pathways to risk: what can we do? ian webster. “ways of seeing” moral - legal issue health -...
TRANSCRIPT
“Ways of Seeing”
• Moral - legal issue
• Health - public health problem
• Psychosocial problems - education
• A social problem
Drugs can be seen as a problem for society or a problem of society.
Prevention Task Force - Tobacco
• Marketing measures – price, act against illicit trade, ban internet sales
• Social marketing – TV, campaigns, message placement, reach socially disadvantaged
• Advertising – cease promotion, report expenditure, packaging• Second-hand smoke - public places, childhood exposure, specific
locations• Regulation – supply, packages,licensing, quality control products• Health warnings• Quit support - training and service development, NRT replacement &
pharmacotherapies• Community programmes – special measures for indigenous
communities & disadvantaged• Support parents and educators• Maintain commitment (at all levels)• Measure and evaluate
Prevention Task Force - Alcohol• Safety of those who drink and those around
them• Promote safer drinking culture• Regulate alcohol promotion• Reform alcohol taxation and pricing• Improve the approach in Indigenous
communities• Upskill primary health care• Build healthy children• Strengthen the evidence base.
Cost-effectiveness study
• Volumetric taxation• Advertising bans• Minimum drinking age to 21• Brief interventions• Licensing controls• Drink driving mass media campaign• Random breath testing• Residential treatment & use of naltrexone
Doran C, Vos T, Cobiac L et al., Identifying cost-effective interventions to reduce the burden of harm associated with alcohol misuse in Australia Alcohol Education Rehabilitation Foundation funded research project, 2008.
Supplyreduction
Demandreduction
Harmreduction
Settings
Stage of life
Disadvantage
Workforce
Evidence of effectiveness
Performance monitoring
Governance
Harm Minimisation
Partnerships
Illegal drugs
Tobacco
Prescribed drugs
Other drugs
Alcohol
Harms to others
• ~ 75% adults negatively affected by others’ drinking.• > 30% neg affected by someone well known• >10 m neg effects of a stranger’s drinking in one year.• >70,000 assault victims per year• >24,000 victims of domestic violence• >20,000 children abused [in 2006/07].• $14 b out-of-pocket expenses lost wages & productivity.• > $6 b in intangible costs.• Additional $20 billion added to the Collins and Lapsley
(updated to 2008) of $17.2 billion = $36 billion annually.
PATHWAYS TO RISK
Sven Silburn 2003
Society & social
Educational development
Early development
MHS
Emotional development
Opportunities for prevention - Anticipatory care
Impairmentof body &mind
Misuse
Loss offunctionperformance
Socialdisadvantage
DiseaseInjury
Use
Addiction
Mental health & suicide risk
Keys to success
• Engagement• Harm minimisation/anticipatory care/limit setting• Long haul & follow-up (‘chain of care’)• Patient’s autonomy• Practical focus - ‘material’ & ‘structural’• Medication choice• Dependence treatment works