New Zealand's drinking culture has come under fire following a new study which shows a link between alcohol consumption and trips to the emergency department.
Experts are linking the result to New Zealand's binge drinking culture and easy access to cheap booze.
The study, recently published in Addiction, shows data from 62 emergency departments in the 28 countries, and includes more than 14,000 patients.
It ranks New Zealand second out of 28 countries for the proportion of injury cases presenting to emergency departments where the person had consumed alcohol in the preceding six hours.
Alcohol Healthwatch director Nicki Jackson said the findings are not a surprise.
"We have a number of studies in New Zealand now that show a significant portion of people coming into EDs are there because of alcohol."
Up to a quarter of ED presentations on the weekends were connected to alcohol consumption, she said.
The study, by the International Collaborative Alcohol and Injury Study (ICAIS) group, found countries with stricter alcohol policies had lower rates of alcohol-related injuries, regardless of individual consumption rates and drinking patterns, and country-level drinking patterns.
Interviews were conducted with patients within six hours of injury and included questions about their alcohol consumption and if they associated their drinking with the injury.
Jackson said such injuries were costing New Zealand billions of dollars.
If we want to improve mental health, reduce suicides and shorten hospital waiting lists, government needed to start making changes around accessibility to alcohol, she said.
"We haven't taken any strong measures against the most harmful drug in our society. We will keep paying this cost until we take strong action."
There were issues around easy access to alcohol, increasing affordability, and marketing.
"We need to raise excise tax on alcohol," she said, adding taxes were "nowhere near the level they should be" when it comes to drinking.
Dr Bridget Kool of the University of Auckland's Faculty of Medical and Health Sciences, led the 2015/16 New Zealand arm of the study with Dr Sarah Buller from Auckland City Hospital.
New Zealand ranked second for the proportion of people who presented to hospital with an injury and who were current drinkers, with a 91 per cent average across the two NZ studies.
This compared to only 26 per cent of people in the lowest ranked country, India.
But the proportion of people in the two New Zealand studies who had consumed alcohol in the six hours preceding their injuries had reduced from 45 per cent in the 2000 study to 25 per cent in the 2015/16 study.
To assess the effect of country-level alcohol policies, the researchers used the International Alcohol Policy and Injury Index (IAPII), which includes policies related to the physical availability of alcohol, vehicle-use limitations, advertising and promotional restrictions and drinking environment, such as host and server laws.
The IAPII was developed to measure the impact of several alcohol-related policies on injury rates within an international context and is one of the only measures that includes policy enforcement.
Kool said New Zealand's IAPII score of 78/100 shows we need to reduce our access to alcohol and alcohol consumption.
"There are considerable gains to be made if we can strengthen our alcohol policy to ensure we don't lag behind the rest of the world in reducing the burden of injury from alcohol in this country.
"The findings of this study have reinforced the positive impact that effective alcohol policy can have on alcohol-related harm."
The study showed Sweden had the most restrictive alcohol policy, with an IAPII score
of 91/100, and one of the lowest rates of alcohol involvement in injury admissions - about 15 per cent.
In contrast, Tanzania had the least restrictive alcohol policy, scoring 21/100, and 51 per cent of injury presentations had consumed alcohol in the previous six hours.