Locked out by the Nanny State? The public health case for Sydney’s lockout laws

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This blog post incorporates a post previously published by Caterina Giorgi on DrinkTank. We’re grateful to Caterina for giving us permission to republish her post.

Sydney’s lockout laws have had a polarizing effect. One view is that they’ve killed off Sydney’s once-thriving nightlife, compromised the incomes of those in the hospitality industry, and simply redistributed alcohol-fuelled violence to other parts of Sydney.

Supporters of the laws – including NSW Premier Mike Baird, the families of assault victims, and St Vincent’s Hospital – cite statistics showing a significant drop in alcohol-related violence in affected areas and no increase in violence in other suburbs.

As a public health lawyer, to me these laws illustrate several themes that often arise in debates about the need for government intervention in public health matters.

  • Public health is only one “social good” among many. Sometimes we need to balance public health objectives against other social and economic goals, such as a vibrant nightlife – although that would be a hard argument to make to the parents of young men who’ve been killed by alcohol-related violence.
  • The introduction of public health legislation can have negative consequences, particularly on groups with a vested interest in the product or practice being regulated, including the hospitality industry.
  • However, these negative consequences can be mitigated, as when Australian government organisations replaced tobacco industry sponsorship of sports clubs with public funding, to ensure that clubs weren’t out of pocket when industry sponsorship was removed.
  • Finally, public health laws become normalized over time. Remember coming home from a club reeking of smoke? What seems like an invasion of individual freedom now often turns into a valuable health protection measure as social norms evolve over time.

Are the lock out laws an example of the Nanny State at its worst, or a proportionate measure designed to protect the public from the harmful, reckless actions of others? I’ll leave that for you to decide. Below we republish (with kind permission) a recent blogpost by Caterina Giorgi at the Foundation for Alcohol Research and Education (FARE) on the public health case for the lockout laws.

 Sydney is not dead. Sydney is not closed

 By Caterina Giorgi

Over the past few months, a small but vocal minority of people in Sydney have called for the Premier to wind back trading measures introduced to reduce alcohol-related violence. They present a narrow, exaggerated argument that Sydney is now ‘closed’ and that Sydney’s reputation as a global city is in shambles.

Some background.

Two years ago the New South Wales Government introduced laws that meant people cannot purchase alcohol from bottle shops after 10pm, and from bars and clubs in Sydney CBD and Kings Cross after 3am. They also introduced a one-way door policy (more commonly referred to as a ‘lockout’), which meant that people cannot move between venues in this precinct after 1.30am. These measures were introduced to keep people safe and stop the violence and deaths that were occurring as a result of alcohol use. Today a vast majority of people in New South Wales (68 per cent) support these measures.

Two years on and these measures are working. Alcohol-related assaults in Sydney have declined by 20.3 per cent and Kings Cross has seen a significant 45.1 per cent decline, there has been no displacement to other areas and businesses continue to grow, with liquor licence numbers continuing to increase across Sydney.

Those opposed to these successful measures allege the measures were a response to “hysteria” and a “knee-jerk reaction following the deaths of some young men”.

Let’s put to one side the seeming disregard and disrespect for those who lost their lives.

And ignore for the time being the hysteria and hyperbole inherent in the ridiculous claims that Sydney is ‘closed’ or the even more insensitive suggestion that the city is ‘dead’, complete with flower adorned casket.

But the suggestion that the introduction of modest trading hour measures was a knee-jerk reaction is completely false and conveniently ignores the evidence.

These measures are as far from a knee-jerk reaction as a policy can be. Reducing the availability of alcohol as a measure to reduce harms was raised with the State Government in 2003 at the New South Wales Alcohol Summit, 11 years before the measures were introduced.

These measures were advocated for after their introduction in Newcastle in 2008, six years before the legislation was implemented in Sydney.

And finally, they were again advocated for when a young man, Thomas Kelly, was killed 18 months before the measures were finally introduced in February 2014.

These measures have been advocated for because international and national research shows that they reduce violence.

In fact, when Yvette D’Ath, Attorney-General of Queensland, spoke about the introduction of similar measures in Queensland in Parliament just last week she said she has never seen so much independent evidence on a bill.

On Sunday thousands of people marched against the earlier closing times and lockouts in Sydney. Part of me thinks that it’s great that people decided to take time out of their lives to march for something that they believe in. But I can’t help wonder: what it is that these people have lost in their lives that they felt driven to protest?

Were they comparing themselves to people who have marched and protested over the weekend for Medicare, refugees or gender equality?

Do they genuinely think that alcohol is needed around the clock for their lives to be whole and fulfilled? And more importantly, if yes, what does this mean more generally about Australia as a society?

Sydney is not dead.

Sydney is not closed.

Sydney responded to significant levels of violence and deaths by introducing evidence-based measures that had been advocated for by experts, doctors, police and community members for many years. Instead of protesting against these measures, we should be congratulating members of government for doing what policy makers should do, fixing a significant social problem by introducing evidence-based solutions.

Premier O’Farrell and Premier Baird should be congratulated for doing what many politicians are afraid to do, introducing and maintaining measures that benefit the community ahead of significant vested interests. For that I congratulate them and I sincerely hope that the New South Wales Government continues to prioritise evidence ahead of hysteria.

 

 

Dancing on Christopher Hitchens’ grave? The tricky business of talking about consequences

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Vanity Fair, February 2004

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A “pro-smoking blogger for the libertarian right”  accuses me of “dancing on Christopher Hitchens’ grave”.

And other stuff.

Christopher Snowdon is a Research Fellow for the UK-based Institute of Economic Affairs, a think tank that receives tobacco funding.  He is an opponent of plain tobacco packaging, keeper of the pure flame of libertarianism etc.

My sin – contained in a paper forming part of a symposium on public health regulation and the “nanny state”, was to reflect on a self-confessed “crime spree” Hitchens took in New York City  in late 2003.

During the course of an autumn day, Hitchens broke as many of the city’s “petty ordinances” as he could, particularly its smoke-free laws.

At the time, Michael Bloomberg was in the second year of his first, 4-year term as NYC Mayor.  He went on to serve 3 full terms, introducing tobacco control laws that saw the adult smoking rate fall by 28% between 2002 and 2012, and the youth smoking rate fall by 52% between 2001-2011 .

Which is a terrible result, if you’re a tobacco company, but a magnificent result for New Yorkers – with changed life trajectories and longer, healthier lives for hundreds of thousands of people.

You can read about Michael Bloomberg’s public health legacy here.

Apparently embittered at the constraints on his smoking, Hitch lashed out, reflecting on the “shriveled core of the tiny Bloombergian mind”, and ending with:

“Who knows what goes on in the tiny, constipated chambers of his mind? All we know for certain is that one of the world’s most broad-minded and open cities is now in the hands of a picknose control freak.”

The editor of Vanity Fair, Graydon Carter, who at the time was being serially fined by the NYC Health Department for flouting its smoke-free laws and smoking in his office, published the whole account.

Then, in June 2010, at the height of his powers, Hitchens announced he had cancer  of the oesophagus.  As one journalist wrote, “The celebrated drinker and smoker who once claimed that “booze and fags are happiness” had succumbed to a cancer most often associated with drinking and smoking.”

Hitchens died less than 18 months later.

Like his hero Hitchens, Snowdon believes that smoke-free laws are anti-libertarian.  The mind boggles at this point, given that globally, one in ten people who die from tobacco are non-smokers who are unintentionally harmed (poisoned) by smokers….

However, to my mind the more interesting theme that excites Snowdon is the question of whether Hitchens’ diagnosis challenged his libertarian convictions.  Snowdon assumes that the rationale for discussing this issue was to concoct some sort of contrived, deathbed confession:

“Magnusson clearly thinks that Hitchens got his comeuppance when he died of cancer and wants to believe that he renounced his principles on his death bed.”

The record shows that Christopher Hitchens castigated those who promoted effective tobacco control, yet spoke frankly and publicly about his own cancer, acknowledging that it was probably caused by his smoking and drinking.

Hitchens made his choices, and talked about them freely.  He made his private life a public matter.

So we have permission, I think, to talk about Hitchens – who I suspect would have approved of being the topic of conversation.

“I’ve come by this particular tumor honestly”, he told Anderson Cooper on CNN in August 2010.  “If you smoke, which I did for many years very heavily with occasional interruption, and if you use alcohol, you make yourself a candidate for it in your sixties.” “I might as well say to anyone who might be watching – if you can hold it down on the smokes and the cocktails you may be well advised to do so”.

Cooper responded “That’s probably the subtlest anti-smoking message I’ve ever heard”.

“The other ones tend to be more strident”, Hitchens replied, “and for that reason, easy to ignore”.

“Even if this weren’t incredibly tasteless” Snowdon writes, “Magnusson could hardly have found a less fitting person to use as an example.”

Snowdon seems to think that the point of discussing Hitchens is to trip him up on his words, seek to make an object lesson out of him, or worse, to gloat.

But there are other reasons why Hitchens’ account of his illness is worth reflecting on.

Certainly, it was a compelling story. Statistics are easy to brush off: just ask a smoker.  But stories are a little harder.

Here comes this libertarian prophet – as sure as any libertarian ever was about the infantilising effect of public health laws – suddenly forced to come face to face with his own premature (and probably preventable) death.  Did he have conflicting feelings, second thoughts?  It’s not an unfair question.

“In whatever kind of a ‘race’ life may be”, Hitchens wrote  in 2010, “I have very abruptly become a finalist….In one way, I suppose, I have been ‘in denial’ for some time, knowingly burning the candle at both ends … .[F]or precisely that reason, I can’t see myself smiting my brow with shock or hear myself whining about how it’s all so unfair … . Instead, I am badly oppressed by a gnawing sense of waste. I had real plans for my next decade and felt I’d worked hard enough to earn it. Will I really not live to see my children married?  To watch the World Trade Center rise again?

Through his story, we catch a glimpse of the public interest that public health laws and policies are intended to protect.

The public interest in tobacco and alcohol control laws does not exist for the sake of some abstracted, disembodied “public”, but ultimately for the sake of all those individuals who might otherwise die prematurely, or just as frequently, as Simon Chapman writes, live long in distress and isolation due to the disintegrating impacts of their illness.

Bloomberg’s tobacco control laws were intended to help prevent the kind of death Hitchens died.  To say that is not to gloat.

Consequences tend to be trivialised or absent when libertarians set out their plans for how the world ought to be.

The narrative we tend to get is the one written by the be-suited Hitchens in 2003, flying through Central Park with his feet off the bicycle pedals, witty, cancer-free, not the man 7 years later, who writes  “The chest hair that was once the toast of two continents hasn’t yet wilted, but so much of it was shaved off for various hospital incisions that it’s a rather patchy affair. I feel upsettingly de-natured. If Penélope Cruz were one of my nurses, I wouldn’t even notice”.

How should public health advocates talk about consequences?

In the United States, gun enthusiasts have become so highly proficient at ignoring consequences that anyone who dares link the most recent gun-related massacre [insert dates & details] with that shocking, leftist, evil thing called “gun control” – is howled down for seeking to “politicise a personal tragedy“.

Plenty of compelling stories, it seems, but never a teachable moment.

But for the rest of us, prevention matters because people matter.  Their needless suffering or death is relevant to how we evaluate the wisdom of government actions, laws and policies.

The nanny state conspiracy theorists overstate their case.  Hitchens’ freedom to make choices about smoking, drinking, diet and lifestyle were his for the taking.  No one stood in his way.

Hitchens had no Damascus conversion over tobacco, or anything else for that matter, but his public expressions of regret were no less powerful for their subtlety.

[Interview between Anderson Cooper (CNN) and Christopher Hitchens, 6 August 2010: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=385×492527 (transcript);  http://ac360.blogs.cnn.com/2010/08/07/video-extended-interview-hitchens-on-cancer-and-atheism/ (video).]

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Our new Nanny State? The Senate inquiry into tobacco, alcohol, and bicycle helmet laws

New Yorkers’ had a Nanny. Do Australians have one too?

Earlier this month, Senator David Leyonhjelm announced aSsenate inquiry into legislative and policy measures introduced to restrict personal choice “for the individual’s own good,” including laws related to tobacco, e-cigarettes, alcohol, marijuana, bicycle helmets, and film classification.

Leaving to one side the irony of a government inquiry into government’s unreasonable interference in our lives, many of the products to be considered by the inquiry are of central concern to public health. Smoking remains Australia’s largest preventable cause of death and disease, responsible for some 15,000 deaths, and costing Australia $31.5 billion in social and economic costs annually. Alcohol is linked to over 60 different health conditions, and accounts for around 3430 deaths per year.

Public health advocates call for a strong government response to these health problems, because preventive measures are more cost-effective than treatment, and because legislative and policy measures work.

Laws and regulations concerned with restricting the sale or promotion of cigarettes and alcohol are often seen as examples of the “Nanny State” in action, i.e., unwanted government interference in what should be our own, freely-made choices. But it’s wrong to frame these measures simply as the state acting “for the individual’s own good.” Governments have a legitimate interest in ensuring population health, and in preventing the healthcare costs associated with alcohol and tobacco consumption. So too do we, as taxpayers.

Governments also act a check on the powerful corporate interests that have a profound influence on our drinking, smoking, and eating habits. We might as well ask, why isn’t there an inquiry into Big Tobacco and Big Alcohol, and their impact on our freedom to live healthy, productive lives?

It’s possible for governments to overstep their boundaries, and to introduce measures that are overly paternalistic and completely out of step with community needs. But by adopting the prejudicial language of “personal choice” the Senate inquiry seems to have closed itself off already to the kind of useful debate that we might have about the role of the modern state in protecting population health.

Perhaps the inquiry should consider a new collection papers published in the journal Public Health under the heading “Who’s afraid of the Nanny State? Freedom, regulation, and public health.” This special issue explores and unpacks the meaning of the Nanny State rhetoric so beloved by Senator Leyonhjelm, drawing upon work by academics from a variety of disciplines. It offers new ways to conceptualise the role of the state, and highlights the vast array of tools available to governments when acting to protect public health.

Don’t be fooled by the rhetoric. Laws and policies on bicycle helmets, cigarettes, and alcohol save lives. And they do so in a much less intrusive way than chemotherapy for lung cancer, a liver transplant, or surgery for traumatic brain injury.