Initiatives for evolving safer public drinking environments

A significant portion of alcohol-related harm is associated with a small number of licensed establishments that fail to meet acceptable standards of responsible beverage service. These places are more likely to serve minors and intoxicated patrons. The facilities may be poorly designed or staff poorly trained, leading to clients becoming upset or getting into altercations. Excessively noisy entertainment and narrow passageways are just a couple of common problems that can contribute to aggressive or damaging behaviour.

Current provincial legislation and municipal by-laws do address such issues. For example, the Serving it Right training program is mandatory for managers and servers. Also, local zoning requirements regulate acceptable floor plans and stipulate crowd limits. Periodic examination of the premises and monitoring of performance by government authorized personnel (e.g., inspectors, police officers, pseudo-shoppers) are important enforcement mechanisms for confirmation of continuing compliance with conditions intended to ensure security and enjoyment for patrons in these settings.

What more can local communities and citizens do to ensure local establishments are safe and enjoyable places to be? We could plaster our communities with “responsible use” messages. But evidence suggests that on their own such strategies have minimal impact. We could adopt a health protection approach with more frequent surveillance and tighter enforcement of regulations. Indeed some element of this is no doubt needed, and it can be effective. But is there more that can be done? Can we also apply the health promotion principle of self-regulation to entities such as licensed establishments?

This has been attempted, first in Australia in the 1990s with promising initial results in reduction of disorderly conduct and violent encounters. The idea was to form an agreement among local operators of licensed establishments to uphold and monitor acknowledged standards for safe and comfortable premises and quality service that consumers could confidently count on. Subsequent programs have not all been so successful, but the principle of supporting self-regulation in preventing harm inspired a 2003 initiative in Manchester England under the moniker of Best Bar None that has spread in the UK with encouraging impact. It has since been positively adopted in Alberta and Ontario.

The program involves the hospitality industry and government authorities (including local police) reaching consensus on appropriate criteria that licensed establishments must meet to gain and retain recognized accreditation in the program. Qualifying applicants are entitled to display the credentials in their promotion and are potentially eligible for awards conferred on those retail outlets who demonstrate the most consistent maintenance of the standards committed to. And citizens get to make informed choices about what establishments they wish to frequent when wanting a safe and enjoyable night out. The program as implemented in Alberta appears to be an approach that merits serious consideration here in BC.

As almost always, the magic is in finding the balance. Health promotion, regulation and education work best when they work together. The enforcement of regulations is required for those that won’t or can’t regulate themselves. In fact, some level of monitoring and enforcement is needed to keep us all honest. Education has a critical role in building shared understanding and evolving social norms. Nonetheless, engaging the operators of licensed establishments together with other members of the community and providing a range of incentives to encourage responsible behaviour is also an important part of building healthy communities.

Image    Image

Authors: Tim Dyck (left), Dan Reist (right)

Public opinion and alcohol policy in BC

As the BC government’s public consultation on liquor control and licensing laws draws to a close at the end of this month we wish to highlight findings from a province-wide opinion survey conducted last month for MADD Canada and CARBC. While telephone surveys have their limitations we believe the results are indicative of broad support across BC for some fundamental principles: that a major purpose of liquor laws should be to reduce alcohol-related harm (84% support); that consumers need to be better informed about risks, e.g. through labeling (71%); and that some kinds of pricing can be used to reduce harm (62% to 65%).

In this blog, we will mainly address the issue of public support for alcohol pricing policies because the strong evidence behind this approach is not widely known. The scientific evidence shows that alcohol consumption decreases when alcohol prices increase – and, more importantly, there are associated reductions in premature deaths, admissions to hospital and accidents on our roads. However, opinion research has found that most people do not believe heavy drinkers will reduce their drinking if prices are increased.

Furthermore, in the many hundred comments on the public consultation website and the blog series from the parliamentary secretary for the review, John Yap, a common sentiment is expressed: why punish the responsible majority for the behaviour of a small minority who misuse alcohol? While this viewpoint overlooks the existence of risks from moderate drinking (e.g. cancers), widespread occasional heavy consumption and harm from others drinking, this is a critical objection to address in discussions of policies like pricing.

Setting a minimum or floor price on alcoholic beverages is a policy that the BC government has implemented for the last 25 years, though BC minimum prices tend to be lower than most other provinces and are considerably lower than some (e.g. Saskatchewan). This type of policy is well targeted towards heavier drinkers as several studies have shown that those who drink low cost alcohol tend to consume higher amounts.

So do BC minimum prices provide any public health or safety benefit? Using BC hospital data, a recent study published in the American Journal Public Health found that for every 10% increase in minimum prices there was an immediate 9% reduction in hospital admissions for injuries and poisonings ‒ and a similar reduction in serious illnesses caused by alcohol (e.g., liver cirrhosis, cancers) 2 to 3 years later. Similarly, we have found immediate and delayed effects from minimum price increases on alcohol-related deaths.

Thus, there is strong evidence that minimum alcohol pricing avoids punishing the majority of responsible drinkers while having the greatest impact on the behaviour and the health of those most at-risk. We would love to know how public opinion would change if these facts were more widely known. We believe British Columbians would tolerate price increases on the very cheapest, often high strength alcohol products if they actually believed this would prevent fellow citizens becoming seriously ill, injured or dying from the effects of alcohol.

Because minimum prices here are relatively low and, unlike in Saskatchewan, they are not adjusted to reflect alcoholic strength, there are some products that cost less than 75 cents per “standard drink” (i.e., 17.05 mL ethanol or the amount of alcohol in a 12oz can of 5%beer). This makes it possible to exceed Canada’s Low-Risk Drinking Guidelines while spending less than three dollars per day – usually less than a loaf of bread.

Would you accept increasing the price of the cheapest alcohol to $1.50 per standard drink if you knew that it would save a few lives each year and reduce health care costs?

Image

Author: Tim Stockwell, Director, CARBC

Image

Author: Gina Martin

Image

Author: Andy Murie, CEO MADD Canada