Políticas Públicas em Alcohol

Alcohol policy-makers are answerable to the policy consumers People consume services, and alcohol policy is a service Alcohol policy serves two purposes: To enhance benefits resulting from use of alcohol To contain/reduce alcohol-related harms Citizens deserve to know whether enacted alcohol policies are apt and well chosen High quality policies will be those that are evidence-based

Chosing effective strategies Need for a systematic procedure to evaluate the evidence, compare alternativa interventions and assess the fbenefits to society of different approaches

Como entender a Tabela 16.1 Evidence of effectiveness 0 lack of effectiveness + limited effectiveness ++ moderate effectiveness +++ high degree of effectiveness ? No studies, or insuficient evidence

Tabela 16.1(cont.) Breadth of research support 0 no studies of effectiveness have been undertaken + only one well designed study of effectiveness ++ two to four studies +++ five ir more studies

Tabela 16.1(cont.) Extent of testing across countries and cultures 0 the strategy has not been tested adequately + strategy studiend in only one country ++ studied in two to four countries +++ five or more countries

Tabela 16.1(cont.) Cost to implement and sustain Low Moderate High

Target groups (TG) GP - General population of drinkers HR - High-risk drinkers or groups particularly vulnerable to the adverse effects of alcohol (adolescents) HD - Persons already manifesting harmful drinking and alcohol dependence

Target groups (cont.) Of the 32 interventions and strategies evaluated, 16 are targeted at the GP, 12 at HR, and 4 at HD. Interventions directed at the general population have higher effectiveness ratings thatn those targeted at other groups. Interventions directed at the general population and high-risk groups tend to be less costly to implement and maintain than interventions with harmful drinkers

Table 16.1. Ratings of policy-relevant stategies and interventions Strategy Effective-ness Breadth of research support Cross-cultural testing Cost to implement Target group Total ban on sales +++ ++ High GP Alcohol taxes Low Training bar staff against aggression + Moderate HR Alcohol education in schools Random breath tests Mandatory treatment of drinking-drivers HD

Breadth of research support Cross-cultural testing Ratings of policy-relevant stategies and interventions – PHYSICAL AVAILABILITY Strategy Effective-ness Breadth of research support Cross-cultural testing Cost to implement Target group Total ban on sales +++ ++ High GP Minimum legal purchase age Low HR Government Monopoly Hours and days of sale restrictions Restrictions on density of outlets Server Liability + TG

Breadth of research support Cross-cultural testing Ratings of policy-relevant stategies and interventions – ALTERING DRINKING CONTEXT Strategy Effective-ness Breadth of research support Cross-cultural testing Cost to implement Target group Outlet policy to not serve intoxicated patrons + +++ ++ Moderate HR Training bar staff Voluntary codes of bar practice Low Enforcement of on-premise regulations and legal requirements High Promoting alcohol free activities and events GP Community mobilization

Breadth of research support Cross-cultural testing Ratings of policy-relevant stategies and interventions – DRINKING-DRIVING Strategy Effective-ness Breadth of research support Cross-cultural testing Cost to implement Target group Sobriety check points ++ +++ Moderate GP Random breath test + Lowered BAC level Low License Suspension HR Low BAC for young Designated drivers and ride services

Breadth of research support Cross-cultural testing Ratings of policy-relevant stategies and interventions – TREATMENT AND EARLY INTERVENTION Strategy Effective-ness Breadth of research support Cross-cultural testing Cost to implement Target group Brief intervention ++ +++ Moderate HR Alcohol Problems Treatment + High Self-help Low Mandatory treatment of repeat drinking drivers

Breadth of research support Cross-cultural testing Ratings of policy-relevant stategies and interventions – EDUCATION AND PERSUATION Strategy Effective-ness Breadth of research support Cross-cultural testing Cost to implement Target group Alcohol education in schools +++ ++ High HR College student education + Public service messages Moderate GP Warning labels Low

Breadth of research support Cross-cultural testing Ratings of policy-relevant stategies and interventions – REGULATING ALCOHOL PROMOTION Strategy Effective-ness Breadth of research support Cross-cultural testing Cost to implement Target group Advertising Bans + ++ Low GP Advertising content controls Moderate

Breadth of research support Cross-cultural testing Ratings of policy-relevant stategies and interventions – TAXATION AND PRICING Strategy Effective-ness Breadth of research support Cross-cultural testing Cost to implement Target group ALCOHOL TAXES +++ LOW GP

Integrated alcohol policies Our ratings suggest that a combination of pjysical availability limits at the general population level, certain drinking-driving countermeasures directed at all three target groups, and brief interventions directed at high-risk drinkers will offer the best value as the foundation for a comprehensive alcohol policy approach

The strong strategies Availability restrictions Taxation Enforcement Good research support Applicable in most countries Relatively inexpensive to implement and sustain

Education and public service messages Expected impact is low for education and public service messages about drinking High cost In terms of impact or value-for-money, education strategies have shown little or no effect, regardless of the investment

Treatment and early intervention strategies Medium effectiveness Limited impact at the population level Full treatment for alcohol problems only benefits a relatively small fraction of the population who come to treatment

Altering the drinking context Research in this area is only now getting under way It seems that strategies will have some impact without being too costly

Science more accessible to policy-makers Policy changes should be made with caution and with a sense of experimentation to determine whether they have their intended effects Interdisciplinary research is capable of playing a critical role in the progress of public health by applying the methodologies of the medical, behavioural, social and population sciences

The precautionary principle A general public health concept “To take preventive action even in the face of uncertainty” To shift the burden of proof to the proponents of a potentially harmful actitivy To offer alternatives to harmful actions To increase public involvement in decision-making Decision-making must be guided by the likelihood of risk, rather than the potential for profit

Extraordinary oportunities Multiple Changes can be made rationally Combine rationally selected strategies into an integrated overall policy The research base is strong Policies can be implemented at multiple levels Public awareness and support can be strengthened International collaboration can be enhanced