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City-based action to reduce the harm done by alcohol

11 May 2018

Why is community action being considered as a means to reduce harmful alcohol use? Peter Anderson discusses this in his Research Article, published on F1000Research. Here he explains how city based policies could help alleviate the problem and who they should target. 

Why city action to reduce the harm done by alcohol?

Cities are natural sites for promoting health, preventing illness and reducing exposure to risk factors, such as drinking alcohol, smoking cigarettes, consuming unhealthy food, and taking inadequate physical activity.

A forty-year old who drinks more than five drinks a day will lose nearly five years of life due to his or her alcohol consumption.

Cities do not necessarily have the full jurisdictional responsibilities of national governments for all health policy issues. Even so, they often have greater flexibility than national governments, and they can be an important site for innovative environmental measures that make healthier choices easier choices, shifting social norms in the process.

Importantly, cities are members of many networks, including Healthy Cities networks, which are natural vehicles for deployment of evidence-based policies and programmes, which can go to full scale globally.

Municipal action plans on alcohol

Cities can develop and implement municipal based action plans that aim to reduce the harm done by alcohol. The action plans should include a range of policies and programmes, allocating roles and responsibilities to different municipal departments and to different stakeholder groups.

The action plans should include a range of policies and programmes, allocating roles and responsibilities to different municipal departments and to different stakeholder groups.

The action plans should be truly multi-sectoral, involving not just health, but sectors that deal with transport, public education, fiscal policies, advertising, and the licensing of pubs, bars and cafes to sell alcohol.

Action plans should include targets, and a rigorous system of monitoring and evaluation. There are many guidelines around and a good starting point is that of Public Health England, Alcohol: applying All Our Health.

Targeting adults

Adults, not young people, should be the target group of city-based actions. This is for two main reasons: first, throughout much of the world, it is middle-aged adults who are the heaviest group of drinkers, and who have the highest rates of alcohol-related hospital admissions and hospital-related deaths.

Adults, not young people, should be the target group of city-based actions.

A forty-year old who drinks more than five drinks a day will lose nearly five years of life due to his or her alcohol consumption, compared to a forty-year old who drinks less than one and a half drinks a day. Secondly, getting heavy drinking adults to reduce their consumption will bring much greater and much more immediate health gain than getting heavy drinking young adults to reduce their alcohol consumption.

Two examples of city-based actions

The two most effective actions that cities can do are to make alcohol more expensive and to make it less available. Not all cities have the legal opportunity to set local alcohol beverage sales taxes, but many do. Where this is possible, implementing and increasing a sales tax will result in less consumption and less harm across all levels of drinking.

Such sales taxes will also bring in much needed municipal revenue. Almost all cities have a jurisdictional responsibility to manage alcohol outlets, setting limits on their numbers, and limits on their days and hours of sale. There is extensive evidence that demonstrates that when the number of alcohol outlets are reduced, and when the days and hours of sale are limited, less drinking and less harm occurs.

Evaluating city-based action

It is no good just saying that cities need to implement municipal-based action plans, they also need to be evaluated for their impact. Evaluating not only needs to look at outcomes, but also at the processes, such as, asking whether programmes were implemented as they should be; and what were the contributing factors to either success or failure.

It is no good just saying that cities need to implement municipal-based action plans, they also need to be evaluated for their impact.

Evaluation could take the form of time-series analyses, i.e., looking at levels of consumption and harm over a reasonable time period before the action is implemented, and then looking at changes as a result of the action. Even better would be to compare cities, those that implement an action plan compared to similar cities, geographically separate, who do not implement an action plan.

Within each city, longitudinal studies of drinkers could compare changes over time between the action cities and the comparator cities. A cheaper alternative is to analyse wastewater to contrast alcohol consumption between action cities and comparator cities.

This is as simple as collecting raw 24-hour wastewater samples over a one-week period and then measuring levels of ethyl sulfate, a stable biomarker of alcohol consumption. Ethyl sulfate concentrations can be used to estimate per capita alcohol consumption in each city.

The post City-based action to reduce the harm done by alcohol appeared first on F1000 Blogs.

Click here to view the full article which appeared in F1000 Research

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