A Summary of Municipal Alcohol Policies and Public Health: A Primer
II Current landscape: municipal alcohol policies in Ontario
III An eight step model for municipal alcohol policy development
-- Submitted by Shawn Prasad, Practicum Student, Health Promotion Capacity Building, Public Health Ontario, and Jason LeMar, Health Promotion Consultant, Health Promotion Capacity Building, Public Health Ontario
The Ontario Public Health Standards (OPHS) require public health units (PHUs) to develop and implement healthy public policies.  This is done to create or enhance supportive environments with regards to both physical and social aspects of the environment in which people live, learn, work and play.  As a type of healthy public policy, Municipal Alcohol Policies (MAPs) align with provincial liquor laws  and assist to manage the drinking environment on local government-owned or managed property. MAPs therefore create supportive environments which enable people to lead healthier lives in regards to alcohol consumption.  MAPs can be an effective means of promoting moderate alcohol consumption by influencing social norms in the community.  Guidance documents produced by the Ontario Ministry of Health and Long-Term Care, such as Prevention of substance misuse: guidance document,  note the evidence base supporting MAP effectiveness and encourage public health staff to work with community stakeholders to increase the implementation of MAPs throughout the province. 
In alignment with the OPHS, and to supplement Public Health Ontario’s (PHO) policy development resources, a MAP primer is being released. The primer explains the process for developing, implementing and/or revising MAPs, and targets health promoters, public health practitioners, and members of local government: Ontario Agency for Health Protection and Promotion (Public Health Ontario), Giesbrecht N, Wettlaufer A. Municipal Alcohol Policies and Public Health: A Primer. Toronto, ON: Queen’s Printer for Ontario; 2016. Available from http://www.publichealthontario.ca/en/eRepository/MAPs_Primer.pdf.
The purpose of this bulletin is to provide a synopsis of this MAP primer resource. Readers interested in developing MAPs should consult the full primer for detailed information about each step within the development process.
A free webinar presentation will be offered on August 22nd 2016 to review the Primer. Please access the link to register. http://www.publichealthontario.ca/en/LearningAndDevelopment/Events/Pages...
II Current landscape: municipal alcohol policies in Ontario
Harms related to alcohol experienced at the local level include: acute health effects such as alcohol poisoning and falls; chronic effects such as cancer and fetal alcohol spectrum disorder and; second-hand effects such as violence, crime and impaired driving. 
Sales and availability
Ontario alcohol sales consist of a mixed, private and provincial government run retail system. There are two main channels of alcohol sales:
- Off-premise outlets which sell packaged alcohol products for consumption off site.
- On-premise licensed establishments which sell alcohol products for consumption on location.
In recent years, a number of regulatory changes have led to the relaxation of alcohol control policies in Ontario.  Specifically, the way alcohol is sold at community events and festivals has changed with such events no longer required to serve alcohol exclusively in separated areas (e.g. beer tents). Additionally, the retailing of alcohol in Ontario is also changing with wine sales now permitted at farmer’s markets and more recently, in 2015, beer sales expanded to selected grocery outlets.
A call for strategy
In order to to help create awareness and guide legislative actions a comprehensive alcohol strategy has been recommended through position papers from groups such as the Canadian Public Health Association (CPHA),  and the Ontario Public Health Agency (OPHA).  The Ontario government is currently in the process of developing a comprehensive strategy specific to alcohol in consideration of the recommendations for alcohol controls referred to in a National framework for action to reduce the harms associated with alcohol and other drugs and substances in Canada. 
The need for further MAP development
To inform the current MAP status in Ontario, PHO conducted a Provincial MAP scan  in 2015. The survey indicated that 53 per cent of municipalities had approved MAPs, two per cent of municipalities had MAPs in development, and 18 per cent of municipalities did not have a MAP. 
III An eight step model for municipal alcohol policy development
When planning, developing, revising, implementing or evaluating a MAP it is important that the impact of MAPs be considered in the greater alcohol policy context. As a localized policy tool, a MAP must align with provincial liquor laws in an attempt to manage the drinking environment, and encourage moderate, responsible consumption by influencing social norms in the community. 
The following section has been adapted from the MAP primer, and provides a summarized description of the MAP development process. The process is presented in an eight step “roadmap” or model. Although the roadmap is presented as a linear process, different municipalities may be at different points on the model at any given time.  Developers may start at any point in the process, or return to previous steps if additional work is required and steps may be repeated more than once. Allocation of time and effort is generally not equal across the different steps, but is based on the municipality and contextual factors.  The roadmap was developed through a multi-phased process which included a thorough literature review by alcohol policy experts and key informant interviews. 
The eight steps are as follows: 
Step 1: Define the problem
A vital first step is to develop an understanding of the problem that needs to be addressed and determining whether it can be addressed by the introduction of a MAP. Within this step, it is important to identify, describe and analyze the alcohol policy’s context and if necessary, to conduct each of these from their foundation, separately. PHUs are integral in supporting the development or revision of a MAP as they can help gather evidence to define a problem and better predict the influence of a MAP as a potential solution. MAP development may occur for several reasons: as a response to community problems; to align with changes within the Liquor Licensing Act, or as a preventive approach towards future harms.
Step 2: Identify policy options
This step focuses on identifying, assessing and selecting policy options for your MAP. This can be accomplished through: a review of academic literature on MAPs; a systematic review of an internet search engine query, such as a customized google search; and a review of MAPs in neighbouring communities.
Step 3: Identify and understand municipal decision-makers and influencers
Consistent with general policy development, there must be identification of, and an understanding with, the people who carry influence to make a proposed MAP a reality. Identify decision makers and those who influence them and, in an ideal situation, foster a champion for the cause.
Step 4: Assess readiness for MAP development
It is essential to determine how ready the key community stakeholders are, as developing a MAP requires a significant investment of time and funding. There are a number of different ways to collect information about readiness, such as conducting a survey or key informant interviews with community stakeholders. At this point, the key question becomes: “Is MAP development an appropriate and feasible strategy?”
Step 5: Develop an action plan for the MAP
Three main activities occur at this stage: 1. Building support for your MAP by utilizing the active endorsement of decision-makers and key influencers identified in Step 3; 2. developing a multistage action plan to track progress and action items; and 3. identifying roles, responsibilities, timelines and resources.
Step 6: Implement the action plan
This step involves drafting a new MAP or revising a current MAP. It is important to consider which resources and expertise are needed to draft the MAP and implement it. Input may be sought from several legal counsel and community stakeholders to provide insightful feedback while encouraging community buy-in and support.
Step 7: Facilitate adoption and implementation of the MAP
The purpose of this step is to encourage uptake or enactment of the MAP by local council. Procedures for approval need to be determined and will vary depending on the policy components you have selected as well as the governance structure of your municipality. Finally, once the MAP is adopted, effective and appropriate communication to the public will foster a full understanding of the purpose and intent of the MAP.
Step 8: Monitor and evaluate the MAP
The purpose of this step is to ensure that the MAP is being implemented as intended, and is having the anticipated impact on the problems it was designed to address. Evaluations of MAPs should focus on both process and outcome variables. Monitoring and evaluation activities should be considered throughout the process of developing a MAP. Evaluation results should then be communicated to stakeholders, and used to improve further MAP development efforts.
MAP development is an important health promotion strategy.  An effective MAP contributes to changing social norms that make socially responsible alcohol consumption the easier choice, by creating an environment supportive of healthy decision making.  A key benefit of MAPs is that once they are implemented, they are likely to endure. However, as trends in alcohol consumption change and the alcohol retail system evolves, MAPs will need to be revised in order to address current issues.  The eight step, iterative roadmap presented in this article is a useful tool to guide the evolving MAP development process.
Links to the following can be found in the reference list below.
Provincial MAP Scan: Summary of findings from a PHU survey 
A scan of MAPs by way of a survey administered to PHUs in Ontario. PHU representatives provided information on MAPs in their area and the status of any existing MAPs.
The CAMH MAP Guide 
Provides a practical resource for managing alcohol service in recreational settings.
A local government guide to creating municipal alcohol policy 
A comprehensive document regarding MAPs and a guide on MAP creation.
- Ontario. Ministry of Health and Long-Term Care. Ontario Public Health Standards 2008. Revised October, 2015. Toronto, ON: Queen’s Printer for Ontario; 2015. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d...
- World Health Organization. Ottawa charter for health promotion: first international conference on health promotion, Ottawa, 21 November 1986 [Internet]. Geneva: World Health Organization; c2016 [cited 2016 Mar 7]. Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
- Ontario. Ministry of Health Promotion, Standards, Programs and Community Development Branch. Prevention of substance misuse: guidance document. Toronto, ON: Queen’s Printer for Ontario; 2010. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d...
- Locally Driven Collaborative Project (LDCP). Addressing alcohol consumption and alcohol-related harms at the local level [Internet]. Toronto, ON: Locally Driven Collaborative Project (LDCP); 2014 [cited 2016 Mar 7]. Available from: http://www.oninjuryresources.ca/downloads/workgroups/ldcpalcohol/LDCP_re...
- Giesbrecht N, Wettlaufer A. Reducing alcohol-related harms and costs in Ontario: a provincial summary report [Internet]. Toronto, ON: Centre for Addiction and Mental Health; 2013 [cited 2016 Mar 7]. Available from: http://www.camh.ca/en/research/Documents/Provincial%20summary_ON_final.pdf
- Giesbrecht N, Stockwell T, Kendall P, Strang R, Thomas G. Alcohol in Canada: reducing the toll through focused interventions and public health policies. CMAJ. 2011;183(4):450–5. Available from: http://www.cmaj.ca/content/183/4/450.full.pdf+html
- Canadian Public Health Association. Too high a cost: a public health approach to alcohol policy in Canada [Internet]. Ottawa, ON: Canadian Public Health Association; 2011 [cited 2016 Mar 7]. Available from: http://www.cpha.ca/uploads/positions/position-paper-alcohol_e.pdf
- Ontario Public Health Association. Promoting healthy communities: a position paper on alcohol policy and public health. Toronto, ON: Ontario Public Health Association; 2015. Available from: http://www.camh.ca/en/hospital/about_camh/influencing_public_policy/Docu...
- Canadian Centre on Substance Abuse. National framework for action to reduce the harm associated with alcohol and other drugs and substances in Canada [Internet]. Ottawa, ON: Canadian Centre on Substance Abuse; 2007 [cited 2016 Mar 7]. Available from: http://www.ccsa.ca/Eng/focus/national/Pages/default.aspx
- Ontario Agency for Health Protection and Promotion (Public Health Ontario). Provincial municipal alcohol policy (MAP) scan: summary of findings from a public health unit survey [Internet]. Version 1.0. Toronto, ON: Queen's Printer for Ontario; 2015. Available from: http://www.publichealthontario.ca/en/eRepository/MAPs_Primer.pdf
- Ontario Agency for Health Protection and Promotion (Public Health Ontario). Municipal Alcohol Policies and Public Health: A Primer. Toronto, ON: Queen's Printer for Ontario; 2016. Available from: http://www.publichealthontario.ca/en/eRepository/MAP_Primer.pdf
- Narbonne-Fortin C, Rylett M, Douglas RR, Gliksman L. The municipal alcohol policy guide: a practical resource for successfully managing drinking in recreational settings. Toronto, ON: Centre for Addiction and Mental Health; 2003. Available from: www.camh.ca/en/education/about/services/camh_library/Documents/Repositor...
- B.C. Ministry of Health, B.C. Healthy Communities. A local government guide to creating municipal alcohol policy [Internet]. Victoria: Province of British Columbia; 2012 [cited 2016 Mar 7]. Available from: http://www.health.gov.bc.ca/library/publications/year/2012/creating-muni...