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.

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

Should the minimum legal drinking age of 19 years old in British Columbia be reduced?

Alcohol use is the largest contributor to injury, disability, and death among adolescents and young adults aged 10-24 years old. As a result, Canada and other countries worldwide have implemented minimum legal drinking age (MLDA) legislation for many decades now, and drinking-age laws are considered a cornerstone of alcohol-control policies designed to reduce harms among young people. In Canada, the minimum legal drinking age is 18 years of age in Alberta, Manitoba, Québec, and 19 years of age in the rest of the country.

No other alcohol policy has generated more research or debate than minimum legal drinking age legislation. Usually the debates about the most appropriate drinking age involve competing views about how society should assign importance to the harms versus the benefits of such legislation. Some people put more emphasis on the importance of individual choice in alcohol consumption, while other people place more value on restricting alcohol consumption in some age groups so as to safeguard young adults and improve overall public health. And so, there is a healthy tension between individual rights and the greater public good underlying debates about the minimum legal drinking age, and where individuals sit on this continuum will often affect how they interpret the scientific findings.

The large majority of the scientific evidence on this topic, however, is consistent and clear: raising the MLDA is associated with reductions in alcohol-related harms (such as motor vehicle collisions, injuries, assaults, and deaths), and lowering the MLDA is associated with increases in alcohol-related harms.

Advocates for lowering the MLDA might argue that most MLDA studies rely on United States’ data from the 1970s and 1980s, and usually have fatal/nonfatal motor vehicle collisions as their most harmful outcomes. And, critics of MLDA legislation might continue, the large MLDA impacts on motor vehicle collisions observed in the 1970s and 1980s might be substantially diminished in the contemporary British Columbia context due, in large part, to advances in both traffic safety and other alcohol policies (e.g., improvements in road safety/motor vehicle safety; introduction of provincial graduated driver licensing legislation; increases in the severity of penalties for drinking and driving).

Could it be that the MLDA has lost much of its effectiveness in reducing alcohol-related harms among young people in British Columbia?

In four recent studies, my colleagues and I have demonstrated that drinking-age legislation continues to have a powerful impact on alcohol-related harms among young people in Canada. Relative to youth slightly younger than the minimum legal drinking age, young adults just older than the MLDA incur immediate and significant increases in a range of serious alcohol-related harms, including: motor vehicle collisions; inpatient/Emergency Department admissions for alcohol-use disorders, attempted suicides, injuries, assaults; and death. An example of our work was published recently in the American Journal of Public Health.

Along with the prior MLDA literature, our Canadian studies provide up-to-date and persuasive evidence that lowering the MLDA will likely result in significant increases in serious alcohol-related harms among young people in British Columbia. Proponents of a lower MLDA in BC will need to make an even more convincing argument that such substantial damages to youth in British Columbia will be outweighed by the benefits of lowering the drinking age in our province.

Authors:

Dr. Russ Callaghan, PhD (Russ.Callaghan@UNBC.ca); Jodi Gatley, BSc (jgatley@gmail.com)

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Jodi Gatley