Transcript Science, Public Policy and the Alcohol Industry: Coalition

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
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BACKGROUND
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Control systems at the provincial level
Research tradition bearing on alcohol policies
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Seeley 1961; Bruun et al. 1975
Task forces examining policy proposals
Application of research to practice
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Critiques of greater access -- from 1970s
Municipal alcohol policies
DUI initiatives
Concern about GATS
Uneven across provinces
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CHALLENGES
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Alcohol monopolies
Alcohol marketing & promotion
Consumption rates, drinking-related
problems & prevention
Evidence-based orientation
Decision-making on alcohol policies
Public health and safety response
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1. Alcohol Control Systems
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Structural changes
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On-site modifications
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Visual image of upscale super-market
Goals of government alcohol retailing
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Higher density, more diversification, public &
private
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
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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
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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
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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
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Marketing & promotion
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Promoting alcohol to best customers
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Not linked to drinking by those who drink the most
Not assumed to increase risks
‘bi-modal’ model accepted and total
consumption model rejected or neglected
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Total consumption model does not inform alcohol
retailing
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Perspectives on Prevention
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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
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Individual orientation dominant
Victim held responsible
Uncommon to see links between sales,
consumption and damage
Evidence-based interventions not high
priority
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among many government sponsored and
industry supported efforts
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4. Evidence-based perspective
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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
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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
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Drinking and driving: Better organized and
often effective
Limited resources and over-extended
Capacity varies by province
Constrained by source of funding
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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 & 4. Action agendas
dialogue
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1. Assessing priorities &
resources
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What are we trying to achieve?
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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
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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
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A priori social impact assessments
Natural experiments
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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
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Health, safety, social impacts & costs
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3. Communication &
Dialogue
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Topics of Communication
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Perspective: links between access,
consumption and problems
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total consumption model
Extent of problems & costs
Community experiences in harm
reduction
Effective policies & interventions
Partnership opportunities
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Communication-- with
whom
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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
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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”
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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:
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Research & Public Policy. Oxford: Oxford University Press.
Analysis of Canadian data
1950-2000*
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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, 1950-1998
Ole-Jorgen Skog*
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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 Canada
Mats Ramstedt*
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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
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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)
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