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Evidence for effective government policies to reduce exposure to alcohol's carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., 'increased prices' or 'reduced affordability'. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.

Abstract

Introduction
Managed Alcohol Programs (MAPs) are designed to improve health and housing outcomes for unstably housed people with an alcohol use disorder (AUD). The present study assesses the association of MAP participation with healthcare and mortality outcomes.


Methods
A retrospective cohort study assessed health outcomes for 205 MAP participants and 128 controls recruited from five Canadian cities in 2006–2017. Survival and negative binomial regression models were used to calculate hazard ratios (HR) of death and emergency room (ER) visits and hospital bed days (HBDs). Covariates included age, sex, AUD severity and housing stability score.


Results
In fully adjusted models, compared with times outside MAPs, participants had significantly reduced risk of mortality (HR = 0.37, P = 0.0001) and ER attendance (HR = 0.74, P = 0.0002), and fewer HBDs yearly (10.40 vs 20.08, P = 0.0184). Over the 12 years, people enrolled in a MAP at some point had significantly fewer HBDs per year than controls after MAP enrolment (12.78 vs 20.08, P = 0.0001) but not significantly different rates of death or ER presentation. MAP participants had significantly more alcohol-related but significantly fewer nonalcohol-related ER presentations than controls.


Conclusion
Attendance at a MAP was associated with reduced risk of mortality or morbidity and less hospital utilization for individuals with unstable housing and severe AUDs. MAPs are a promising approach to reduce mortality risk and time spent in hospital for people with an AUD and experiencing homelessness.

The current report compares Canadian provinces across three policy/program dimensions demonstrated to reduce alcohol-related problems among 15–24-year-olds. The dimensions, Legal Drinking Age, Server and Manager Training/Challenge and Refusal Programs, and Drinking and Driving, were assessed using specified indicators with provincial scores reflecting the percentage of the ideal attained. National means for each dimension were also calculated. Legal Drinking Age attained the highest national mean at 75% of the ideal; Server and Manager Training/Challenge and Refusal Programs achieved 61%; Drinking and Driving achieved 34% of the ideal. Results specify how provinces can increase prevention impact through evidence-based policy and program measures.

Giesbrecht, N., Wettlaufer, A., Simpson, S., April, N., Asbridge, M., Cukier, S., Mann, R., McAllister, J., Murie, A., Pauley, C., Plamondon, L., Stockwell, T., Thomas, G., Thompson, K., & Vallance, K. (2016). Strategies to reduce alcohol-related harms and costs in Canada: A comparison of provincial policies. The International Journal Of Alcohol And Drug Research, 5(2), 33-45. doi:http://dx.doi.org/10.7895/ijadr.v5i2.221Aims: To compare Canadian provinces across 10 research-based alcohol policy and program dimensions.Design and Measures: The 10 Canadian provinces were assessed on the following 10 policy dimensions: alcohol pricing; alcohol control system; physical availability; drinking and driving; marketing and advertising; legal drinking age; screening, brief intervention, and referrals; server training, challenge, and refusal programs; provincial alcohol strategy; warning labels and signs. Data were collected from official documents, including provincial legislation, regulations, and policy, and strategy documents. Three international experts on alcohol policy contributed to refining the protocol. Provincial scores were independently determined by two team members along a 10-point scale for each dimension, and the scores were expressed as a percentage of the ideal. Weighting of dimensions according to scope of impact and effectiveness was applied to obtain the final scores. National and provincial scores were calculated for each dimension and consolidated into overall averages.Findings: Overall, the consolidated national mean is 47.2% of the ideal, with Ontario scoring highest at 55.9%, and Québec lowest at 36.2%. Across dimensions, Legal Drinking Age and Challenge and Refusal Programs scored highest at 75% and 61%, respectively, while Warning Labels and Signs scored lowest at 18% of the ideal. Pricing, rated third highest among dimensions at 57%, should nevertheless remain a priority for improvement, given it is weighted highest in terms of effectiveness and scope.Conclusions and Implications: Policy dimension scores vary among the provinces, with substantial room for improvement in all. Since spring 2013, several provinces have taken steps to implement specific alcohol policies. Concerted action involving multiple stakeholders and alcohol policies is required to reduce the burden of alcohol problems across Canada.