Fase III: Arrepentimiento y reconciliación
ESTADO CIVIL Soltera 18 38,
Alcohol is a causal factor in at least 60 different types of disease and injury and a contributing factor in 200 others (WHO, 2011). Not only does it contribute to these devastating health
consequences but the harms of alcohol also impact individuals, families, workplaces and communities.
With Canadians drinking an estimated 50% or more above the world average and
demonstrating more detrimental drinking patterns than many EU countries, there is a critical need for public health to address alcohol consumption and alcohol-related harms (Shield et al., 2013).
This need is further demonstrated by alarming trends such as the increasing socio-political acceptance of alcohol, increasing alcohol industry activity and the increasing consumption levels that accompany this (especially among women).
The goal of this report was to triangulate data from a literature search on effective
interventions to address alcohol consumption and alcohol-related harms with valuable knowledge and insight gathered from
interviews with key informants and a survey of Ontario PHUs.
The importance of surveillance, evaluation and research, a comprehensive approach and partnering with community stakeholders emerged as three key themes throughout this research. These themes are pillars for
interventions within the seven areas for local action (originally captured by Babor et. al. 2010 in Alcohol: No Ordinary Commodity—Research and Public Policy, 2nd ed). The seven areas for intervention are:
1. Pricing and taxation
2. Regulating physical availability 3. Modifying the drinking environment 4. Drinking-driving countermeasures 5. Restrictions on marketing
6. Education and awareness-raising 7. Treatment and early intervention The report has explored each of these areas to offer recommendations on how PHUs can address alcohol consumption and alcohol- related harms at the local level.
Because communities vary so greatly, it is crucial for each health unit to communicate with
community stakeholders and assess its own community for applicability and feasibility of the recommendations offered. PHUs can then
prioritize their plans appropriately based on their current situation.
Interviews with key informants and a survey of Ontario PHUs also revealed several important lessons from initiatives to prevent and reduce tobacco consumption, which may be applied to reduce alcohol misuse. One example is the need for a stakeholder group, such as the Ontario Tobacco Research Unit (OTRU) or the Ontario Campaign for Action on Tobacco (OCAT), which can be a strong advocate for evidence-based policy measures to reduce alcohol consumption and alcohol-related harms. Additionally, the
“I think the greatest risk is not acting and not doing what you have to do. I think there is a risk in partnering with the industry.”
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importance of engaging communities in understanding the social, economic and health costs of alcohol is clear from the tobacco experience. Stakeholders should pay particular attention to the second-hand harms of alcohol and youth binge drinking rates to build
awareness and gain support for a comprehensive approach to alcohol. The hope is that this report not only offers effective interventions to address alcohol at the local level through its 13 recommendations for local action and six areas for advocacy in Ontario, but also that it highlights and acknowledges the extensive work which is currently being done by PHUs across Ontario to reduce alcohol use and alcohol-related harms.
One key informant offered thoughts on the importance of staying optimistic:
“I think optimism is a critical thing. I think there is a tendency for people to say, these problems are just too big. And it's true, but I think we need a sense of ‘yes indeed, this is possible and if we keep at it we can actually chip away at it and make a big difference’. It's a matter of being positive and being optimistic and of celebrating the successes as you go too.”
132 Addressing Alcohol Consumption and Alcohol-Related Harms at the Local Level
Based on the research evidence and grey literature on reducing alcohol consumption and alcohol-related harms at the local level, as well as the PHU survey and key informant interview ndings, the following recommendations are offered:
Recommendations
Policy Area Recommendations Consider the following...
Pricing and Taxation
Physical Availability Marketing and Advertising Modifying the Drinking Environment
Drinking and Driving Countermeasures
Education and Awareness-Raising Initiatives
Treatment and Early
1. Work with community partners to support the creation and advancement of a local stakeholder group to educate the public and policy makers.
2. Work with local municipalities to identify and implement local pricing strategies. *17, 27, 28, 29, 33
3. Work with community stakeholders to continue to prevent further expansion of alcohol sales. *16a, 19, 20, 27
4. Continue to inuence policy development around outlet density and hours of alcohol sale at the provincial and/or
*16c, 18, 27, 33 local level.
5. Implement youth engagement strategies to empower youth to advocate against alcohol marketing and advertising. *5, 31
6. Continue to explore effective counter-marketing
approaches to alcohol advertising and marketing.
7. Create an alcohol report about your community to show alcohol consumption, availability and alcohol- related harms at the local level. *18, 33
8. Work with local businesses and stakeholders to modify the drinking environment. *6, 16b, 21, 22, 23, 25, 33, 24, 35, 36
9. Work with law enforcement and community stakeholders to incorporate local
surveillance data on alcohol- related harms into a
community report, including local drinking and driving statistics.
10. Support municipalities and law enforcement to continue to enforce existing laws and regulations around drinking and driving. *37
11. Implement education and awareness raising strategies as a part of a balanced and comprehensive approach. *5, 6, 12, 14c, 32, 35
12. Build the capacity of health care professionals to
implement early intervention and screening into their practice. *7, 11, 12, 13
13. Implement early intervention strategies as a part of an overall strategy to reduce
q Assess how decreasing alcohol-related harms ts into stakeholders' agenda.
q Dene common goals among stakeholders q Utilize existing evidence and examples to support
evidence-based pricing policies
Risk mitigation, through municipal alcohol policies q
may be appealing to local leaders
Minimizing local pricing wars and the discounting q
of alcohol by addressing alcohol density
q Assess the potential threats of increasing availability of alcohol through:
l The potential privatization or semi- privatization of the LCBO
l Increase in privately-owned channels of alcohol access (e.g. farmers markets and convenience stores)
l Increase in retail outlets that offer alcohol at prices which do not meet minimum pricing (e.g., ferment-on-premise businesses) q Participate in active public health surveillance of
outlet density and associated harms
q Gather and present evidence on the need to set outlet density limits
q Assist municipalities to develop, implement and evaluate municipal alcohol policies and other strategies to address alcohol availability
q Partner with educational institutions and/or other community youth serving organizations
q Consider using the 'healthy schools model' with schools
q Work with other Ontario public health units and community stakeholders to identify a coordinated approach to countering alcohol marketing q Utilize social media and other communication
channels that appeal to youth
q Participate in active public health surveillance of local outlet density, alcohol consumption and alcohol-related harms
q Collaborate with community stakeholders to frame alcohol as a community issue not just a health issue q
q Encourage local bars to implement a licensed establishment alcohol policy
q Encourage local municipalities and law
enforcement authorities to continue to enforce liquor laws and regulations
q Advocate for safer drinking environments and communities
q Identify and target high-risk areas within your community
q Focus education and awareness strategies on inuencing attitudes and increasing knowledge in the target population
q Move current and future education and awareness initiatives towards a more comprehensive
approach
q Continue to use education and awareness-raising strategies as one important step in the policy road map
q Share evidence and information about early intervention strategies with local health care professionals
q Explore the development and use of practice standards or guidelines for early intervention with professional practice organizations
q
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Addressing Alcohol Consumption and Alcohol-Related Harms at the Local Level
Policy Area Recommendations Consider the following...
Modifying the Drinking Environment
Drinking and Driving Countermeasures
Education and Awareness-Raising
Treatment and Early Intervention
7. Create an alcohol report about your community to show alcohol consumption, availability and alcohol- related harms at the local level. *18, 33
8. Work with local businesses and stakeholders to modify the drinking environment. *6, 16b, 21, 22, 23, 25, 33, 24, 35, 36
9. Work with law enforcement and community stakeholders to incorporate local
surveillance data on alcohol- related harms into a
community report, including local drinking and driving statistics.
10. Support municipalities and law enforcement to continue to enforce existing laws and regulations around drinking and driving. *37
11. Implement education and awareness-raising strategies as a part of a balanced and comprehensive approach. *5, 6, 12, 14c, 32, 35
12. Build the capacity of health care professionals to
implement early intervention and screening into their practice. *7, 11, 12, 13
13. Implement early intervention strategies as a part of an overall strategy to reduce alcohol-related harms. *7, 13
q Participate in active public health surveillance of local outlet density, alcohol consumption and alcohol-related harms
q Collaborate with community stakeholders to frame alcohol as a community issue not just a health issue q Encourage local bars to implement a licensed
establishment alcohol policy
q Encourage local municipalities and law
enforcement authorities to continue to enforce liquor laws and regulations
q Advocate for safer drinking environments and communities
q Identify and target high-risk areas within your community
q Focus education and awareness-raising strategies on inuencing attitudes and increasing knowledge in the target population
q Move current and future education and awareness- raising initiatives towards a more comprehensive approach
q Continue to use education and awareness-raising strategies as one important step in the policy road map
q Share evidence and information about early intervention strategies with local health care professionals
q Explore the development and use of practice standards or guidelines for early intervention with professional practice organizations
q Use online self-screening tools on public health unit websites to provide normative feedback q Include alcohol screening and brief intervention in
public health direct-client service programs
*Refers to the alignment with specic recommendations within the National Alcohol Strategy Working Groups, Reducing Alcohol-Related Harm in Canada: Toward a Culture of Moderation – Recommendations for a National Alcohol Strategy (National Alcohol Strategy Working Group, 2007). Please note that this has been provided as a suggestion and others may nd that the recommendations align differently.
Critical Areas for Advocacy in Ontario
While this report is meant to identify local action for public health, it is important to also identify areas for advocacy within Ontario. The following information is drawn from our work with the advisory committee and is meant to align with the 13 recommendations in the report.
1 2 3 4 5 6
The importance of a provincial stakeholder group to act as a network and advocacy body for alcohol policy. This group would work to inuence the adoption of evidence-based policy measures to reduce alcohol consumption and alcohol-related harms.
¡ Ontario Campaign for Action on Tobacco (OCAT) is a successful example of such a group for the area
of Tobacco Control.
The importance of a provincial research network that is responsible for research, monitoring and evaluation, teaching and training and is a respected source of science based information regarding alcohol use. *6, 10, 11, 14a, 15, 19, 20, 23, 26, 30, 34, 36
¡ The Ontario Tobacco Research Unit has long been recognized as a Canadian leader in these areas for
Tobacco Control.
The need for up to date surveillance data on the economic and social costs of alcohol use in Ontario. The most recent evaluation of the direct and indirect economic costs of alcohol use is derived from 2002 statistics and doesn't account for the social costs of alcohol use. This research can therefore be expanded on to strengthen the case for addressing alcohol consumption and alcohol-related harms. *14a
The need for an impact assessment to identify the social and health effects of recent and proposed policies that increase the availability of alcohol within the Province of Ontario. This work is critical in limiting the further expansion of alcohol availability. *14a, 16c, 18, 19
The need for a coordinated provincial strategy to address alcohol consumption and alcohol-related harms in Ontario. A provincial strategy is critical to the implementation of a comprehensive and coordinated
provincial approach. Within this strategy, provisions for an alcohol coordinator for each Public Health Unit would be of benet. This would be a similar model to that of the Ontario Tobacco Strategy.
If use of the a physician billing code for SBIR is proven to be an effective intervention, partner with local stakeholders to advocate for the creation of an OHIP billing code for alcohol screening and early intervention strategies. As it becomes available, a review of British Columbia's evaluation data for this intervention may be useful in determining effectiveness.
*Refers to the alignment with specic recommendations within the National Alcohol Strategy Working Groups, Reducing Alcohol-Related Harm in Canada: Toward a Culture of Moderation – Recommendations for a National Alcohol Strategy (National Alcohol Strategy Working Group, 2007). Please note that this has been provided as a suggestion and other may nd that the recommendations align differently.
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