Why you should care more about overall alcohol policy

If you work in the area of FASD prevention, you are probably familiar with the idea of different levels of prevention. For example, Poole (2008) describes the four levels below:

Level 1 – Broad awareness building, health promotion efforts, and public policy
Level 2 – Brief Counselling with Girls and Women of Childbearing Age
Level 3 – Specialized Prenatal Support
Level 4 – Postpartum Support

However, after spending at a few days at the 4th International FASD Conference a couple of weeks ago, I would like to suggest that perhaps we need to expand our understanding of this first level. It seems to me that most of our discussion and activities are related to prevention campaigns, warning signs in bars, and other forms of public education. And this is great! Especially as these activities form the foundation for our work at the other levels.

But I think we’re forgetting a public health truth – that the more a behaviour increases in a population, the greater the number of individuals who will experience difficulties as a result of this behaviour. For example, if we all decided to buy pogo sticks tomorrow (after seeing a great clip on this trend on Ellen), we would suddenly see an increase in the number of injuries due to unsafe pogo stick use, etc. Now, this might seem like a trivial example, but it holds true for alcohol use as well.

Alcohol use is increasing in Canada and many of the controls on alcohol use are eroding. This means that we, as a society, can expect to see more individuals who experience direct and indirect harms from alcohol – including higher rates of FASD.  In turn, this means that overall alcohol policy is vital to the success of FASD prevention.

What is alcohol policy all about and where does FASD prevention fit in? Just like FASD prevention, alcohol policy can be both general/universal and specific/targeted. Examples of universal evidence-based policies include alcohol taxes and prices and restricting the number of outlets in a particular geographical area. Examples of specific/targeted policies include drinking and driving interventions like sobriety checkpoints and server training programs.

Alcohol policy and FASD prevention overlap in several areas. One area of alcohol policy focuses on curtailing alcohol marketing, especially to youth. We know from FASD prevention that girls and women are targeted differently in marketing and that this is not always considered in policy analysis – which can potentially affect some of the solutions proposed to address this. Screening and brief interventions (e.g., in health clinics or with on-line tools) have evidence to support their effectiveness and the screening of girls and women of childbearing age is something that we already encourage. Increased screening in the general population could have considerable impacts on the contexts in which women consume alcohol (e.g., just think about how many women who have substance use issues have partners who also have substance use issues).

The field of FASD prevention has a lot to gain from increasing involvement with other alcohol policy initiatives – without successful overall alcohol policy, effective FASD prevention will remain out of reach.

Quick Facts:

  • Overall per capita sales of alcohol have been rising since 1996,  from 7.2 L of pure alcohol in 1996 to 8.2 L in 2009 — a 13.0% increase in 13 years
  • About one in five Canadians drink amounts that exceed recommended low-risk drinking guidelines

References:

Giesbrecht, N., Stockwell, T., Kenadall, P., Strang, R., Thomas, G. (2011). Alcohol in Canada: reducing the toll through focused interventions and public health policies. Canadian Medical Association Journal. Published online ahead of print February 7, 2011. 10.1503/cmaj.100825

Poole, N. (2008). Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives. Ottawa, ON: Public Health Agency of Canada

Poole, N. and DePape, D. (2010). Addressing the disconnect between alcohol policy and FASD prevention. Powerpoint presentation, November 16, 2010. Ontario: Alcohol Policy Network Webinar.