1. Políticas Públicas em Alcohol

2. 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

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

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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