.4% of the total burden to the net effects of alcohol consumption. For Aboriginal and Torres Strait Islander males aged 15–34 years, alcohol was responsible for the greatest burden of disease and injury among the 11 risk factors considered (Vos et al. 2007) and is a serious public health issue facing Indigenous Australians (Calabria et al. 2010). Reducing alcohol and other substance misuse can significantly reduce levels of assaults and homicides and disability, while improving the overall health and wellbeing of the population (see measure 3.11) (SCRGSP 2009).
Findings:The 2004–05 NATSIHS collected data on alcohol consumption based on levels of risk associated with short-term drinking (consuming alcohol at risky levels in a single day over the past 12 months) and long-term risk levels (based on average daily consumption over the previous week) (NHMRC 2001). In 2004–05, 24% of Indigenous Australians aged 18 years and over had abstained from alcohol consumption in the last 12 months. After adjusting for differences in the age structure of the two populations, this was twice the non-Indigenous rate. However, a greater proportion of Indigenous Australians who did drink consumed alcohol at levels that posed risks for their health. In 2004–05, 17% of Indigenous adults reported drinking at long-term risky/ high-risk levels. This was similar to the non-Indigenous rate. An estimated 55% of Indigenous Australians reported drinking at short-term risky/ high-risk levels at least once in the last 12 months and 19% at least once a week over this period. After adjusting for the difference in age structure of the two populations, rates of binge drinking among Indigenous adults were twice the non-Indigenous rates. In addition, Indigenous males were more likely than females to report drinking at both short-term and long-term risky/ high-risk levels.
The 2008 NATSISS included a set of questions on chronic alcohol consumption (amount consumed on a usual drinking day in previous 12 months) and binge drinking (largest quantity of alcohol consumed in a single day during the previous fortnight). Note that these are not the same questions that were asked in the 2004–05 NATSIHS and therefore results are not comparable. In 2008, 17% of Indigenous Australians aged 15 years and over reported drinking at chronic risky/ high-risk levels in the past 12 months, representing no significant change since 2002 (15%). A further 46% of Indigenous Australians were low risk drinkers and 35% had abstained from drinking alcohol in the last 12 months. Indigenous males were more likely than females to drink at chronic risky/ high-risk levels (20% compared with 14%), and this pattern was evident in all age groups. Approximately 80% of Indigenous women did not drink during pregnancy.
Chronic risky/high risk drinking was highest among those aged 35–44 years (22%) and lowest among those aged 55 years and over (10%). Rates of risky/high risk drinking ranged from 14% in major cities to 20% in outer regional areas. However, Indigenous Australians in remote areas were more likely than those in non-remote areas to be abstainers (46% compared with 31%).
In 2008, 37% of Indigenous people aged 15 years and over reported drinking at acute risky/ high-risk levels (binge drinking) in the two weeks prior to interview. Binge drinking was more common among Indigenous males (46%) than Indigenous females (28%), with men aged 25–44 years reporting the highest rates. Rates of binge drinking were higher in non-remote than remote areas (38% compared with 33%). Alcohol was perceived as a neighbourhood/ community problem by 41% of respondents aged 15 years and over in the 2008 NATSISS.
Over the period 2006–10, in NSW, Qld, WA, SA and the NT combined, Aboriginal and Torres Strait Islander males died from alcohol-related causes at five times the rate of non-Indigenous males. Indigenous females died from causes related to alcohol use at eight times the rate of non-Indigenous females. Most deaths (261 out of 382 deaths) were due to alcoholic liver disease. Indigenous Australians died from mental and behavioural disorders due to alcohol use at seven times the rate of non-Indigenous Australians; alcoholic liver disease at six times the rate of non-Indigenous Australians; and poisoning by alcohol at five times the rate.
Over the period July 2008 to June 2010, there were 7,763 hospitalisations of Indigenous Australians (excluding Tasmania and the ACT) that had a principal diagnosis related to alcohol use. This represented 2% of all hospitalisations of Indigenous Australians (excluding dialysis). Indigenous males were hospitalised for diagnoses related to alcohol use at five times the rate of non-Indigenous males, and Indigenous females at four times the rate of non-Indigenous females. Eighty-six per cent of all hospital episodes of Indigenous Australians related to alcohol use had a principal diagnosis of mental and behavioural disorders due to alcohol use, including acute intoxication, dependence syndrome and withdrawal state. Indigenous Australians were hospitalised for alcoholic liver disease at six times the rate of non-Indigenous Australians. Rates were highest in remote areas (14 per 1,000) and lowest in very remote areas (7 per 1,000).
Implications:The health effects of risky/high risk alcohol consumption are evident in both mortality and morbidity statistics. Alcohol misuse is linked to social and emotional wellbeing, mental health and other drug issues. Under the National Drug Strategy 2010–2015, seven sub-strategies will be developed. One of the sub strategies is the National Aboriginal and Torres Strait Islander Peoples Drug Strategy (NATSIPDS). The NATSIPDS will be informed by the other sub strategies, including the National Alcohol Strategy which will aim to prevent and minimise alcohol-related harm to individuals, families and communities through the development of a safer drinking culture in Australia.Top of Page
From 2012–13, around 100 Indigenous service providers and 150 non-government organisations across Australia are funded by the Australian government to provide, or support, alcohol and other drug treatment and rehabilitation services. These services provide a variety of treatment models including rehabilitation in a residential setting and drug and alcohol workers in primary care services.
There are a number of local initiatives to reduce risky levels of alcohol consumption. For example in WA, the Strong Spirit Strong Mind Metro Project aims to raise awareness of alcohol and other drug misuse among Aboriginal and Torres Strait Islander peoples, families and communities. With a focus on young people aged 12–25 years, the project encourages Aboriginal people to develop the knowledge, attitudes and skills to choose healthy lifestyles, promote healthy environments and create safer communities.
On 1 March 2012, the Australian Government committed $20 million for Indigenous communities to tackle alcohol and substance abuse under the Breaking the Cycle of Alcohol and Drug Abuse in Indigenous Communities initiative.
Community involvement in local actions to alleviate the problems of alcohol misuse is vital. In the Fitzroy Valley, WA, the community-driven Lililwan Project is underway to determine the prevalence of FASD in the area and to support the community through education, diagnosis and support (see measure 2.21).Top of Page
Figure 124—Alcohol risk levels by Indigenous status, persons aged 18 years and over, age-standardised, 2004–05
Source: ABS & AIHW analysis of 2004–05 NATSIHS and 2004–05 NHSTop of Page
Figure 125—Persons aged 18 years and over who drank at short-term risky/ high-risk levels at least once a week, age standardised, 2004–05
Source: ABS & AIHW analysis of 2004–05 NATSIHS and 2004–05 NHSTop of Page
Figure 126—Aboriginal and Torres Strait Islander adults who drank at short-term risky/ high-risk levels at least once a week, by jurisdiction, 2004–05
Source: ABS & AIHW analysis of 2004–05 NATSIHSTop of Page
Figure 127—Age-standardised rates for deaths related to alcohol use, NSW, Qld, WA, SA and the NT, 2008–10
Source: AIHW analysis of National Mortality DatabaseTop of Page