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Binge Drinking (16/365) by chrisie.b, on Flickr

Good to see an anthropologist engaging with the ‘old’ (i.e. public health and medical) evidence on the problems associated with alcohol consumption, but her suggestion for a new message seems to throw the baby out with the bath water:

I would like to see a complete change of focus, with all alcohol-education and awareness campaigns designed specifically to challenge [erroneous beliefs that alcohol is a disinhibitor] – to get across the message that a) alcohol does not cause disinhibition (aggressive, sexual or otherwise) and that b) even when you are drunk, you are in control of and have total responsibility for your actions and behaviour.

This seems to be a case of new evidence being used to replace one narrow view with another narrow view by ignoring old but still relevant evidence.

There are three reasons why Fox’s call for a new message is misplaced and why the existing message, in Australia, of drinking in moderation needs to be continued.

Firstly, alcohol is associated with poor health outcomes for social binge drinkers and long-term drinkers (e.g. increased risk of heart disease, certain cancers and liver disease).

Secondly, many things you do under the influence are not out of your control, as Fox points out, but they are based on impaired judgement. The effects of drinking are such that certain functions of your brain are no longer able to operate as per normal (see here and here, for example). You still have enough brain function to make decisions about things, but you might not be able to execute them properly. Plus, how this manifests itself as behaviour, as Fox rightly indicates, is culturally and socially determined. Rather than engineering cultural shifts that make drunkenness safer, why not make people safer drinkers by encouraging moderation? It reduces overall risk in the end.

Thirdly, it’s easier to craft and communicate a message of moderate and responsible drinking. What Fox suggests is rather convoluted, but I think I know what she means: if you’re going to drink until your wits leave you, fine, but don’t expect to use this as an excuse for the bad decisions you make whilst under the influence. In the end, it’s easier, more efficient and probably more effective to simply say: drink responsibly, drink in moderation. You can attach a variety of other messages in educational and awareness campaigns, but I seriously doubt you can engineer or even spark off the sort of cultural change that Fox hopes will happen by changing the focus of the message.

Given we are unlikely to completely eliminate problem drinking, I think the research that Fox is citing is useful as a complement to existing public health explanations and recommendations. And this is despite her overly naive suggestion that alcohol regulation along with harsh messages about the effects of alcohol is driving people to desire it more. As an anthropologist I would have thought she could have relied on, say, the concept of ritual as a better lens through which to explain cultural patterns of social drinking (e.g. TGIF). In the end though, yes, cultural change needs to be part of the solution, but not as the dominant focus.

In Australian Indigenous communities, alcohol consumption is so problematic that it can have fatal consequences (i.e. massively increases risk of death due to external causes). I’m sorry Dr. Fox, but we’re struggling to keep these people alive for long enough to hear any message to begin with, let alone your complex one. And, as the research cites, reducing the supply of alcohol and tough messages about the ill-effects of alcohol are doing their job to provide some relief from the consequences of problematic alcohol consumption in Indigenous communities. I think Fox’s suggestions have limited applicability (e.g. middle-class binge drinkers). The other problem with Fox’s suggestion is that it lets governments off the hook when it really boils down to dealing with problem drinking: rather than pouring money into treatment and rehabilitation, governments are happier to make legislative changes. I would add to d’Abbs’ critical observations that another cheap and easy way for governments to deal with any type of social problem is through educational campaigns designed to raise awareness. Fox’s suggestions fit into this suite of armchair policies that hopes for change rather than facilitates it.

McCoy, Brian (2008) Holding Men: Kanyirninpa and the health of Aboriginal men, Canberra: Aboriginal Studies Press

The complex social and cultural determinants of the health of Aboriginal men are given coherence by McCoy through the desert society concept of kanyirninpa. Whilst the term ‘holding’ provides a succinct rendering of kanyirninpa into English, it fails to capture the full range of meanings associated with this idea in desert society culture. Put simply, kanyirninpa is a concept that describes the normative system that balances the opposing forces of nurturance and authority, relatedness and autonomy in a bid to ensure the social, cultural and material reproduction of desert society as a series of relationships to family (walytja), land (ngurra) and ancestral dreaming (tjukurrpa).

After explaining its post-settlement history, McCoy uses the concept of kanyirninpa as a lens through which to understand the paradoxical nature of the social and cultural determinants of the health of Aboriginal men. He uses the particular sites of male sociality within petrol sniffing, prison and football as a way to show how kanyirninpa and its absence can impact healthy outcomes. Petrol sniffing, for example, provides a bridge between childhood and adulthood where young boys can explore the extremes of the value of autonomy, albeit at the expense of their own physical health. Initiation into manhood offers the countervailing force of relatedness that tends to untether boys’ dependence on petrol sniffing as a mode of exploring their autonomy. However, similar problems can be reproduced in adulthood where alcohol presents itself as a substitute for exploring adult male autonomy. As this example demonstrates, the male praxis that both gives expression to and is expressed by the normative system of kanyirninpa can produce adverse health outcomes, in both black and white terms, as much as it produces improvements. More…