IT STARTS HERE:A Conversation About Alcohol in the City of Kingston Cathy Edwards Public Health Nurse, KFL&A Public Health Coordinator, Safe & Sober Community Alliance Wellington Guelph Harm Reduction Forum March 20, 2013
“Holding peoplesolely responsiblefor poor healthoutcomes is likeholding fishresponsible fordying in a pollutedstream.” - unknown
Reducing Alcohol-related harm " Harm reduction is any policy or program designed to reduce drug-related harm without requiring the cessation of drug use. Interventions may be targeted at the individual, the family, community or society.“ CAMH and Harm Reduction: A Background Paper on its Meaning and Applications for Substance Use Issues, CAMH, 2002
Distribution of Alcohol-related Risk in Canada, 2009 8,915,000 8,961,000 6,081,000 number of persons 1,623,000 No-risk Low-risk Moderate-risk High-risk Source: Canadian alcohol and drug use monitoring survey (CADUMS 2009).
The Prevention Paradox • “A large number of people exposed to a small risk can create many more cases of harm than a small number exposed to a high risk.”
, Cultural, and Envir n omic onm eco ent cio al l So Wo rking Condi Co ra and tion nd e ing s Liv n ito Ge ns d Community In l an flu cia en So c al Lifestyle Fa es idu ct div In or s Age, sex, and heredity factorsFraming the IssueAlcohol and the Determinants of Health
• Pricing and affordability of alcohol• Availability and accessibility of alcohol• Regulations for Alcohol marketing and promotion• Alcohol laws• Work environment• Income• Education• Early childhood development
• Alcohol advertising and local business promotions• Bar environments and staff training• Liquor enforcement capacity• Parental attitudes and role modelling• Individual choice • social circle, consumption patterns• Education and informed choice• Individual resilience
• Youth and young adults more susceptible to risk taking• Older adults more vulnerable to alcohol and related harms• Women at increased risk because alcohol is processed differently in women’s bodies• Certain hereditary factors can predispose individuals for alcohol addiction
Percentage of those w ho are heav y drinkersby age group in Ontario, 2009 - 2010 3.8 13.7 16.2 18.6 percentage 32.5 Age group
How much are we drinking?Patterns and Trends in OntarioYoung Adults (ages 18-29 in Ontario)Weekly heavy drinking increased from 11% in 1995 to 26% in2007,Hazardous or harmful drinking increased from 22% in 2002 to39% in 2007.A significantly higher proportion drink above the Low RiskDrinking Guidelines* than any other age group in Ontario.
How much are we drinking?Patterns and Trends in OntarioYouth (grades 7-12)About 22% of students reported drinking 5+ drinks on oneoccasion at least once during the past month (this representsabout 223,500 Ontario students).5% reported binge drinking four or more times in the past month.One third reported drinking hazardously and harmfully in 2011.One in 10 students reported injuring themselves or someone elseas a result of their drinking. These behaviours were most commonin students in grades 11 and 12, with both boys and girls equallylikely to engage in these dangerous patterns of drinking.
How much are we drinking?Patterns and Trends in OntarioOlder Adults (ages 65+)Average number of drinks consumed per week has graduallyincreased from just over 3 drinks per week to almost 5 per week.That is a 67% increase between 1996 and 2009.WomenTrends indicate that Ontario women are fast approaching theconsumption patterns of men.Past year drinking in women increased from 72% in 1998 to 78%in 2007.Daily drinking increased from 2.6% in 2001 to 5.3% in 2007, andHazardous or harmful drinking increased from 5% in 1998 to 8% in2007.
How does alcohol impact communities?SECOND HAND EFFECTS OFDRINKING
Kingston Whig Standard, March 19, 2013Police Monitor Aberdeen St. Patricks Day Party
Second hand effects – Alcohol and Crime • Provincial Liquor (LLA) offenses • Drinking and driving • Alcohol and violence • Domestic violence • Alcohol and sexual assault
Alcohol and Sexual Assault• A 2004 survey showed that the rate of sexual assault for Canadians aged 15 to 24 was almost 18 times greater than for adults over 55.• In a University of Alberta study, almost half of the sexual assaults that young adults experienced took place under the influence of alcohol• Data from police-reports in Canada for 2007 indicate that in 82 percent of the cases where the relationship could be determined, the victim knew the perpetrator.
Second hand effects - FASD“Prenatal alcohol exposure can producelifelong brain dysfunction that, withoutsupport and treatment, severely impacts anindividual’s ability to function in school, theworkplace and to become a contributingmember of society.” Dr. James Reynolds, Queen’s University
Revenues and Benefits vs. Costsand Harms of Alcohol
Revenue Cost Analysis for Ontario Comparison of Direct Alcohol-related Revenue and Costs, Ontario, 2002-2003 Deficit= $456,390,738 $45,700,000 $2,500,000,000 $1,160,104,734 $2,000,000,000 $619,402,996 $1,500,000,000 $1,000,000,000 $1,406,451,000 $1,276,440,000 $500,000,000 $0 Direct Costs Direct Revenue (2002) (FY2002/03) Enforcement Costs Health Care Costs Other Costs Net Revenue Sales Taxes Source: Thomas, Gerald. The Economics of Alcohol Control Policy in Canada, Alcohol Policy Network webinar, September 2010.
ALCOHOL POLICY: Local action toreduce alcohol-related harm
Strengthen localzoning regulations toavoid density andcongestionEvaluate liquor license 51% agreed or strongly agreed that there should be a limit on theapplications based on number of alcohol retailers andpotential community licensed establishments that can exist in a given area in the City of Kingston.impactEvaluate licenseapplication processconsidering health andsafety decisions
61% agreed or strongly agreed that people should beAdvocate for stricter required to have a special permit to buy beer kegscontrols on the sale oflarge volume containers 51% agreed or strongly agreede.g. beer kegs that there should be a ban on alcohol delivery services.Advocate for theauthority to restrict orban alcohol deliveryservices within themunicipality
Controlling affordabilitySample policy strategies:• 1. Appeal to provincial government• 2. Appeal to federal government
Work with communities 52% of Kingston respondents agreed orand government to strongly agreed that theimplement minimum price of alcohol should bepricing laws, volumetric based on its alcohol content.mark-ups, and penaltiesfor drink discountingviolationsAppeal for governmentto index prices to cost ofliving. Keep at or above theconsumer price index
Restrictions on marketingSample policy strategies:• Pursue local regulations• Support counter- advertising• Appeal for healthier alcohol advertising policies and practices
73% of Kingston respondents would support the Ontario government establishing stricter advertising standards for alcohol.Strengthen local restrictions on alcoholadvertising such as imposing constraints onnumber, location, size, content of adsFile advertising concerns and complaints toAdvertising Standards Canada and advocate fornew standards
Modify the Drinking ContextSample policy strategies:• 1. Regulate special occasion events• 2. Improve conditions of on-premise alcohol outlets (e.g. bars, restaurants)
Enact responsible beverage 92% of respondentsservice training and in-house bar agree or stronglypolicies agree that bar training to reduce alcohol problems and violence shouldMandate Safer Bars training as be required topart of licensing to reduce obtain a license.problems and violence in barsProvide inspectors and policewith data on problem areas andassist with targeted policinginitiatives
Taking Shared Responsibility• Municipal Government – Mayor, City Council, City Administrators• Provincial and Federal Governments – Politicians• Health Care Professionals and organizations• Enforcement agencies• Licensed establishments• Business community• Media• Post Secondary institutions• Teachers and School Boards• Parents• Students• Community Members