Addiction (1999) 94(6), 801± 811

ENCOUNTERS AT THE SCIENCE POLICY INTERFACE

Not much to ask for, really! The introductionof standard drink labelling in Australia

DAVID HAWKS

National Centre for Research into the Prevention of Drug Abuse, Curtin University ofTechnology, Perth Australia

Abstract

An account is provided of the processes leading up to the introduction of standard drink labelling on all

alcoholic beverage containers in Australia. The roles of research and advocacy in recommending theintroduction of such labelling are analysed as is the resistance of some parts of the alcohol beverage industry.

It is concluded that the success of this policy initiative derived from the carefully orchestrated campaign in

which researchers co-operated with health advocates. The prior existence of nationally endorsed guidelines forsafe drinking expressed in terms of standard drinks, recommendations of the National Health Policy on

Alcohol and an accumulation of relevant research were crucial elements for success. However, the role played

by some fortuitous circumstances cannot be ruled out.

Introduction

The encounter at the science policy interface tobe described in this paper did not concern someissue of great moment, the implementation ofwhich could be expected to result in immediatelysigni® cant gains, although it did represent aworld ® rst. On the contrary, the addition ofstandard drink labelling to all alcoholic beveragecontainers could be considered a very modestaspiration indeed, serving as it does merely toprovide consumers of alcohol with what might beconsidered an essential item of consumer infor-mation.

Nevertheless, its successful negotiation as anational policy over a period of 4 years illustratesthe dif® culty of persuading governments toimplement healthy public policy in relation to acommodity which contributes handsomely to its

revenue base and which is represented by apowerful industry body.

In the event, there is reason to believe that theargument was eventually won not wholly forhealth reasons but for reasons of consumerrights: but that is to jump to the end of the storywhen the beginning is yet to be told.

The idea (or policy)

The idea that alcohol containers might usefullydepict the number of standard drinks (or stan-dard units) contained therein had, it wouldseem, several origins and not all in the sameplace. The Royal Automobile Club of WesternAustralia, the Western Australian Alcohol andDrug Authority and the Police and HealthDepartment of Western Australia (WA) had all

Correspondence to: Professor David Hawks, National Centre for Research into the Prevention of Drug Abuse,Curtin University of Technology, GPO Box U1987, Perth, WA 6001, Australia.

Submitted 20th January 1997; initial review 15th July 1997; ® nal version accepted 6th December 1998.

0965± 2140/99/060801± 11 $9.50 Ó Society for the Study of Addiction to Alcohol and Other Drugs

Carfax Publishing, Taylor & Francis Ltd

802 David Hawks

used the term ª standard drinkº for educationpurposes in a variety of publications dating fromas early as 1984 (Police Department of WA,1984; Health Department of WA, 1986; West-ern Australian Alcohol and Drug Authority,1986; Royal Automobile Club of Western Aus-tralia, 1987).

Reference to standard drinks or standard unitshad also been made in publications of the severalRoyal Colleges of Medicine in Britain (RoyalCollege of Psychiatrists, 1979; Royal College ofPhysicians, 1987) while a consensual statementpublished by the joint Royal Colleges recom-mended that ª alcohol manufacturers should berequired to label clearly the beverages with theirstrength and alcoholic content. Labelling shouldbe easily understood, i.e. as units of alcoholº(Lancet, 1987).

Coincidental with the publication of theseBritish reports consideration was being given inAustralia to the drafting of the national healthpolicy in relation to alcohol (Hawks, 1990,1993), one of which recommendations was ª thedepiction of the alcohol content of beverages onall containers of alcohol beverage in a way read-ily understandable by the publicº (MCDS,1987). While the draft policy was subsequentlyamended and took 2 years to become of® ciallyendorsed, the recommendation regarding stan-dard drinks survived.

When in 1986 consideration was being givento what might comprise the ® rst work plan of thenewly established National Centre for Researchinto the Prevention of Drug Abuse it was sug-gested that some of the error associated withpopulation surveys of consumption might beattributed to the fact that different units ofmeasurement were being employed by respon-dents and researchers. While researchers weredutifully recording respondents’ recollections oftheir consumption in standard units, the respon-dents themselves were recalling their consump-tion in the units they poured for themselves orwere poured by their friends. The possibilityexisted, therefore, that what researchers wererecording as a respondents’ account of theirdrinking, for example that 30 standard units hadbeen drunk in a week, might in reality be con-sumption of between 20 and 50 units per week,depending on the pouring proclivities of thedrinker. The extent to which drinkers over-poured and researchers counted in terms of stan-dard drinks would contribute to the gap usually

recorded in any comparison of sales data withconsumption data collected in the traditionalway. The decreasing tendency for alcohol to bedrunk in licensed premises (where standarddrinks are more often poured) would only serveto widen this gap.

To test this hypothesis a survey was under-taken which invited respondents to pour theirown beverages into familiar drink containers, thecontents of which were then measured in stan-dard units. What this research revealed was thatknowledge of the alcohol content of beverageswas very poor, as was familiarity with the termstandard drink and its absolute alcohol equiva-lent. Wine and spirits tended to be poured wellin excess of a standard drink, beer less so. It wasconcluded that for educational messagesdesigned to encourage safe and responsibledrinking to be effective the concept of standarddrink would need to become more familiar andwell understood by the community (Carruthers& Binns, 1987, 1992).

In a separate but complementary exercise theAustralian National Health and MedicalResearch Council published a document entitledª Is there a safe daily consumption of alcohol formen and womenº (National Health and MedicalResearch Council, 1987, 1991) which de® ned asthe upper limit of safe daily drinking for men andwomen 4 and 2 standard drinks, respectively,with a standard drink being de® ned as 10 g ofabsolute alcohol. Table 1 provides the standarddrink equivalents for a number of populardrinks, employing this Australian standard.

In summary, there have been since at least1984 a number of publications in Western Aus-tralia referring to standard drinks culminating in1987 with the publication of national guidelinesfor safe drinking expressed in terms of standarddrinks. Despite the number of such publicationsthere had been no systematic attempt to educateconsumers about standard drinks nor was thereany requirement that their number be depictedon beverage containers. Such little research ashad been done suggested that consumers typi-cally poured themselves in excess of one stan-dard drink when instructed to do so usingfamiliar containers and showed little understand-ing of the concept of a standard drink.

The research

Stockwell & Stirling (1989), in a study carried

Standard drink labelling in Australia 803

Table 1. Standard drink equivalents Ð Australia (all contain 10 g absolute alcohol)

Full strength Low alcoholBeer 5.6% vs. , 3% vs.

255 ml 453 ml

Wine Port or Sherry ChampagneWine & forti® eds 12% vs. 20% vs. 12% vs.

100 ml 63 ml 105 ml

Spirits Ready mixedSpirit & mixed 40% vs. 5.7% vs.drinks 30 ml 222 ml

Cooler Alcoholic lemonadeCoolers & 3.5% vs. 5.5% vs.ª alco popsº 363 ml 230 ml

CiderCider 6% vs.

211 ml

out in England, found that while subjects couldbe taught to accurately apply the unit (or stan-dard) system of drinking to drinks of standardstrength they made serious errors when theyapplied it to either low or high strength drinkseven when instructed to make allowance for vari-ations in alcohol content.

Stockwell & Honig (1990), in a survey of threerepresentative liquor outlets, found that thestrength of drinks available for sale of a givenbeverage type varied widely and that those ofª atypicalº strength formed a signi® cant pro-portion of the sales, leading them to conclude onthe basis of previous research that drinkers wouldhave greater dif® culty applying the standarddrink system without the number of standarddrinks being depicted on alcohol beverage con-tainers.

In a direct test of the ability of drinkers to poura standard drink if provided with containersrecording the number of standard drinks Stock-well, Blaze-Temple & Walker (1991b) found thatcompared to a ª percentage labelº beer drinkerswere better able to pour a standard drink into avariety of glass sizes if provided with a bottle onwhich the number of standard drinks wasdepicted. Wine drinkers by contrast had equaldif® culty, regardless of the form of label used,but were assisted by the addition of a ladderalong the side of the bottle expressed in standarddrinks.

Using percentage labels (the current form oflabelling) subjects consistently made large errors

when attempting to pour one standard drinkwhen both glass size and beverage strength werevaried.

While the ability of different groups of drinkersto pour standard drinks from various containersinvolving different beverages varies, being easierfor beer and less so for spirits, research under-taken in Australia shows that the greater pro-portion of drinkers who drink at hazardous levelsfavour beer, while the total consumption of spir-its expressed in terms of absolute alcohol is lessthan 15% of the volume drunk.

This being the case, while it is yet to bedemonstrated that all drinkers bene® t from theaddition of standard drink labelling, the potentialat least exists for the heaviest drinkers to bene® tthe most.

Unfortunately, there is as yet no research evi-dence that shows that this potential is beingwidely realized, unsurprisingly given that therehas been as yet no comprehensive campaigndesigned to educate drinkers in relation to stan-dard drinks. The authors concluded that theintroduction of standard drink labelling onalcohol containers would greatly facilitate theefforts of health educators to communicateadvice about responsible alcohol use.

In a related study Stockwell, Blaze-Temple &Walker (1991a) found that after attempting analcohol estimation task a substantial majority ofthe respondents expressed a preference for stan-dard drink labelling compared to labels whichwere expressed in terms of grams or decigrams.

804 David Hawks

Table 2. Alcoholic beverages: drinking sessions greater than fourstandard drinks per session (%)

Alcoholic beverage

FullWine strength Spirits Light beer

beer

Male 24.4 57.2 30.7 15.4Female 19.2 41.8 21.3 8.4

Source: ABS, Population Survey Monitor, May, August and Novem-ber 1994.

An aside

The National Health Policy on Alcohol wasof® cially endorsed at a meeting of the MinisterialCouncil on Drug Strategy in 1989 and publishedas such in 1990. Coincidentally, the proposal torequire alcohol manufacturers in Australia tolabel their product with information on the num-ber of standard drinks in each container waspresented to the Ministerial Council on DrugStrategy in 1990 and referred to them by theNational Food Authority in 1991. While logic(most health education in Australia related toalcohol since 1984 referred to standard drinks)and the results of the research done to this pointwould have recommended the adoption of thisproposal, in fact a further 4 years were to elapsebefore standard drink labelling was introducedof® cially, in part it would seem re¯ ecting theopposition of the brewers and distillers and inpart because it was argued that research support-ing the proposal was too parochial being limitedto West Australian samples.

The research, continued

There followed a series of market surveys,some commissioned by the Federal Departmentof Community Services and Health and othersundertaken by its own staff which largelycon® rmed the results of the West Australianresearch. The ® rst of these, undertaken by RearkResearch (1991), concluded that ª standarddrink information when presented with a symbolindicating the National Health and MedicalResearch Council recommendations, is typicallyconsidered to be signi® cantly more useful thanthe existing labelling information of percentage

alcohol by volumeº . Furthermore, ª most alcoholconsumers believed that people would be capa-ble of using standard drink information to assesstheir alcohol consumption while a majority werealso able to demonstrate their ability to actuallyuse this information when asked to convert agiven volume of various alcohol types into num-bers of standard drinks. Moreover, the majorityof alcohol consumers expressed themselves `atleast likely’ to use standard drink information tomeasure or regulate their consumptionº .

Taylor & Pidic (1992), in an internal study,found that while there was reasonable knowledgeof the concept of a standard drink, speci® cknowledge as to what actually constitutes a stan-dard drink was low, especially for wine. As aconsequence it was concluded that respondents,while aware of the National Health and MedicalResearch Council recommendations, would havegreat dif® culty putting them into effect even ifmotivated to do so.

In a study timed to coincide with the Minis-terial Council on Drug Strategy’ s reconsider-ation of the proposal to introduce standard drinklabelling (and also intended to address the criti-cism that much earlier research have been lim-ited to West Australian samples) Stockwell &Beel (1994) commissioned a survey of publicsupport for standard drink labels employing sam-ples recruited from rural and urban areas in fourAustralian states. They found that there wasstrong community support for the introductionof standard drink labelling and that a largemajority of those questioned expressed the viewthat such information would allow them to mod-erate their drinking. Of those respondents whowanted information about the health effects of

Standard drink labelling in Australia 805

Table 3. Apparent per capita consumption of alcohol expressed in litres of alcohol 1984± 1996 (% in brackets)

1984± 85 1985± 86 1986± 87 1987± 88 1995± 96

Total beer 5.19 (58.5) 5.24 (58.0) 5.07 (58.3) 5.03 (58.0) 4.16 (54.6)Wine 2.48 (27.9) 2.51 (27.8) 2.44 (28.0) 2.40 (27.7) 2.09 (27.4)Spirits 1.20 (13.5) 1.27 (14.0) 1.18 (13.5) 1.24 (14.3) 1.35 (17.7)Total 8.87 9.02 8.69 8.66 7.61

moderate alcohol use nine out of 10 wantedinformation about moderation to be expressed interms of standard drinks.

Despite these preferences it was found thatdrinkers were extremely poor at knowing howmany drinks would put them over the legal limitto drive and how many standard drinks werecontained in containers of their preferredalcoholic beverage.

In summary, then, it was clear that whilemuch health education, advice regarding safedrinking and drinking and driving was expressedin terms of standard drinks and the public atleast had an awareness of this concept, they wereunable to estimate the number of standarddrinks in familiar containers or glasses, wereunable to pour standard drinks with any degreeof accuracy and unable to convert the then cur-rent form of labelling, the percentage by alcoholvolume, into standard drinks.

While information about the alcoholic contentof drinks alone will not necessarily reducealcohol-related morbidity and mortality not tohave such information available in a readilyunderstandable form is clearly an impediment tohealth education and reduces the possibility thateven those so motivated will moderate their con-sumption.

To comprehend how this most obvious insighttook 4 years to be enacted as policy it is neces-sary to understand the role of the brewers anddistillers in resisting it.

The role of advocacy

In the 4 years which elapsed between the Minis-terial Council on Drug Strategy’ s adoption of theNational Health Policy on Alcohol which calledfor the depiction of ª the alcoholic content ofbeverages on all containers of alcoholic beveragein a way that is readily understandable by thepublicº and the National Food Authority’ s pub-lication of its draft variation requiring the

addition of standard drink labelling to allalcoholic containers, there was ample formal andinformal opportunity for parties opposed or sup-porting the variation to make their representa-tions. The process of consideration wasprolonged in part at least because the originalapplication made by the Ministerial Council onDrug Strategy on 21 May 1991 was imprecise insome of its details, necessitating a resubmission(as it happened, jointly with the WinemakersFederation of Australia).

Even then the assessment of this joint appli-cation was subsequently suspended when theMinisterial Council on Drug Strategy wrote tothe National Food Authority (in May 1991)advising that it wished to conduct furtherresearch to address the most appropriate andeffective form of labelling.

In the interval between May 1991 and the® nal submission made on 23 December 1992 theMinisterial Council on Drug Strategy attemptedto reach an agreed position with the severalalcohol interests. While the winemakers hadbeen supportive of the Ministerial Council onDrug Strategy’ s position from the outset (and itsmembers in some cases had started to add stan-dard drinks to their labels) the brewers anddistillers were opposedÐ the brewers preferringlabelling in terms of grams on the grounds that itprovided greater exactitude and the distillersundecided, but eventually supporting the brew-ers position (Australian Brewers Association,1994).

When it was clear that agreement could not bereached the Ministerial Council on Drug Strat-egy, together with the Winemakers Federation,made their ® nal submission and the assessmentof the application recommenced. The brewerspresented their submission on 21 December1992 and the distillers presented theirs 3 dayslater on 24 December 1992. Both opposed theintroduction of standard drink labelling.

While the Ministerial Council on Drug Strat-

806 David Hawks

egy and the winemakers were attempting to reachan agreed position with the brewers and distillers,the National Food Authority had, on 29 January1992, published notices inviting public commenton the original application. Thirty-eight submis-sions were received, 25 supportive of the appli-cation, 10 opposed and two indeterminate. Ofthose which supported the application themajority derived from health professionals oragencies dealing with alcohol and drug problems,while the majority of those opposed representedthe brewing and distilling industries.

Some indication of the strength of the oppo-sition to the application is shown by the fact thatin summarizing their assessment of the appli-cation the National Food Authority listed 18categories of objection including a number ques-tioning the appropriateness of the National FoodAuthority acting in the matter at all. Among theobjections were a number relating to the researchused by the Ministerial Council on Drug Strategyto support its case. Of the four research studiesidenti® ed by the National Food Authority intheir summary as bearing on the application,three were carried out by staff of the NationalCentre for Research into the Prevention of DrugAbuse. Also of note is the fact that nine of the25 submissions supporting the applicationspeci® cally identi® ed the research undertaken bythe National Centre for Research into the Pre-vention of Drug Abuse or the Centre’ s ownsubmission as supporting their case (NationalFood Authority, 1993).

While the formal representations made are rela-tively easy to identify, those made informally, par-ticularly those made by the brewers and distillers,are much harder to document. What is known isthat the brewers produced a document entitledª Standard drinks: myths, facts and some sur-prisesº on 15 August 1994 copies of which weresent to all State ministers having responsibility forhealth, police and liquor licensing matterstogether with the Premiers of each of the statesand territories. Representatives of the brewing anddistilling industries also personally visited each ofthe health ministers, both state and federal.

An interesting sidelight on the alcohol indus-try’ s opposition to the application of standarddrink labelling was their reference of the appli-cation to the Industry Directorate of the Com-mission of European Communities (GATT) in1993.

The European Communities expressed the

view that the effectiveness of standard drinklabelling for public health not being scienti® callyestablished Australia had provided insuf® cientreason to support the necessity of its introductionon a unilateral basis, particularly as it was arguedthat it would create unnecessary obstacles tointernational trade (a view surprisingly supportedby the NSW Department of Health) (NationalFood Authority, 1993).

While the argument that standard drink label-ling would constitute a barrier to internationaltrade was rejected by the National Food Auth-ority that standard drink labelling of itself wouldlead to signi® cant public health bene® ts had notformed part of the application. It was alwaysacknowledged by those supporting the introduc-tion of standard drink labelling that it wouldneed to be accompanied by a comprehensiveeducational campaign emphasizing the desirabil-ity of conforming to safe drinking levels, forwhich an understanding of standard drinks was anecessary prerequisite. In other words, whilestandard drink labelling provided a meanswhereby drinkers could moderate their consump-tion, the mere addition of these labels to bever-age containers did not of itself guarantee thatdrinkers would be motivated to do so.

For their part Stockwell and colleagues at theNational Centre for Research into the Preventionof Drug Abuse kept up a steady stream of corre-spondence, some of it published (Stockwell &Blaze-Temple, 1990; Stockwell, 1992) advocat-ing the adoption of standard drink labelling.They also enlisted the advice of the AlcoholAdvisory Council, a non-governmental incorpor-ated advocacy group registered in Western Aus-tralia, to spread the message in a series of pressreleases (The Australian, 17 October 1994; Tele-

graph Mirror, 21 October 1994; The Age, 21October 1994; Alcohol and Other Drug Councilof Australia, 22 September 1994; AustralianDrug Foundation Inc., 16 September 1994)which were issued in the name of the AlcoholAdvisory Council and a number of other health,professional and consumer organizations. Of par-ticular note was the support, both ® nancial andpersonal, provided by the Australian ConsumersAssociation. Their argument, which provedincontestable, was that consumers of alcohol hada right to know how much alcohol was in acontainer in terms which were understandable tothem, and related to ongoing health education. Ahalf-page advertisement was also placed in The

Standard drink labelling in Australia 807

Australian on 15 March 1994 supported by 19individuals and related organisation (The Aus-tralian is Australia’ s only national daily newspa-per) (The Australian, 1994).

One day earlier (14 March 1994) the AlcoholAdvisory Council had issued a press releaseheaded ª Alcohol information for consumersblocked by industryº (Alcohol Advisory Councilof WA, 1994) which was very nearly its undo-ing, implying as it did that all components of thealcohol industry opposed the introduction ofstandard drink labelling whereas in fact thewinemakers had been supportive from the out-set. Letters from the Winemakers Federationwere sent to all the organizational signatories toThe Australian advertisement stating that theirposition had been misrepresented by implyingthat all components of the alcohol industryopposed the introduction of standard drinklabelling. The Alcohol Advisory Councilacknowledged the error and distributed a mediarelease under the heading ª Winemakers supporthealth groups on drink labellingº , so avertingwhat could have been an expensive and damag-ing legal challenge.

Of particular consequence was the releasethrough the Alcohol and Drug Council of Aus-tralia and the Alcohol and Drug Foundation ofthe national survey results commissioned by thenational centre for Research into the Preventionof Drug Abuse, the conclusions of which were tocon® rm the studies carried out earlier in West-ern Australia.

When on 30 September 1994 the Common-wealth Minister for Human Services and Healthannounced, following a meeting of the Minis-terial Council on Drug Strategy, that standarddrink labelling would be introduced in associ-ation with a comprehensive education campaign,she speci® cally mentioned the research carriedout by the National Centre for Research into thePrevention of Drug Abuse. Standard drinklabelling was ® nally introduced on all beveragecontainers manufactured for Australian con-sumption on 22 December 1995, 3 years almostto the day after the ® nal submission was madeto the National Food Authority.

What can be concluded?

It might be asked why standard drink labellingwas ® rst applied in Australia, rather than in theUnited States, where there had been a tradition

of adding warning labels to beverage containers(Hilton & Kashutas 1991; Green® eld &Kashutas, 1993; Green® eld, Graves & Kashutas,1993), but where the addition of informationabout alcohol content was considered contro-versial because of its implied inducement.

The fact that Australia had a health policy inrelation to alcohol in place since 1989, the draftof which had been under discussion since 1986,both of which recommended the addition ofcomprehensible information on alcoholic con-tent is undoubtedly part of the explanation. Soalso is the fact that there was established as partof the National Campaign Against Drug Abusea National Research Centre whose brief wasspeci® cally to undertake research relevant topolicy, in particular research which had thepotential to prevent problems associated withthe hazardous consumption of alcohol.

Given the existence of this research brief anda policy recommending comprehensible label-ling, it is hardly surprising that the NationalResearch Centre diverted some of its resourcesto identify the preferred form of such labellingand its public acceptability. The fact that theResearch Centre received a block grant, whichwas not tied to speci® c projects, allowed itsDirector to commit resources to this enterprise.

While the Research Centre’ s ManagementCommittee did not question the commitment ofthe Centre’s scarce core resources to elucidatingthe best form of labelling, the advocacy of theresults of that research did draw some criticismand allegations of perseveration, illustrating thetension which is always inherent in policy relevantresearch (Hawks, Stockwell & Casswell, 1993).

The particular division of labour betweenthose undertaking research and those advocatingits implications is managed in Western Australiain what is perhaps a unique way, the descriptionof which requires a personal aside.

The Alcohol Advisory Council of WesternAustralia is an incorporated body established toadvocate the application of public health princi-ples to the formulation of alcohol policy. It was® rst established in 1987 on the basis of fundingreceived from the West Australian Alcohol andDrug Authority (the statutory body in WesternAustralia responsible for providing services tothose with alcohol and drug related problems)which itself receives money from the Govern-ment to support the activities of non-govern-ment bodies in this area.

808 David Hawks

Unusually and at times controversially theDirector of the West Australian Alcohol and DrugAuthority was elected Chairman of the AlcoholAdvisory Council and while no longer Director ofthe West Australian Alcohol and Drug Authoritycontinues in that capacity to this day.

The Alcohol and Drug Authority, having alegislative mandate to provide government withpolicy advice in the alcohol area and carry outresearch relevant to that advice regularly used theAlcohol Advisory Council to garner support forsuch policies and even at times to advocate poli-cies which were not yet adopted by government.

When the Director of the West AustralianAlcohol and Drug Authority moved to becomethe foundation Director of the National Centrefor Research into the Prevention of Drug Abusehe continued to chair the Alcohol Advisory Coun-cil and so maintain the link between research andadvocacy, with the added advantage that theNational Research Centre being independent ofgovernment, unlike the Alcohol and Drug Auth-ority, could be more critical of it.

As a consequence, and in the event a happyhappenstance, the chairman of the subcommitteewhich had drafted the national health policy onalcohol occupied the twin roles of Director of theNational Centre for Research into the Preventionof Drug Abuse, which had the capacity to under-take the relevant research, and Chairman of theadvocacy group mandated to advocate the impli-cations for policy of that research.

While I have chosen on this occasion to high-light the adoption of standard drink labelling Icould, although it would be less topical, haveillustrated the complementary role of these twoorganizations in effecting the adoption of randombreath testing in Western Australia and the lower-ing of the legal limit to 0.05.

What can be concluded from this encounterof research policy and Realpolitik? What werethe ingredients of success, however modest?They would appear to be the prior existence ofnationally endorsed guidelines for safe drinkingexpressed in terms of standard drinks; theadoption of a National Health Policy on Alcoholrecommending labelling in a form understand-able to the public; and the accumulation ofresearch evidence showing that the existingform of labelling was neither understandable nordid it permit drinkers to make sense of theguidance they were being given regarding safedrinking.

To these ingredients must be added the exist-ence of a Ministerial Council of Drug Strategycomprising Health Ministers from each of thestates and territories responsible for the formu-lation of National Drug Policy and their parallelmembership of the National Food StandardsCouncil, which has a mandate to ª develop stan-dards with respect to any information about food,including labelling, promotion and advertisingºand to do so in the interests of public health andsafety. While the Ministerial Council on DrugStrategy had to make application to the NationalFood Authority and due process had to beobserved they were in essence making applicationto themselves.

That research evidence played a crucial role isattested to by the fact that it was mentioned asbeing persuasive by the National Food Authorityin its assessment of the application, it was referredto repeatedly in the submissions supporting theapplication and was identi® ed by the Common-wealth Minister of Health as having in¯ uencedthe Ministerial Council on Drug Strategy in its® nal decision. The fact that brewers and distillersspeci® cally commissioned independent reviews ofthat research evidence and attacked it in theirsubmissions to the National Food Authority alsosuggests they accorded it importance.

More dif® cult to assess is the role played byadvocacy. Research showing that the public wassupportive of standard drink labelling was madeavailable to those bodies charged with making thedecision to introduce it. They did not need to bepersuaded of that support by other means. Ofmore importance was the role of the severaladvocacy bodies in disseminating the results ofthe research and publicising the alcohol industry’sopposition to its conclusions. That a number ofrelated health agencies and professional bodiescame out in support of the application andid enti® ed the National Centre for Research intothe Prevention of Drug Abuse’ s research in theirsubmission was due to the networking undertakenby the Alcohol Advisory Council and the decisionof the Centre to circulate its submission inadvance to interested parties. Finally, there wasthe fact that in the middle of the MinisterialCouncil on Drug Strategys’ consideration ofthe matter of the identity of the Common-wealth Minister for Health changing from some-one who had been unsympathetic to standarddrink labelling to someone who supported itenthusiastically.

Standard drink labelling in Australia 809

Finally

As has already been observed, the proponents ofstandard drink labelling were careful not to claimthat its addition to alcoholic beverage containerswould, of itself, result in safe drinking, only thatit provided the means whereby drinkers couldimplement the advice provided in other morecomprehensive campaigns.

In the event, while reference continues to bemade to standard drinks in the various publica-tions of health and transport departments inAustralia, the promised comprehensive nationalalcohol education campaign featuring standarddrinks has not eventuated. While the reasons forits absence are undoubtedly complex, at leastthree suggest themselves. The political complex-ion of the national government changed in early1996, funding for the National CampaignAgainst Drug Abuse was cut in the 1996/97budget and the National Campaign itself is underreview.

In the absence of such a campaign the littleevidence that does exist (Chan et al., 1996)suggests that while a signi® cant majority of thosequestioned had heard of the term standard drinkslightly fewer than one half had noticed theaddition of standard drinks to alcoholic beveragelabelling, in part one supposed because of its lackof prominence. The guidelines issued by theNational Food Authority while insisting that thelabel be distinct, and conspicuously visible to aprospective purchaser and in a colour contrastingwith the background, only required that the printbe at least 1.5 mm high in bold face sanserifcapital letters, a point adversely commentedupon by the Australian Medical Association in apress release (Australian Medical Association,1994).

Chan et al. found that subjects took less timeto ® nd the number of standard drinks if they weredisplayed on the front label than if they were (asthey usually were) displayed elsewhere.

Since the introduction of standard drink label-ling in Australia there have been two signi® cantdevelopments of relevance to this initiative: theproposal to add health warnings to labels (alreadyapplied in the United States of America) and thesuggestion that moderate amounts of alcohol arebene® cial to health, the latter leading to theproposal that such bene® ts to be listed on labels.

While the addition of warning to alcohol bever-age labels was never a part of the imperative tohave standard drink labelling adopted in Aus-

tralia, The National Health and MedicalResearch Council in Australia has recently beenasked to consider the question of warnings,speci® cally warnings about the effect of alcoholon the unborn fetus. This request is currentlybeing considered by the same task force commis-sioned to review Australia’ s guidelines regardingsafe levels of drinking.

The addition of positive messages, as advo-cated by the wine industry in America, is muchmore controversial and has been resisted in thatcountry by a consortium of health bodies on thegrounds that it is misleading and fails to acknowl-edge the manifold harms associated with theconsumption of alcohol.

As a ® nal irony, given their opposition to theintroduction of standard drink labelling, the Dis-tilled Spirits Industry Council of Australia hasbeen the principle industry backer of a newcampaign which features a poster showing fourstandard drinksÐ a standard spirit, a spirit withmixer, a glass of regular beer and a glass ofwineÐ presumably because it contradicts theview that a standard measure of spirits is in someway more alcoholic than the standard measure ofany other beverage.

Acknowledgements

The author has bene® ted in the preparation ofthis paper from discussions with Tim Stockwelland Terry Slevin, respectively Deputy Director ofthe National Centre for Research into the Pre-vention of Drug Abuse and Campaign Directorof the Alcohol Advisory Council during the nego-tiation of standard drink labelling. Their assist-ance in recalling the events of this ª encounterºand in making their papers available is gratefullyacknowledged. During the period in question theauthor was Director of the National Centre forResearch into the Prevention of Drug Abuse andChairman of the Alcohol Advisory Council andtherefore in a position to in¯ uence the directionof both. While it would be immodest to suggestthis happy coincidence played a crucial role in thesuccess of the negotiation it undoubtedly playeda part. That the writer was also one of the authorsof the National Health and Medical ResearchCouncil guidelines in relation to safe drinkingand the Chairman of the subcommittee whichdrafted the National Health Policy on Alcoholmight also be thought to be of some conse-quence.

810 David Hawks

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Standard drink labelling in Australia 811

Appendix

Timeline of signi® cant events

1979 Reference to ª standard unitsº in publications and of the Royal College of Psychiatrists1984 West Australian publications referring to standard drinks1985 Drafting of Australian National Health Policy in relation to alcohol1985 Establishment of the Alcohol Advisory Council of Western Australia (Inc.)1986 Establishment of the National Centre for Research into the Prevention of Drug Abuse as part of

Australia’s national campaign against drug abuse1987 Concensual statement of the joint Royal Colleges recommending labelling by alcohol content1987 First Australian research into pouring practices1987 Publication by the National Health and Medical Research Council of guidelines on ª safe drinkingº

referring to standard drinks1989± 1991 First West Australian research testing ability to pour standard drinks of various beverages1990 Publication of Australia’ s National Health Policy in relation to alcohol making reference to standard

drinks1990 Proposal to require alcohol manufacturers to label containers with the number of standard drinks

referred to the Ministerial Council on Drug Strategy1991 Ministerial Council on Drug Strategy refers standard drink labelling request to the National Food

Authority for the ® rst time1991 Ministerial Council on Drug Strategy advised National Food Authority of wish to commission

additional research to address labelling issue1991± 1994 Commissioned research into the ability to pour standard drinks, etc. undertaken in other Australian

States29/1/92 National Food Authority invites public comment on original Ministerial Council on Drug Strategy

application21/12/92 Brewers make their submission to National Food Authority recommending labelling in terms of

grams23/12/92 Revised submission by Ministerial Council and Wine Industry to National Food Authority recom-

mending labelling in terms of standard drinks24/12/92 Distillers make their submission to the National Food Authority recommending labelling in terms

of grams1993 National Food Authority published their assessment of the submissions made in respect of the

requirement that alcoholic beverage containers identify the number of standard drinks1993 Alcohol industry applied to industry directorate of the commission of the European Community

(GATT) on grounds of labelling requirement will present an obstacle to international trade15/3/94 Half-page advertisement in ª The Australianº supporting standard drink labelling signed by 19

individuals in related organisations15/8/94 Brewers produce documents ª standard drinks, myths, facts and some surprisesº1994 Extensive lobbying in media and public health bodies advocating standard drink labelling30/9/94 Commonwealth Minister of Human Services and Health announces that standard drink labelling

would be introduced in association with an education campaign following meeting of theMinisterial Council on Drug Strategy

22/12/95 Standard drink labelling becomes mandatory on all containers manufactured or imported intoAustralia

1995 National Food Authority issue guidelines on the form standard drink labelling to take1996 Change in Federal GovernmentÐ Standard drink labelling educational campaign put on hold;

National Drug Strategy placed under review