Moving the yardstick – Is there a need for an alcohol control strategy for Ontario?
III Signs of interest
IV Going forward
--submitted by Benjamin Rempel, MPH, Health Promotion Field Support Specialist in Alcohol Policy, Health Promotion, Chronic Disease & Injury Prevention, Public Health Ontario
On April 2, 2013, at the 10th annual Alcohol: No ordinary commodity forum, Ontario’s Chief Medical Officer of Health Dr. Arlene King began and ended her presentation with the same statement: “We need a comprehensive alcohol control strategy for Ontario.” Addressing nearly 100 participants, Dr. King argued that the field of alcohol policy should learn from the successes of the tobacco control field from the past 30 years. She stated that despite alcohol being associated with preventable morbidity and mortality rates, along with significant health care and societal costs, the burden of alcohol misuse and its consequences are still not well understood. She went on to say that the alcohol policy field would do well to raise this level of understanding through proven health promotion and treatment approaches.
“There is much more work to be done to de-normalize excessive alcohol consumption and to make the public aware of the risks,” states Dr. King in the 2011 Annual Report to the Legislative Assembly of Ontario.  “There is still a great deal of work to be done to educate the public about the dangers associated with alcohol consumption … more effort must be made to increase public awareness of the health and economic impacts of alcohol misuse in Ontario.” In the report she goes on to argue that more discussion about how to acknowledge alcohol in government policy is needed.
Alcohol is carcinogenic to humans, contributing to cancers of the oral cavity, pharynx, larynx, esophagus, colon, rectum, liver and female breast.  Additionally, regular moderate to heavy alcohol consumption has been causally associated with Type 2 diabetes, adverse cardiovascular outcomes and cardiovascular disease. 
Other chronic conditions resulting from heavy alcohol consumption include cirrhosis of the liver, fetal alcohol spectrum disorder and fetal alcohol syndrome. Negative acute events associated with alcohol use include crime, family abuse, motor vehicle crashes, and non-intentional and intentional injuries. 
III Signs of interest
Dr. King’s presentation in April came just three weeks after the Centre for Addiction and Mental Health (CAMH) released the report Strategies to Reduce Alcohol-Related Harms and Costs in Canada: A Comparison of Provincial Policies, a systematic and comparative review of Canadian provincial policies and programs with the potential to reduce the considerable health and social harms from alcohol.  The objective of this report was to “encourage greater uptake of these practices and thereby improve public health and safety in Canada.” Critically assessed across 10 policy dimensions such as pricing, physical availability, and warning labels and signs, Ontario, along with British Columbia and Nova Scotia received the highest scores through this review. However, as both the CAMH report and Dr. King point out, there is still considerable room for improvement, as Ontario ranks at only 50 percent of the ideal score.
In the past 12 months, several Ontario public health units have released community reports focused on alcohol with the intent to educate and engage residents in dialogue around effective control policies. A unique example of this can be seen in the community of Grey Bruce. Following the release of a community report on alcohol, Grey Bruce passed a council-endorsed resolution that “the Board of Health of the Grey Bruce Health Unit take a leadership role within the community to support movement towards a culture of drinking in moderation, thereby reducing the burden of illness and costs to health and community safety.”  More information on how this community moved from research to a resolution will be discussed in an upcoming PHO webinar on July 24, 2013. Visit http://www.publichealthontario.ca/en/LearningAndDevelopment/Events/Pages... for further details.
Other recent Ontario public health efforts include hosting public education forums, producing marketing and resource materials, implementation of social marketing campaigns, public opinion polls, and working with media to produce news stories.
In November 2012, the Ontario Chronic Disease Prevention Alliance moderated a webinar and in-person forum on alcohol and chronic disease. In February 2013, the Ontario Injury Prevention Resource Centre hosted the 4th Annual Injury Prevention Forum titled Alcohol, other drugs and injuries: Evidence and prevention, attended by over 100 public health practitioners in the province. In March 2013, the Atkinson Fellowship sponsored a national roundtable titled Girls, Women and Alcohol, focused on increasing dialogue and political attention to the emerging trend of alcohol abuse among females. On June 9, 2013, a Canadian Public Health Association conference session led by the Centre for Addiction and Mental Health and Public Health Ontario titled Reducing alcohol-related harm through prevention planning and implementation: local successes, challenges and resources focused on reducing alcohol-related harm through prevention planning and implementation.
Future events planned for the fall of 2013 include a campus and alcohol policy session in Montreal sponsored by the Canadian Centre on Substance Abuse and a Toronto-based event on alcohol and cancer organized by the Toronto Cancer Prevention Coalition.
IV Going forward
CAMH suggests that in addition to a provincial alcohol control strategy, the government can act on a variety of other fronts to decrease harms from alcohol in communities across Ontario. 
- Adjust all prices to keep pace with inflation.
- Do not permit exceptions to minimum prices such as delisted products or free samples.
- Stop further privatization of alcohol retail outlets.
- Reduce the amount of marketing including advertisements that make use of the LCBO logo and branding.
- Involve citizens in decisions regarding the placement of all retail outlets and licensed establishments.
- Limit the availability of alcohol by reducing the hours of operation, starting with agency stores.
- Implement the drinking and driving counter measures recommended by MADD Canada.
- Prohibit the advertisement of prices or other sales incentives by all alcohol retailers.
- Tighten restrictions on sponsorship specifically, begin by banning alcohol sponsored scholarships and/or bursaries that target youth and young adults.
- Increase the minimum legal drinking age to 21 years of age.
- Implement a fee for service code for physicians that can be used specifically for screening, brief intervention and referral activities.
- Conduct outcome evaluations of server training programs.
- Collaborate with administrators of server training programs in other provinces.
- Track challenge and refusals in on-premise establishments as well as private retail outlets and make this data readily available for monitoring and surveillance activities.
- Implement mandatory warning labels on beverage containers with clear and direct health messages.
- Expand the current repertoire of mandatory warning signs in on-premise and off-premise outlets to include clear and direct messages on other health topics such as moderate consumption, underage drinking, drinking and driving, and alcohol as modifiable risk factor for chronic disease.
As Dr. King noted in her presentation at the annual alcohol policy forum, “there have been a number of efforts to control alcohol use which have had a positive impact.”  Public health and partners should be supported to maintain this momentum. However, she also warns that “many efforts are fragmented and not sufficiently coordinated to address the harm associated with alcohol misuse in Ontario.” Full alignment of these efforts to achieve maximum impact may only be achievable through Dr. King’s vision of a province-wide alcohol strategy.
1. King, A. (2013). Maintaining the gains, moving the yardstick: Ontario health status report,
2011. Retrieved June 2013 from:
2. Cancer Care Ontario, Ontario Agency for Health Protection and Promotion (Public Health Ontario). (2012). Taking action to prevent chronic disease: recommendations for a healthier Ontario. Toronto: Queen’s Printer for Ontario. Retrieved June 2013 from: http://www.oahpp.ca/resources/documents/takingactionreport%20Mar%2015-12... [Now available at: https://www.cancercare.on.ca/pcs/prevention/healthieron/?WT.mc_id=/takingaction]
3. National Alcohol Strategy Working Group, Health Canada. (2007). Reducing alcohol-related harm in Canada: toward a culture of moderation—recommendations for a National Alcohol Strategy. Retrieved June 2013 from:
4. Giesbrecht, N., Wettlaufer, A., April, N., Asbridge, M., Cukier, S., Mann, R., McAllister, J.,
Murie, A., Plamondon, L., Stockwell, T., Thomas, G., Thompson, K., & Vallance, K. (2013).
Strategies to Reduce Alcohol-Related Harms and Costs in Canada: A Comparison of
Provincial Policies. Toronto: Centre for Addiction and Mental Health
5. Grey Bruce Health Unit Board of Health. Re: Reducing Alcohol Related Harm: Moving Toward a Culture of Moderation in Grey Bruce. Resolution #2012 – 75. September 2012. Retrieved June 2013 from: http://www.publichealthgreybruce.on.ca/home/publications/Board/BOH_Resol...
6. Giesbrecht, N. & Wettlaufer, A. (2013). Reducing Alcohol-Related Harms and Costs in
Ontario: A Provincial Summary Report. Toronto: Centre for Addiction and Mental Health
Public Health Ontario site includes programs and services, resources, and a listing of events at http://www.oahpp.ca/
Centre for Addiction and Mental Health (CAMH) website includes research, news and publications, studies and reports at http://www.camh.ca/en/hospital/Pages/home.aspx
CAMH Health Promotion Resource Centre; Ontario Agency for Health Protection and Promotion (Public Health Ontario). Making the case: Tools for Supporting Local Alcohol Policy in Ontario. Toronto, ON: Centre for Addiction and Mental Health; 2013
Ontario Health Promotion E-Bulletin. (2012). Alcohol Policy in Ontario: The Importance of On-going Dialogue and Discussions. Retrieved June 2013 from: http://www.ohpe.ca/node/13459