Supporting and developing healthy policies

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... Gurungu Council requested that the health promotion team from Tennant Creek conduct a survey to determine community support of these strategies. The purpose, process and methodology for the survey and how the results would be used were decided after a group discussion involving the health promotion team and Gurungu Council representatives … it was decided that the survey should focus on three basic issues:

• the limits on take-away alcohol
• children being allowed in the public bar
• whether take-aways on Sundays should cease.

...[Two health promotion officers] walked around the community, explaining to people what the survey was about. A simple ballot type paper was used and community members marked appropriate boxes... Analysis of the data was undertaken by people elected by the community and included members from all sections of the community.

Participation in the survey was by choice, but it did cover a very broad section of the community and included known drinkers as well as non-drinkers.

According to the electoral roll, 188 out of a possible 287 adults (65%) participated in the survey. The results are shown in Table 1.

After the survey data was analysed another meeting with the Liquor Commissioner was arranged to report the results and discuss the appropriate strategies.

With community support the three strategies were ratified and are now formally in place and apply to all, including people passing through town.

The people of Elliott have set a precedent in the Northern Territory by implementing these strategies and they are proud of the way they confronted the alcohol issue.

The community members pursued something they believed in and achieved the outcome they desired. The confidence they have gained through this process will place them in a strong position to further address alcohol and other drug issues in the future.

Extracts from an article by Gwen Walley and Darrin Trindall 1994.
For the whole story see 'Strengthening community action in the
Northern Territory', Health Promotion Journal of Australia 4 (1): 60-61

Some communities choose to live with alcohol by having their own licensed premises, including hotels, sports and social clubs...One of the main reasons for starting a social club is to create a safe drinking environment in the community. In many places, people need to leave their community if they would like to drink alcohol, and family members worry about their safety, about the amount of time and money spent away from the family and community, and about culture. In communities where there is a club, it means that people can choose to drink alcohol, or not to drink, in their own community.

From 'Ideas for Sports and Social Clubs:
Creating Safer Drinking Environments' by Hunter and Clarence 1996:5-6

Some communities experience problems because of misuse of alcohol, and the women have become the 'meat in the sandwich'. They have said "yes I had the money to buy food for my kids but he (husband/partner) took it off me to buy grog".

One of the ways to work with these women is to say "alright, there is a club here on this community - but who runs the club? Who is on the committee? Who makes the rules for this club?" People must be given the correct information, and knowledge of how decisions are made in that club. Misuse of alcohol doesn't just affect one person. It affects a widening circle of people and eventually, the whole community can be affected in differing degrees.

Let us look at just one such family _ husband, wife and kids. If the husband (who is represented by the central dot in the diagram) is drinking all or a large percentage of the money, this could be the start of malnutrition in the kids as there is little or no money to feed them (first circle). The next circle represents the extended family who are obliged to feed this family and therefore there is less food to go around both families.

If family violence occurs then the next circle represents night patrol/health workers and/or police involvement. Family fighting also affects neighbours, and the next day in a 'flow on effect', the school teachers trying to teach kids who can't concentrate or are half asleep. Lots of times these kids don't even go to school because of the trauma of the previous night and consequently their education is spasmodic and not achieving desired results.

The next circle represents health staff /ambulance drivers and airport workers at light airstrips should the need arise for medical evacuation. So you can see that this can grow into a huge situation and everybody gets involved in different ways.

So it is important to talk to people about when the club elections are due and that it is necessary for the whole community to have a say in how the club is being run. You don't leave the running of the club up to the drinkers, because we have seen how the whole community can be affected through one persons misuse. People should be encouraged to get elected to the committees and to be able to say "we want a cross section of people on that club committee. We want people from the Health Centre, we want people from the school, we want women from the Women's Centre because they're the ones running the nurtrition programs, we want Night Patrol people. We want people from right around the community".

Everyone should be involved because eventually everyone is affected. It can be a long project to help women to see this point of view and be empowered to act on it. But some women have done this, and got themselves on the club committee.

By Sarah Huppatz, Darwin

Umbakumba is the oldest existing community on Groote Eylandt. Umbakumba is a restricted Aboriginal community of about 400 people, including 16 non-Aborigines.

The ladies at Umbakumba invited Living With Alcohol to visit their community, because they were getting worried about alcohol problems at Umbakumba.

Aboriginal Living with Alcohol Program people had 6 visits to Umbakumba from December 1994 to October 1995. People shared their stories about alcohol, and about the controls on the beer rations. Their stories talked about grog, domestic violence, firing guns (with no licences), family problems through alcohol, information from other communities and the actions they are taking, the ration of grog and excess of grog in the community, money problems.

Then the community organised a meeting with the Liquor Commission. The men and women attended, as well as the Liquor Commissioner, Police and Bernadette and James from the Aboriginal Living With Alcohol Program.

• The community decided to control the amount of alcohol coming into the community.
• For a 6 month trial period the daily beer ration would be no more than 14 cartons.
• Special conditions were written into the Alyangula Recreation Club's ARC Liquor Licence for 6 months.
• No extra cartons could be purchased by anybody, including non-traditional residents.
• If the conditions are broken, alcohol would be banned until the Council and Liquor Commission had held another meeting.

The new rules were put up at the council office for everybody to see.

Results of the rations and rules:

People from Umbakumba know what the controls are and mostly support the rules. There have been times when the rules were broken and sometimes it has been difficult for the men from Umbakumba to pick up the rations, because of their family relationships with Angurugu people.

When some of the rules were broken, Umbakumba community took its own action, without the need to involve the Liquor Commission or the Police.

The community is quieter and there has been less violence.

Based on 'This is a story for the beer rations in Umbakumba
Community from January to July 1995', Territory Health Services (1995)

The most important step for the community is to do something. Accordingly we have been positive about every intervention we have encountered and given it every support we can. In communities that currently have no intervention we have found that there are invariably plans and dreams. We have encouraged people to embark on their plans and given every support we can. It is also clear that people have been inspired by the stories from other communities.

From 'Petrol Link Up' by Shaw, Armstrong and San Roque 1995:13

From the mid 1960s sniffing was a big problem in Maningrida community in the Top End. Numbers of youths sniffing ranged from 20-200. In 1989 Maningrida community replaced leaded petrol with unleaded petrol. The aim was to reduce lead toxicity in petrol sniffers. To evaluate the strategy hospital admissions for petrol sniffing were compared between Maningrida and another community using only leaded petrol. Records were checked for the years 1987 to 1992. It was found that hospital admissions from Maningrida decreased significantly after they introduced unleaded petrol. When blood levels were checked those sniffing unleaded petrol from Maningrida had significantly less lead in their blood compared to sniffers in hospital who had come from communities that still used leaded petrol.

In 1992 Maningrida community requested help from Menzies School of Health Research to assist in assessing the situation. After working with Menzies the community decided to replace unleaded petrol with AVGAS. It had been reported from other communities that kids did not like sniffing AVGAS because it caused severe headaches and stomach cramps. On December 31, 1992 avgas was introduced. This required the cooperation of Maningrida Progress Association which ran the local store, including the only petrol outlet. The Community Council also initiated employment and skills-training programs.

By April 1993, four months after the introduction of AVGAS, petrol sniffing had stopped in Maningrida. In a follow up study it was shown that blood lead levels of both petrol sniffers and ex-sniffers decreased significantly. There was a lot of skills training, organised through the Council, followed by a big increase in employment among the group who had been sniffing. These jobs were mainly in housing construction and other community projects through CDEP and employment with the Council. There was also a large reduction in crime in the community. Overall yearly crime decreased from 147 court files between 1987-1990 to 62 files between 1991-1994.

While AVGAS was an important strategy in the overall program, it has not been successful everywhere else. Community determination and meaningful occupation (employment and skills training) for young people are critical. It has been suggested by others that the most effective measures might be those which change the economic, cultural and spiritual aspects of people's lives and environments.

Based on an article by Chris Burns, Bart Currie, Alan Clough and
R Wuridjal 1995, 'Evaluation of strategies used by a remote Aboriginal
community to eliminate petrol sniffing' in The Medical Journal of Australia 163:82-86.

In many communities there is a movement towards seeing petrol sniffing and other substance abuse by young people as just one of the many issues concerning young people growing up in Aboriginal communities.

There is a "three way" approach that:

1. reduces availability of petrol by the substitution of AVGAS;
2. that rehabilitates damaged sniffers through outstations; and
3. provides positive alternatives through youth programmes.

From 'Petrol Link Up' by Shaw et al 1995:19

1. As much as possible, individuals and families must take responsibility for their behaviour and for that of children in their care.
2. Services and activities addressing ISA should be initiated and controlled at the local community level as much as possible, and information and education should be available to assist this process.
3. Communities should be provided with support to develop appropriate responses, and interventions which, where possible, reintegrate inhalant abusers into the community.
4. A range of complementary interventions should be provided with priority given to long term prevention, in accordance with a harm minimisation approach.
5. All services having contact with inhalant abusers should be provided with appropriate information and training to enable assessment and, where relevant, provide appropriate referral and care.
6. The care of people who become disabled as a result of ISA should be guided by general disability policies.
7. ISA is a social and community issue that requires coordination, inter-sectoral cooperation and regular monitoring and review.

THS Strategy on Petrol and Other Inhalant Substance Abuse, 1998

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