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Developing & Implementing Effective Alcohol Policies in Canada – A

Commentary

Norman Giesbrecht

Global Alcohol Policy Alliance MeetingWestminister College, Cambridge University

September 24, 2003

Centre for Addiction & Mental Health, Toronto, Ontario M5S 2S1 Canada

Email: norman_giesbrecht@camh.net Fax: 416-595-6899

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BACKGROUND Control systems at the provincial level Research tradition bearing on alcohol

policies Seeley 1961; Bruun et al. 1975 Task forces examining policy proposals

Application of research to practice Critiques of greater access -- from 1970s Municipal alcohol policies DUI initiatives Concern about GATS Uneven across provinces

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CHALLENGES1. Alcohol monopolies2. Alcohol marketing & promotion3. Consumption rates, drinking-related

problems & prevention4. Evidence-based orientation5. Decision-making on alcohol policies6. Public health and safety response

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1. Alcohol Control Systems

Structural changes Higher density, more diversification, public

& private On-site modifications

Visual image of upscale super-market Goals of government alcohol retailing

Best customers and generate more revenue Marketing in retail stores & beyond Social responsibility vs control

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Conclusion: Control Systems Are Being Eroded

Mixed public & private systems

Increased density & greater access

Social responsibility narrowly defined

Low priority of control aspects of liquor boards

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2. Alcohol Marketing & Promotion Federal committee no longer directly

oversees proposed alcohol ads Spirits advertising allowed Many ads ‘push the envelop’ -

government codes Extensive sponsorship & other types

of promotion Warning labels not mandated

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Marketing in Retail Stores

On-site promotions Order by telephone or home

delivery Marketing of store system (e.g.,

LCBO & SAQ) and products

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Conclusion- Alcohol marketing & promotion increasing

Expanded methods and exotic techniques

Control agencies involved in extensive marketing

Fewer checks and balances

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3. Alcohol, Problems & Prevention – Popular perspectives

Marketing & promotion Not linked to drinking by those who drink the

most Promoting alcohol to best customers

Not assumed to increase risks ‘bi-modal’ model accepted and total

consumption model rejected or neglected Total consumption model does not inform

alcohol retailing

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Perspectives on Prevention Social responsibility--Mainly education &

information Control --A minor aspect Alcohol industry -- Considered a legitimate

player in prevention Focus -- Deviant drinkers not total population Framing -- Prevention not seen as

inconsistent with extensive marketing Priority -- Low compared to marketing &

promotion

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Perspectives on Alcohol Problems & Prevention Misguided

Individual orientation dominant Victim held responsible Uncommon to see links between

sales, consumption and damage Evidence-based interventions not

high priority among many government sponsored

and industry supported efforts

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4. Evidence-based perspective

Unevaluated measures promoted Attempts to evaluate thwarted Need a better match of prevention

with scale of the problem Exception – campaigns to prevent

drinking and driving

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5. Policy Making Process Policy deliberations not transparent – e.g

Arthur Anderson scenarios on privatization Public debate uncommon—e.g. Canada

Post Liquor Boards close ties with producers Last minute consultations with health &

safety advocates Social & health impact assessments

uncommon prior to policy change

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6. Public health & safety response Drinking and driving: Better organized and

often effective Limited resources and over-extended Capacity varies by province Constrained by source of funding

Government or alcohol industry Not consistently evidence-based Alcohol low priority relative to tobacco,

etc. Need for a national network

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NEXT STEPS….

Concurrent & not necessarily sequential

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Next Steps

1. Priority & resource assessment

2. Policy relevant monitoring & research

3. Communication & dialogue

4. Action agendas

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1. Assessing priorities & resources

What are we trying to achieve? Reduce damage and death

Which challenges are most critical? Which policy goals are achievable? What resources are needed? What arrangements are needed to

move our agendas forward?

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2. Policy Relevant Monitoring and Research

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Monitoring Alcohol policies decisions and their

enforcement Alcohol industry & prevention

initiatives Alcohol in trade agreements Changes in access, promotion and

consumption Community experiences in harm

reduction Public opinion on alcohol policies

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Research A priori social impact assessments Natural experiments

Funding bodies need to welcome innovative designs & fast track reviews

Volume of alcohol by high risk drinkers

Abstaining and drinking in a ‘wet’ climate

Damage from alcohol and high risk alcohol policies Health, safety, social impacts & costs

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3. Communication & Dialogue

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Topics of Communication Perspective: links between access,

consumption and problems total consumption model

Extent of problems & costs Community experiences in harm

reduction Effective policies & interventions Partnership opportunities

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Communication-- with whom Policy makers and advisors Governments—local to national Regulators and law enforcement personnel Local retailers of alcohol NGOs and local groups Public health sector General public High risk populations

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4. Action Agendas Increase awareness of alcohol as not

an ordinary commodity Draw attention to drinking-related

risks & damage Strengthen and expand partnerships Get a place at the policy table Support enforcement of effective

regulations Direct resources and attention to

the more effective strategies

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[There was not enough time to show the following slides at Cambridge GAPA meeting – September 24, 2003]

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10 Policy Options selected as “Best Practices”

Minimum legal drinking age Government monopoly of retail sales Restrictions on hours or days of sales Outlet density restrictions Alcohol taxes Sobriety check points Lowered BAC limits Administrative license suspension Graduated licensing for novice drivers Brief interventions for hazardous drinkers

Based on Thomas Babor et al. (2003) Alcohol No Ordinary Commodity: Research & Public Policy. Oxford: Oxford University Press.

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Analysis of Canadian data 1950-2000*

Rates of alcohol sales associated with: alcohol-related mortality liver cirrhosis fatal accidents suicide rates homicide rates total mortality

Overall consumption may be detrimental to male hearts, wine may have protective effect

*Based on Canadian – Nordic Alcohol Policy Project

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Alcohol Consumption and Fatal Accidents in Canada,

1950-1998Ole-Jorgen Skog*

Conclusion: “Changes in alcohol consumption have had substantial effects on all main types of fatal accidents in Canada during the second half of the 20th century. The size of association is comparable to the one previously reported from Northern Europe”

*Addiction 98 (7), 883-895 (published 2003).

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Per Capita Alcohol Consumption and Liver Cirrhosis Mortality—the case of

CanadaMats Ramstedt*

Conclusion: “The overall level of drinking is a crucial determinant of liver cirrhosis mortality in Canada in particular for cirrhosis deaths where alcohol abuse has been mentioned as the cause on the death certificates. Still, in accordance with previous suspicions in other countries, alcohol involvement tends to be underreported in certification of cirrhosis deaths also in Canada.”

* Addiction 98, 1267-1276. (forthhcoming Sept. 2003)

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Main Findings of Canadian Nordic Alcohol Policy Project --

Comments

Further information on contextual or other variables is not likely to undercut main conclusions

Analysis techniques are conservative and may understate conclusions

Are generally in line with ECAS project of 15 European countries (focusing on 1950 to 1995)