Public policy sets parameters within which society operates. However, healthy public policy is concerned with more than operating principles. Its purpose is to create a healthy society. [8] As the Second International Conference on Health Promotion in Adelaide in 1988 declared, "Healthy public policy is chiefly characterized by an explicit concern for health and equity in all areas of policy and an accountability for health impact." [9]

Healthy public policy seeks to create an environment that supports healthy living. It shapes individual and community lifestyles by making healthy options available to people, either directly or indirectly. Municipal alcohol policies contribute to healthy choices by establishing the rules for appropriate alcohol consumption in municipal facilities. Their ultimate goal is the encouragement of moderate, responsible consumption for those who choose to drink alcohol.

There are a number of reasons why every community needs to consider implementing a municipal alcohol policy:

- MAP fits with other initiatives -

The Ontario government acknowledges the success of population-based strategies for the prevention of substance abuse problems. MAP's are endorsed and recommended in Ontario's Substance Abuse Strategy. The government's aim is for 50% of Ontario municipalities to have a MAP by the year 2000. [10]

Many of Ontario's municipal councils recognize the need for alcohol management policies. Estimates for 1995 estimates show that at least 117 of the 816 municipalities in the province have a MAP in place, and approximately another 50 are under consideration. This rapid proliferation in a few short years is partly a result of the leadership that the Addiction Research Foundation and others initially provided for this issue.

A MAP needs to be part of a healthy public policy framework at the community level in Ontario. The Mandatory Health Programs and Services Guidelines goal for substance abuse prevention establishes the need for local boards of health to engage in comprehensive programming to improve population health.

MAP addresses three of the four objectives and three of the five requirements of the mandatory program in Substance Abuse Prevention. It also links three effective strategies for substance abuse programming: education, policy/legislation and environmental support (Ministry of Health, 1991). It does this by raising awareness of alcohol related issues and influencing social norms that contribute to drinking behaviour. As such, it is an important component in community substance abuse prevention.

- MAP increases overall awareness of alcohol related issues-

Research evidence supports healthy public policy as an effective means for reducing alcohol-related problems. Experience in areas such as drinking and driving have demonstrated that we need to use a three-pronged approach to achieve long-term impact: control policy, adequate enforcement, and broadly disseminated awareness.

The process of developing a MAP is as valuable as the eventual outcome for the community. Putting a MAP in place facilitates community education and/or mobilization on other aspects of alcohol abuse. The endorsement of a MAP by municipal council is a perfect opportunity for educating community groups about alcohol issues, in the context of both liability and responsibility to their members.

- MAP influences the social environment to support health -

The ultimate challenge is to change social norms and the value placed on alcohol in a community. In many communities there is some resistance to the notion of controlling individual drinking behaviour. Aside from drinking and driving, most other consequences of alcohol abuse such as intoxication or dependency are seen as individual concerns, not social concerns. As long as "getting wasted" is perceived by some as normal recreation for young people, and as long as charity fund-raising through alcohol sales which encourages drinking to impairment is acceptable, encouraging a healthier approach to alcohol consumption is a great challenge. MAP can create a foundation for community values which offset the existing strong reinforcers for irresponsible consumption.

Local boards of health have a unique role to play in the community response to alcohol-related problems. As facilitators, the public health staff nurture partnership among the key players, bridging sensitive issues and helping navigate the process. With the Medical Officer of Health acting as a health advocate, public health professionals can do much to focus community attention on the broader alcohol-related issues.

The public health perspective is pivotal in broadening the goal of MAP from legal liability and financial risk management to the broader promotion of community health and well-being. The public health authority has a legislated mandate to "prevent, protect and promote". This includes monitoring community health status and advocating for public polices that address alcohol-related community health issues such as rates of overall alcohol consumption, drinking/driving, and consumption by minors.

Public health leadership and community partnership can give voice to reasonable community health values about alcohol. This strategy has proven very useful in other areas such as tobacco use prevention and nutrition promotion.

The local players and politicians, as well as community interests, often determine the specific functions required of local boards of health in the process of MAP development. These include the following options:

In some cases, the role of the local board of health is instigating or initiating the MAP process by raising the issue with key municipal stake-holders. Sometimes the most important contribution of the board of health may be to convene the process. Clearly the key stakeholder is the section of the municipal government that manages the municipal facilities, usually the Parks and Recreation Department. The local board of health must respect the facilities managers' mandate for responsible stewardship of public property and buildings, not just when attempting to initiate MAP development but throughout the process. While local boards of health are key partners in MAP, they will not necessarily have the lead.

Alcohol abuse touches on legal/financial liability, safety, personal choice and the health of the community. By facilitating the merging of these concerns, local boards of health are well situated to influence public policy regarding alcohol use at the municipal level. Boards of health bridge the interests of various partners in the MAP process by representing the common goal of a healthy community.

Recent costly judgements in provincial and federal courts against licensed providers of alcohol (including a few municipalities) have added impetus for change. The Supreme Court of Canada has ruled recently that servers of alcohol are liable not only for people who get drunk at their establishments but also for people hurt by intoxicated patrons after they leave the premises.

As a result of such court cases, some municipalities may institute a MAP in reaction to the fear of financial and legal risks. Such a limited purpose is likely to result in a policy which concentrates solely on issues of liability related to drinking behaviour on municipal property only. This approach will, at best, attempt to create a balance between the amount of risk which the municipality is willing to assume versus the level of control which citizens are willing to accept. It isolates drinking behaviour in one setting from other concerns in the individual's life. It imposes an assumption of individual irresponsibility (or at most partial responsibility) taken from civil law which runs counter to the health promotion value of personal empowerment. Here again, there is an opportunity to broaden risk management concerns to address an important environmental determinant of health in relation to alcohol use.

When local boards of health participate as a stakeholder in MAP, these concerns about liability and the experience of tragic events can be an entry point for arousing municipal leaders and the public about alcohol use and its impact throughout the community.

Using the health promotion orientation, MAP becomes only one element in a comprehensive approach. By emphasizing collective responsibility for providing a healthy social environment and individual responsibility for lifestyle matters, local boards of health encourage health-enhancing behaviour and positive health outcomes. The focus is not on minimizing damage but on creating the will to promote and achieve non-harmful alcohol use throughout the community. MAP then helps establish a supportive environment for positive behaviour and is an important catalyst for changing community acceptance of high alcohol consumption.

While a MAP only controls alcohol use on municipal property, making alcohol a public health issue has a synergistic effect on all alcohol-related health promotion initiatives. The stakeholders who come together to explore the need for a MAP will work through the stages of gathering information, constructing a policy response, and building support to achieve a formal policy endorsed by municipal government. This process facilitates buy-in because it allows many opportunities for education. Because the process raises awareness, it can help mobilize the community around alcohol issues.

The Medical Officer of Health (MOH) is an important contributor to the MAP process. The MOH supports and leads the local board of health's efforts in these ways:

Local boards of health can play a vital role in community MAP development. MAP is an ideal opportunity for implementation of population-based health promotion. It provides health benefits both during the policy development process and as an outcome of the policy itself. Development of a MAP is a suitable vehicle to mobilize the community on alcohol-related issues as well as other health concerns. It provides an ideal opportunity for the community to use the considerable expertise and unique perspective of its local board of health. By working together on a MAP, the public, politicians, voluntary sector and local boards of health can forge a healthier community.