The Demise of Evidence-based Alcohol Policies in Ontario
Health practitioners and researchers have long held that government should adopt evidence-based policies in order to maximize health benefit and minimize harm. However, recently adopted alcohol policies in Ontario illustrate quite the opposite. In 2015, the former Liberal government opened beer and wine sales to 450 grocery stores, each capped at $1 million annual revenues (the equivalent of about 225 million bottles of beer). More recently, the Progressive Conservative government under Premier Doug Ford is further increasing availability by introducing beer sales to as many as 9,000 privately owned convenience stores, lowering minimum prices, pegging price increases below the CPI, increasing retail hours of sale, re-introducing happy hours, and legalizing tailgate parties (Government of Ontario, 2018).
A recent review of international research identified 10 policy measures which most affect the burden of alcohol problems, and ranked all provinces and territories in relation to each (Giesbrecht et al. 2016). Weak policies would contribute to increased harm, while robust policies would reduce it, and a cumulative index allowed for the overall rankings. Although Ontario was ranked highest overall, the newly introduced changes would demote it from Canadian leader to a failing grade of “F.”
This change in status has three over-riding implications.
First, the research review found that lowering price, expanding the number of retail outlets, and transferring sales to the private sector are the three most significant drivers of increased alcohol consumption. As overall consumption increases, so does the proportion of heavy drinkers – the very group that experiences alcohol-related harm. Already, the top 10% of drinkers consume over 50% of all alcohol (Skinner 2019). Moreover, a recent study found that alcohol-related emergency room visits have increased following the 2015 grocery store expansion (Myran et al. 2019). Across Canada, hospitalization rates due entirely to alcohol are higher than for heart attacks (CIHI 2017) – this when government ostensibly is focussing on addressing “hallway medicine” (Government of Ontario 2018).
Second, alcohol-related harm is costly. Heavy and alcohol-dependent drinkers experience a daunting range of health and social problems, with fallout extending to their families, employers, and communities. Associated costs in Ontario already exceed its take from alcohol sales – in 2014, these costs totalled $5.3 billion against $3.9 billion in revenues (UVic 2019). This net loss will only widen as overall consumption and the attendant problems increase.
Third, other parts of the economy will be harmed. Alcohol purchases usually come from discretionary income, and the hundreds of millions in added beer and wine sales will displace expenditures otherwise destined for elsewhere in the economy. In particular, Statistics Canada’s “entertainment and leisure” sector (restaurants, performing arts, sporting events, museums, etc.) can be expected to see a corresponding loss of income and jobs.
Policy changes to the 10 domains, in rank order of impact, are as follows.
Pricing and Taxation: The minimum price for alcohol has been lowered; alcohol price adjustment has been pegged below the Consumer Price Index (CPI); ever-present "on sale" pricing in retail outlets effectively lowers price and promotes increased purchasing.
Physical Availability of Alcohol: The dramatic increase in alcohol availability and the transfer to the private sector, first through 450 grocery stores, and now potentially 9,000 convenience stores, will increase overall consumption and the number of heavy drinkers; legalized tailgate parties will further contribute.
Impaired Driving Countermeasures: Ontario’s server training (Smart Serve) critically underplays the prevention of intoxication – this, and happy hours, will contribute to increased intoxication and impaired driving.
Marketing/Advertising Controls: Ever-present "on-sale" retail prices and happy hours are powerful "point of purchase" tools, and will contribute to increased consumption; convenience store advertising rules have yet to be specified.
Minimum Legal Drinking Age: Convenience store sales will substantially increase opportunities for those of legal age to purchase for underage drinkers – prevention will be near impossible.
Screening, Brief Intervention, Referral: The existing response capacity for these critical clinical interventions will be further strained by the increase in heavy drinkers.
Liquor Law Enforcement: Already-insufficient inspection and enforcement resources will be further challenged; the promising "last drink" program (Police officers ask apprehended impaired drivers where they had their last drink, and issue warnings and sanctions to licensed premises as applicable.) for identifying over service in licensed premises remains voluntary and, therefore, seldom adopted.
Alcohol Control System/Strategy: Ontario’s policy framework, which began to unravel with the previous Liberal government, is now substantially eroded.
Monitoring and Reporting: There is no built-in pre/post research to determine the impact of new policies.
Health and Safety Messaging: The educational capacity of Health Units will be compromised by planned budget cuts, at a time when new policies are effectively undermining “low risk” drinking.
It is clear that government demonstrates no interest in applying research evidence to alcohol policy or the prevention of related harm. Those interested in policy formulation are left with the vexing question of why politicians would introduce measures which knowingly harm the people they were elected to serve.
About the Author(s)Rob Simpson has been involved in alcohol research, program development, and policy development over the past four decades. He was principal author of Ontario’s Server Intervention Program (SIP), which evolved into Smart Serve. He has served as a consultant and expert witness in over 80 liability actions involving the over-service of alcohol in licensed premises.
Canadian Institute for Health Information. 2017. “Alcohol Harm in Canada: Examining Hospitalizations Entirely Caused by Alcohol and Strategies to Reduce Alcohol Harm.” Ottawa, ON.
Giesbrecht, N., A. Wettlaufer, S. Simpson, et al. 2016. “Strategies to reduce alcohol-related harms and costs in Canada: A comparison of provincial policies.” International Journal of Alcohol and Drug Research, 5(2): 33–45.
Government of Ontario, Fall Statement. 2018. “Saving Money, While Improving Choice and Convenience for Beer and Wine Consumers.” Retrieved June 4, 2019. <https://www.fin.gov.on.ca/fallstatement/2018/making-ontario-better.html#section-2>
Government of Ontario, Fall Statement. 2018. “Supporting Mental Health and Ending Hallway Health Care.” Retrieved June 4, 2019. <https://www.fin.gov.on.ca/fallstatement/2018/making-ontario-better.html#section-2 >.
Myran, D., J. Chen, N. Giesbrecht, and V. Rees. 2019. “The association between alcohol access and alcohol?attributable emergency department visits in Ontario, Canada.” Addiction. 14(7), 1183-1191.
University of Victoria Canadian Institute for Substance Use Research, Reducing Alcohol-Related Harms and Costs in Ontario. “A Policy Review.” Retrieved June 4, 2019. <https://www.uvic.ca/research/centres/cisur/assets/docs/report-cape-on-en.pdf >.
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