Alcohol abuse is more harmful than meth, and the Government could do more to change the message around New Zealand's harmful drinking culture, according to a senior medical professor.
"There's a huge social cost to alcohol and we need a whole system change to address that problem," says Dr Warwick Bagg, head of the medical programme at the University of Auckland.
The Government's Budget 2018 revealed a vast bulk of spending is going into healthcare - $4 billion to be exact. But Dr Bagg says there is "room for work" in curbing alcohol-related health issues in New Zealand.
"One of the big challenges people face is fighting against the system. When everything around you is telling you to eat more and drink more then that's always going to be a problem."
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New Zealand's drinking landscape has changed considerably over the last 30 years. Wine and beer became available in supermarkets and grocery stores in 1989 and 1999 respectively, and the minimum legal age to purchase alcohol was reduced from 20 to 18 in 1999.
Within prime-time television viewing in New Zealand, a scene depicting alcohol occurs every nine minutes, according to a research by Auckland-based NGO Alcohol Healthwatch.
This normalisation of alcohol consumption needs to change in New Zealand, Dr Bagg says.
"Alcohol is legal and that's the drug that's causing the most harm."
He says education plays an important role in changing the public's perception around alcohol and drug consumption, despite recent controversy surrounding the distribution of a New Zealand Drug Foundation pamphlet to year 13 school students which contained information on consuming meth safely.
"I think there's a role for education around all drug use," he says.
"Hiding information away doesn't help people."
Does New Zealand need a new healthcare approach?
The Ministry of Health estimates that over 780,000 adults are hazardous drinkers, and almost half of young men aged 18 to 24 are estimated to drink harmfully. What's more, 18 percent of the New Zealand Police budget is spent on alcohol-related incidents.
American cardiologist and author Dr Kevin Campbell has written about changing the focus of healthcare from treatment to prevention - making people more aware of the harm they're causing themselves.
"We must hold patients individually accountable for behaviours that put them at higher risk for certain diseases," he says.
This thinking could be applied to New Zealand's approach to alcohol-related health issues. After all, alcohol is a known carcinogenic. Alcoholic beverages are classified by the International Agency for Research on Cancer (IARC) as a Group 1 carcinogen, similar to arsenic, benzene and asbestos.
But Dr Bagg says individuals cannot be solely responsible for changing New Zealand's attitude towards alcohol.
"There is a role for behaviour modification, but I don't think it's enough in itself," he says.
"No single person will be able to solve alcohol abuse. But if we all work together to solve the problem - and first of all admit that there is a culture of excess alcohol use - then we can work towards reducing that intake of alcohol."
This could be achieved through legislation and through health professionals working alongside the media and the general public, he says - spreading the message.
"That whole system approach is quite likely to be interventional."
Barriers preventing change
Aside from the challenge people face in fighting against a system that often encourages alcohol consumption, Dr Bagg says another barrier New Zealand faces is the willingness of regulators and policymakers to make meaningful changes.
"Changing the message around smoking wasn't easy, but we got there."
"We have yet to get to a place where we have regulation around alcohol-related harm. To do this, you have to consider all the players involved who may have an interest. Everyone has their own agenda as to why they may or may not want to limit alcohol use."
The Government has made efforts in recent years to thwart alcohol-related harm. Section 237 of the Sale and Supply of Alcohol Act 2012 highlights the "irresponsible promotion of alcohol".
It prohibits encouraging excessive alcohol consumption and also bans promoting discounts on alcohol that lead people to believe the price is 25 percent or more below the regular price.
Advertising alcohol that's free is also illegal.
"Many people will think it all comes down to individual responsibility, but it's not - it's also about society agreeing that we need to make a change," says Dr Bagg.
"If you think about alcohol-related harm, it is way more than methamphetamine. The greatest harm to society out of all drugs is alcohol. We can do simple things from a policy point of view that will make a difference and save lives and reduce costs."
Could the Government do more?
New Zealand had record alcohol consumption in the last three months of 2017, according to a February report commissioned by Alcohol Healthwatch. The report found that more alcohol was available per person in the last quarter of 2017 than at any other time in the past five years.
It's becoming widely accepted that New Zealand has a heavy drinking culture. Prime Minister Jacinda Ardern acknowledged the issue in February when the Alcohol Healthwatch report was released.
One change that's been suggested is enforcing minimum pricing on alcohol - a policy that was recently introduced in Scotland. Dr Bagg says the Government could also consider further limiting the advertising around alcohol.