Abstract
Introduction: There is increasing demand for orthopaedic surgery and public health systems, in NZ and around the world, are struggling to manage. In New Zealand emphasis has been placed on fairness, timeliness, and giving the patient certainty which has led to the development of prioritisation systems and explicit rationing. This thesis of publications is based on research undertaken in Dunedin over the past 20 years. During this period there has been an increasing mismatch between demand and capacity for orthopaedic surgery in general, and hip and knee arthroplasty in particular. A variety of strategies have been employed to try to improve access to elective orthopaedic surgery.
Objective: The Anglo-Celtic colonists of Australia and New Zealand brought with them heavy beer-drinking customs, and each country later developed similar temperance movements and alcohol policies. Yet their beer markets differed throughout the 20th century; for example, Australian men typically drank lager with 5% alcohol-by-volume (ABV), whereas New Zealand men drank ale with 4%ABV. We investigated the public health implications of recent developments in product availability, marketing, and country-level consumption patterns.
Method: We analyzed official data reporting beverage- and strength-specific volumes of ethanol available for sale in beer from 2000 to 2016, a period in which the countries had similar consumption trends; and did a thematic analysis of "market intelligence" reports.
Results: Per capita ethanol beer sales fell in both countries, accompanied by increases in market share of higher %ABV categories. Different definitions of beer strength hampered comparison between countries. In Australia, consumption of ethanol in mid-strength beer (3.01%–3.5%ABV) increased, whereas consumption of low-strength beer (<3%ABV) decreased. In New Zealand, consumption of high-strength beer (4.351%–5%ABV) increased whereas that of traditional mid-strength beer (2.501%–4.35%ABV) decreased substantially. Market reports cited consumer health concerns and demand for "craft beer" (typically high-strength) as competing influences in both markets, and reduced-alcohol beer as "the alcoholic drinks industry’s—potentially lucrative—shield against accusations of irresponsibility."
Conclusions: Declines in both high- and low-strength beer in Australia have potentially important implications. In New Zealand, the failure of low-strength beer to establish significant market share, along with increased consumption of high-strength beer, are noteworthy developments. Trend data on product ethanol content warrants scrutiny in public health surveillance globally, whereas research is needed on the role of ethanol content within industry strategy.