The Risk of Complacency
- On March 12, 2018
- March/April 2018
The risk of complacency
Witnesses to unspeakable tragedies, doctors have been powerful proponents of major public safety campaigns. However, government must be vigilant in upholding these policy measures, writes Prof Brad Frankum.
Doctors are uniquely placed to witness first-hand the end results of avoidable illness and injury.
It should therefore come as no surprise that some of the strongest proponents for health policy change should come from the medical profession.
The AMA is proud to count so many members who have advocated for changes to legislation that have made society safer. Many will recall the push for seatbelt use, led by the late Dr Gordon Kerridge, a lifetime AMA member. Gordon was among the first to fit seatbelts in his own family car and worked closely with the Minister for Transport to win community support for legislation to make the wearing of seatbelts compulsory in 1971.
Road safety was also an issue that resonated with former AMA President, Prof Brian Owler, who was the face of the "Don't Rush" campaign. Prof Owler was particularly motivated to be involved in this campaign after becoming increasingly frustrated by the avoidable tragedies he witnessed in his hospital theatre.
"This is a message from the coal face, a message from the doctors, the nurses, the emergency service personnel that deal with the results and the trauma from road crashes on a daily basis," Prof Owler told The Daily Telegraph ahead of the campaign launch in 2010.
Other examples include the AMA's advocacy work on button batteries, pool safety, falls from windows, child abuse and family violence, to name but a few. And the impetus for change in all of these areas share one common denominator – doctors who witnessed avoidable tragedies and cared enough to speak out.
Occasionally, we are so successful in achieving the goals we set out to accomplish, that we get complacent.
The success of vaccination programs is a terrific example of this. Today, the majority of Australian children have been vaccinated. The uptake of immunisation has been slowly increasing since 2000, and rates in NSW currently sit at 94% – a record high for the State.
The death rate from infectious diseases has dropped by 99% since childhood vaccinations were introduced in Australia, and devastating diseases such as diphtheria and polio have virtually disappeared.
And yet, despite this success, there remains a small but vocal anti-vaccination lobby in Australia. It appears that vaccines have become a victim of their success, and a sense of complacency has replaced the urgency the community once had to eradicate these infectious diseases. As the risk of disease has declined, the perceived risk of vaccines has increased. To combat this complacency, the Government must continue to be vigilant in its support for immunisation programs.
It has a similar duty when it comes to the Newcastle Conditions. The package of special conditions, which includes a 3am closing time, with a half hour last drinks time, a 1am one-way door requirement and a number of drinks restrictions, were introduced in 2008 in response to concerns from police and local residents regarding violence and anti-social behaviour. A repeal in August 2008 resulted in a half hour increase in these times.
These policies have been an overwhelming success in curtailing night-time assaults. Research revealed a 31% relative rate reduction in alcohol-related facial injury hospital admissions. By 2014, it was estimated 4000 assaults had been prevented as a result of these measures being implemented.
This means there have been less people, many of them young men and women, turning up in emergency departments with fractured jaws, fight bites, broken noses, head injuries, or facial lacerations from glassings. This means hospital staff have had to make fewer phone calls to mums and dads to tell them their son was on life support after being hit with a coward punch, or their daughter was in critical condition after being assaulted.
This also means that doctors had to spend less time dealing with the injuries from alcohol-related assaults – or responding to threats from drunk patients – and more time with patients who faced other health emergencies.
Doctors aren't the only ones applauding these measures. A survey of 376 Lower Hunter residents found 77% supported the reduced trading hours conditions, while 80% of community members supported the lock-out conditions, and 89% of community members supported the responsible service of alcohol conditions.
So, why is the Independent Liquor & Gaming Authority conducting a review of measures that have not only been an international success story, but also enjoys the support of the community?
The review of the Sydney measures by Justice Ian Callinan appears to have emboldened the Australian Hotels Association NSW to demand a similar review for Newcastle.
Justice Callinan's report identified that the purpose of the Sydney measures was to create safer, quieter and cleaner environments in Sydney CBD and Kings Cross. Industry groups, however, manipulated the report's findings to imply that since the objectives had been met, there was no longer any impetus to continue with the restrictions.
The subsequent changes – which includes extended lockouts and last drinks for "live music venues", extended trading hours for bottleshops, exemptions for small bars, changes to the three strikes disciplinary scheme, changes to the NSW Civil and Administrative Tribunal (NCAT) appeals system (thereby limiting community involvement) and the move of liquor regulation from the Department of the Attorney-General to the Department of Industry – are not so much a "tinkering around the edges" but a complete backslide.
It is clear the AHA NSW is hoping to achieve the same results in Newcastle.
But we must not sacrifice the public health outcomes we've gained for the profits of industry groups.
We must not forget that prior to 2008, Newcastle – the sixth largest city in Australia – had the highest rate of alcohol-fuelled violence in the State. Or that it had the highest rate of drink driving charges and one of the highest rates of assaults on emergency workers.
We must not forget the harms that alcohol-fuelled violence is responsible for, such as the deaths Thomas Kelly, Daniel Christie or Cole Miller.
And we must remember that complacency is not an option.
The deadline for submissions to the NSW Independent Liquor & Gaming Authority was 7 February. AMA (NSW) filed its submission in support of the recommendations made by the NSW ACT Alcohol Alliance. As part of his review, Jonathan Horton QC met with key stakeholders in Newcastle to get their feedback. Once Mr Horton has finalised his review and drafted his report, the matter will be considered by the Authority.