Wgds harm reduction forum alcohol presentation

IT STARTS HERE: A Conversation About Alcohol

in the City of Kingston

Cathy Edwards Public Health Nurse, KFL&A Public Health

Coordinator, Safe & Sober Community Alliance

Wellington Guelph Harm Reduction Forum March 20, 2013

“Holding people solely responsible for poor health outcomes is like holding fish responsible for dying in a polluted stream.”

- unknown

Reducing Alcohol-related harm

" Harm reduction is any policy or program

designed to reduce drug-related harm

without requiring the cessation of drug use.

Interventions may be targeted at the

individual, the family, community or society.“

CAMH and Harm Reduction: A Background Paper on its Meaning and

Applications for Substance Use Issues, CAMH, 2002

6,081,000

8,915,000 8,961,000

1,623,000

No-risk Low-risk Moderate-risk High-risk

nu

mb

er o

f p

erso

ns

Distribution of Alcohol-related Risk in Canada, 2009

Source: Canadian alcohol and drug use monitoring survey (CADUMS 2009).

The Prevention Paradox

• “A large number of people exposed to a small risk can create many more cases of harm than a small number exposed to a high risk.”

Framing the Issue

Age, sex, and

heredity factors

In

divid

ual Lifestyle Factors

Social and Community Influences

Livingand WorkingConditions

Gene

ral S

ocioe

conomic, Cultural, and Environmental Conditons

Alcohol and the Determinants of Health

• Pricing and affordability of alcohol • Availability and accessibility of alcohol • Regulations for Alcohol marketing and promotion • Alcohol laws

• Work environment • Income • Education • Early childhood development

• Alcohol advertising and local business promotions • Bar environments and staff training • Liquor enforcement capacity • Parental attitudes and role modelling

• Individual choice • social circle, consumption patterns

• Education and informed choice • Individual resilience

• Youth and young adults more susceptible to risk taking

• Older adults more vulnerable to alcohol and related harms

• Women at increased risk because alcohol is processed differently in women’s bodies

• Certain hereditary factors can predispose individuals for alcohol addiction

HOW MUCH ARE WE DRINKING?

Patterns and trends

Percentage of those who are heav y drinkers

by age group in Ontario, 2009 - 2010

perc

enta

ge

3.8

13.7

16.2

18.6

32.5

Age group

How much are we drinking? Patterns and Trends in Ontario

Young Adults (ages 18-29 in Ontario)

Weekly heavy drinking increased from 11% in 1995 to 26% in

2007,

Hazardous or harmful drinking increased from 22% in 2002 to

39% in 2007.

A significantly higher proportion drink above the Low Risk

Drinking Guidelines* than any other age group in Ontario.

How much are we drinking? Patterns and Trends in Ontario

Youth (grades 7-12)

About 22% of students reported drinking 5+ drinks on one occasion at least once during the past month (this represents about 223,500 Ontario students).

5% reported binge drinking four or more times in the past month.

One third reported drinking hazardously and harmfully in 2011.

One in 10 students reported injuring themselves or someone else as a result of their drinking. These behaviours were most common in students in grades 11 and 12, with both boys and girls equally likely to engage in these dangerous patterns of drinking.

How much are we drinking? Patterns and Trends in Ontario

Older Adults (ages 65+)

Average number of drinks consumed per week has gradually increased from just over 3 drinks per week to almost 5 per week. That is a 67% increase between 1996 and 2009.

Women

Trends indicate that Ontario women are fast approaching the consumption patterns of men.

Past year drinking in women increased from 72% in 1998 to 78% in 2007.

Daily drinking increased from 2.6% in 2001 to 5.3% in 2007, and

Hazardous or harmful drinking increased from 5% in 1998 to 8% in 2007.

SECOND HAND EFFECTS OF DRINKING

How does alcohol impact communities?

Police Monitor Aberdeen St. Patrick's Day Party

Kingston Whig Standard, March 19, 2013

Second hand effects – Alcohol and Crime

• Provincial Liquor

(LLA) offenses • Drinking and

driving • Alcohol and

violence • Domestic

violence • Alcohol and

sexual assault

Alcohol and Sexual Assault • A 2004 survey showed that the rate of sexual

assault for Canadians aged 15 to 24 was almost 18 times greater than for adults over 55.

• In a University of Alberta study, almost half of the sexual assaults that young adults experienced took place under the influence of alcohol

• Data from police-reports in Canada for 2007 indicate that in 82 percent of the cases where the relationship could be determined, the victim knew the perpetrator.

Second hand effects - FASD

“Prenatal alcohol exposure can produce lifelong brain dysfunction that, without support and treatment, severely impacts an individual’s ability to function in school, the workplace and to become a contributing member of society.”

Dr. James Reynolds, Queen’s University

THE BUSINESS OF ALCOHOL

Revenues and Benefits vs. Costs and Harms of Alcohol

Revenue Cost Analysis for Ontario

$0

$500,000,000

$1,000,000,000

$1,500,000,000

$2,000,000,000

$2,500,000,000

Direct Costs (2002)

Direct Revenue (FY2002/03)

$1,276,440,000

$1,160,104,734

$45,700,000

$1,406,451,000

$619,402,996

Comparison of Direct Alcohol-related Revenue and Costs, Ontario, 2002-2003

Enforcement Costs Health Care Costs Other Costs Net Revenue Sales Taxes

Deficit= $456,390,738

Source: Thomas, Gerald. The Economics of Alcohol Control Policy in Canada, Alcohol

Policy Network webinar, September 2010.

ALCOHOL POLICY: Local action to reduce alcohol-related harm

Regulating Physical Availability

Sample policy strategies:

• 1. Limit alcohol outlet density

• 2. Confine hours of service

• 3. Limit alcohol allowed public events

Strengthen local zoning regulations to avoid density and congestion

Evaluate liquor license applications based on potential community impact

Evaluate license application process considering health and safety decisions

51% agreed or strongly agreed that there should be a limit on the number of alcohol retailers and licensed establishments that can exist in a given area in the City of Kingston.

Advocate for stricter controls on the sale of large volume containers e.g. beer kegs

Advocate for the authority to restrict or ban alcohol delivery services within the municipality

61% agreed or strongly agreed that people should be required to have a special permit to buy beer kegs 51% agreed or strongly agreed that there should be a ban on alcohol delivery services.

Controlling affordability

Sample policy strategies:

• 1. Appeal to provincial government

• 2. Appeal to federal government

Work with communities and government to implement minimum pricing laws, volumetric mark-ups, and penalties for drink discounting violations

Appeal for government to index prices to cost of living. Keep at or above the consumer price index

52% of Kingston respondents agreed or strongly agreed that the price of alcohol should be based on its alcohol content.

Restrictions on marketing

Sample policy strategies:

• Pursue local regulations

• Support counter-advertising

• Appeal for healthier alcohol advertising policies and practices

Strengthen local restrictions on alcohol advertising such as imposing constraints on number, location, size, content of ads File advertising concerns and complaints to Advertising Standards Canada and advocate for new standards

73% of Kingston respondents would support the Ontario government establishing stricter advertising standards for alcohol.

Modify the Drinking Context

Sample policy strategies:

• 1. Regulate special occasion events

• 2. Improve conditions of on-premise alcohol outlets (e.g. bars, restaurants)

Enact responsible beverage service training and in-house bar policies

Mandate Safer Bars training as part of licensing to reduce problems and violence in bars

Provide inspectors and police with data on problem areas and assist with targeted policing initiatives

92% of respondents agree or strongly agree that bar training to reduce alcohol problems and violence should be required to obtain a license.

Taking Shared Responsibility

• Municipal Government – Mayor, City Council, City Administrators • Provincial and Federal Governments – Politicians • Health Care Professionals and organizations • Enforcement agencies • Licensed establishments • Business community • Media • Post Secondary institutions • Teachers and School Boards • Parents • Students • Community Members