Update: National Alcohol Strategy presentation to Alcohol: NO Ordinary Commodity Forum 5 by Carolyn Franklin,

1. 1 Update: National Alcohol Strategy presentation toAlcohol: NO Ordinary Commodity Forum 5 by Carolyn Franklin, Senior Advisor, Canadian Centre on Substance AbuseMarch 27, 2008

2. 2 Costs of Alcohol-Related Harm in Canada Costs to Canadian society rising: $40b a year from $18.45b in 1992 Tobacco: $17b (42.7%); alcohol: $14.6b (36.6%); illegal drugs: $8.2b (20.7%) Alcohol cost the Canadian economy $7.1 billion in lost productivity due to illness and premature death. The cost in direct health care was $3.3 billion and $3.1 billion in law enforcement—30.4% of all recorded criminal offences are attributable to alcohol = 760,000/year. This translates into $463 for every Canadian.

3. 3 National Alcohol Strategy (NAS)—Background & Process Reducing Alcohol-Related Harm in Canada—one of 13 priorities of the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada The Process: Cross-Canada consultations on substance use and abuse held in 2004 and 2005; Alcohol Thematic Workshop in Nov. 2004; 3 meetings of the NAS Working Group of 31 multi-sectoral participants Results: Consensus on a vision, approach and agreement in principle on 41 recommendations Next steps: Implementation of the Recommendations

4. 4 National Alcohol Strategy—Current Status 14 partners have confirmed support of the NAS: Association of Canadian Distillers Alberta Alcohol and Drug Abuse Commission Brewers Association of Canada Canadian Association of Chiefs of Police Canadian Centre on Substance Abuse Canadian Public Health Association Canadian Vintners Association Centre for Addiction and Mental Health Centre for Addictions Research of B.C. MADD Canada Manitoba Liquor Control Commission Nova Scotia Department of Health Promotion and Protection Ontario Public Health Association Toronto Drug Strategy Implementation Panel Partners have identified their interest in leading or participating in 37 of the 41 recommendations

5. 5 Four NAS Strategic Areas for Action & Activities 1. Health Promotion, Prevention and Education—six recommendations to raise public awareness and enhance capacity and resilience 2. Health Impacts and Treatment—nine recommendations to reduce negative health impacts of alcohol consumption and address its contribution to injury and chronic disease 3. Availability of Alcohol—16 recommendations to implement and enforce effective measures that control alcohol availability 4. Safer Communities—10 recommendations to create safer communities and minimize harms of intoxication

6. 6 The 41 Recommendations Health Promotion, Prevention and Education Recommendation 1: Develop and promote national alcohol drinking guidelines to encourage a culture of moderation, and aim for consistency and clarity of messages across all alcohol-related health and safety arenas (Health Canada, British Columbia Ministry of Health, Centre for Addictions Research of BC (CARBC), Mothers Against Drunk Driving [MADD], National Native Addiction Partnership Foundation (NNAPF), Centre for Addictions and Mental Health (CAMH), all governments). Recommendation 2: Develop a comprehensive, sustained and coordinated social marketing campaign with multi-sectoral partners to promote the national alcohol drinking guidelines. This would include building on existing social marketing campaigns such as those targeting drinking and driving and high-risk drinking patterns (MADD, CARBC, NNAPF, Manitoba Liquor Control Commission (MLCC), all governments, NGOs, alcohol and hospitality industries). Recommendation 3: Support and fund local communities to develop and implement community-wide health promotion initiatives that emphasize the national alcohol drinking guidelines, and prevent and reduce alcohol-related harm (MADD, NNAPF, all governments, alcohol and hospitality industries). Recommendation 4: For alcohol beverage containers, regulate standardized, easily visible labels that convey the number of standard drinks in each container (Health Canada, Brewers Association of Canada (BAC), NNAPF).

7. 7 The 41 Recommendations (cont’d) Recommendation 5: With regard to underage youth, develop and evaluate policies and programs that are appropriate to youth stages of development and that promote abstinence as a valid goal for everyone, adherence to the national alcohol drinking guidelines and avoidance of high-risk drinking for those who choose not to abstain from alcohol (Canadian Centre on Substance Abuse (CCSA), MADD, British Columbia Centre for Social Responsibility (BCCSR), NNAPF, MLCC, all governments, NGOs, alcohol and hospitality industries) Recommendation 6: With regard to young adults, through a national collaborative initiative, develop and evaluate policies and programs in schools, colleges and universities (CCSA, CARBC, MADD, BCCSR, NNAPF, all governments, NGOs, alcohol and hospitality industries). Recommendation 7: Develop integrated and culturally sensitive screening, brief intervention and referral tools and strategies (CCSA, CARBC, Traffic Injury Research Foundation, College of Family Physicians of Canada, NNAPF, CAMH, P/T governments). Recommendation 8: Ensure adequate ongoing funding, quality training and accreditation for specialized addiction services (CCSA, P/T governments). Recommendation 9: Improve access to addiction services in isolated, rural and remote regions of Canada and for vulnerable populations (all governments). Recommendation 10: Evaluate treatment programs to determine promising practices and disseminate the findings (BCCSR, NNAPF, CAMH, all governments and NGOs).

8. 8 The 41 Recommendations (cont’d) Recommendation 11: Co-ordinate the transfer of knowledge relating to the evaluation and research of prevention, treatment and population health policies and programs addressing alcohol (CCSA, CARBC, NNAPF). Recommendation 12: Strengthen drug and alcohol curriculum in undergraduate, post-graduate and continuing professional development programs (CCSA, CARBC, NNAPF, P/T governments, NGOs, colleges and universities). Recommendation 13: Disseminate FASD screening and diagnostic tools to, and promote their use by, family physicians, pediatricians and other health professionals (Public Health Agency of Canada (PHAC), CCSA, CARBC, NNAPF, all governments and NGOs). Recommendation 14: Regarding the contribution of alcohol to chronic diseases: a) Prepare periodic reports on the impact of alcohol on chronic disease within Canada and coordinate these with the ongoing Costs of Substance Abuse reports (Ontario Public Health Association (OPHA), CARBC, NNAPF, CAMH, PHAC) b) Ensure that alcohol is consistently included in policies and programs focused on chronic disease (all governments, NGOs); c) Collaborate with the Chronic Disease Prevention Alliance of Canada (CDPAC) and others to improve the prevention of alcohol-related chronic disease, including implementation of a public awareness campaign (PHAC).

9. 9 The 41 Recommendations (cont’d) Recommendation 15: Regarding research: a) Develop a national, coordinated, ongoing data-collection and reporting system of common indicators relevant to acute and chronic alcohol-related harm across Canadian jurisdictions (Health Canada, MADD, NNAPF, Health Canada). b) Develop a strategic national alcohol-research program that is informed by a determinants-of-health approach and is directed at gaining a better understanding of the risk and protective factors surrounding alcohol use (Health Canada, CIHR). c) Collect data on alcohol-related health impacts and treatment outcomes specific to First Nations, Inuit and Métis, using appropriate research ethics (including ownership, control, access and possession principles). These data should be comparable to those collected for the general Canadian population (BCCSR, Health Canada, NGOs).

10. 10 The 41 Recommendations (cont’d) Availability of Alcohol Recommendation 16: Maintain current systems of control over alcohol sales ( OPHA, MADD, MLCC, CAMH – lead in a) and c), P/T governments). Under these systems, it will be important to a) Require liquor control boards to maintain a social-responsibility frame of reference for all matters pertaining to their operations and governance, and to maintain or increase their spending and programming in this area b) Enhance staff training at outlets and implement ongoing enforcement compliance programs to ensure that alcohol is consistently sold in a socially responsible way and in accordance with the law; and c) Encourage the systematic reexamination and analysis of hours and days of alcohol sales and outlet density, recognizing that increased physical availability of alcohol can lead to increased harm. Recommendation 17: Collaborate with liquor control boards to ensure alcohol cost and availability in high-risk communities are managed in a socially responsible manner (NNAPF, MLCC, P/T and municipal governments). Recommendation 18: Request all liquor licensing authorities and liquor control boards to collect and make public, detailed information on both off-premise and on-premise alcohol-outlet density (P/T governments).

11. 11 The 41 Recommendations (cont’d) Recommendation 19: Conduct research to specify the magnitude and nature of third-party supply of alcohol in Canada (e.g., supply of alcohol outside the legal distribution system and in those jurisdictions where alcohol is banned) (all governments). Recommendation 20: Evaluate the outcomes of trial alcohol-control measures in remote communities (particularly in the three territories), including total bans, limitations on importing alcohol into the community, and severely restrictive selling practices (CAMH, P/T and municipal governments, First Nation communities). Recommendation 21: Implement server-training programs in Canada as a pre-condition for receiving and/or renewing licences for serving alcohol. These training programs should include regular recertification of servers, ongoing enforcement compliance checks and periodic program evaluations to sustain and improve impacts over time. In addition, server training and compliance checks should be conducted more frequently for establishments with a history of service-related problems (MADD, MLCC, CAMH (lead), P/T and municipal governments, First Nation communities). Recommendation 22: Investigate the implications of making liability insurance mandatory for all licensed establishments in Canada, using options that do not place undue economic burdens on the hospitality industry (for example, self-insurance programs) (MADD, MLCC, P/T governments).

12. 12 The 41 Recommendations (cont’d) Recommendation 23: Conduct research on the nature and extent of underage access to alcohol, including in licensed venues, and implement appropriate programs and policies to respond to the issue (BCCSR, P/T governments). Recommendation 24: Given the relationship between legal purchase age and alcohol-related harm, consider increasing the legal purchase age of alcohol to 19 years (MADD, governments of Alberta, Quebec and Manitoba). Recommendation 25: Strengthen enforcement and sanctions for people producing or using fake identification (MADD, MLCC, P/T governments). Recommendation 26: Adopt minimum retail social-reference prices for alcohol and index these prices, at least annually, to the Consumer Price Index (CPI). A competent body should review alcohol pricing throughout Canada, at least annually, and publish a report recommending increases where prices are not keeping pace with inflation (BAC, CARBC, MLCC, CAMH, P/T governments).

13. 13 The 41 Recommendations (cont’d) Recommendation 27: Discourage the introduction or expansion of U-Brew and U-Vin industries. Where these industries currently exist, make licensing contingent upon matching the socially referenced price for beverage alcohol in that jurisdiction (MLCC, P/T and municipal governments). Recommendation 28: Create incentives, whether through tax or price adjustments, to promote the production and marketing of lower-alcohol-content beers and coolers, with the overall goal of reducing the volume of absolute alcohol consumed per capita in Canada (CCSA, BAC, CARBC, MLCC, all governments, alcohol industry). Recommendation 29: Move towards alcohol volumetric pricing (based on the volume of ethyl alcohol in alcohol products) within each beverage class (CARBC, all governments, alcohol industry). Recommendation 30: Coordinate funding for research and publication of an annual report documenting the exposure of underage youth in Canada to alcohol advertising (Health Canada, OPHA, MADD, CAMH, all governments). Recommendation 31: Review existing advertising regulatory systems with a view to updating the standards, especially as they pertain to youth, as well as the mechanisms of receiving and responding to consumer complaints about alcohol advertising (OPHA, BAC, MADD, all governments).

14. 14 The 41 Recommendations (cont’) Safer Communities Recommendation 32: Develop and adopt comprehensive policies for alcohol within every sector of the Canadian workforce, with special emphasis on safety-sensitive professions (all governments, NGOs, industries). Recommendation 33: Partner with community groups to develop municipal alcohol policies and programs that address local issues (CCSA, CARBC, MADD, BCCSR, NNAPF, CAMH (lead), P/T and municipal governments, NGOs). Recommendation 34: Implement the use of proven violence-prevention programs in licensed establishments (Toronto Drug Strategy Implementation Panel, CAMH (lead), P/T governments, alcohol and hospitality industries). Recommendation 35: Develop a public awareness campaign to raise awareness about alcohol liability (MADD, Toronto Drug Strategy Implementation Panel, MLCC, all governments, NGOs, alcohol industry). Recommendation 36: Amend or develop policies and programs that incorporate evidence-based solutions that reduce alcohol-related harm in colleges and universities (CCSA, CARBC, MADD, BCCSR, MLCC, colleges and universities, NGOs). Recommendation 37: Endorse and support the Strategy to Reduce Impaired Driving 2010 (MADD, RCMP, CAMH, all governments).

15. 15 The 41 Recommendations (cont’d) Recommendation 38: Adopt the Canadian Council of Motor Transport Administrators’ (CCMTA) short-term suspension model and other proposed actions to address drinking drivers with lower BACs (MADD, RCMP, CAMH, P/T governments). Recommendation 39: Reinvigorate law enforcement around drinking and driving (MADD, RCMP, all governments). Recommendation 40: Pursue approaches that focus on high-risk or alcohol-dependent drivers (i.e., with BACs of 0.15% or higher) to better deter and rehabilitate repeat offenders (MADD, RCMP, P/T governments, NGOs). These would include a) Technology-based solutions (e.g., ignition interlock systems); b) Education and public awareness initiatives; c) Improved assessment protocols; and d) Improved treatment and rehabilitation, drawing on harm reduction and medical models to better address the concurrent issues of chronic alcohol misuse and possible cognitive impairments. Recommendation 41: Adopt, within their graduated driver-licensing programs, zero-tolerance alcohol (0.00% BAC) provisions for all drivers until age 21 (MADD, RCMP, CAMH, P/T governments).

16. 16 The role of OPHA: Advocate and Advise Encourage public health communities, municipal and provincial health officials to support activities to implement recommendations, such as letter writing campaigns to medical officers of health in the 36 public health units and to provincial and municipal health officials to support implementation of recommendations, such as Recommendation 9: improve access to addiction services in isolated regions Recommendation 13: encourage promotion of FASD screening tools Recommendation 14: report on impact of alcohol on chronic disease Recommendation 16: maintain current systems of control over alcohol sales Recommendation 18: LCBO and Brewer’s Retail to collect alcohol-outlet information Recommendation 20: evaluate outcomes of alcohol control measures Recommendation 34: implement violence-prevention programs in licensed establishments Recommendations 30 and 31: alcohol advertising and youth Join committees as advisors, such as advertising and violence prevention program committees Presentations at annual conferences/one-on-one meetings Advise the NAS Secretariat of support required, ideas and sharing with other jurisdictions

17. 17 Implementation of the NAS The Canadian Centre on Substance Abuse is working with Health Canada to provide Secretariat support to assist the NAS partners with the coordination of information and activities to implement the 41 recommendations. Next Steps: The Secretariat will be contacting many stakeholders to discuss the challenges, opportunities and ways to work together to proceed with the implementation of the NAS recommendations, developing communications strategy and working with partners to develop an NAS steering committee

18. 18 National Alcohol Strategy Secretariat Contact Carolyn Franklin, CCSA 613-235-4048, ext. 253 cfranklin@ccsa.ca National Framework Website (includes the National Alcohol Strategy and Updates) www.nationalframework-cadrenational.ca