II Alcohol: No ordinary commodity forum
--submitted by Ben Rempel, MPH, Health Promotion Field Support Specialist, Health Promotion, Chronic Disease & Injury Prevention, Public Health Ontario
The Alcohol Policy Network (APN), formerly under the Ontario Public Health Association (OPHA), and now with Public Health Ontario (PHO), has offered annual Alcohol Policy forums since 2003, encouraging dialogue and discussions on timely and important alcohol policy topics. Named after the seminal text Alcohol: No ordinary commodity by Thomas Babor and colleagues; these forums attract leading researchers, direct service providers, policy analysts, government officials and public health professionals who are all working to reduce alcohol-related harms.
One doesn’t need to go far to be convinced that alcohol needs to be a priority among public health interventions – the harms associated with alcohol are well documented.
The World Health Organization has indicated that alcohol is the world’s third largest risk factor for disease burden and globally, the harmful use of alcohol results in approximately 2.5 million deaths each year.  Alcohol is associated with increased levels of health and social costs and is causally related to over 65 medical conditions. 
Provincially, data shows that a significant portion of the population drink alcohol (~79%), exceed low risk drinking guidelines (~21%), report hazardous or harmful drinking practices (~16%), and consume alcohol daily (~9%). 
We also know alcohol costs Ontario a lot of money … More so than it brings in.
There is a profit each year from alcohol of about $1.9 – 2.0 billion in Ontario. At the same time however, there is a deficit of about $2.4 billion in direct hospital, lost productivity and enforcement costs. This results in a net loss to the Government of Ontario of approximately $450 million each year, and still does not include societal costs associated with hidden harms such as family violence, financial problems, stress, and other issues that often go unreported. 
II Alcohol: No ordinary commodity forum
This past February 2012, APN hosted the ninth annual Alcohol: No ordinary commodity forum in Toronto, looking to accomplish the following objectives:
- Enhance knowledge related to the alcohol-policy field
- Provide practical application of alcohol policy theory
- Allow for networking and relationship building.
Over the two day event, participants were challenged to use research, advocacy, and the media to produce significant changes within the alcohol misuse field. This years’ forum, along with those of the past, have provided an opportunity to discuss the benefits of alcohol, the risks of alcohol, the harms of alcohol, and evidence-informed strategies to help mitigate harms. 
Since the event, numerous alcohol issues have been covered within the media including a recent article in the London Free Press questioning an arena in London, Ontario being named after a prominent beer producer.  Each time alcohol policy issues surface in the media, it is an opportunity to inform dialogue and opinion on matters which can negatively affect communities.
Of course, discussions and dialogue of this nature are arguably only useful if they lead to action. As such, this year’s forum presenters Jason Chapman and Tara Maher reminded participants it is possible to strategically use mass media and community advocacy to advance social policy. Participants at the forum were also convinced how local action can produce pressure for change provincially. Citing the journey to Smoke-Free Ontario, Michael Perley explained that the majority of municipalities in Ontario passed smoke-free legislation before the province enacted legislation. Public health professionals may do well to ask if this is the same process for alcohol. Can local jurisdictions implement alcohol management strategies which counter the alcohol-related harms with evidence-informed interventions?
Summarizing thinking over the past several forums, several recommendations surface. These include the following:
The province of Ontario needs to establish a strategy specific to alcohol: Based on the high financial, health, and social costs associated with alcohol, the province of Ontario should consider creating, implementing, supporting, and evaluating an alcohol strategy with a strong health mandate.
Work can be done locally to build momemtum towards an alcohol strategy: Initiatives include developing regional alcohol management strategies, creating and/or updating municipal alcohol policies, pressing for strong regualtory controls on alcohol, actively supporting alcohol-related health resolutions, and implementing proven interventions such as the Safer Bars program and Road Safety initiatives.
Prevention of alcohol controls from further erosion needs to occur: Medical Officers of Health may be better and strategically utilized as community champions to the provincial Medical Officer of Health, Members of Provincial Parliament, and other influential community members to ensure alcohol controls are maintained.
A formal alcohol-specific organizing body needs to exist: A formal well-resourced provincial alcohol-specific organizing body needs to exist to coordinate, mobilize, advocate, and respond to alcohol policy issues, specifically from a public health perspective.
Each year, components of the forum are evaluated using a variety of measures. A four-month follow-up survey is being compiled during summer 2012 to help inform what action has been taken by individuals and organizations since the forum occurred. Below are data collected through immediate post-evaluation surveys.This year’s findings are similar to past years in that:
- Knowledge significantly increases: 28% of survey respondents rated their knowledge of the topic as “high” or “very high” prior to the forum. This number increased to 78% after the forum.
- Confidence significantly increases: 43% of survey respondents rated their confidence in applying the content as “high” or “very high” prior to the forum. This number increased to 78% after the forum.
- The forum spurs action: 43% of survey respondents are intending to take action within the next six months to apply the content learned.
- The forum brings people back: Nearly 25% of survey respondents attended at least one forum in the past three years.
The planning committee and staff associated with the forum have compiled reports over the years which include learnings and commentary from forum participants. Perhaps one of the greatest learnings from this exercise is that the field of alcohol policy is never boring. It can be controversial and polarizing with deep opinions on either side of the issue. In Ontario, it has been made clear that we have a population-level problem with alcohol. Alcohol has been given a role in our society, but how prominent that role should be, has, and needs to continue to be discussed and argued.
Staff at PHO and members of the forum planning committee will be meeting over the summer to plan the 10thannual Alcohol: No ordinary commodity forum. Stay tuned to www.oahpp.ca for further information and we look forward to you joining us for the tenth year of important and timely dialogue and discussion!
1. World Health Organization. Global strategy to reduce the harmful use of alcohol. Geneva: Switzerland: 2010.
2. Babor, T. et al. Alcohol: No ordinary commodity – research and public policy, 2nd Edition. New York: Oxford University Press; 2010.
3. Lalomiteanu, A.R., Adlaf, E.M., Mann, R.E. & Rehm, J. CAMH Monitor eReport: Addiction and Mental Health Indicators Among Ontario Adults, 1977-2009 (CAMH Research Document Series No. 31). Toronto: Centre for Addiction and Mental Health; 2011. Available from: http://www.camh.ca/en/research/news_and_publications/Pages/camh_monitor.....
4. Rehm, J. et al. (Canadian Centre on Substance Abuse). The Costs of Substance Abuse in Canada 2002. Highlights.Ottawa: CCSA; 2006.
5. Visit the forum’s webpage for information on past events: http://www.apolnet.ca/resources/education/ANOCforums.html
6. Gillespie, I. Beer-named arena poor message. London Free Press. June 28, 2012. Accessed at: http://www.lfpress.com/news/columnists/ian_gillespie/2012/06/26/19923266...
Public Health Ontario site includes programs and services, resources, and a listing of events at http://www.oahpp.ca/.
Alcohol Policy Network site includes information and resources at http://www.apolnet.ca/Index.html and information on past forums at http://www.apolnet.ca/resources/education/ANOCforums.html.
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.