Abstract
Evidence for effective government policies to reduce exposure to alcohol’s carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., ‘increased prices’ or ‘reduced affordability’. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.
Highlights
Alcohol and public health policy as an organised field of academic inquiry is relatively new
The Sheffield Alcohol Policy Model (SAPM, e.g., [5]) has been effectively applied over the last decade to inform legal and policy processes culminating in the introduction of a Minimum Unit Price (MUP) for alcohol in Scotland in May 2018 [6], a successful policy which is rapidly being emulated in other countries (e.g., [7,8,9])
There could not be a starker contrast between government responses to the COVID-19 pandemic versus those to the health and safety problems associated with alcohol use, despite the related harms often being similar in scale [30]
Summary
Alcohol and public health policy as an organised field of academic inquiry is relatively new. Using case studies mostly from Scandinavia and other parts of Europe, they provided evidence that the total consumption of alcohol was a reliable predictor of the extent of serious alcohol-related harms in any particular population, e.g., liver disease, injury and alcohol use disorders. The Sheffield Alcohol Policy Model (SAPM, e.g., [5]) has been effectively applied over the last decade to inform legal and policy processes culminating in the introduction of a Minimum Unit Price (MUP) for alcohol in Scotland in May 2018 [6], a successful policy which is rapidly being emulated in other countries (e.g., [7,8,9]) Both InterMAHP and SAPM have been used to estimate policy impacts of MUP on such sensitive outcomes as government revenues and consumer expenditure (e.g., [3,10]). We highlight “circuit breaker” strategies which can create a more favourable climate for governments being prepared to implement policies with demonstrated effectiveness in reducing alcohol-related harms
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