Emerging Issues in Alcohol Policy
Alcohol-we celebrate with it, unwind with it and sometimes we even to drown our sorrows in it. It's the drug of choice for most Ontarians and one that can have devastating consequences for the health and safety of our friends, families and communities.
Alcohol
- is associated with nearly half of all motor vehicle fatalities, and 75% of snowmobile and marine vehicle deaths in Ontario.
- has a harmful effect on the friendships, social life, physical health, home life, marriage, work, studies, employment opportunities or financial position of one in three Ontarians.
- costs Ontario taxpayers and businesses an estimated $4.3 billion annually in lost productivity, extra law enforcement and health care services.
An evidence-based perspective clearly implies that there should be some association between the level of damage from a risk factor and the attention and resources directed to control that risk factor and reducing damage emerging from it. However, despite the high rates of damage from alcohol,
1,
2,
3,
4,
5,
6 there are signals that it is not given appropriate attention at all levels of government. For example, at the national level initiatives to prevent chronic disease typically do not mention alcohol as a risk factor, and in most provinces it also not among the risk factors formally recognized by provincial groups focusing on chronic disease, even though the contribution of alcohol to damage may be equal to or greater to others that are of current interest. Ontario's Chronic Disease Prevention Alliance is unique in that it recognizes that drinking is indeed a contributor to a number of chronic diseases.
Therefore, an emerging challenge is keeping attention to all relevant risk factors for both chronic disease and trauma, and recognizing those that have been overlooked or neglected and drawing additional attention to them.
A second challenge is that in many public health and safety arenas the capacity to address harm from alcohol is not fully developed. Many prevention experts experience very high demands and formal priorities with regard to other health issues, and alcohol, since it is a widely accepted, used and legal drug, receives low priority. Or these experts may not yet developed expertise and knowledge of how to best address drinking-related harm.
Third, the alcohol arena is not unique from others, in that available resources are not necessarily directed to the most effective interventions (see Babor et al. 2003, chapter 161). For example, while controls on alcohol distribution, price and sales practices have been shown time and again to reduce harm from alcohol, these are being eroded or neglected. In contrast, information and persuasion techniques are given high priority, even though their potential to impact drinking behaviours or reduce harm is at best modest. A comprehensive evidence-based prevention strategy would assign special attention to prevention measures with the most potency, and with some others playing a supplemental or supportive role. Therefore, a challenge within the alcohol arena is shifting priorities so that greater attention is directed to those interventions with a strong potential and established track record.
A fourth challenge relates to the policy-making process. Alcohol policy-making typically does not give much attention to health and safety issues. There may be acknowledgement of some risks, but seldom, if ever, is there impact assessment before a policy is initiated or a regulation changed. Also, trial introduction of a policy -- accompanied by time-limited systematic evaluation and reporting of the results - is also uncommon.
Therefore, a three-part challenge is evident: insuring that health and safety experts are an integral part of the discussion from the outset and involved in decisions about policy details; that the deliberations be based not only on economic and business agendas and also on social and health impact assessments; and, three, process and outcome evaluations be part of the planning, implementation and review processes related to new policy initiatives.
Statistics Canada, 2002. Cat. 63-202, Control and Sale of Alcoholic Beverages in Canada. Table 1.5
See
Xie, X., Mann, R.E. & Smart, R.G. 2000. The direct and indirect relationships between alcohol prevention measures and alcoholic liver cirrhosis mortality. Journal of Studies on Alcohol 61: 499-506.
Canadian Centre on Substance Abuse 2004. Canadian Addiction Survey. Prevalence of Use and Related Harms. Highlights.