A Public Policy Approach to Reducing Harms Associated with Alcohol and Other Drugs

1. A Public Policy Approach to Reducing Harms Associated with Alcohol and Other Drugs Canadian Public Health Association Monday, June 2, 2008 Denise De Pape, M.Sc. Toronto Public Health

2. Causal model of alcohol consumption, intermediate mechanisms, and long-term consequences Source: T. Babor et al. 2003 * Independent of intoxication or dependence

3. Developing countries Developed countries High mortality Low mortality Underweight 14.9% Alcohol 6.2 % Tobacco 12.2 % Unsafe sex 10.2 % Blood pressure 5.0 % Blood pressure 10.9 % Unsafe water & sanitation 5.5 % Tobacco 4.0 % Alcohol 9.2 % Indoor smoke (solid fuels) 3.6 % Underweight 3.1 % Cholesterol 7.6 % Zinc deficiency 3.2 % Body mass index 2.7 % Body mass index 7.4 % Iron deficiency 3.1 % Cholesterol 2.1 % Low fruit & vegetable intake 3.9 % Vitamin A deficiency 3.0 % Low fruit & vegetable intake 1.9 % Physical inactivity 3.3 % Blood pressure 2.5 % Indoor smoke from solid fuels 1.9 % Illicit drugs 1.8 % Tobacco 2.0 % Iron deficiency 1.8 % Unsafe sex 0.8 % Cholesterol 1.9 % Unsafe water & sanitation 1.8 % Iron deficiency 0.7 % Leading risk factors for disease in emerging and established economies (% total DALYS*) World Health Report, 2002)

4. Drinking Patterns & Rates -- Canada • Both high risk drinking patterns and overall consumption levels have been shown to impact chronic disease and trauma related harm from alcohol. • Results from the Canadian Community Health Surveys suggest that high-risk drinking has increased from 10% to 14% between 1993 and 2004. • The per capita (aged 15+) has increased from 7.3 to 7.9 litres between 1997 and 2004

5. Drinking Patterns & Rates -- Canada...continued • The 2004 Canadian Addiction Survey found that 23% of past-year drinkers exceeded the low-risk drinking guidelines. • Also, 17% of past-year drinkers were considered to drink hazardously (8+ on AUDIT) • Overall consumption and high risk drinking are on the increase Source: Statistics Canada, Canadian Community Health Surveys; Adlaf, Begin & Sawka, 2005

6. Ratings of policy-relevant strategies and interventions Source: Adapted from T. Babor et al, Alcohol: No ordinary commodity (Table 16.1), 2003, by T. Greenfield, et al. 2007

7. Alcohol taxes Minimum legal purchase age Government monopoly of retail sales Sobriety check points Lowered BAC limits Administrative license suspension Graduated licensing for novice drivers Restrictions on hours and days of sale Restrictions on outlet density Enforcement of on-premise regulations Brief interventions for high risk drinkers Best Practices & Practices with Good Support & Feasibility Source: T. Babor et al. 2003, chapter 16

8. A Prediction • Alcohol-related burden (mortality, damage, social and • personal and financial costs) is expected to increase in • Canada in the coming years, because: • Overall consumption is increasing • High risk drinking is increasing • Alcohol is not on agenda, or only modestly so, with regard to generic/general chronic disease and injury prevention efforts • Substantial attention is still devoted to the least or less effective interventions and prevention strategies • - Drinking & driving prevention initiatives are a significant exception

9. Lessons from Tobacco Control (courtesy of John Garcia, PhD) * • There are no “magic bullets” • Health behaviour is social behaviour • Combine scientifically valid interventions and social movements • Multi-faceted, multi-level approaches are needed • Research, monitoring and evaluation must be integral • Dose matters; investment is essential * *

10. Lessons from Tobacco Control...continued * • Public Health infrastructure is essential • Take advantage of inter-dependence of strategies to achieve multiple ends • Prevention among youth requires societal approach, as opposed to a narrowly targeted approach • Leadership is essential • A long-term perspective is needed • Gains can be reversed * * *Key considerations

11. Challenges • Bridging perspectives that are based on values rather than evidence • Generating political leadership • Securing resources and sustainability • Negotiating the divide between public health and community safety • Shifting policy environment across levels

12. Elements for Success • (Political) leadership and support • Multi-sector involvement, including major NGOs and government • Use of evidence to inform policy • Relevance/resonance • A focus on health • A provincial/national advocacy network • Dedicated staff/support

13. Role for the Public Health Community • Advocacy skills • Experience in partnerships • Understanding of the need to be comprehensive • Leadership • Implementing some of the recommendation

14. Some specific activities for the Public Health Community: • Engage in development of Municipal Alcohol Policies • Analyze learnings from tobacco use prevention and apply to alcohol • Stop doing ineffective activities • Promote Low-Risk Drinking Guidelines and combine with controls on alcohol and partner with advocates for other health issues • Hone advocacy skills • Advocate for and support municipal, provincial and national drug/alcohol strategies through reports to Board of Health • Collaborate