The public in Aotearoa New Zealand support policies to reduce alcohol harm: results from a national survey

Alcohol is the most widely consumed psychoactive drug in Aotearoa New Zealand and a leading contributor to preventable health, social and economic harm.^1,2 Alcohol has been ranked as the most harmful drug overall in Aotearoa New Zealand, causing greater harm to both users and others than illicit drugs when assessed across health, social, community and economic domains.³ Alcohol is associated with a diverse range of health harms, including cancer, injury, violence and mental health issues, therefore putting significant pressure on emergency departments and the health system.^4–6 Alcohol consumption is a cause of at least seven types of cancer and contributes substantially to Aotearoa New Zealand’s cancer burden.⁷ In 2019, alcohol was estimated to account for around 6–7% of all cancer deaths in Aotearoa New Zealand, with disproportionate impacts on Māori and people living in higher-deprivation communities.⁸

Patterns of alcohol use and harm are strongly shaped by availability and access, which is why the World Health Organization (WHO) recommendations for reducing alcohol-related harm include: the use of policies strengthening restrictions on availability; enforcing bans on alcohol advertising, sponsorship and promotion; and raising the price of alcohol.⁹ These policies have been assessed as effective in reducing alcohol consumption in a recent global review by the International Agency for Research on Cancer and are recommended by the Cancer Society of New Zealand.^10,11 However, Aotearoa New Zealand’s policy environment compares poorly with other high-income jurisdictions.¹² If these evidence-based recommendations were implemented in Aotearoa New Zealand, modelling finds that it would result in both substantial health gains for the total population and reduced inequity for Māori, with 726,000 health-adjusted life years (a measure of the health of the population that combines mortality and morbidity effects) gained across the lifetime of the modelled population, or 87.6 days per person.¹³

Previous public opinion research indicates there is substantial support for these evidence-based alcohol policies in Aotearoa New Zealand.^14,15 Policies such as restricting alcohol marketing and sponsorship, increasing alcohol prices and reducing alcohol availability have previously received majority support or neutrality, with opposition consistently lower than support.^10,14,15 Despite strong evidence and public support, alcohol policy reform remains challenging.¹⁶ Given the political nature of some of these challenges, coalition building (the process of building alliances among diverse stakeholder groups) has been identified as a means of achieving consensus and policy change.^16,17

Given that alcohol remains a leading driver of preventable harm (including cancer) in Aotearoa New Zealand, there is a need for stronger alcohol policy grounded in public health evidence. While some Aotearoa New Zealand–specific evidence on public support for alcohol policy options exists,^10,14,15 up-to-date evidence on public support across a range of policy options is essential to inform evidence-based policymaking (particularly given that legislative reform in this area is currently occurring), and to support consensus building, with the aim of reducing alcohol-related harm and advancing health equity in Aotearoa New Zealand. This study (part of a series examining public opinion on cancer-related policies) specifically aims to investigate: 1) how much public support there is for increased action by politicians to reduce alcohol-related harm, and 2) what policies are both strongly supported by the public and have high consistency of support by voting intention.

Methods

This study presents results from a nationally representative, cross-sectional online survey examining public support for evidence-based cancer-related policies in Aotearoa New Zealand. Although the broader survey encompassed multiple cancer policy domains, this brief report focusses specifically on alcohol control policies. Detailed methods are reported in the published study methodology.¹⁸ In brief, 1,635 participants aged 18 years and over were recruited through a large commercial online panel using quota sampling to approximate national distributions by age, gender, ethnicity and region, with deliberate oversampling of Māori and Pacific people.

Data collection occurred between November and December 2025, and used a structured questionnaire. Survey items were primarily closed-ended and covered a range of cancer policy areas, including prevention, early detection, treatment, supportive care and related policy issues. Public attitudes towards alcohol policy were assessed using survey items examining perceptions of government action and support for specific alcohol control measures (Appendix A). Respondents were asked whether politicians should do more to protect people from alcohol-related harm, followed by a series of statements assessing support for evidence-based alcohol policies, including online alcohol delivery safeguards (age and drunkenness tests), limits on alcohol outlet density, cancer warning labels, restrictions on alcohol marketing and sponsorship, pricing and taxation measures and exclusion of the alcohol industry from policy development. The policies asked about in the survey reflect WHO and World Cancer Research Fund policy recommendations that are relevant to cancer prevention,^19–21 with specific policy wording derived or adapted from previously published surveys.^10,14,15 Support for each policy was measured on a six-point scale ranging from strongly support to strongly oppose, with a do not want to answer option available. Views on alcohol availability were additionally assessed by asking whether current alcohol trading hours should be shorter, longer or remain the same.

Total (design and poststratification) weights were applied to align the sample with 2023 New Zealand Census benchmarks for age groups, gender and Māori ethnicity. All analyses incorporated these survey weights and were performed both for the total population and within the sub-groups of four demographic variables (age group, gender, prioritised ethnicity and voting intention) (Appendix B). After accounting for weighting, the survey estimates have approximately the same precision as a simple random sample of 1,161 equally weighted respondents. Subsequently, given this effective sample size, the approximate margin of error for a total population percentage estimate is ±2.9% in the worst case.

Ethical approval

Ethical approval was granted by the University of Otago Human Ethics Committee (25/1184). Ethical approval processes and Māori consultation procedures are detailed in the methodology publication.¹⁸

Results

An estimated 71.1% of the Aotearoa New Zealand population (almost three-quarters) think that politicians should do more to keep people safe from alcohol harm (Appendix tables), and only 27.1% believe that politicians are doing enough to keep people safe from alcohol harm. How much more should be done is relatively even (34.0% felt there should be some more action, and 37.1% a lot more). Combined desire for more action (some more and a lot more) varied by voting intention. A higher percentage of Aotearoa New Zealanders intending to vote for Te Pāti Māori (85.1%), the Greens (83.1%) or Labour (79.4%) wanted more action, compared with a lower, but still majority, percentage of those intending to vote for NZ First (58.7%), National (57.4%) or ACT (54.5%). Interestingly, a higher percentage of intending NZ First voters (33.7%) indicated they wanted a lot more action compared with intending ACT (19.5%) or National (23.3%) voters.

View Table 1–2.

The overall majority of Aotearoa New Zealanders support each of the 10 alcohol policies/laws proposed (Table 1). Support ranged from an estimated 54.9% for increasing the price of alcohol using excise tax to 84.4% for the requirement of online alcohol delivery safeguards. Almost three-quarters (74.8%) of Aotearoa New Zealanders support that the alcohol industry should not be involved in alcohol harm reduction policy. Support rose for policies when more specificity (e.g., wording that suggests protection of vulnerable groups) was provided in the options and/or when it was specified that this funding would be used to benefit particular groups. For example, while 56.4% supported banning all alcohol marketing and sponsorship, this rose to 77.7% when focussed on banning alcohol sponsorship at events that under-18s attend. Similarly, while an estimated 54.9% of Aotearoa New Zealanders supported using excise tax to raise the price of alcohol, this rose to 65.3% when the question specified that this money would then be used to fund treatment and harm reduction efforts.

When investigating overall high levels of support with low variability of support by voting intentions (Table 2), several policies stood out as being both highly (over 75% total support) and widely (lowest level of support by political party was 60% or greater) supported. These were:

1. A limit on the number of places that can sell alcohol in a neighbourhood (78.2% total support: lowest 68.4% for those who intended to vote for ACT, highest 81.7% for those who intended to vote for the Greens).
2. Banning alcohol sponsorship at sporting, community and other events that under-18s go to (77.7% total support: lowest 66.4% for those who intended to vote for ACT, highest 82.8% for those who intended to vote for Labour).
3. A law that all alcoholic drinks must have a warning label that says alcohol can cause cancer (75.4% total support: lowest 62.6% for those who intended to vote for ACT, highest 81.5% for those who intended to vote for the Greens).
4. Online alcohol delivery safeguards (84.4% total support: lowest 76.5% for those intended to vote for NZ First, highest 89.6% for those who intended to vote for the Greens; NB: support was 56.2% among n=17 Other voters).

Majority support was not consistent across all political parties for four of the 10 proposed alcohol policies (increase excise tax on alcohol—use for treatment/harm prevention, raise the price of cheap alcohol, ban alcohol marketing and sponsorship and increase excise tax on alcohol). A greater percentage of ACT voters opposed, rather than supported, all four of these policies; individuals who would vote National were not more supportive of the latter two policies; and, additionally, those intending to vote for NZ First or Other were more in opposition to the introduction of a policy to increase tax on alcohol. Undecided voters showed majority support for all the alcohol policies asked about (51.8–79.6%). They most supported “Online delivery age and drunkenness tests same as in stores” and least supported “Increase excise tax on alcohol”. A higher percentage of this group chose do not want to answer (7.5–12.5%) instead of support or oppose options compared with other voter groups (0–5.3%).

Overall, most people supported reducing the current hours that alcohol can be sold (45.3%) or maintaining them (40.9%); very few (8.0%) supported extending them.

Discussion

This study highlights that there is strong public support for politicians to take more action to reduce alcohol-related harm. Despite a majority of voters from all political parties thinking that politicians should do more to keep people safe from alcohol harm, there were differences between parties from the left and the right of the political spectrum. This suggests that values are strongly influential, and policy support could be particularly impacted by views on the overall role of the state to intervene for health gain and/or beliefs around personal choice/responsibility.²² Our finding that the public want politicians to do more to reduce alcohol-related harm is consistent with international results from a 2019 survey pooled across seven countries, where 66% thought that governments should be responsible for alcohol-related actions.²³ Interestingly, in this previous study, it was Aotearoa New Zealand respondents who most strongly attributed responsibility to governments (77.8% selected government).²³ The results of the current study also highlight that the Aotearoa New Zealand public support the exclusion of the alcohol industry from policymaking. National and international alcohol advocates agree with the Aotearoa New Zealand public. They argue that excluding the alcohol industry from policymaking is a key strategy for generating political priority for alcohol policy reform.¹⁶ This provides a strong mandate from the Aotearoa New Zealand public for governments and politicians to act, and to reduce the involvement of the alcohol industry in policymaking.

Support for specific policy actions differed, with high levels of support (over 75%) for online alcohol delivery safeguards, limits on retailer numbers, banning alcohol sponsorship at events where under-18s may be present and cancer warning labels. A mixed-methods study from the United Kingdom had similarly found that support differed by policy type, and that perceived effectiveness was a moderator of support.²⁴ This suggests that communicating the established effectiveness of interventions will influence public opinions and highlights the importance of conducting and publicising policy evaluation studies to enhance public knowledge of policy efficacy. The majority of policies in the current study not only had a high degree of public support, but support for six of the 10 was observed across supporters of different political parties. Therefore, these policies represent opportunities for cross-party consensus. However, these reforms would be made more politically challenging by industry involvement,²⁵ which further highlights the importance of restricting this influence.

There is strong evidence internationally that increased knowledge of alcohol-related harms is associated with increased support for stronger public health policies.^26–29 This survey did not specifically survey people’s knowledge of alcohol-related harm, which is a limitation of the study; nevertheless, previous Aotearoa New Zealand research had found that public awareness of alcohol as a cancer risk factor is low.¹⁴ Only a minority of Aotearoa New Zealanders (18%) spontaneously identify alcohol consumption as increasing cancer risk, although recognition increases substantially when respondents are prompted directly, indicating that awareness is shallow rather than firmly held.¹⁴ This emphasises the importance of increasing public knowledge of the causal link between alcohol and cancer, but in ways that resonate with the public and bridge the known disconnect between expert and public understanding.³⁰ Our findings reveal strong support for cancer warning labels, which, if implemented, would increase awareness of the link between alcohol and cancer. As previous research suggests, public support for alcohol policies is then likely to further increase as public awareness grows.^26–29

Beyond the overarching limitations of this survey research¹⁸ (including potential selection and participation bias, an over-representation of those intending to vote Labour and low numbers in some sub-groups where we would expect margins of error to be larger than 2.9% and the corresponding confidence intervals wide), there are some specific alcohol-related limitations. One was that the survey did not ask people if they drank alcohol or at what level, and consumption is known to moderate views on policy responses.^27,31 Furthermore, each demographic variable was only examined descriptively, without epidemiological consideration of potential effect modification, interaction or mediation. Australian studies, however, have suggested that the interaction between age and sex is an important moderator of support for governments to implement prevention policies.³² Despite these limitations, this survey presents a timely and representative picture of Aotearoa New Zealanders’ views on different alcohol policies.

Conclusion

This study reveals strong, broad and consistent public support for politicians and the government to act to reduce alcohol-related harm in Aotearoa New Zealand, including banning alcohol industry participation in policymaking. There is majority support for action across the political spectrum. Further, a significant majority of Aotearoa New Zealanders support the introduction of alcohol policies that are consistent with evidence, and recommended by the WHO, with the aim of reducing alcohol-related health burdens and inequities, including cancer.

View Appendix.