Best practices in preventing alcohol problems International evidence base Øystein Bakke, FORUT Development and welfare in Malawi – the case of alcohol problems Thematic session 3: Alcohol Policy

Knowledge base vs.

Knowledge base Evidence based best practices Smokescreen draws attention away from effective policies vs.

Asahi Breweries, LTD. Bacardi-Martini Beam Global Spirits & Wine Brown-Forman Corporation Diageo PLC Heineken N.V. InBev Molson Coors Pernod Ricard SABMiller PLC Scottish & Newcastle

Recapture: Best Practices Minimum legal purchase age Government monopoly of retail sales Restriction on hours or days of sale Outlet density restrictions Alcohol taxes Sobriety check points Lowered BAC limits Administrative license suspension Graduated licensing for novice drivers Brief interventions for hazardous drinkers

Least Effective Practices Voluntary codes of bar practice Promoting alcohol-free activities Alcohol education in schools College student education Public service messages Warning labels Designated drivers and ride services

Alcohol: No ordinary commodity Opportunities for effective, evidence-based alcohol policies are more available than ever to better serve the public good. Alcohol policies that limit access to alcoholic beverages, increase the price of alcohol, and enforce laws and regulations through deterrence, are likely to reduce the harm linked to specific drinking patterns and per capita consumption.

How harm is generated There is strong evidence that alcohol related harm is directly related to the aggregate amount of alcohol consumed in a particular population The more people who drink and the more they drink, the bigger the problem

Implications for prevention Reduce overall consumption –Delay initiation of use –Reduce heavy alcohol use –Reduce population consumption Minimise harmful patterns of consumption –Change harmful behaviours associated with alcohol use –Insulate alcohol use from special situations (e.g. driving)

The simple assumption does not work: Knowledge > Attitudes/values > Action A comprehensive and integrated strategy is more likely to work Comprehensive strategy

Prevention and policy Alcohol prevention and policy goes hand in hand –Policy measures reduce consumption and harm –Information campaigns and education programs are not effective means to change drinking behaviour –Campaigns may create a more receptive climate to policy control –Complementary strategies will be more effective than single strategies

Control policies EducationMobilization A broad set of interventions Interlinked and coordinated Each type of interventions serve their specific purpose The prevention triangle

A top-down approach Regulation of markets by governments to reduce the availability of a substance and to guarantee - from a health/social point of view - safest possible production and distribution system. EducationMobilization Control policies

The owner of a national strategy is the state: –Need to involve several state actors, including Ministry of Health or Social Welfare, law enforcement, the judiciary, and the Ministry of Finance Contribution of the alcohol industry –only in the context of their roles as producers, distributors and marketers of alcohol, and not in terms of alcohol policy development or health promotion. (WHO Expert Committee – Recommendation no. 9)

Education: Provide information and training and influence values – to help people to decide and act adequately in their respective settings Control policies Mobilization Education

Mobilization: Make alcohol and drug prevention a part of the agenda for social/political movements, link the issue to other key policy issues and involve leadership and members in practical activities. Control policies Education Mobilization

Checklist for local context Which types of substances are available and are being used? –Homemade traditional beverages –Industrially produced traditional beverages –Domestic production of international beverages –Imported international alcohol brands Illegal Drugs?

Checklist for local context Who are the users? –Proportion of non-users and users –Gender differences –Age differences Situations of use? –Regularity, amount? –Kind of situations? –Risky situations –Risky patterns

Checklist for local context The consumption context? –Traditional context –Ritual context –Poverty context (urban or rural) –Modernity context (Westernized values, globalization) –Crisis context (conflict, war, disaster)

Checklist for local context The consequences of alcohol and drug use? –Which are the most frequent negative con- sequences of taking alcohol and drugs; –for the users themselves; for their family;

Checklist for local context The consequences of alcohol and drug use? (cont.) –for friends, colleagues, neighbourhood; –for the local community –for the society at large? –Which do you consider to be the most serious problems following substance abuse? –Which consequences are the most detrimental from a development perspective?

Checklist for local context Distribution systems? –Who are the producers or the sources for the various substances? –Who are the distributors and retailers? –Which other vested interests are involved?

Checklist for local context Level of alcohol consumption? –Recorded consumption –Un-recorded, legal consumption –Consumption of illegal beverages

Checklist for local context The use-values of the substances? –Which values are attributed to the substance use, by the users or the surroundings? –Cultural values –Social values –Economical benefits –Psychological effects –Physical effects

Checklist for local context What are the means available to constrain the availability of alcohol? –… and to structure consumption into the least harmful forms? How are taxes on alcohol collected? How well informed are politicians and decision- makers? –Is there a need to disseminate public information on these topics, to create an sustain political support for effective alcohol policies?

Alcohol in Devloping Societies The most effective approaches to reducing alcohol problems regulate alcohols availability and the conditions of its use. The research evidence clearly indicates that governments possess the powers and policy levers to reduce and prevent alcohol problems. Developing systems for regulating the alcohol market to reduce alcohol related problems is an essential task for developing states.