Local alcohol policy

Integrated local alcohol policy

Alcohol related problems are most visible in local communities: accidents, public drunkenness, criminality and delinquency, domestic violence, alcohol intoxications and addictions. This is why these problems are best addressed in the local setting. In some countries community officials and professionals will come together to create local alcohol policy, while in other countries these types of actions are usually instigated by groups of concerned citizens, non-profit foundations or religious organizations.
The power and reach of the local initiatives will be amplified when community officials actively support or participate in the creation of local alcohol policy.

Local alcohol policy should be characterised by an active long term cooperation between policy makers with different specializations and local stakeholders from various organizations. Active and open support from the mayor, aldermen and the city council is of great importance. A clear analysis and communication of the local alcohol related problems is a powerful tool to create awareness of the need for action and to get the support of the city administration and stakeholders. In the short-term, visible results of policy can be accomplished by publicising the results. However, really establishing local alcohol policy and getting tangible lasting results demands a long-term approach and therefore everyone needs to support the long-term strategy. Based on an analysis of local alcohol related problems, each community will set their own goals. The ways in which these alcohol related problems can be tackled is similar for every community. Research has shown (Holder, 1999) that alcohol use is not only a personal choice, but that drinking patterns and the resulting harm is largely influenced by the physical availability of alcohol in the community and the existing norms and values of alcohol use. In combination these factors form a systems model of alcohol prevention.

The core goals of every local alcohol policy are listed below.
• Reduce the availability of alcohol in the community: e.g. number of alcohol selling points, hours of alcohol sales, price actions such as happy hours, rate of over-serving (serving to intoxicated patrons) and rate of compliance and enforcement of the existing age limits;
• Create awareness and change norms of alcohol use in the community: inform citizens and especially parents on a strategic and systematic way of reducing the harmful consequences of alcohol, change norms related to the common starting age of drinking, norms related to intoxication and norms related to the enforcement of the laws and regulations that aim to reduce the informal (at home) and formal (commercial) availability of alcohol.

There are three essential parts of effective alcohol prevention: (1) public support and education, (2) regulations and (3) enforcement (Reynolds, 2003). The importance of enforcement is underlined by Anderson and Baumberg (2006); they found growing evidence for strategies that alter the drinking context in reducing harm done by alcohol (e.g. passing a minimum drinking age). However, the effectiveness of these strategies relies on adequate enforcement.

There are three policy pillars of an universal alcohol prevention approach. Universal prevention strategies address the entire population (local community, pupils, neighborhood). Each pillar represents an essential part of the local alcohol policy and demands its own strategy, work plan and involvement of stakeholders.
These building blocks include the provision of education and creating public support, defining national and local alcohol regulations that apply to the goals of the local alcohol policy and enforcement of these legislations.
The harmful effect of regular alcohol use is different for each individual, based for example on their genetic up make, medicine use, general health and life style.

Effective policy measures

In the development of local alcohol policy, ‘integrated’ and ‘effective’ are the two most important key terms. Through scientific evaluations and field experiences, much is known about the effectiveness of measures and activities that can be implemented in order to tackle alcohol related harm. It is advised only to use a compilation of proven effective measures in the local alcohol policy. An international group of leading scientists, sponsored by the WHO have published a rating list of the effectiveness of policy relevant strategies and interventions (Babor et all, 2010). In the table below we have selected those interventions that are most relevant for the local policy strategy.

WHO rating shows that measures that correspond to the policy pillars of regulations and enforcement belong to the most effective policy measures. Educational measures are less effective in changing behaviour. However, public support measures are also (not less) important in creating effective alcohol policy. Regulations on alcohol are only possible to implement if there is support for those measures on a public and political level.

The minimal package

Even if one wishes to implement all evidence-based policy measures mentioned in the previous paragraph, communities often have to choose a certain mix of interventions. Financial limitations and capacity problems force policy makers to make a realistic policy plan. The Building Capacity expert group formulated a minimal package for local alcohol policy based on the WHO rating and practical experiences in the different EU countries. The minimal package is listed from top to bottom on a level of priority, in both the categories and the measures.

Enforcement
Enforcement of the legal age limits for selling alcohol;
Enforcement of regulations concerning public drunkenness and over-serving.

Regulations
Restricting the number of points of sale (especially in and around schools and festivities); Hours and days of sale restrictions.

Public support
Expanding the provision of basic information about the risks of alcohol use on health (special target groups are parents and adolescents); Media advocacy, creating and establishing an agenda on alcohol problems in all relevant local organisations and within the media.
For specific high-risk groups research has shown that early interventions and treatment can be very successful in changing drinking behaviour. For example we mention brief interventions
in the primary health care sector.

Empowerment of local stakeholders and the community

Ideally, in theory, internal cues to action trigger the start of community alcohol prevention projects. In practice, this is not often the case. One essential component of developing a local, effective, long-term alcohol policy is community mobilization. Although definitions on community mobilization might be slightly different, the meaning is practically the same. Following the principles of the systems model, community mobilization typically consists of the following methods: (1) a full or part-time person serves as a community organizer, (2) the community organizer works with the local government, businesses, police and others to support prevention policies and strategies, (3) local committees are usually formed to develop or refine policies and support their implementation, (4) media advocacy, or the use of local news coverage of alcohol issues and public policy, is used as a key strategy.

Different alcohol projects have shown what happens if the coordination and linked community mobilization is not organized as Holder suggests. In the end, the lack of a community organizer can lead to a lack of agreement between involved parties about the content of the project. Other projects have shown that one of the most successful components is the capacity building component.
By involving several community stakeholders, community awareness about alcohol problems is raised. The alcohol issue thereby becomes a vital part of the local agenda, and the action group members diffuse their newly gained knowledge within their existing social and professional networks. In the Community Trials Project, community mobilization was seen as a means of supporting other strategies and not an end in itself. Moreover, they suggest that local staff should play the leading part in the development and implementation of community alcohol policies. Key leader support is necessary to enable changes.

This paragraph is partly borrowed from the literature study accomplished at the start of the Building Capacity project (Van Poppel, 2007).

Source: Creating local alcohol policy (1,44 MB)