Galway Healthy Cities Project

How best to address alcohol problems in Galway City?

Dr. Ann HopeDepartment of Public Health and Primary Care,Trinity College, Dublin

18th September, 2012

Outline of Presentation

• Strategies that increase harm

• Evidence of effectiveness to reduce harm

• Turning Science into Action

• Community Action –a road map

• Key Ingredients for Success

Strategies that work to increase alcohol use & harm

PriceAvailability Marketing

Free alcohol

• Most common location – street fliers

Cheap Prices

• One in every four alcohol marketing practices involved a price promotion

Policy measures that work to reduce harm

Alcohol taxes • Affordability

Regulating availability• Minimum legal purchase age• Restrictions on hours /days of sale, • Outlet density restrictions

Drink driving countermeasures • Random breath testing• Lowered BAC• License suspension• Graduated licensing for novice drivers

Source: Babor et al 2010

. . Policy measures that work Modifying drinking environment

• Enforcement of laws and legal requirements• Server liability• Staff training with enforcement

Restrictions on marketing• Legal restrictions on exposure

Community action with multiple componentsTreatment and early intervention

• Brief advice with at risk drinkers• Mutual help/Self-help attendance• Medical detoxification• Talk therapies

Source: Babor et al 2010

. . . Policy Measures that DON’T work to reduce harm

Voluntary code of bar practice Alcohol education in schools Advertising content regulations Alcohol industry’s self regulation codes Warning labels Alcohol-free activities Mass media campaigns

Source: Babor et al 2010

SummaryEffective Measures to reduce harm

All measures are NOT equal. Measures that influence the environment are

more effective than targeting the individual drinker.

Measures targeting young people only, are doomed to failure

Education is a supporting rather than a lead strategy.

Evidence of Community Action success

• Underage drinking

• Intoxicated patrons

• Drunk driving

• Alcohol related violenceWHO, Regional Office for Europe 2012

Community Action success. .

• Increased community awareness– Wider acceptance of public health material– Sharing of local institutions to promote healthy

lifestyle – Increased support for public health approach

• Reduced underage drinking– Changed attitudes toward alcohol sales to minors– Reduced alcohol sales to minors– Delayed onset age of drinking

. . . . Community Action success • Reduced alcohol consumption

• Reduced heavy drinking

• Reduced drunkenness

• Reduce intoxicated patrons

• Reduced drunk driving

• Reduced alcohol related violence

Community Mobilisation

is when a community

comes together

when an issue is

too big for one sector to tackle alone

Community Action

“Community action seeks to change collective rather than individual

behaviour”

WHO, 2009

Community Alcohol Action Plan

an integrated set of actions

that tackle the community environmental factors

(social, cultural, policy practices)

A roadmap for community action to prevent and reduce alcohol harm

1. Community Norms– High risk drinking encouraged/discouraged ?

2. Access and Availability– Alcohol that’s cheap and easy to get is linked

to harm3. Media Messages– Advertising etc glamorizes excessive drinking

4. Policy and enforcement– Shapes how alcohol is promoted, sold and

consumed

Community action roadmap- Options

1. Community norms• Promote general community programmes– Recreational/Lifestyle programmes– Alcohol/Drug-free environments – Safe space for youth to hang out

2. Access and Availibility• Shape planning laws to limit density of outlets • Use powers to influence late openings• Limit drinking in public places• Discourage high risk promotions

Community action roadmap– options3. Media messages• Reduce exposure of children to alcohol marketing – Ask local radio to avoid alcohol ads before 9pm– Avoid alcohol ads in public places– First step, no ads near child facilities, schools, youth

centres, on school buses etc.– Cut link between alcohol and sport

• Promote local festivals & events free from alcohol sponsorship

• Influence attitude of parents to underage drinking

Community action roadmap– options

4. Policy and Enforcement• Increase enforcement of alcohol laws– Minimum age– Server liability– Stop supply of alcohol to youth (direct & indirect)– Test purchase checks– Stop supply to intoxicated persons– Last drink survey to identify hot spots

• Develop specific programmes for vulnerable sub-populations (Youth / Young Adults)

Community Action roadmap - Options

. . . 4. Policy and Enforcement• Put in place alcohol screening in relevant

health/social services.• Provide brief advice for those involved in hazardous

use of alcohol.• Develop treatment pathways for those with alcohol

problems and those who are addicted.• Provide support services for those affected by other

peoples drinking

Community Action - Process

• Set up a local network of stakeholders

• Undertake assessment– drinking culture– Negative consequences– Major influencing factors/triggers

• Have a clear common goal• Develop key outcome indicators

Key Ingredients for Success . . 1. All relevant stakeholders working together

towards a common goal

2. Clear assignment of responsibility

3. A community action plan should be • guided by evidence, • planned in response to local needs, • have measures to tackle environmental and

individual factors. • Include training provision

. . . Ingredients for Success4. Advocacy role central to

• raising public awareness of the extent of alcohol related problems,

• benefits of reducing alcohol harm• gaining public acceptance of the alcohol action

plan and • communicating implementation of the action

plan.5. Community action to reduce alcohol

problems takes time. Five year Action Plan 6. Integrate community action into local

structures

High Risk groups

Young AdultsYoung people (u18)

Protecting Children from harm

PROTECT againstpressures to drink3. Limit marketing

4. Act as role model

REDUCE supply1.Stop access to alcohol2. Server/seller liability

5. PROMOTE communities to act in best interest of children

6. SUPPORT families

7. SUPPORT children

at high risk

Are we making progress?