Effective vs. Popular: An analysis of local alcohol policies & prevention initiatives

Introduction:   Several scholars have posited that effective alcohol policies tend to be unpopular, and those largely ineffective are more popular. We examine this theme by assessing locally driven alcohol policies in the 36 health units in Ontario, Canada.

Methods:  Three methods were used: Following an initial extraction of 7,000 articles, 18 systematic reviews on alcohol prevention strategies were assessed; a survey of 36 public health units (PHU) was conducted via the PHU’s Medical Officer of Health; key informant interviews (KII) were conducted with 9 experts from alcohol or tobacco  and results coded using NVivo 10 software.

Results:  Seven policy interventions were assessed: pricing and taxation controls; regulating physical availability; marketing /advertising restrictions; modifying the drinking environment; drinking and driving countermeasures; education/ awareness-raising strategies; treatment / early  intervention. The PHU survey and KII pointed to the importance of all 7 interventions; nevertheless, there was a contrast between evidence of systematic reviews and PHU activities.  Pricing and taxation controls with extensive international evidence of effectiveness, was one of the least advocated policy measures by PHUs. In contrast education and awareness-raising strategies, with equivocal evidence of impact, was most highly-valued of the seven, commonly advocated and most often mentioned as the most important issue not currently addressed.

Conclusions/recommendations: Without wide public support for the most effective alcohol policies there are current limitations on local action. We recommend building capacity through training on comprehensive approaches, and demonstrating how effectiveness and scope of impact are important in strategic decisions on allocating resources and assigning priorities.