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Developing & Implementing Effective Alcohol Policies in Canada – A Commentary. Norman Giesbrecht Global Alcohol Policy Alliance Meeting Westminister College, Cambridge University September 24, 2003 Centre for Addiction & Mental Health, Toronto, Ontario M5S 2S1 Canada

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Developing implementing effective alcohol policies in canada a commentary
Developing & Implementing Effective Alcohol Policies in Canada – A Commentary

Norman Giesbrecht

Global Alcohol Policy Alliance Meeting

Westminister College, Cambridge University

September 24, 2003

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

Email: [email protected]

Fax: 416-595-6899

BACKGROUND Canada – A Commentary

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

CHALLENGES Canada – A Commentary

Alcohol monopolies

Alcohol marketing & promotion

Consumption rates, drinking-related problems & prevention

Evidence-based orientation

Decision-making on alcohol policies

Public health and safety response

1 alcohol control systems
1. Alcohol Control Systems Canada – A Commentary

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

Conclusion control systems are being eroded
Conclusion: Control Systems Are Being Eroded Canada – A Commentary

Mixed public & private systems

Increased density & greater access

Social responsibility narrowly defined

Low priority of control aspects of liquor boards

2 alcohol marketing promotion
2. Alcohol Marketing & Promotion Canada – A Commentary

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

Marketing in retail stores
Marketing in Retail Stores Canada – A Commentary

On-site promotions

Order by telephone or home delivery

Marketing of store system (e.g., LCBO & SAQ) and products

Conclusion alcohol marketing promotion increasing
Conclusion- Alcohol marketing & promotion increasing Canada – A Commentary

Expanded methods and exotic techniques

Control agencies involved in extensive marketing

Fewer checks and balances

3 alcohol problems prevention popular perspectives
3. Alcohol, Problems & Prevention – Popular perspectives Canada – A Commentary

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

Perspectives on prevention
Perspectives on Prevention Canada – A Commentary

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

Perspectives on alcohol problems prevention misguided
Perspectives on Alcohol Problems & Prevention Misguided Canada – A Commentary

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

4 evidence based perspective
4. Evidence-based perspective Canada – A Commentary

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

5 policy making process
5. Policy Making Process Canada – A Commentary

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

6 public health safety response
6. Public health & safety response Canada – A Commentary

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

Next steps

NEXT STEPS…. Canada – A Commentary

Concurrent & not necessarily sequential

Next steps1
Next Steps Canada – A Commentary

1 assessing priorities resources
1. Assessing priorities & resources Canada – A Commentary

  • 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?

Monitoring Canada – A Commentary

  • 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

Research Canada – A Commentary

  • 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

3 communication dialogue

3. Communication & Dialogue Canada – A Commentary

Topics of communication
Topics of Communication Canada – A Commentary

  • Perspective: links between access, consumption and problems

    • total consumption model

  • Extent of problems & costs

  • Community experiences in harm reduction

  • Effective policies & interventions

  • Partnership opportunities

Communication with whom
Communication-- with whom Canada – A Commentary

  • 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

4 action agendas
4. Action Agendas Canada – A Commentary

  • 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

10 policy options selected as best practices
10 Policy Options selected as “Best Practices” Cambridge GAPA meeting – September 24, 2003]

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.

Analysis of canadian data 1950 2000
Analysis of Canadian data 1950-2000* Cambridge GAPA meeting – September 24, 2003]

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

Alcohol consumption and fatal accidents in canada 1950 1998 ole jorgen skog
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).

Per capita alcohol consumption and liver cirrhosis mortality the case of canada mats ramstedt
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)

Main findings of canadian nordic alcohol policy project comments
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)