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

• Date: 01 September 2019
• Author: Norman Giesbrecht,Linda M. Bosma,Emilene Reisdorfer
• Published date: 01 September 2019
• DOI: http://doi.org/10.1002/wmh3.314

248

doi: 10.1002/wmh3.314

© 2019 Policy Studies Organization

Reducing Harm Through Evidence‐Based 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. Twenty‐five

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 decision‐making focusing on short‐range 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

Introduction

There is extensive robust evidence on the effectiveness of both population‐level

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

late‐night on‐premise sales; controls on density of alcohol outlets in order to curtail

social disorder; controls on drinking and driving; and health interventions aimed at

high‐risk 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 high‐risk or binge drinking, or control alcohol‐related 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, Klein‐Geltink, & Giesbrecht,

2018); infectious disease; and Alzheimer’s, 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

policy—such as reducing alcohol prices, increasing physical access to alcohol,

longer hours of sale, and others—were 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.

Method

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