Reducing Harm Through Evidence‐Based Alcohol Policies: Challenges and Options

Date01 September 2019
Published date01 September 2019
doi: 10.1002/wmh3.314
© 2019 Policy Studies Organization
Reducing Harm Through EvidenceBased Alcohol
Policies: Challenges and Options
Norman Giesbrecht , Linda M. Bosma, and Emilene Reisdorfer
This article examines challenges in implementing and sustaining effective alcohol policies and
proposes several strategies to counter them. A narrative review was undertaken of recent pub-
lications that document challenges in implementing alcohol policies in various contexts. MED-
LINE/PubMed were searched for publications in English between 2011 and 2018. Twentyfive
keywords and 25 scholar names were used in the search. From 1,169 hits, 168 full research papers
and commentaries were examined. Eight main groups of challenges were identified: interventions
of inadequate dose, support, scope, or fidelity; confounding impacts from alcohol industries and
other sectors; uneven implementation or inadequate enforcement; popular policies are largely in-
effective and effective policies unpopular; policy decisionmaking focusing on shortrange per-
spectives and skewed to favor commercial interests; low awareness of alcohol as a health risk;
challenges in getting information on relevant interventions, local data, and insider information;
and insufficient capacity or training to implement a policy. Several strategies are offered to counter
these challenges: provide evidence to policymakers: conduct assessment and pilot studies; provide
enhanced training on alcohol issues and policy implementation; develop allies; promote strong
leadership; use media advocacy; engage voices of those impacted by flawed policies; and promote a
comprehensive approach.
KEY WORDS: alcohol policy, challenges, response options
There is extensive robust evidence on the effectiveness of both populationlevel
policies and focused interventions in reducing the high level and multidimensional
harms from alcohol, and considerable convergence in conclusions from assess-
ments over the past decade (Anderson, Chisholm, & Fuhr, 2009; Babor, Caetano,
et al., 2010; Burton et al., 2016; Chisholm et al., 2018; Giesbrecht & Bosma, 2018;
Giesbrecht, Stockwell, Kendall, Strang, & Thomas, 2011; Nelson et al., 2013;
Stockwell et al., 2019). In the review by Burton et al. (2016)the authors highlight
several policy dimensions: tax increases and minimum unit pricing regulations;
marketing regulations; policies that reduce hours of sale, especially those related to
latenight onpremise sales; controls on density of alcohol outlets in order to curtail
social disorder; controls on drinking and driving; and health interventions aimed at
highrisk drinkers.
In the previous paragraph we cite recent reviews and analyses pointing to
which alcohol policies are especially effective. However, this evidence has been
building over decades (e.g., Bruun et al., 1975; Edwards et al., 1994). As noted by
Babor, Caetano, et al. (2010)effective policies are those that control overall con-
sumption, control highrisk or binge drinking, or control alcoholrelated harms
such as trauma, violence, chronic disease, and social problems related to alcohol
use. The evidence of harm from alcohol has been growing in recent decades: for
example, harms to others who may not be drinkers (Laslett, 2018); numerous types
of cancer (see Bagnardi et al., 2015; Young, Candido, KleinGeltink, & Giesbrecht,
2018); infectious disease; and Alzheimers, to mention a few (Greenfield &
Martinez, 2018; World Health Organization, 2010, 2018).
However, policy implementation has not kept pace with the harm from alcohol
nor with the evidence on which policies are effective. In many cases this evidence of
exemplary policies is based on regional or national experiences where a flawed
policysuch as reducing alcohol prices, increasing physical access to alcohol,
longer hours of sale, and otherswere implemented and their impact assessed
(Babor, Caetano, et al., 2010). These untoward experiences are either not widely
known to policymakers, or ignored because they run counter to the vested interests,
script, or rationale to expand access to alcohol and promote sales (Babor & Robaina,
2018). For example, a comparison of provincial Canadian alcohol policies on 10
domains shows that despite getting low scores in 2012 with regard to evidence
based policies (Giesbrecht et al., 2013, 2016)there was little if any improvement in
scores in 2017 (Stockwell et al., 2019)on key domains. This was despite the growing
international evidence of potent interventions already recommended in 2013. In
some cases, the developments, such as an increase in alcohol outlet density and
privatization, were clearly contrary to the recommended approach.
Evidence of effectiveness does not necessarily mean that these policies are
implemented, or if implemented, enforced and sustained (Thomas, Paschall, Grube,
Cannon, & Treffers, 2012; van Hoof and van Velthoven, 2015). Effective policies
may be underutilized (Fell et al., 2016; Giesbrecht et al., 2016), guidelines ignored
(Grubesic et al., 2012), or policies contrary to the international evidence im-
plemented (Gruenewald et al., 2015; Rossow & Buvik, 2018). We examine key
challenges in implementing and sustaining alcohol policies and propose several
strategies to counter these challenges.
Our assessment was based on a nonsystematic, narrative review of recent
publications that document challenges in implementing alcohol policies in local,
state, national, or international contexts. The main goal of narrative reviews is to
provide a comprehensive synthesis of the existing information about the chosen
topic (Green, Johnson, & Adams, 2006). MEDLINE/PubMed were searched for
publications in English between 2011 and 2018. The timeframe was chosen to
include only recently published papers that could provide an updated overview
of challenges and options currently described by the literature.
Giesbrecht et al.: Reducing Harm Through Alcohol Policies 249

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