Government Options to Reduce the Impact of Alcohol on Human Health: Obstacles to Effective Policy Implementation

Abstract

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.

Non-communicable disease policy implementation in Libya: A mixed methods assessment

“…Two high quality country case studies reported that delayed action can stem from alcohol not being perceived as a national priority [111,112]. Countries ran into difficulties when specific directions were not provided about how all information should be presented on labels (size, font, position, wording etc) or where WHO recommendations were not followed [113]. We note that Libya has implemented all alcohol Best Buy policies.…”

The Impact of Alcoholic Beverages on Human Health

“…Governments and governmental organizations seem to consider that the pleasure is worth the pain. As Stockwell and colleagues point out, it is possible to provide very specific and detailed advice to governments regarding the public health consequences of policy decisions in such concrete terms as how many people will become ill, injured or die prematurely from alcohol-related reasons if policy X or Y is not introduced [13]. Yet, almost all countries fall far short of implementing effective public health policies to reduce the harm done by alcohol [13].…”

“…As Stockwell and colleagues point out, it is possible to provide very specific and detailed advice to governments regarding the public health consequences of policy decisions in such concrete terms as how many people will become ill, injured or die prematurely from alcohol-related reasons if policy X or Y is not introduced [13]. Yet, almost all countries fall far short of implementing effective public health policies to reduce the harm done by alcohol [13]. Further, despite alcohol being a carcinogen, [4,5], at least in Europe, health warning labels are notable by their absence [14].…”

“…Product reformulation of existing products to contain less alcohol, and more extensive market penetration of no and low alcohol products could lead to consumers drinking less ethanol (see [15]). Yet, overall, there seem to be only very limited moves in this direction [15], and the alcohol industry continues to counter the implementation of effective policies that could reduce the harm done by alcohol [13].…”

“…Why is there a dissonance between what the science says about alcohol's toxicity, and the failure to prevent two million deaths a year amongst the under seventies and provide adequate treatment to the 4% of adults who experience alcohol dependence? Stockwell et al [13] 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'.…”