Reducing Alcohol-Related Harms and Costs in British Columbia€¦ · CARBC Bulletin #10 August...

Reducing Alcohol-Related Harms and Costs in British Columbia:

A Provincial Summary Report

Overview• ThisbulletinreportsonthecurrentstateofalcoholpolicyinBritishColumbia(BC)fromapublichealthandsafety

perspectiveusingresultsfromacomprehensivenationalstudy• BC’salcoholpolicystrengthsandweaknessesarehighlightedincomparisonwithotherprovincesandspecific

recommendationsforimprovementprovided.• The10policydimensionswereweightedbytheirpotentialtoreduceharmandreachthepopulationsatrisk.• BCranked2nd overallnationallywith53.4%oftheidealscore(seeFig.1),butitfaredpoorlyonthemore

importantpolicydimensionsofpricingandregulatorycontrolsystem.ThereforemuchunrealizedpotentialremainsinBCforfurtherpublichealthandsafetybenefits.

RankingsandRecommendationsInorderofpotentialforimpactonharmsandcosts:1. Pricing(9th):Setminimumpricestoatleast

$1.50perstandarddrinkinliquorstoresand$3.00forbarsandrestaurants.Adjustpricestokeeppacewithinflationandtoreflectalcoholstrength

2. ControlSystem(10th):Reduceaccesstoalcoholthroughotherchannels(e.g.onlinesalesandu-brew);increasesocialresponsibilitymessaging

3. PhysicalAvailability(2nd):Restrictoutletdensitybasedonpopulation;reducehoursofsale

4. Drinkinganddriving(1st):ImplementallMADDCanadarecommendations

5. Marketingandadvertising(1st):Restrictquantityofadvertisements;introduceaformalcomplaintprocessforadvertisingviolations

6. Legaldrinkingage(1st):Considerincreasingthelegaldrinkingageto21yearsofage

7. ScreeningandBriefIntervention(1st):Seektoincreaseutilizationbyhealthcareproviders8. ServerTraining,ChallengeandRefusal(1st):Offerface-to-facetraining;requiretrainingandregular

recertificationforallservers;evaluatestrategiestoreduceservicetointoxicatedandunderagecustomers9. Provincialalcoholstrategy(2nd):Developanoverarchingalcoholspecificprovincialstrategy10.Warninglabelsandsigns(5th):Implementmandatorywarningsonalcoholcontainersandinallliquoroutlets;

createspecificmessages(e.g.includelow-riskdrinkingguidelines)

ReducingAlcohol-RelatedHarmsandCostsinBritishColumbia:AProvincialSummaryReport

1KaraThompson,1TimStockwell,1KateVallance,2NormanGiesbrecht,&2AshleyWettlaufer1CentreforAddictionsResearchofBC,2CentreforAddictionandMentalHealth

0102030405060708090

100

Scor

e (%

of i

deal

scor

e)

Policy Dimension

Fig. 1 Weighted Policy Scores: British Columbia vs. National Average

British ColumbiaNational Average

CARBCBulletin#10August2013

Centre for Addictions Research of BC2

IntroductionThisbulletinsummarizesthecurrentstateofalcoholpolicyinBCrelativetobestpracticesandotherCanadianprovincesusingresultsfromacomprehensivenationalstudyfundedbytheCanadianInstitutesofHealthResearch(Grant#234859).BC’salcoholpolicystrengthsandweaknessesarehighlightedincomparisonwithotherprovinces,andspecificrecommendationsforimprovementprovided.TheobjectiveofthisprojectistoencouragegreateruptakeofthesepracticesandtherebyimprovepublichealthandsafetyinCanadaandreducealcohol-relatedcosts.

AlcoholiswidelyconsumedandenjoyedbymanyBritishColumbians,butalcoholconsumptionalsocontributestosubstance-relatedinjuriesandoverdoses,violenceandthedevelopmentofmanychronicdiseases(e.g.pancreatitis,cirrhosis,etc).AlcoholconsumptioninBChasbeenabovetheCanadianaverageforthelastdecade.TheratesofhospitalizationsinBCforconditionsrelatedtoalcoholhaveshownasignificantincreasesince2002,reflectinganoverallincreaseinalcoholconsumptionintheprovince(seeFig.2).In2011,therewere21,542alcohol-relatedhospitaladmissionsand1,191alcohol-relateddeathsinBC.

MethodTheBCspecificdatainthisreportwerecollectedaspartofanationalstudyfundedbytheCanadian

InstitutesofHealthResearch(PrincipalInvestigator:NormanGiesbrecht).The10policydimensionscentraltothisprojectwereselectedbasedonrigorousreviewsoftheliterature.Datawascollectedsystematicallyfromofficialsourcesandverifiedbyrepresentativesfromtherelevantministrieswheneverpossible.Eachofthe10policydimensionswerecomprisedofseveralscaledindicatormeasures(tabulatedtoobtainarawscoreoutof10),andwereweightedaccordingtotheirpotentialbothtoreduceharmfromalcoholandtoreachthepopulationsatrisk.ThisstudybuildsonthemodelimplementedbyMADDCanadainwhichtheprovincesareregularlyratedonbestpracticestoreduceimpaireddriving.Amoredetailedreportofthenationalstudyisavailableat:http://www.camh.ca/en/research/news_and_publications/reports_and_books/Pages/default.aspx.

Theresultspresentedbelowareinorderofpotentialforimpactonreducingalcoholrelatedharmsandcosts.

Results1.PricingSummary:BCwasrankedninthoutofthe10provincesontheextenttowhichalcoholpricingpolicieswereassessedasconsistentwithpublichealthobjectives.Systematicreviewsidentifyalcoholpricingashavingthestrongestevidenceofeffectiveness.Increasingthepriceofalcoholreducesalcoholconsumption

NationalRanking

Rank Prov. WeightedScore/20

1 SK 15.262 NS 14.563 NB 13.544 NL 13.005 MB 11.906 AB 11.067 PEI 10.268 ON 9.509 BC 9.4610 QC 6.00

Table1.BCscorebreakdownforPricingIndicators Score

Minimumpricing 1.8/4Indexationtoinflation 2/4Pricingonalcoholcontent 0.9/2Total 4.7/10

0

5000

10000

15000

20000

25000

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

Num

ber o

f Hos

pita

lizat

ions

Fig. 2 Number of Hospitalizations Related to Alcohol Use in BC, 2002-2011

3Reducing Alcohol-Related Harms and Costs in British Columbia

andalcohol-relatedharmatthepopulationlevel(Stockwelletal.,2012).Strongpricingpoliciesinclude(1)settingminimumpricesonalcoholicbeveragestoreduceeconomicavailabilityofcheapalcohol,(2)regularlyadjustingalcoholpricestokeeppacewiththecostoflivingsoalcoholdoesnotbecomecheaperrelativetoothergoodsovertimeand(3)settingpricesandtaxesbasedonalcoholcontenttoencourageconsumptionofloweralcoholcontentbeverages.

PromisingPractices:BChasminimumpricesforallbeveragecategoriessoldinoff-premiseoutlets.

Areasforimprovement:BCisonlymeetingabouthalfofitspotentialforeffectivepricingpolicy.Figure3showsthattheaverageminimumpricesperstandarddrinkfallbelowtherecommendedbenchmarksof$1.50perstandarddrinkforoff-premiseoutletsand$3.00perstandarddrinkforon-premiseoutlets.Additionally,existingpricingloopholesunderminethevalueofminimumpricesincluding(1)thediscountingofde-listedordiscontinuedproducts;(2)freeon-sitetastings;(3)privatestorescanundercuttheminimumpriceswhichapplytogovernmentliquorstores;(4)theminimumpricesdonotapplytofermentonpremiseoutlets(i.e.UBrewandUVin).Alcoholpriceshavelaggedbehindinflationsince2006.Further,BC’sminimumpriceandmark-upstructuresdonottakeintoconsiderationalcoholcontent,meaningmanyhigherstrengthproductsarecheaperperstandardserving.

Recommendations:• Increaseminimumpricesforallbeveragetypesto

atleast$1.50perstandardforoff-premiseoutletsand$3.00perstandarddrinkforon-premiseoutlets

• Adjustalcoholpricesatleastannuallytokeeppacewithinflation

• Placerestrictionsondiscountedalcoholsoldbelowminimumprice

• Adjustpricesforalcoholcontenttomakehigherstrengthproductsmoreexpensive

2.AlcoholControlSystemSummary:BCwasrankedlastamongthe10provincesonthisimportantindicator.Inadditiontothetypeofretailingsystem,importantelementsofaneffectivecontrolsystemincluderestrictingthesalealcoholbeyondon-premiseandoff-premiseoutlets(i.e.,on-lineshoppingandfermentonpremiseoutlets),maintainingabalancebetweensocialresponsibilityandproductpromotionandaligningliquorretailandcontrolunderaministrythatisconcernedwith

$1.50

$3.00

$1.07 $1.07

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

Off-premise On-premise

Min

imum

Pric

e pe

r sta

ndar

d dr

ink

Ideal

BC

Fig. 3 Average price per standard drink for products of typical strength and volume in BC

compared to the recommended ideal

NationalRanking


1 NB 9.382 PEI 8.633 NS 7.884 MB 7.505 ON 6.006 SK 5.637 AB 4.888 QC 4.509 NL 4.5010 BC 2.25

Table2.BCscorebreakdownforAlcoholControlSystem

Indicators ScoreTypeofRetailSystem 1/4Alcoholsalesbeyondon-premiseandoff-premiseoutlets

0/2

EmphasisonSocialResponsibility 0.5/3MinistryResponsibleforalcoholcontrol

0/1

Total 1.5/10


thehealthandsafetycostsofalcohol.Maintainingagovernment-controlledalcoholmonopolyisassociatedwithreducedalcoholconsumptionandrelatedharmsandfacilitatestheimplementationofotherevidence-basedpolicies,suchassocialresponsibilitymessaging(Baboretal.,2010;Stockwell,Zhao,Macdonald,etal.,2009).BChasamixedsystemofgovernmentoperatedoutletsandprivateretailoutletswhichincreasesthenumberofaccesspointsforalcoholandmakesitdifficulttoimplementotherevidence-basedpoliciesconsistently.

PromisingPractices:BCintroducedamoratoriumonissuingnewlicencesforprivatelyownedretailoutletsin2006,andin2012thismoratoriumwasextendeduntil2022.Recently,BCmovedtheLiquorControlandLicensingBranchandtheLiquorDistributionBranchtotheMinistryofJusticefromtheMinistryofEnergyandMines;anindicationthatalcoholisbeingrecognizedasahealthandsafetyissueinBC.Further,boththegovernmentrunretailoutletsandprivatestoresinBCdisseminatesocialresponsibilitymessagesinvariouswaysincluding:posters,pamphletsandonlinecontent.

AreasforImprovement:BCreachedonly15%of

itspotentialforeffectivecontrolsystempolicy.BC’spoorscoreonthisdimensionisareflectionofthefollowing(1)88%ofretailoutletsinBCareprivatelyowned;(2)alcoholisavailablethroughvariousadditionalchannelsincludingliquordeliveryservices,fermentonpremiseoutlets,fermentathomekitsandonlinesales,whichincreasethenumberofaccesspoints;and(3)over75%ofBCadvertisingbudgetsarespentonproductpromotion,indicatingsocialresponsibilitymessagingisalowpriority.

Recommendations:• Reduceaccesstoalcoholthroughotherchannels

suchasonlinesalesanddeliveryservices

• Increasespendingonsocialresponsibilitymessagingtobeequalorgreaterthanthatspentonproductpromotion

3.PhysicalAvailabilitySummary:BCtiedforsecondplacewithAlbertaonpoliciesthatrestrictthephysicalavailabilityofalcohol.Reducingaccesstoalcoholbyrestrictingthenumberofalcoholoutletsandlimitingthehoursanddayswhentheseoutletsareopen,decreasesthelikelihoodofexperiencingalcohol-relatedharm,includingassaultsandalcohol-relatedcrashes,aswellaspublicdisturbances(Wilkinson&Livingston,2012).

NationalRanking


1 ON 8.252 BC 7.503 AB 7.504 NS 6.755 MB 6.006 SK 5.257 NB 5.258 QC 4.509 PEI 4.5010 NL 0.75

Table3.BCscorebreakdownforPhysicalAvailabilityIndicators Score

Regulationsforoutletdensity 1/2OutletDensity,off-premise 2/3OutletDensity,on-premise 1/2Hoursofoperation 1/3Total 5/10

Public 12%

Private 88%

Fig. 4 Retailing System Ratio of public to private retailers


PromisingPractices:Thehoursofoperationforon-premiseandoff-premiseoutletsareprovinciallyregulated.RegulationsinBCprovideopportunityforcitizeninputwithregardstotheplacementofcertainalcoholoutlets,includinglicensedestablishmentsandagencystores.

AreasforImprovement:BCisstillonlyreachinghalfofitspotentialforphysicalavailabilitypolicies.AlcoholoutletdensityisnotprovinciallyregulatedandthedensityofBCstoresbasedonpopulationisaveragecomparedtootherprovinces(SeeFig5).Further,acrossallalcoholsaleschannels,alcoholisavailableformostoftheday.Off-premiseoutletsarepermittedtosellalcoholfrom9amto11pmandon-premiseretailersfrom9amto4am.Thesehoursfarexceedtherecommendedmaximumhoursof11amto8pmforoff-premiseoutletsand11amto1amforon-premiseoutlets.

Recommendations:• Explorewaystorestrictdensityofoutletsbased

onpopulation,suchasprovinciallegislationorenhancingmunicipalpolicyoptions,toreducehigh-densityareas

• Reducethehoursofoperationforon-andoff-premiseestablishments,specificallylimittheavailabilityofalcoholintheearlyhoursofthemorningandverylateatnight

4.DrinkingandDrivingSummary:BCrankedfirstoutofthe10provincesondrinkinganddrivingpolicies.Alcohol-relatedcollisionsremainoneoftheleadingsourcesofalcohol-relateddeathsandinjuriesinCanada.Toeffectivelyreducealcohol-relatedcollisionrates,provincesneedtohaveacomprehensive3yeargraduatedlicensingprogram,sanctionsforimpaireddriversandremedialprogramsforrepeatoffenders(Solomon,Cardy,Nobleetal.,2012).InrecentyearsBChasimplementedseveralnewcivilroadsidesanctionsforimpaireddriverswhichhave

NationalRanking


1 BC 6.202 ON 5.863 MB 5.474 SK 4.325 PEI 4.136 NS 3.577 NB 3.058 AB 2.949 NL 2.8910 QC 2.44

Table4.BCscorebreakdownforDrinkingandDrivingpolicy

Indicators ScoreLicensing 0.63/4Licensingsuspensionsandrevocations 3/3Vehicleandremedialprograms 1.54/3Total 5.17/10

0

10

20

30

40

50

BC AB SK MB ON QC NB NS PEI NLPer 1

0,00

0 po

pula

tion

age

15+

Province

Fig. 5 Density of on- and off-premise outlets

On-premise

Off-premise


reducedtheratesofmortalityandmorbidityfromalcohol-relatedcollisions(Macdonald,Zhao,Martinetal.,2013).

Note:DataisbasedoninformationprovidedbyMADDCanada.

PromisingPractices:BCsetsthegoldstandardinadministrativelicensingsuspensionsandrevocationsprograms,providingimmediatesanctionstoimpaireddriversandholdingthemaccountablefortherisktheyposetothemselvesandothers.FordriverswithBACsabove0.05%,orwhorefuseorfailsobrietytests,BCimposesanimmediate3-daylicensesuspensionandvehicleimpoundment,a$250reinstatementfee,arecordofsuspensionandescalatingsanctionsforrepeatoffenders.BCistheonlyprovincetoscore100%onthisindicator.BCalsohasmandatoryinterlockprogramforfederalimpaireddrivingoffenderswithescalatingsanctionsforrepeatoffenders.Finally,BChasa3yeargraduatedlicencingprogramthatincluderestrictionsonnight-timedriving,numberofpassengers,andabanonelectronicdevices.

AreasforImprovement:Despiterankingfirstoverall,BCisstillonlyreachingabouthalfofitspotentialfordrinkinganddrivingpolicies.TheeffectivenessofBC’sgraduatedlicensingprogramisreducedbecauseofalackofpoliceenforcementpowers.Forexample,currentlypolicearenotauthorizedtodemandanapprovedscreeningdevicetestfromallnewdriverswhofallunderthegraduatedlicensingprogramandtheirsupervisingdrivers.Furthermore,policedonothavetheauthoritytosuspendthelicenseofdriverswhoarejudgedtobeimpairedbyalcohol.BCalsodoesnotrequireaBACof0.00%fordriverswithlessthan5years’experienceorunder21yearsofage.

Recommendations:(moredetailedrecommendationscanbefoundintheMADDCanadareport):

• StrengthenthegraduatedlicensingprograminBCby:introducingnighttimerestrictionsfornovicedrivers,broadeningpoliceenforcementpowersandintroducingamandatoryBACof0.00%fordriverswithlessthan5years’experienceorunderage21,aswellasfor

supervisingdrivers

• Strengthenadministrativesanctionsfornewandyoungdriverswhoviolatethegraduatedlicensingprogram

• Introducemandatoryvehicleforfeitureandmandatoryremedialprogramsfordriverswith3ormorerepeatoffenceswithin10years

5.MarketingandAdvertisingSummary:BCistiedforfirstplacewithOntarioforpoliciesthatregulatealcoholmarketingandadvertising,butthereisstillroomforimprovement.Alcoholadvertisingencouragesdrinking,reinforcespositiveattitudesaboutalcoholandassociateddrinkingbehaviorsandisassociatedwithincreaseddrinking,particularlyamongyoungpeople(Anderson,DeBruijn,Angusetal.,2009).Alcoholadvertisingregulationsshouldcontrolthecontentofads,theplacementofads(e.g.reduceexposuretominors)andthenumberofadsincirculationtoreduceoverallexposure.Moreover,regulationsneedtobeenforcedtoholdalcoholadvertisersaccountable.

PromisingPractices:BC’sprovincialmarketingregulationsextendbeyondthoserequiredbytheCRTCandincluderestrictionsontheplacementofads(i.e.adscannotbeplacedinareaswhereminors

NationalRanking


1 BC 6.501 ON 6.502 MB 6.002 NL 6.003 AB 5.003 SK 5.003 NB 5.004 QC 4.505 NS 4.006 PEI 3.50

Table5.BCscorebreakdownforMarketingandAdvertising

Indicators ScoreProvincialmarketingregulations 3/4Enforcementofregulations 2/3PracticeIndicator-Focusoftheliquorboard’swebsite

0.5/1

Ad.Sponsorship 1/2Total 6.5/10


predominate),aswellasrestrictionsonadvertisingprice(i.e.,cannotadvertisediscounts,2for1specialsor‘happyhour’specials).TheLiquorControlandLicensingBranchisresponsiblefortheenforcementoftheprovincialadvertisingregulationsandhasstrongpenaltiesforviolationsoftheregulations.BCis1ofonly2provincesinwhichtheliquorboardwebsitebalancesproductpromotionmessageswithsocialresponsibilitymessaging.Further,BChasclearrestrictionsonalcoholsponsorship(i.e.,ifsponsorshipincludessaleorserviceofliquorthesponsorsmustpostsignsthatpromoteresponsibleconsumption).

AreasforImprovement:TherearecurrentlynorestrictionsonthequantityofalcoholadvertisementsinBCandthecomplaintprocessisnotuserfriendlyforthepublic.Asaresult,itislikelythatmanycomplaintsgounreported,despiteviolations.Further,whilenotaddressedinthisevaluation,socialmediaisrapidlybecomingapopularmediumforalcoholadvertising.Considerationshouldbegiventowhetherexistingregulationsandenforcementpoliciesareadequateforthisnewformofmarketing.

Recommendations:• Introducerestrictionsonthequantityofalcohol

advertisements

• Introduceaformalprocessforcomplaintsandviolationsofadvertisingregulations

6.LegalDrinkingAgeSummary:BCistiedforfirstplacewithSaskatchewan,Ontario,NovaScotia,PrinceEdwardIslandandNewfoundlandonlegaldrinkingagepolicies.Minimumlegaldrinkingagelawsplayanimportantroleinreducingalcoholuseandrelatedharmamongyoungerpopulations(Baboretal.,2010).Therearetwominimumlegaldrinking

agesinCanada,18and19,dependingontheprovince.Acomprehensivereviewoftheevidenceconcludedthatalegalageof21isthemosteffectiveforreducingrelatedproblemsamongyoungerdrinkers(WagenaarandToomey,2002).However,theeffectivenessofaminimumlegaldrinkingageisalsostronglyinfluencedbythelevelandconsistencyoflawenforcementefforts.

PromisingPractices:BCisreaching80%ofitspotentialforlegaldrinkingagepolicies.TheminimumlegaldrinkingageinBCissupportedbylegislationprohibitingthesaleofalcoholtoaminorandthepurchaseofalcoholbyaminorundertheageof19.EnforcementoftheminimumlegaldrinkingageinBCisstronginbothoff-andon-premiseoutlets.TheLCLBhasaliquorinspectionprogram(MinorsasAgents)toenforcethelegaldrinkingageandalsocollaborateswithlawenforcementtoenforcethelegaldrinkingageinon-premiseestablishments.

AreasforImprovement:TheminimumlegaldrinkingageinBCis19yearsofage,belowtherecommendedageof21.

Recommendations:• Considerincreasingtheminimumlegaldrinking

ageinBCto21yearsofage

NationalRanking


1 BC 6.401 SK 6.401 ON 6.401 NS 6.401 PEI 6.401 NL 6.402 AB 5.602 MB 5.602 NB 5.603 QC 4.80

Table6.BCscorebreakdownforLegalDrinkingAgepolicy

Indicators ScoreLegaldrinkingageandsupportinglegislation

4/5

Enforcementoflegaldrinkingage(off-premise)

3/3

Enforcementoflegaldrinkingage(on-premise)

2/2

Total 8/10


7.Screening,BriefInterventionandReferralsSummary:BCwasrankedfirstoutofthe10provincesandscored100%onScreening,BriefInterventionandReferral(SBIR)policies.Thisistheonlypolicyareawhereaprovincehasscored100%.SystematicreviewsconcludethattheuseofSBIRinhealthcaresettingsreducesalcoholconsumptionandrelatedproblems,reducesdemandonhealthcare,andhealthcarecosts(Rehm,Gnam,Popovaetal.,2008).TheuptakeofSBIRinpracticerequiresdisseminationofpracticeguidelinesorapositionpapertophysiciansandfinancialsupportforSBIRactivities(Johnson,Jackson,Guillaumeetal.,2010).

PromisingPractices:BCsetsanexemplaryexampleforotherprovinces.ScreeningbriefinterventionandreferralareincludedinBC’sprovincialstrategy:HealthyMinds,HealthyPeople:a10yearplantoaddressmentalhealthandsubstanceuseinBritishColumbia.BCalsoprovidesprovincialguidelinesandaspecificfeeforservicecodethatsupportsSBIRuptakebyphysicians.BCistheonlyprovincetoscore100%onanyofthe10policydimensions.

Recommendations:• SeektoincreaseutilizationofSBIRbyhealthcare

providers

8.ServerTraining,ChallengeandRefusalSummary:BCrankedfirstoutofthe10provincesonservertrainingaswellaschallengeandrefusalprograms.However,muchworkremainstoimprovethequalityofsuchprograms.Thegoalofservertrainingprogramsistoreduceserviceofalcoholtominorsandintoxicatedpatrons.Researchsuggeststhattheeffectivenessofsuchprogramsisgreatestwhentheprogramsaremandatory,comprehensive,valuedbyprovincialalcoholmanagementauthorities,activelyenforced,andperiodicallyevaluated(Baboretal.,2010).

PromisingPractices:BCisreaching78%ofitspotentialonthispolicydimension.BChasamandatoryservertrainingprogramforbothon-andoff-premiseretailerscalledServingitRight.Thisprogramincludesacomprehensivesetofchallengecriteriaincludingchallengingthosewholookunderageorwhoappeartobeintoxicated.BCevaluates

NationalRanking


1 BC 4.652 PEI 4.353 NL 4.204 ON 3.905 NS 3.756 MB 3.607 AB 3.458 QC 3.309 NB 3.0010 SK 2.40

Table8.BCscorebreakdownforServerTrainingandChallengeandRefusal

Indicators Score

Serverandmanagement

trainingprogram(on-premise)

Programstatus 0.75/1Qualityoftheprogram 0.5/2

Programenforcement 2/2Challengeandrefusalprogram

(off-premise)

Programstatus 1/1Qualityoftheprogram 1.5/2

Programenforcement 2/2Total 7.75/10

NationalRanking


1 BC 8.002 ON 7.203 SK 4.803 NL 4.804 AB 3.204 QC 3.205 NS 1.606 MB 0.006 NB 0.006 PEI 0.00

Table7.BCscorebreakdownforSBIRIndicators Score

TheinclusionofSBIRinaprovincialstrategy

2/2

Practiceguidelinesand/orpositionpaper 3/3Feeforservicecodes 5/5Total 10/10


itsoff-premiseprogramthroughtheuseofmysteryshopperprogramsandisoneofonly3provincestotrackchallengesandrefusalsforon-premiseoutletsinadditiontooff-premise.

Areasforimprovement:WhiletheServingitRightprogramismandatory,thereareseveralexceptionsincludingserversinrestaurantswithoutalicensedloungeandserversatspecialoccasionlicenseevents.Further,theprogramhasnotyetbeenevaluatedforeffectivenessinreducingoverserviceandservicetominors,isofferedonlineonly,anddoesnotrequirerecertification.

Recommendations:Improveservertrainingprogramsby:

• incorporatingscenariobasedactivities

• offeringtrainingface-to-face,inadditiontoonline

• requireperiodicretraining

• requiretrainingforallindividualswhoservealcohol,includingserversatrestaurantswithoutalicensedloungeandserversatspecialoccasionlicenseevents

• incorporateCanada’slow-riskdrinkingguidelinesintotheprogramcontent

• conductanoutcomeevaluationofServingitRightforeffectivenessandinstitutethesechangestoincreasesuccess

• BCmayalsoconsiderofferingtheSaferBarsprogram.SaferBarsisa3-hourtrainingprogramdesignedtoincreasebarstaff’sabilitytomanageaggressivecustomersandkeepcustomersandothersfrombecomingviolent,aggressiveorinjured.Moreinformationcanbefoundathttp://www.camh.ca/en/education/about/camh_publications/Pages/safer_bars_program.aspx

Note:SeveraloftheCanadianprovinceshaveservertrainingprogramswiththeirownareasofstrength.Itisrecommendedthattherebeincreasedcollaborationamongprovinceswithregardstotheseinitiativesandthattheseprogramsundergooutcomeevaluationtodeterminetheireffectiveness.

9.ProvincialAlcoholStrategySummary:BCtiedforsecondwithQuebeconthispolicydimension.Aprovincialstrategythatincludesalcohol,suchastheHealthyMindsHealthyPeople:a10-YearplantoaddressmentalhealthandsubstanceuseinBritishColumbia,providesacomprehensivesetofgoalsthataddressawiderangeofpopulationlevelpoliciesincludinghealthservices’responses,communityaction,pricingandmarketingpoliciesaswellasmonitoringandevaluation.Moreover,aprovincialstrategymarksalcoholasanimportanthealthandsocialissueworthyofgovernmentattentionandhelpsshapeacoordinatedresponsetoaddressthesegoals(Baboretal.,2010)

PromisingPractices:AlcoholisincludedinBC’sHealthyMindsHealthyPeople:a10-YearplantoaddressmentalhealthandsubstanceuseinBritishColumbiaprovincialreport,aswellastheFollowingtheEvidence:PreventingharmsfromsubstanceuseinBCprovincialreport.Togetherthesestrategiesrecognizetheimportanceof9outof10oftheprioritiesintheWorldHealthOrganizationGlobalStrategyonAlcohol(2010)including:

• leadership,awarenessandcommitment

• ahealthservicesresponse;mobilizingcommunityaction

• drinkinganddrivingpoliciesandcountermeasures

NationalRanking


1 AB 4.001 NS 4.002 BC 3.502 QC 3.503 SK 2.503 NB 2.503 ON 2.503 NL 2.504 MB 0.004 PEI 0.00

Table9.BCscorebreakdownforProvincialAlcoholStrategyIndicatorsIndicators Score

Focusoftheprovincialstrategy 1/2RangeofWHOpolicyinterventions 6/8Total 7/10


• availabilityofalcohol

• marketingofalcoholicbeverages

• pricingpolicies

• reducingnegativeconsequencesofdrinkingandalcoholintoxication

• monitoring,surveillanceandevaluationactivities

AreasforImprovement:BCdoesnothaveanalcoholspecificprovincialstrategy.Theissueofalcoholconsumptionissignificantenoughintermsofpublichealthandsafetyandhasramificationsforpolicyandpracticeacrossmultiplesectorsofgovernmenttowarrantafocusedandoverarchingguidetostrategy.Thedevelopmentofanalcoholspecificstrategy,whichconsolidatescomponentsofthetwocurrentstrategies,wouldhelpshapeamorecomprehensiveandcoordinatedresponsetoaddressalcoholuseandrelatedharmsinBCandmarkalcoholasakeyhealthpriorityrequiringapopulationhealthapproach.

Recommendations:• Considerthedevelopmentofanoverarching

alcoholspecificprovincialstrategyconsistentwiththeevidencebaseandWorldHealthOrganizationalcoholpolicyinitiatives(2010)

• Ensureahealthperspectivebasedonevidenceisincludedintheprovincialliquorreview

10.WarningLabelsandSignsSummary:BCistiedforfifthwithQuebec,PrinceEdwardIslandandNewfoundlandonthispolicydimension.Warninglabelsonalcoholcontainersandwarningsignsatpointsofsaleareimportantcomponentsofacomprehensivealcoholstrategy.Theyinformconsumersofthehealthandsafetyrisksassociatedwithalcoholconsumptionandimprovepublicdiscoursesothatmoreeffectivealcoholpolicies

canbeimplemented(Giesbrecht,2007).However,theireffectivenessiscontingentonthequality,visibilityandcontentofthemessages.

PromisingPractices:BCliquorretailersdisplaysocialresponsibilitymessagesaboutdrinkinganddriving,drinkingduringpregnancyandmessagesindicatingthatindividualswhoappeartobeundertheageof25willnotbeservedwithoutpropergovernmentissuedidentification.

AreasforImprovement:BCisreachingonly12.5%ofitspotentialinthispolicyarea.BC,alongwithallotherprovinces,doesnothavemandatorywarninglabelsaboutthehealthrisksofalcoholonbeveragecontainersoralcoholpackaging.Further,BCdoesnothavemandatorywarningsignsforon-andoff-premiseestablishments,leavingituptoindividualretailerstopostsocialresponsibilitymessages.Moreover,thewarningmessagesBCdoeshaveaboutdrinkinganddriving,servingtominorsanddrinkingduringpregnancyareofpoorquality(i.e.,lackprecision,ahealthfocusandgraphics).Moreover,currentwarningsignsdonotmakereferencetotherisksofchronicdiseasesassociatedwithalcoholorhowtoreducetheserisks(i.e.thelow-riskdrinkingguidelines).Forexample,vague‘pleasedrinkresponsibly’messagesshouldbereplacedwithexpandedtextofferingconcreteadviceondailyandweeklydrinkinglimits,aswellasspecificadviceonhowthedrinkercanachievemoreresponsiblelevelsofalcoholconsumption.

Recommendations:• Implementmandatorywarninglabelsaboutthe

healthrisksofalcoholconsumptiononalcoholbeveragepackaging

• Makethepostingofwarningsignsinon-andoff-premiseoutletsmandatory

NationalRanking


1 ON 1.502 MB 1.003 AB 1.204 SK 0.705 BC 0.505 QC 0.505 PEI 0.505 NL 0.506 NS 0.407 NB 0.30

Table10.BCscorebreakdownforWarningLabelsandSigns

Indicators ScoreWarninglabelsonalcoholcontainers 0/1Thequalityofwarninglabelmessages 0/3Thestatusofwarningsigns,on-premiseandoff-premiseoutlets(1pt.each) 0/2

Thequalityofwarningsigns,on-premiseandoff-premiseoutlets(2pts.Each) 1.25/4

Total 1.25/10


• Warningmessagesshouldcoverthefollowingtopics:drinkinganddriving,therisksofunderagedrinking,therisksofdrinkingduringpregnancy(e.g.FASD),low-riskdrinkingguidelinesandalcohol’scontributingroleinseriouschronicdiseases

• Messagesshouldbeclear,visibleandconcise,haveahealthfocusandusegraphics

RecentDevelopmentsinAlcoholPolicyinBritishColumbia(sinceNov1st2012whendatacollectionforthisprojectwascompleted)• Therehavebeenonlymodestchangestoalcohol

policyandpracticeinBCsincetheendofthedatacollectionperiodofthemainreportinfall2012

• TheLiquorControlandLicensingBranchandtheLiquorDistributionBranchhasrecentlybeenmovedtotheMinistryofJusticefromtheMinistryofEnergyandMines,reflectingapositiveshifttowardsviewingalcoholasahealthandsafetyissueinBC

• BCwillbeshortlyreviewingthe1996BCLiquorControlandLicensingAct

• Thereareseveralprojectsunderway,fundedbytheMinistryofHealth,toassistcampusesinaddressingalcohol-relatedproblemsandtoworkwithlocalgovernmentstodevelopmunicipalalcoholpolicy

• However,overallrecentchangestoalcoholpolicylargelyreflectalooseningofcontrolsaroundeventsponsorship.Forexample,manufacturersarenolongerrequiredtonotifytheLiquorControlandLicencingBranchofsponsorshipactivitiesworthmorethan$1,500andlicensedestablishmentsarenowlegallypermittedtosponsoreventsoractivities

• Further,breweriesanddistilleriesmaynowapplyforendorsementsontheirlicencetoprovideadditionalopportunitiesforpatronstoconsumeliquorwhilevisitingthefacility(e.g.inaloungeortourarea)

ConclusionExtensiveinternationalandnationalresearchhaspointedtoalcoholpoliciesasbeingcentraltocontrollingandreducingtheharmfromalcoholanditsassociatedcoststosociety.ThisbulletinsummarizesthecurrentstateofalcoholpolicyinBCrelativetobestpracticesandotherCanadianprovinces.IthighlightscurrentpolicystrengthsinBCandpointstofutureopportunitieswherefurtheractionscanbeundertaken,andwhichpoliciescanbemodifiedorenhanced.Whileranking2ndplaceoverall,BChasonlyreached53%oftheidealscore,signalingtherearestillsignificantareasforimprovement.Inaddition,BCplaced9thand10thintermsofperformanceinrelationtothetwomostimportantpoliciesfromapublichealthandsafetyperspective:alcoholpricingandthesystemofregulatorycontrol.ItishopedthatthisreviewwillactasacatalystandfacilitatediscussionandchangeinBCalcoholpolicyandprovideusefulinformationfortheprovincialliquorreview.Inordertorefineandimplementtheserecommendationsitwillrequireleadership,commitmenttoreducingalcohol-relatedharmandaspiritofcollaborationamongkeystakeholdersincludingvariousministriesandsectorsofgovernment,NGOsworkingonhealthissues,publichealthadvocates,communitiesandrepresentativesfromtheprivatesector.

AcknowledgementsWewishtoacknowledgefundingfromtheCanadianInstitutesofHealthResearchinsupportoftheoriginalstudy“ReducingAlcohol-RelatedProblemsbyImplementingEvidence-basedToolsthatTranslateResearchKnowledgeintoPreventionPractice”(Grant#234859).Wegratefullyacknowledgethecontributionsoftheotherco-investigatorsMarkAsbridge,SamanthaCukier,RobertMannandGeraldThomasandcollaborators.WewouldalsoliketogratefullyacknowledgereceiptofdatafromtheProvincialLiquorBoardaswellasfromtheMinistriesofHealthandMinistryofEnergyandMines.WealsosincerelythankKathleenPerkinforherdesignofthisbulletin.Pleasenotetheviewsandopinionsexpressedinthisreportarethoseoftheauthorsanddonotnecessarilyreflecttheperspectivesorpoliciesoftheorganizationsacknowledged.

PreferredCitationThompson,K.,Stockwell,T.,Vallance,K.,Giesbrecht,N.,&Wettlaufer,A.(2013).Reducingalcohol-relatedharmsandcostsinBritishColumbia:Aprovincialsummaryreport.CARBCbulletin#10,Victoria,BritishColumbia:UniversityofVictoria.

www.carbc.cawww.facebook.com/CARBC.UVicwww.twitter.com/CARBC_UVic

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