Políticas Públicas em Alcohol

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

Chosing effective strategies

• Need for a systematic procedure to evaluate the evidence, compare alternativa interventions and assess the fbenefits to society of different approaches

Como entender a Tabela 16.1

• Evidence of effectiveness0 lack of effectiveness

+ limited effectiveness

++ moderate effectiveness

+++ high degree of effectiveness

? No studies, or insuficient evidence

Tabela 16.1(cont.)

• Breadth of research support0 no studies of effectiveness have been

undertaken

+ only one well designed study of effectiveness

++ two to four studies

+++ five ir more studies

Tabela 16.1(cont.)

• Extent of testing across countries and cultures0 the strategy has not been tested adequately

+ strategy studiend in only one country

++ studied in two to four countries

+++ five or more countries

Tabela 16.1(cont.)

• Cost to implement and sustainLow

Moderate

High

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

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

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 GP

Training bar staff against aggression

+ +++ ++ Moderate HR

Alcohol education in schools

0 +++ ++ High HR

Random breath tests +++ ++ + Moderate GP

Mandatory treatment of drinking-drivers

+ ++ + Moderate HD

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

+++ +++ ++ Low GP

Hours and days of sale restrictions

++ ++ ++ Low GP

Restrictions on density of outlets

++ +++ ++ Low GP

Server Liability +++ + + Low TG

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 + + + Moderate HR

Voluntary codes of bar practice

0 + + Low HR

Enforcement of on-premise regulations

and legal requirements

++ + ++ High HR

Promoting alcohol free activities and

events

0 ++ + High GP

Community mobilization

++ ++ + High GP

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 +++ ++ + Moderate GP

Lowered BAC level +++ +++ ++ Low GP

License Suspension ++ ++ ++ Moderate HR

Low BAC for young +++ ++ + Low HR

Designated drivers and ride services

0 + + Moderate HR

Ratings of policy-relevant stategies and interventions – TREATMENT AND EARLY

INTERVENTIONStrategy Effectiv

e-nessBreadth

of research support

Cross-cultural testing

Cost to implem

ent

Target

group

Brief intervention

++ +++ +++ Moderate

HR

Alcohol Problems

Treatment

+ +++ +++ High HR

Self-help + + ++ Low HR

Mandatory treatment of

repeat drinking drivers

+ ++ + Moderate

HR

Ratings of policy-relevant stategies and interventions – EDUCATION AND PERSUATION

Strategy Effective-ness

Breadth of research support

Cross-cultural testing

Cost to impleme

nt

Target

group

Alcohol education in

schools

0 +++ ++ High HR

College student education

0 + + High HR

Public service messages

0 +++ ++ Moderate GP

Warning labels 0 + ++ Low GP

Ratings of policy-relevant stategies and interventions – REGULATING ALCOHOL

PROMOTIONStrategy Effecti

ve-ness

Breadth of

research

support

Cross-cultural testing

Cost to

implement

Target

group

Advertising Bans

+ ++ ++ Low GP

Advertising content controls

0 0 0 Moderate

GP

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

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

The strong strategies

• Availability restrictions

• Taxation

• Enforcement

Good research support

Applicable in most countries

Relatively inexpensive to implement and sustain

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

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

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

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

The precautionary principleA 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

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