Article Text


Global systematic review of Indigenous community-led legal interventions to control alcohol
  1. Janani Muhunthan1,2,
  2. Blake Angell1,3,
  3. Maree L Hackett1,
  4. Andrew Wilson2,4,
  5. Jane Latimer1,
  6. Anne-Marie Eades1,
  7. Stephen Jan1,6
  1. 1The George Institute for Global Health, Sydney, Australia
  2. 2The Australian Prevention Partnership Centre, Australia
  3. 3The Poche Centre for Indigenous Health, Sydney Medical School, University of Sydney, Sydney, Australia
  4. 4Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
  5. 5The University of Central Lancashire, Preston, UK
  6. 6Sydney Medical School, University of Sydney, Australia
  1. Correspondence to Janani Muhunthan; jmuhunthan{at}


Objectives 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.

Results 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.

Conclusions Indigenous-led policies that are developed or implemented by communities can be effective in improving health and social outcomes.

  • Indigenous health
  • Alcohol control
  • Public health law

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors JM wrote the first draft and led the writing process. JM and BA independently conducted the systematic review with any uncertainties about inclusion or exclusion of empirical studies resolved in discussion with SJ and MLH. All authors contributed to the conceptualisation and design of the paper. All authors contributed to the refinement of the manuscript.

  • Funding This research was supported by a Doctoral Scholarship (held by JM) from The Australian Prevention Partnership Centre, funded by NHMRC, the Australian Government Department of Health, NSW Ministry of Health, ACT Health and the HCF Research Foundation. SJ was in receipt of a NHMRC Senior Research Fellowship. MH was in receipt of a National Heart Foundation Future Leader Fellowship (100034).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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