1. Against The Current: Alcohol, Cancer and Public Health Dr. Charles Gardner MD, CCFP, MHSC, FRCPC Medical Officer Of Health

2. What can MOHs / physicians do to raise awareness about alcohol as a carcinogen? MOH’s lead local Public Health Agencies to address alcohol as a public health issue. Public Health usually addresses unhealthy and dangerous drinking as an issue, rather than focusing on cancer as a specific outcome… …though at times we have focused on the chronic disease effects separate from the acute effects. There may well be added value in focusing on alcohol and cancer. Clinical physicians focus on screening patients for elevated risk and addiction… and they treat the resultant health outcomes (including cancer).

3. Alcohol: A Major Cause Of Illness And Death In Ontario

4. Alcohol’s Contribution To Cancer

5. Canada’s low-risk drinking guidelines (2011) is an important tool…

6. … however, the recommendations for cancer control are more stringent. “If alcoholic beverages are consumed, limit consumption to no more than two drinks per day for men and one drink per day for women.” World Cancer Research Fund/American Institute for Cancer Research – used by Canadian Partnership Against Cancer and Cancer Care Ontario

7. The OMA supports maintaining alcohol control. Prevention with harm reduction should be implemented Some portion of $100 additional LCBO revenues should go to prevention Secondary and post-secondary school programs Screening, Brief Intervention, and Referral, Guided Self-Change, Project TrEAT, and Project GOAL should be implemented Research on heavy drinking and addition – trauma, mental illness and addiction Substance abuse interventions to address violence, trauma, stigma, and discrimination

8. Patient Screening By Physicians

9. CCO / PHO Chronic Disease Prevention Recommendations Maintain and reinforce the socially responsible pricing of alcohol by: a) Establishing minimum pricing per standard drink b) Maintaining average prices at or above the consumer price index c) Adopting disincentive pricing policies for higher alcohol content beverages Ensure effective controls on alcohol availability a) Ensuring that there is no increase in hours of sale b) Ensuring that the overall population density of on- and off -premise outlets per capita does not increase c) Not undertaking further privatization of “off - premise” alcohol retail sales in Ontario

10. Ontarians support maintaining alcohol controls: Hours of Access.

11. The industry has been active...

12. … and effective.

13. “Modernizing” Alcohol Regulation In Ontario Contrasting views of Public Health versus alcohol manufacturers Citation of CAMH study showing that Ontario has the strongest alcohol regulation in Canada Streamlining regulatory process – job creation and economic growth “Looking ahead the AGCO wants ensure its regulatory approach remains modern, effective, and responsive to evolving economic and social realities.”

14. “Ontario Investing $2.25 Million in World-Class VQA Wines” May 2, 2016 | Government of Ontario

15. Public Health’s Alcohol Control Mandate Ontario Public Health Standards Chronic Disease Prevention Prevention of Injury and Substance Misuse Reproductive Health  Board of Health, community partners, policy-makers, schools, the public and priority populations  Aware, engaged, collaborate, enabled with information  Regarding the epidemiology, legislation, factors associate with injury and substance misuse (including alcohol)  To develop healthy public policy, have capacity to prevent, live in safe and supportive environments, reduced incidence of substance misuse injuries, hospitalizations, illnesses and deaths Accountability Agreements – monitoring population compliance with LRADG

16. Public Reporting

17. A Health Equity Paradox: Increased consumption with increased income…

18. … but increased impacts with reduced income.

19. Social Media Engagement Are You Ready to be Thirsty? Are You Ready to be Thirsty? https://howmanydrinks.org/page/8/ “Enjoying a Cold One #R2BT“Enjoying a Cold One #R2BT” “Enjoying a Cold One #R2BT

20. Municipal Political Engagement Consultation with municipal leaders in Simcoe Muskoka. Key themes – dynamics / issues:  Expressed significant concern re binge drinking, particularly for youth.  Perceived increase: causes include more permissive and affluent society, permissive parents who themselves binged as youth, social norm that demands drinking.  Major concerns re liability potential for municipalities (citing local incidents) – yet restrictive action taken is met with strong public opposition.  Revenue stream for municipality and charity groups.  Cited major social norm changes re “drinking and driving” – but also possible unintended behaviour changes (e.g. ‘booze buses”)  Alcohol use is embedded into both our social and economic environments- normalized.

21. Municipal Alcohol Policy Development Alcohol use in municipally own properties: parks, beaches, arenas, sports stadiums and community centres Work with CAMH since early 1990’s Increased MAP from 19 in 1991 to 236 by 1998 (out of 444 municipalities = 53% coverage) Greater coverage in southern municipalities (69% central west) 52% of MAPs developed with local Public Health involvement Challenges:  HR, municipal relationships, competing priorities, loss of revenue, political readiness, enforcement, small municipalities, geography, evidence

22. Municipal Alcohol Policy Development

23. MAP Development Evaluation (Simcoe Muskoka)

24. Provincial Public Health Advocacy: alPHa / OPHA 25 resolutions / advocacy actions since 2004 Regarding the following:  Alcohol sales in grocery stores and farmers’ markets  Increasing price (rather than increasing sales) as a means of increasing revenue  Prohibit sale of alcohol in energy drinks  Conduct a provincial alcohol health and economic impact assessment, and develop a provincial alcohol control strategy / support for National AC Strategy Also a provincial strategy re substance use including alcohol  Stricter advertising restrictions  Public education on the negative health impacts / alcohol warning labels  Restrict all alcohol sales to the LCBO / restrict expansion of LCBO outlets  Safer driving through the promotion of designated drivers, with a focus on youth  Reduce BAC driving limit to 0.05% / 0% BAC for drivers under 22 / random checks for drinking and driving  Note: Provincial Alcohol Control Strategy is presently under development

25. Take-away Thoughts Alcohol is still a major public health issue in Ontario – including as a cause of cancer. Public health agencies are held accountable for programs and services to support alcohol control. The public health community is concerned about a government direction of withdrawal of important alcohol control measures. We anticipate increasing health and social impacts that will rival the present economic stimulation and revenue generation being sought by government. We continue our public health activities, and we continue to express our views… swimming against the current.