Public health policy in practice

Associate Professor Penny Buykx is a behavioural scientist whose research examines public health implications for alcohol and substance use.

How aware is the population of the link between alcohol consumption and cancer? And what effect does alcohol pricing having on the amount of alcohol we consume? Why do some health authorities offer better alcohol treatment programs than others?

These are the types of questions that Associate Professor Penny Buykx asks in her work as a behavioural scientist with the School of Humanities, Creative Industries and Social Sciences and Healthy Communities and Social Futures Cluster.

Early in her career Associate Professor Buykx worked as a Juvenile Justice Case Manager and had many clients with drug and alcohol problems. It was then that she first became interested in treatment for and the public health effects of alcohol and substance use.

“I had a psychology degree but I didn’t feel particularly well-equipped to deal with the drug and alcohol aspects of the case worker role. I recognised a gap in my knowledge so did a certificate in addiction studies,” Dr Buykx said.

Her research career began when while working for the National Drug Institute at Curtin University in Perth on a project to do with the decriminalisation of cannabis. She then joined the research team at Turning Point Alcohol & Drug Centre in Melbourne before moving to a role with the School of Rural Health at Monash University in Bendigo.

“When you live in a regional and remote community you may not have access to health services as readily as you would in the city. Plus the services, which are available, may need to cater to a much broader scope of practice. This awareness spurred my research into access to treatment systems,” she said.

Investigating access to treatment services

Associate Professor Buykx joined the University of Sheffield Alcohol Research Group in 2014 where she became involved in a project investigating access to alcohol treatment in English local authorities and how the prevalence of alcohol dependence would change if the level and mix of service provision were to alter.

The research team found that there could be large differences in treatment access rates depending on what local authority area you live in.

“In England you can be living in one local authority area (similar to a local government area in Australia) which has many alcohol treatment services, and ten miles away in the next local authority area there can be very minimal services available.”

“We found that there might be a seven fold difference in the amount of people who can access treatment in one area compared to another,” she noted.

This finding was the genesis of another project to better understand how local authorities make decisions around what treatment services to fund.

“Ideally, it shouldn't matter where you are, there should be a reasonable level of service provision,” Associate Professor Bukyx said.

“However, local authorities need to decide how to share out their money to meet the needs of the community. Some might have more need for in-home care of the elderly, disability programs or physical activity options so in some cases alcohol treatment services are just one of many priorities.”

“This research circles back to my time in rural health in Australia. I am keen to delve more into the management of service provision in rural and remote Australian areas and how our authorities deal with providing services in large geographic areas,” Associate Professor Buykx said.

Alcohol pricing to reduce harm

While at the University of Sheffield in the United Kingdom Associate Professor Buykx became involved in several major public health research projects, including one evaluating the impact of the recently introduced minimum unit alcohol pricing policy in Scotland.

“Minimum unit pricing stipulates a price that alcohol can’t be sold below. The price of the alcohol is based on the standard number of drinks in the product. It primarily has an effect on the price of takeaway alcohol purchased at bottle shops,” Associate Professor Buykx said.

Minimum unit pricing legislation came into effect in Scotland in May 2018 but it is subject to a sunset clause. Associate Professor Buykx’s research is part of a wider program of commissioned research looking at the effect of the policy.

“My ongoing research with colleagues at the University of Sheffield and Figure 8 Consultancy examines the impact of the policy on those who are accessing treatment for alcohol dependency. We are undertaking face-to-face interviews with people who are dependent on alcohol prior to the introduction of the policy and are interviewing a similar cohort post implementation of the policy to see the impact the pricing has had on them. These are the people that are most likely to find it difficult to reduce their drinking.”

“Scotland introduced the policy because evidence suggests that, at a whole population level, it will result in fewer alcohol related hospitalisations and deaths. The main part of the policy evaluation is looking at that general population effect. But we’re also interested in how the group of people who can’t easily alter their drinking are coping. Before the policy was introduced we asked a series of detailed questions about what people drank in the 7 days before they entered treatment, particularly how much they drank and what they paid. We then undertook another series of interviews after the policy became active in May 2018 and will be doing a third round of interviews later this year,” Associate Professor Buykx said.

The Northern Territory of Australia also introduced minimum unit pricing in October 2018, with a minimum floor of $1.30 per standard drink now in effect. Associate Professor Buykx is keen to contribute to the evidence base and debate in Australia around this.

“It’s a live policy question in Australia at the moment. There’s also been interest in Western Australia around minimum unit pricing with that government considering implementing the policy as well.”

Impacting the community

An advocate and supporter for early career researchers, Associate Professor Buykx says that research is an excellent career as it allows you to be curious about important issues of social policy and take the time to think about them deeply. She worked for a doctoral training centre in the United Kingdom and welcomes PhD students whose research interests are close to her own.

“There’s such a variety in research work; some days you are doing really detailed analyses of data sets and other days it’s quite exciting to see the work you done being applied to a relevant to public health policy debate.”

“Working in public health and policy research can really provide impact and shape how the government does things. It’s very motivating to see the information you provide being considered by policy makers whose decisions are going to have a profound impact on many people’s lives,” Associate Professor Buykx concluded.