Políticas Públicas em Alcohol
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Transcript of Políticas Públicas em Alcohol
Políticas Públicas em Alcohol
Alcohol policy-makers are answerable to the policy consumers
• People consume services, and alcohol policy is a service
• Alcohol policy serves two purposes:– To enhance benefits resulting from use of alcohol– To contain/reduce alcohol-related harms
• Citizens deserve to know whether enacted alcohol policies are apt and well chosen
• High quality policies will be those that are evidence-based
Chosing effective strategies
• Need for a systematic procedure to evaluate the evidence, compare alternativa interventions and assess the fbenefits to society of different approaches
Como entender a Tabela 16.1
• Evidence of effectiveness0 lack of effectiveness
+ limited effectiveness
++ moderate effectiveness
+++ high degree of effectiveness
? No studies, or insuficient evidence
Tabela 16.1(cont.)
• Breadth of research support0 no studies of effectiveness have been
undertaken
+ only one well designed study of effectiveness
++ two to four studies
+++ five ir more studies
Tabela 16.1(cont.)
• Extent of testing across countries and cultures0 the strategy has not been tested adequately
+ strategy studiend in only one country
++ studied in two to four countries
+++ five or more countries
Tabela 16.1(cont.)
• Cost to implement and sustainLow
Moderate
High
Target groups (TG)
• GP - General population of drinkers
• HR - High-risk drinkers or groups particularly vulnerable to the
adverse effects of alcohol (adolescents)
• HD - Persons already manifesting harmful drinking and alcohol dependence
Target groups (cont.)
• Of the 32 interventions and strategies evaluated, 16 are targeted at the GP, 12 at HR, and 4 at HD.
• Interventions directed at the general population have higher effectiveness ratings thatn those targeted at other groups.
• Interventions directed at the general population and high-risk groups tend to be less costly to implement and maintain than interventions with harmful drinkers
Table 16.1. Ratings of policy-relevant stategies and interventions
Strategy Effective-ness
Breadth of research support
Cross-cultural testing
Cost to implement
Target
group
Total ban on sales +++ +++ ++ High GP
Alcohol taxes +++ +++ +++ Low GP
Training bar staff against aggression
+ +++ ++ Moderate HR
Alcohol education in schools
0 +++ ++ High HR
Random breath tests +++ ++ + Moderate GP
Mandatory treatment of drinking-drivers
+ ++ + Moderate HD
Ratings of policy-relevant stategies and interventions – PHYSICAL AVAILABILITY
Strategy Effective-ness
Breadth of research support
Cross-cultural testing
Cost to implement
Target
group
Total ban on sales +++ +++ ++ High GP
Minimum legal purchase age
+++ +++ ++ Low HR
Government Monopoly
+++ +++ ++ Low GP
Hours and days of sale restrictions
++ ++ ++ Low GP
Restrictions on density of outlets
++ +++ ++ Low GP
Server Liability +++ + + Low TG
Ratings of policy-relevant stategies and interventions – ALTERING DRINKING CONTEXT
Strategy Effective-ness
Breadth of research support
Cross-cultural testing
Cost to implement
Target
group
Outlet policy to not serve intoxicated
patrons
+ +++ ++ Moderate HR
Training bar staff + + + Moderate HR
Voluntary codes of bar practice
0 + + Low HR
Enforcement of on-premise regulations
and legal requirements
++ + ++ High HR
Promoting alcohol free activities and
events
0 ++ + High GP
Community mobilization
++ ++ + High GP
Ratings of policy-relevant stategies and interventions – DRINKING-DRIVING
Strategy Effective-ness
Breadth of research support
Cross-cultural testing
Cost to implement
Target
group
Sobriety check points
++ +++ +++ Moderate GP
Random breath test +++ ++ + Moderate GP
Lowered BAC level +++ +++ ++ Low GP
License Suspension ++ ++ ++ Moderate HR
Low BAC for young +++ ++ + Low HR
Designated drivers and ride services
0 + + Moderate HR
Ratings of policy-relevant stategies and interventions – TREATMENT AND EARLY
INTERVENTIONStrategy Effectiv
e-nessBreadth
of research support
Cross-cultural testing
Cost to implem
ent
Target
group
Brief intervention
++ +++ +++ Moderate
HR
Alcohol Problems
Treatment
+ +++ +++ High HR
Self-help + + ++ Low HR
Mandatory treatment of
repeat drinking drivers
+ ++ + Moderate
HR
Ratings of policy-relevant stategies and interventions – EDUCATION AND PERSUATION
Strategy Effective-ness
Breadth of research support
Cross-cultural testing
Cost to impleme
nt
Target
group
Alcohol education in
schools
0 +++ ++ High HR
College student education
0 + + High HR
Public service messages
0 +++ ++ Moderate GP
Warning labels 0 + ++ Low GP
Ratings of policy-relevant stategies and interventions – REGULATING ALCOHOL
PROMOTIONStrategy Effecti
ve-ness
Breadth of
research
support
Cross-cultural testing
Cost to
implement
Target
group
Advertising Bans
+ ++ ++ Low GP
Advertising content controls
0 0 0 Moderate
GP
Ratings of policy-relevant stategies and interventions – TAXATION AND PRICING
Strategy Effective-ness
Breadth of research support
Cross-cultural testing
Cost to implement
Target
group
ALCOHOL TAXES +++ +++ +++ LOW GP
Integrated alcohol policies
Our ratings suggest that a combination of pjysical availability limits at the general population level, certain drinking-driving countermeasures directed at all three target groups, and brief interventions directed at high-risk drinkers will offer the best value as the foundation for a comprehensive alcohol policy approach
The strong strategies
• Availability restrictions
• Taxation
• Enforcement
Good research support
Applicable in most countries
Relatively inexpensive to implement and sustain
Education and public service messages
• Expected impact is low for education and public service messages about drinking
• High cost
• In terms of impact or value-for-money, education strategies have shown little or no effect, regardless of the investment
Treatment and early intervention strategies
• Medium effectiveness
• Limited impact at the population level
• Full treatment for alcohol problems only benefits a relatively small fraction of the population who come to treatment
Altering the drinking context
• Research in this area is only now getting under way
• It seems that strategies will have some impact without being too costly
Science more accessible to policy-makers
• Policy changes should be made with caution and with a sense of experimentation to determine whether they have their intended effects
• Interdisciplinary research is capable of playing a critical role in the progress of public health by applying the methodologies of the medical, behavioural, social and population sciences
The precautionary principleA general public health concept
• “To take preventive action even in the face of uncertainty”
• To shift the burden of proof to the proponents of a potentially harmful actitivy
• To offer alternatives to harmful actions• To increase public involvement in decision-
making• Decision-making must be guided by the
likelihood of risk, rather than the potential for profit
Extraordinary oportunities
• Multiple • Changes can be made rationally• Combine rationally selected strategies into an
integrated overall policy• The research base is strong• Policies can be implemented at multiple levels• Public awareness and support can be
strengthened• International collaboration can be enhanced