Prioritization - a study of alcohol and drug prevention i Västra Götaland County, Western Sweden, 2002-

2004

Fredrik Spak, Per Blanck

MD, PhD, ass. prof. at Social medicine, Sahlgren Academy, Göteborg University

Department of Public Health, Västra Götalandsregionen

Prevention activities: alcohol, drugs, program evaluation, secondary prevention in primary health care och working life, education

National Action Plan for Alcohol and Drug Prevention,

areas that concern local municipalities, 2001

Support to risk groups and individuals with risk behavioursSupport treatmentRestrict accessibility of alcohol beveragesCompetence enhancement Monitoring trendsInfluence public opinion

Method, Västra Götaland49 municipalities

1.5 million inh.

Municipal size: 475 000 – 5 000

61 % < 20 000

Interview at base-line and 2 year follow-up

4 municipalities studied in more detail

MethodInterviews x 2 in 49 municipalities + 4 townships Interviews x 2 in 4 municipalities (deeper studies)Survey study: contact personsDocument, plans, webb sitesParticipating observation

RESULTS

(So far only available in a Swedish– two articles to appear in J Subst. Use and Abuse)

Alcohol and other drugs

Gradually the task changed from implementation of the alcohol problem prevention plan to implementation of the alcohol- och drug prevention plans

Concordance with the national alcohol prevention plan

The plan has target 6 areas. 30 % of the municipalities had activities in at least 4 areas>50 % of the municipalities had activities in at least 3 areas

The most common activies:1. Opinion making2. Competence enhancement3. Work with risk groups

Activities: Substance abuse prevention groups

Develop and strenghten networks in and inbetween municipalities

Meetings with substance abuse coordinatorsMeetings för exchanging ideasEducationStudy trips (Denmark, Norway, Stockholm)

Policy programs39 municipalities

But 27 of these ”outdated”policy never acceptedpolicy not knownold

Substance coordinatorsIn 40 of 49 municipalities,else public health officersCommon tasks

Monitor substance useDevelop or enforce policy programsPromote preventive efforts

Unclear expectations, low sustainability

Economy och mandate

First interview:FreedomMany interestedSmall resources

Second interview:Mandate unclearMandate not respectedActivities ceased Small, but increased resources

Target groups

Almost all municipalities:

Youthor

Children and youth

Few municipalities:

Adults Young adults

Arenas

All municipalities:SchoolParents

Fewer municipalities:(Leisure time) associations Work lifePrimary health careTraffic

EducationEfforts in all municipalities

wide varietyusually grade 7-9

Often a part of ”Health promoting schools”

undocumented

No well documented programs

Information to teenage parents

Lecture seriesStudy circles

few

But: lacks sustainability and large impact

Sales restrictionsControlling (low alcohol) beer sales

regulation adherence = 50%

Restuarant and bar license increase (per 10.000 inh.)1998: 9.82003: 12.4

Secondary prevention in health care/

primary health care

New parents (Mother and child care) Yes

Early secondary intervention No

Activities in the traffic area

Swedish police very active, activities increasing

No community cooperation

Conclusions

Network building: rather successful Municipalities adhere to the national alcohol

and drug action plans to some extent Low sustainability Too many activities in relation to resource

avialability Do stakeholders agree on the benefit of the

activities? (different rational fields –Seedhouse)

RecommendationsMore realistic och evaluable programsPrioritization among the many different activitiesClearer mandates – allocate resourcesMore focus on adults as a target groupMore focus on structures than on individualsSustainability requires political cooperationInvite implementation specialists

Recommendations

Increase activities aming at reducing availability – not in the least concerning sales of alcohol purchased abroad Promote secondary prevention in primary health care (mainly concerning alcohol), (family practice, maternity care and child care)Support substance prevention in work life Support well functioning parent programs General improvement of the school ”milieu”

Alcohol policy in the regions of Europe – factors to be

considered

What is the LEAST we can do to set off an effective program?

SURPLUS VALUE NEEDED - All resources allocated to alcohol prevention could have been used for some other purpose

SMALL EFFECT TO BE EXPECTED - Even if a municipality does everything correct in working to reduce demand – this will have less effect than working with alcohol availability.

Why are so MANY TIRED today?