1. 1 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: norman_giesbrecht@camh.netnorman_giesbrecht@camh.net Fax: 416-595-6899

2. 2 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

3. 3 CHALLENGES 1. Alcohol monopolies 2. Alcohol marketing & promotion 3. Consumption rates, drinking-related problems & prevention 4. Evidence-based orientation 5. Decision-making on alcohol policies 6. Public health and safety response

4. 4 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

5. 5 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

6. 6 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

7. 7 Marketing in Retail Stores On-site promotions Order by telephone or home delivery Marketing of store system (e.g., LCBO & SAQ) and products

8. 8 Conclusion- Alcohol marketing & promotion increasing Expanded methods and exotic techniques Control agencies involved in extensive marketing Fewer checks and balances

9. 9 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

10. 10 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

11. 11 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

12. 12 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

13. 13 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

14. 14 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

15. 15 NEXT STEPS…. Concurrent & not necessarily sequential

16. 16 Next Steps 1. Priority & resource assessment 2. Policy relevant monitoring & research 3. Communication & dialogue 4. Action agendas

17. 17 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?

18. 18 2. Policy Relevant Monitoring and Research

19. 19 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

20. 20 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

21. 21 3. Communication & Dialogue

22. 22 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

23. 23 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

24. 24 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

25. 25 [There was not enough time to show the following slides at Cambridge GAPA meeting – September 24, 2003]

26. 26 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.

27. 27 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

28. 28 Alcohol Consumption and Fatal Accidents in Canada, 1950-1998 Ole-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 20 th century. The size of association is comparable to the one previously reported from Northern Europe” *Addiction 98 (7), 883-895 (published 2003).

29. 29 Per Capita Alcohol Consumption and Liver Cirrhosis Mortality—the case of Canada Mats 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)

30. 30 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)