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Strategies to Reduce Alcohol-Related Harms and Costs in Canada:

A Comparison of Provincial Policies

Presented by Norman Giesbrecht

CPHA Conference, May 28, 2014, Toronto

Authors Norman Giesbrecht, Centre for Addiction & Mental Health, Toronto Ashley Wettlaufer, Centre for Addiction & Mental Health, Toronto Stephanie Simpson, Centre for Addiction & Mental Health, Toronto Nicole April, Institut national de santé publique du Québec, Québec

City Mark Asbridge, Dalhousie University, Halifax Samantha Cukier, Johns Hopkins University, Baltimore Robert Mann, Centre for Addiction & Mental Health, Toronto Janet McAllister, Centre for Addiction & Mental Health, London Andrew Murie, Mothers Against Drunk Driving - Canada, Oakville Chris Pauley, Dalhousie University, Halifax Laurie Plamondon, Institut national de santé publique du Québec,

Québec City Tim Stockwell, Centre for Addictions Research of BC, Victoria Gerald Thomas, Gerald Thomas & Associates, Summerland, BC Kara Thompson, Centre for Addictions Research of BC, Victoria Kate Vallance, Centre for Addictions Research of BC, Victoria

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Alcohol-Related Harms & Social Costs in Canada

Alcohol is a leading risk factor for death, disease and disability (WHO 2014).

Significant economic costs $14.6 billion in 2002 for Canada.

Associated with injuries, trauma, violence and social disruptions.

Contributes to health inequities. Population level of drinking is associated

with level of harm from alcohol

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What can be done to reduce harm & costs?

Reduce overall consumption and high-risk drinking by:

Implementing more effective policies and prevention strategies, and

Strengthening and expanding evidence-based

policies already in place.

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Aims of the project

Collecting, assessing and disseminating up-to-date alcohol policy information.

Highlighting exemplary efforts in Canada. Working with stakeholders to support knowledge

exchange activities and implementation of effective alcohol policies.

In order to encourage evidence-based approaches to alcohol policy in Canada

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Methodology

1. Selecting the 10 policy dimensions and indicators A review of the literature and best practices including:

Babor et al 2010, Oxford U. Press; Anderson et al. 2009 Lancet; CCSA 2007, National Strategy; WHO 2010 Global Strategy - Alcohol

2. Development of the scoring rubric Scaled indicator scores (10 dimensions and 75 indicators) Weighted policy dimensions (reach x effectiveness) Review by three external international experts

3. Data collection Standardized data collection template including policies &

regulations up to October 2012

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Methodology (continued)

4. Data verification Ministry of Health, Ministry responsible for Alcohol

Retailing and/or Control, Ministry of Finance

5. Pilot testing and final scoring Blinded data Scoring reliability checks (data scored twice)

6. Calculating the final policy and weighted scores Percent of ideal score Weighted by effectiveness and scope

PROJECT ASSESSED PROVINCES ON 10 ALCOHOL POLICY DIMENSIONS

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*Summarized in this presentation. Other dimensions discussed in 3 other presentations at CPHA

Policy Dimension Effectiveness

(out of 5)

Scope of Impact

(out of 5)

Total Product

1.Pricing

4

5

20

2. Control System*

3

5

15

3. Physical Availability*

3

5

15

4. Drinking & Driving

4

3

12

5 5`5. Marketing & Advertising

2

5

10

6 Legal Drinking Age

4

2

8

7. Screening, Brief Intervention and Referral*

4

2

8

8.Server Training & Challenge & Refusal

2

3

6

9. Provincial Strategy*

1

5

5

10. Warning Labels/Signs

1

4

4

Total: 103

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Control System Policy ScoresIndicators: Type of retail system Alcohol sales channels Emphasis on social responsibility Ministry responsible for retail and control of alcohol

Control System Scores (% of ideal score)

0

10

20

30

40

50

60

70

80

90

100

Province

Po

lic

y s

co

re (

% o

f id

ea

l s

co

re)

Top ranking

Middle ranking

Bottom ranking

Average score

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Physical Availability Policy ScoresIndicators: Regulations pertaining to outlet density Actual outlet density (on-premise and off-premise) Actual hours of operation

Physical Availability Scores (% of ideal score)

0

10

20

30

40

50

60

70

80

90

100

Province

Po

licy

sco

re (

% o

f id

eal s

core

)

Top ranking

Middle ranking

Bottom ranking

Average score

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Screening, Brief Intervention & Referral Policy Scores

Screening, Brief Intervention and Referral Scores (% of ideal score)

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Province

Ind

icat

or

sco

re (

% o

f id

eal s

core

)

Top ranking

Middle ranking

Bottom ranking

Average score

Indicators: SBIR identified as priority in provincial strategy Practice guidelines or position paper Fee for service codes

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Provincial Alcohol Strategy ScoresIndicators: Focus of provincial strategy Inclusion of components from WHO’s (2010) alcohol strategy

Provincial Strategy Score (% of ideal score)

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Province

Po

licy

sco

re (

% o

f id

eal

sco

re)

Top ranking

Middle ranking

Bottom ranking

Average score

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Overall Results: Comparing the provinces on all 10 policy dimensions

0

10

20

30

40

50

60

70

80

90

100

Province

To

tal W

eig

hte

d S

core

(%

of

idea

l)

Top ranking provinces

Middle ranking provinces

Bottom ranking provinces

Average score

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Overall Results: Across all provinces

Top ranking provinces were ON, BC, NS. An average national score of 47%. Top 5 policy dimensions all fall below 60%

of a perfect score -- i.e., price, control system, physical availability, drinking & driving, marketing and advertising.

A notable strength is Legal Drinking Age and enforcement.

Lowest scoring policy dimension is Warning Labels & Signs, which is also policy dimension with the lowest weighting.

The policies with the widest range of scores were SBIR and Provincial Alcohol Policy, respectively.

Recommendations & Knowledge Transfer

Standardize inter-provincial documentation of policies with a safety and/or health perspective

Enhance policy-relevant information exchange between jurisdictions

Conduct social impact assessment of existing policies and pilot recommended policies

Create mechanisms for inter-sector planning (e.g. between public health, liquor boards, finance and public safety sectors)

Encourage provinces to strength areas with lowest scores

Recommendations & Knowledge Transfer

Main report & 10 provincial summaries, with province-specific recommendations, have been widely distributed and generated media attention

To date our findings have been used to inform: alcohol policy reviews in at least 5 provinces progress in a provincial alcohol strategy in 2 strengthened drinking and driving strategies in 2 strengthened alcohol pricing policies in 2 promote harm reduction policies on sponsorship in

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Acknowledgements Funding from the

Canadian Institutes of Health Research Receipt of data from the Provincial Liquor Boards as

well as from the Provincial Ministries of Finance, Health and Ministries responsible for the control and sale of alcohol in each province.

Mothers Against Drunk Driving (MADD) Canada for permission to use materials collected for their 2012 Provincial and Territorial Review.

Feedback on the selection of policy dimensions and scoring template by Thomas Greenfield, Esa Österberg and Robin Room.

Francois Benoit, Denise De Pape and Robert Strang for their contributions to the project.

Ann Dowsett Johnston for her input and guidance. The in-kind support provided by our co-investigators’

organizations is gratefully acknowledged.

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Contact InformationNorman Giesbrecht, Ph. D.Senior Scientist EmeritusSocial & Epidemiological Research Dept.Centre for Addiction and Mental Health 33 Russell St. Toronto, Ontario, Canada M5S 2S1Associate Professor, Dalla Lana School of Public Health

Phone: (416) 535-8501 ext. 36895

email: norman.giesbrecht@camh.ca

Link to the report on the CAMH website: http://www.camh.ca/en/research/news_and_publications/reports_and_books/Pages/default.aspx