Muhunthan Janani, Angell Blake, Hackett Maree L, Wilson Andrew, Latimer Jane, Eades Anne-Marie, Jan Stephen
The George Institute for Global Health, Sydney, Australia.
The Australian Prevention Partnership Centre, Australia.
BMJ Open. 2017 Mar 27;7(3):e013932. doi: 10.1136/bmjopen-2016-013932.
The national and subnational governments of most developed nations have adopted cost-effective regulatory and legislative controls over alcohol supply and consumption with great success. However, there has been a lack of scrutiny of the effectiveness and appropriateness of these laws in shaping the health-related behaviours of Indigenous communities, who disproportionately experience alcohol-related harm. Further, such controls imposed unilaterally without Indigenous consultation have often been discriminatory and harmful in practice.
SETTING, PARTICIPANTS AND OUTCOME MEASURES: In this systematic review of quantitative evaluations of Indigenous-led alcohol controls, we aim to investigate how regulatory responses have been developed and implemented by Indigenous communities worldwide, and evaluate their effectiveness in improving health and social outcomes. We included articles from electronic databases MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science from inception to December 2015.
Our search yielded 1489 articles from which 18 met the inclusion criteria. Controls were implemented in rural and remote populations of high-income nations. Communities employed a range of regulatory options including alcohol rationing, prohibition of sale, importation or possession, restrictions on liquor sold, times of sale or mode of sale, Indigenous-controlled liquor licensing, sin tax and traditional forms of control. 11 studies reported interventions that were effective in reducing crime, injury deaths, injury, hospitalisations or lowering per capita consumption. In six studies interventions were found to be ineffective or harmful. The results were inconclusive in one.
Indigenous-led policies that are developed or implemented by communities can be effective in improving health and social outcomes.
大多数发达国家的国家和地方政府已成功地对酒精供应和消费采取了具有成本效益的监管和立法控制措施。然而，对于这些法律在塑造原住民社区与健康相关行为方面的有效性和适当性缺乏审查，而原住民社区遭受与酒精相关伤害的比例过高。此外，在未经原住民协商的情况下单方面实施的此类控制措施在实践中往往具有歧视性且有害。
背景、参与者和结果指标：在这项对由原住民主导的酒精控制措施的定量评估的系统评价中，我们旨在调查全球原住民社区如何制定和实施监管应对措施，并评估其在改善健康和社会成果方面的有效性。我们纳入了从MEDLINE、EMBASE、CINAHL、PsycINFO和Web of Science电子数据库自创建至2015年12月的文章。
我们的检索共得到1489篇文章，其中18篇符合纳入标准。控制措施在高收入国家的农村和偏远地区实施。社区采用了一系列监管措施，包括酒精配给、禁止销售、进口或持有、限制酒类销售、销售时间或销售方式、原住民控制的酒类许可证发放、罪恶税以及传统控制形式。11项研究报告了在减少犯罪、伤害死亡、伤害、住院或降低人均消费量方面有效的干预措施。在6项研究中，干预措施被发现无效或有害。1项研究结果尚无定论。
由社区制定或实施的原住民主导政策在改善健康和社会成果方面可能是有效的。
