1. Module 7- Regulating the physical availability of alcohol
Part One- Alcohol Policy and Public Health
The physical availability of alcohol refers to the accessibility or convenience of obtaining and consuming alcoholic beverages.
Restrictions on alcohol availability focus on regulating the places, times, and contexts in which consumers can obtain alcohol, and include both partial and total bans on alcohol sales. There is great variability in regulation of access to alcohol. A number of countries have monopolies for at least some form of retail sale, and many Islamic states and some localities elsewhere practice total prohibition. In contrast, there is concern in many developing countries that cheap, informal-produced and illegal alcohol is largely unregulated.
Module 7- Regulating the physical availability of alcohol
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2. Learning Objectives
Upon completion of this module you will be able to:
Describe policies to restrict the availability of alcoholic beverages and their effectiveness.
Upon completion of this module you will be able to: describe policies to restrict the availability of alcoholic beverages and the effectiveness of such policies.
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3. Formal and Informal Markets
Formal markets are regulated by the government
Informal markets are unregulated
The retail markets that make alcoholic beverages available to people can be described as either formal or informal. Formal alcohol markets are regulated by government, whether at the community level or at the regional or national levels. The special regulation of alcoholic beverage sales often reflects social concerns about health, safety, and public order; it includes general limits on opening hours, days for retail sales, the placement and location of retail markets, who may purchase alcohol and how alcohol can be advertised and promoted (which is discussed in Module 10). Informal markets provide alcohol largely through unregulated social and commercial networks (e.g., through home production and distribution and sale of alcohol). Informal alcohol markets are a relatively small part of total consumption in most of the developed world. In LAC, informal retail markets can be important, accounting in some places for as much as 30% of total consumption.
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4. Licensing Systems Alcoholic beverages are sold in two ways:
‘On-premises’: for consumption on the premises
Bars, cafés, restaurants
‘Off-premises’: to take away for consumption elsewhere
Liquor stores, supermarkets
Alcoholic beverages are sold in two ways; either for consumption on the premises, such as at a bar, café or restaurant, or to take away for consumption elsewhere, as in the case of a liquor store or a supermarket. In mature markets for alcohol, both ‘on-premises’ and ‘off-premises’ sales are typically regulated through laws on sale of alcohol and licensing systems. These laws and policies specify who may sell alcohol, to whom alcohol may be sold (e.g., restricting sales to minors or intoxicated customers), conditions of sale (e.g. purchase quotas or sales over the counter), and days or hours of trading. Regulation of ‘on-premises’ sales offers additional opportunities to influence what happens during and after the purchase (see Module 11).
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5. Monopoly Systems Reduction in physical and economic availability
Reduced private-profit opportunity (alcohol sales, marketing or promotion)
Elimination of price competition, high retail prices
Fewer outlets, limited hours of sale
In a monopoly system, the state controls all or most of the retail sales of alcohol. Monopolies lead to a reduction in both physical and economic availability by reducing the opportunity for making profit in the private sector, whether through sales, marketing or promotion. This reduced opportunity lowers incentives and motivation for private entrepreneurship, thereby eliminating price competition and enabling high retail prices. State monopoly systems also often lead to a smaller number of outlets and limited hours of sale.
Traditionally, state monopoly systems were enacted in most Nordic countries, Canada, parts of the US, some central and eastern European countries and the former Soviet Union. However, recent political developments have led to market deregulation and increased availability in some of these countries.
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6. State Monopolies per Region
WHO Region
Percent of countries with state
monopolies for at least one beverage
AFR
13.6 (n=3)
AMR
8.0 (n=2)
EUR
19.0 (n=8)
SEAR/WPR
15.0 (n=3)
World
14.7 (n=16)
Only 8% of countries in the Americas regulate the sale of alcohol through a state monopoly system, making it the Region with both the lowest relative and absolute numbers of monopolies in the world. The absence of monopolies in the Region could contribute to alcohol-related problems, since a reduction in the availability of alcohol can lead to a reduction in harms, as we will see later in this module.
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Source:
WHO Global Status Report: Alcohol Policy, 2004.

7. Assumptions Underlying Restrictions on Alcohol Availability
POLICY
ASSUMPTIONS
Restrictions on time, place, and density of alcohol outlets
Reduce demand by restricting physical availability
Increase effort to obtain alcohol
Reduce total volume consumed as well as alcohol-related problems
The main assumption behind this approach to alcohol control policy is that restrictions on time, place, and density of alcohol outlets reduce the demand for alcoholic beverages by increasing the time and effort to obtain alcohol. In this way, availability restrictions reduce total volume consumed as well as alcohol-related problems. Availability approaches to prevention also attempt to reduce drinking and drinking problems by increasing the economic and opportunity costs associated with obtaining alcohol. Consistent enforcement of regulations is a key ingredient of effectiveness. License suspensions and revocations often provide the most direct and immediate enforcement mechanism.
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8. Total Bans and Related Restrictions
Strategy or Intervention
Effectiveness
Supporting Research
Cross-National Testing
Ban on sales
+++ ++
Ban on drinking in public places ? +
Minimum legal purchase age
Rationing
Government monopoly of retail sales
Restrictions on hours and days of sale
Restrictions on density of outlets
Restrictions on availability according to alcohol strength
Alcohol availability is often regulated by enacting partial or total bans, restricting hours and days of sale, and controlling the number, location, and type of retail outlets. All of these restrictions have been evaluated in a variety of countries, and the research shows very good evidence of effectiveness in reducing both alcohol consumption and alcohol-related problems. Total prohibition of alcohol sales on a countrywide basis is uncommon in the modern world. All modern countries with total prohibition, such as Saudi Arabia and Iran, are Islamic. In Canada and the United States, many First Nations and Native American tribes living on designated lands have implemented total prohibition of alcohol within the boundaries of the reservation. Research demonstrates that reductions in the hours and days of sale, numbers of alcohol outlets, and restrictions on access to alcohol are associated with reductions in both alcohol use and alcohol-related problems. Another strategy is the promotion of alcohol-free environments such as the workplace or sports arenas. Laws that raise the minimum legal purchasing age reduce alcohol sales and problems among young drinkers. The evidence also suggests that making beverages of low alcohol content (e.g., 3% alcohol or less) more available than higher-strength beverages may also be effective in reducing overall alcohol consumption and problems. Regulations directed toward commercial vendors of alcohol who sell to minors and ignore other restrictions can also be effective, but these regulations need to be supported by a system of specific licenses for selling alcoholic beverages that is enforced through the power to suspend or revoke a license in the case of selling infractions. A comprehensive alternative method to regulate alcohol availability is through government-owned retail monopolies. There is strong evidence that state monopoly systems consisting of stores selling alcoholic beverages for off-premise consumption can limit alcohol consumption and alcohol-related problems, and that elimination of government off-premise monopolies can increase total alcohol consumption. Government-owned retail systems generally have fewer outlets, shorter opening hours, and better control of sales to minors and intoxicated persons. Historical evidence and the experience of countries like India has shown that extreme restrictions on alcohol availability, such as the complete banning of all alcohol sales (i.e., total prohibition), reduces drinking and alcohol-related problems, at least in the short run. These restrictions, however, often have adverse side effects, such as the crime associated with illicit production and sales. In general, the cost of restricting physical availability of alcohol is inexpensive relative to the costs of health consequences related to drinking, especially heavy drinking.
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9. “Feed the Children First!”
Aboriginal community in Tennant’s Creek, Australia
Campaign to close local pubs and off-premises outlets on the day pay checks arrived
‘Feed the children first’ was the slogan of the campaign
A 19.4% decrease in drinking was found over a two-year period, with a concomitant reduction in arrests, hospital admissions, and women’s refuge admissions
In Tennant’s Creek, an outback community in Australia, an Aboriginal community group mounted a campaign to close the local pubs and off-premises outlets on the day pay checks arrived. On Thursdays, off-premises alcohol sales were banned, and on other days take-away sales were limited to the hours of noon to 9 p.m. In addition, bars were closed until noon on Thursdays and Fridays. ‘Feed the children first’ was the slogan of the campaign. Evaluation research found a 19.4% decrease in drinking over a two-year period, with a concomitant reduction in arrests, hospital admissions, and women’s refuge admissions. Concentrated efforts to control alcohol availability can produce substantial reductions in alcohol-related problems.
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10. Effects on Youth
Temporary bans on the sale of alcohol from midnight Friday through 10 am Monday reduced cross-border drinking by young Americans
Early closing on Friday night was associated with a 34% net reduction in the number of persons with BACs of 0.08% or higher
One of the few studies focusing on youth (Baker et al. 2000) found that temporary bans on the sale of alcohol from midnight Friday through 10 am Monday (because of federal elections in Mexico) reduced cross-border drinking by young Americans. In particular, the early closing on Friday night was associated with a 34% net reduction in the number of persons with BACs of 0.08% or higher. In a similar study Voas et al. (2002) found that after bar closing hours in Juarez, Mexico were changed from 5 am to 2 am, the number of young American pedestrians returning with BACs of 0.08% or higher from Juarez at 3 am or later was reduced by 89%.
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Baker et al. 2000

11. Homicides in Diadema, Brazil, Before and After Closing-Time Regulation (1995-2005)
There is strong evidence that substantial changes in the number of alcohol outlets result in significant changes to alcohol consumption and related harm. Overall, the evidence of an association between outlet density and alcohol-related harms is quite consistent. A growing number of studies find higher rates of alcohol-related problems in areas with higher outlet densities. A Brazilian study examined how restrictions on hours of sale affected the rates of alcohol-related harm. A new law in Diadema (an industrial city near São Paolo in Brazil) mandated all on-premise alcohol outlets to close at 11p.m. Prior to the law most bars traded 24 hours a day. The study found a reduction of around nine murders a month after the restrictions were imposed. This figure shows how the closing hour restrictions dramatically influenced homicide rates after they were introduced in This and other research suggests that dense clustering of alcohol outlets into entertainment districts is likely to be particularly problematic because it increases niche environments or the number of interactions among drinkers, thus increasing the likelihood of violent incidents. These entertainment districts often involve large numbers of drinkers moving from premise to premise throughout the night, increasing the likelihood of alcohol-related aggression. When restrictions are placed on hours of sale, they can reverse the negative effects of concentrated alcohol establishments.
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12. Alcohol Control Policies and Homicides; Cali, Colombia 2004-2008
A study done on alcohol control policies in Cali, Colombia found an association between the implementation of policy and the rate of homicides. The more restrictive the policy, the lower the homicide rate. This study lends weight to the assertion that restricting alcohol availability can reduce the incidence of interpersonal violence in communities such as Cali, where rates of violence and homicide are especially high.
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Source: Sanchez et al, 2011

13. Regulating Alcohol Availability Through Minimum Legal Purchase Age (MPLA)
1984 National Minimum Purchase Age Act: encouraged states to adopt the age 21 purchase standard
The number of young
people who died in a
crash when an intoxicated
young driver was involved
has declined by almost
63%
Another example of a successful alcohol policy based on restricting physical availability is the enforcement of age restrictions on drinking. In 1984 the US Congress passed the National Minimum Purchase Age Act, which encouraged states to adopt the age 21 purchase standard. As each of the 50 states implemented the standard, the number of young people who died in a crash when an intoxicated young driver was involved has declined by almost 63%.
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14. Strength of Alcoholic Beverages
The consumption of lower-alcohol-content beverages can be encouraged through tax policies
Consumption of lower-alcohol-content beverages can reduce the level of absolute alcohol consumed and associated intoxication and impairment
Lower-alcohol content beverages have been encouraged in many countries in recent years through policies that have made them more available or affordable, such as reduced rates of taxation. The evidence suggests that making available and promoting beverages of lower alcohol content can be an effective strategy. With no tax on 2.8% beer in Sweden, it often costs half as much as the 3.5% beer, which is also available in the grocery stores. As a result, it has captured half the grocery sales market. Such a strategy has the potential to reduce the level of absolute alcohol consumed and associated intoxication and impairment.
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15. Bans on Public Drinking
Dramatic declines in arrests, assaults and ejections from a University football stadium following a ban on alcohol sales
86% of Canadian communities that adopted formal policies experienced reductions in problems such as underage drinking, fighting, and vandalism
Some availability restriction policies target specific events or locations where drinking occurs such as drinking in parks or recreational locations, or in the workplace. Such restrictions have the potential for affecting youth drinking, in particular, since they often use public venues such as public parks, beaches, and lakes, for drinking. One study found dramatic declines in arrests, assaults and ejections from a University football stadium following a ban on alcohol sales. Despite the limited literature in this area, it has become common for alcohol to be restricted in sports stadiums, with patrons prevented from bringing alcohol into the stadium. Another study (Glicksman et al. (1995) found that 86% of Canadian communities that adopted formal policies experienced reductions in problems such as underage drinking, fighting, and vandalism. Other effects were seen in the reduced number of police interventions and public complaints involving alcohol.
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16. Other Strategies to Reduce Alcohol Availability and Harm
"Shoulder tap" operations
"Party Patrols"
Banning beer in kegs
Prohibiting home deliveries of alcohol
"Alcohol-Free Activities"
A number of strategies to reduce social availability of alcohol are in use but have so far not been evaluated with respect to their effects on consumption or harms. "Shoulder tap" operations use minors, working with police, to approach adult strangers outside of an alcohol outlet and ask them to purchase alcohol. If the older person actually makes the alcohol purchase and gives it to the youth, then they can be arrested or cited by the police. "Party Patrols" are a local enforcement strategy in which police arrive at a social event in which alcohol is being served and check age identifications of participants. Police can use noise or nuisance ordinances as a basis for entering a social gathering to determine whether underage drinking is taking place. Another strategy involves restricting the flow of alcohol at parties and other events to reduce the overall social availability of alcohol. Policies for preventing underage access to alcohol at parties can also be used to decrease the amount of drinking among young adults who may be of legal drinking age. Policies include banning beer in kegs and prohibiting home deliveries of large quantities of alcohol. "Alcohol Free Activities" are specific events or activities (e.g. 21st birthdays, New Year’s Eve, etc.) that have traditionally been associated with particularly high levels of alcohol-related harm. To reduce these harms the events are organized by either promoting alcohol-free alternatives or by banning alcohol availability at them. Although such strategies have the potential to be effective as part of policy efforts to reduce physical availability of alcohol, there is little research on their actual impact. But these policies are nevertheless supported by a large body of theory on the mechanisms of availability responsible for alcohol misuse.
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17. Interventions to Reduce The Impact of Informal Alcohol
Abolish the use of methanol to denature alcohol, thereby preventing abuse
Treat automobile products with bittering agents to make alcohol undrinkable
Rigorous control of medicinal alcohol sales and selling of only small container sizes
Test illegally produced but available products
Increase attractiveness/availability of commercial alcohol?
Interventions to reduce the impact of informal or surrogate alcohol have also been evaluated in several countries. One procedure is to abolish the use of methanol to denature alcohol, thereby preventing abuse, as in Australia and many European countries. Another procedure is to treat automobile products with bittering agents to make alcohol undrinkable. Rigorous control of medicinal alcohol sales and selling of only small container sizes can also reduce the misuse of these products. Testing of illegally produced but available products should be conducted to monitor the toxicity of surrogate alcohols. One strategy promoted by the alcohol industry is to increase attractiveness and availability of commercial alcohol. There is no evidence that this will reduce the use of informal alcohol, and availability theory suggests that it may merely add commercial alcohol to the amount consumed from the informal market.
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18. Summary: Regulating Alcohol Availability
Restrictions on availability can have large effects in nations or communities where there is popular support for these measures.
For young people, laws that raise the minimum legal drinking age reduce alcohol sales and problems.
The cost of restricting alcohol availability is cheap relative to the costs of health consequences related to drinking, especially heavy drinking.
Adverse effects include increases in informal market activities (e.g., cross-border purchases, home production, illegal imports).
 Restrictions on availability can have large effects in nations or communities where there is popular support for these measures. The best available evidence comes from studies of changes in retail availability, including reductions in the hours and days of sale, limits on the number of alcohol outlets, and restrictions on retail access to alcohol. There is also good evidence concerning reductions in the number of outlets or outlet density. For young people, laws that raise the minimum legal drinking age reduce alcohol sales and problems. This strategy has the strongest empirical support, with dozens of studies finding substantial impacts on traffic and other casualties from changes to the drinking age. The cost of restricting alcohol availability is cheap relative to the costs of health consequences related to drinking, especially heavy drinking. Adverse effects include increases in informal market activities (e.g., cross-border purchases, home production, illegal imports)
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19. Questions Module 7: Regulating the Physical Availability of Alcohol
Please answer the following questions to test your knowledge of the regulation of the physical availability of alcohol.
Questions
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20. Limit the physical availability of alcohol
Restrictions on time, place and density of alcohol outlets reduce the demand for alcoholic beverages because they:
Upset the public
Limit the physical availability of alcohol
Decrease the convenience of obtaining alcohol
Increase the cost of alcohol
Restrictions on time, place, and density of alcohol outlets tend to reduce the demand for alcoholic beverages. Why is this the case?
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21. Limit the physical availability of alcohol
Restrictions on time, place and density of alcohol outlets reduce the demand for alcoholic beverages because they:
Upset the public
Limit the physical availability of alcohol
Decrease the convenience of obtaining alcohol
Increase the cost of alcohol
In slide 6, we saw that restrictions on time, place and density of alcohol outlets have the ability to increase the effort, or decrease the convenience, to obtain alcohol. Increased effort leads to a reduction in demand.
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22. There are higher rates of alcohol-related problems in areas:
With lower outlet densities
With higher outlet densities
With bans on public drinking
With later closing times for alcohol outlets
Alcohol-related problems affect some areas more than others. Why is this so?
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23. There are higher rates of alcohol-related problems in areas:
With lower outlet densities
With higher outlet densities
With bans on public drinking
With later closing times for alcohol outlets
In Slide 10, you learned that a growing number of studies find higher rates of alcohol-related problems in areas with higher outlet densities.
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24. REFLECTION
Describe the main policies regulating the availability of alcohol in your country.
How are they enforced?
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