April 2008

 

What age to start drinking?

On March 27, 2008, the Middlesex-London Board of Health put forth six strong resolutions [PDF] related to alcohol control in Ontario that are to be considered at the Association of Local Public Health Agencies (alPHa) 2008 Annual Meeting in June. These resolutions include:

• the need to establish stricter advertising standards for alcohol;
• advocate for an enhanced provincial public education and promotion campaign on the negative health impacts of alcohol misuse;
• eliminate the availability of alcohol except in liquor control board outlets (LCBO);
• advocate to reduce the legal Blood Alcohol Concentration (BAC) from 0.08% to 0.05%; and,
• provide support in advocating for a provincial strategy for alcohol and other drugs.

Taking a public and population health approach to alcohol-related harms, the majority of these resolutions support recommendations from a landmark document on alcohol policy published by the World Health Organization. Further, these resolutions are supported by decades of research linking alcohol to harm, where here in Canada, alcohol is a factor in about 6,000 deaths per year and accounts for about $14.6 billion in costs, including healthcare, law enforcement, and work absenteeism.

However, the resolution receiving the most attention from media and public health revolves around the drinking age in Ontario, which states the Middlesex-London Board of Health will advocate for an increase in the legal drinking age from 19 to 21 years of age AND enact a zero Blood Alcohol Concentration (BAC) limit on drivers until they reach the age of 21.

CBC host Jane Hawtin interviewed Dr. Norman Giesbrecht [need RealPlayer to hear] from the Centre for Addiction and Mental Health on March 31st regarding this issue. Dr. Giesbrecht stated that he supports the evidence from the United States around raising the drinking age, adding that it "is quite convincing in reducing alcohol harms". Giesbrecht made clear that the drinking age issue needs to be "part of a larger discussion of can we do a better job of managing alcohol in Canadian society than we have in the past".

Other strategies presented by Giesbrecht, in addition to raising the drinking age, include the price of alcohol keeping pace with the cost of living; placing a ceiling on outlet density; alcohol marketing to be more effectively controlled, particularly marketing attractive to youth; and to provide better treatment, including brief interventions for high-risk drinkers. Giesbrecht concludes that to effectively address alcohol control in Ontario, there "needs to be a combination of strategies in addition to the ones we already have".

Other jurisdictions outside Ontario are starting to address these issues as well. On March 24th, it was announced that Acting U.S. Surgeon General Steven Galson will be kicking off a nationwide series of more than 1,600 town hall meetings in March and April to encourage action against underage drinking.

The town hall meetings will bring together public officials, parents and youth with community leaders and organizations in health, education, law enforcement, highway safety, and alcohol control. These meetings hope to raise awareness and greater insight into the public health dangers of underage drinking, with prevention issues such as reducing demand, availability, and access being addressed.

In Australia, similar conversations are taking place: the federal government has announced that with community support for such measures, the government would consider raising the legal drinking age, increasing alcohol taxes, putting cigarette-style warning labels on alcohol packages, establishing national laws to govern the supply of alcohol to minors, and instituting nationally consistent rules for the responsible services of alcohol in bars, pubs and clubs. Further, Australia's Health Minister Nicola Roxon is taking a broad, comprehensive approach citing that drinking is "a social problem, not just a legal problem, and we need to make sure that we are addressing it as such."

Interestingly, while Ontario is busy discussing raising its drinking age, the state of Vermont is currently discussing lowering theirs. A bill is being put forward with recommendations to create a committee to review lowering Vermont's drinking age. However, many alcohol education groups, such as Mothers Against Drunk Driving, are opposed to even the consideration of lowering the drinking age, citing the reduction in alcohol-related fatalities since the National Minimum Drinking Age Act was enacted in 1984.

The police don't agree with this bill either. Hanover Police Chief Nicholas Giaconne points out that a reduction in the drinking age would have a negative impact on surrounding communities. "Having done my police work through the era when the drinking age was 18, we found out that it took an increase in car accidents in that age group," Giaconne said. "Also, there is a more direct pipeline to alcohol for kids underage. There is always a group of 18-year-olds still in high school. They have immense peer pressure to acquire alcohol."

William Goggins, director of education and enforcement for the Vermont Liquor Control Board, sums up the issue of lowering the drinking age more succinctly — "I think it's irresponsible and a waste of valuable time."

 

Moving right along with a provincial alcohol strategy

The resolutions recently put forth by Middlesex-London Board of Health reads, "Public health units have a direct mandate in several key areas related to the use of alcohol and other drugs, specifically: chronic disease prevention, injury prevention, Fetal Alcohol Spectrum Disorder prevention, substance misuse prevention and harm reduction". These resolutions outline that "in order to move forward and reduce the incidence of under age drinking, impaired driving, alcohol-related injury, death and economic burden, a provincial alcohol strategy must be developed".

As highlighted in the March Issues to Watch column, an alcohol and drug strategy for Ontario is still outstanding, albeit underway. Such a strategy is looking to: build a supportive infrastructure in Ontario; reduce, prevent and address alcohol and other drug related issues and harms — harms that include high risk drinking, inappropriate drug use, injury, chronic and infectious disease, addiction, and crime; and address the unique needs of Ontario and its diverse populations.

As presented at the Alcohol: No Ordinary Commodity Forum on March 27th by Reggie Caverson from the Centre for Addiction and Mental Health, the process of forming a strategy has completed some milestones. These accomplishments include:

• forming a provincial planning and advisory committee which meet regularly,
• the formation of a provincial strategic working group,
• phase 1 of an environmental scan of alcohol and drug issues in Ontario, and
• a draft Ontario drug strategy.

This process has included a comprehensive approach to alcohol and legal/illegal drugs while soliciting input from various sources, embracing a multi-sector perspective, and promoting a coordinated and balanced approach to health and safety. Those invested in public health look forward to continued dialogue and action on this issue over the next several months.

Caverson made clear, however, that a key step in this process is for the provincial government to recognize such a strategy is of great importance for our province and to become officially engaged in the process of developing, implementing, and evaluating it.

The recent resolution from the Middlesex-London Board of Health (see article above) may be the push that is needed.