Middlesex-London Health Unit

TO: Chair and Members of the Board of Health

FROM: Graham L. Pollett, MD, FRCPC, Medical Officer of Health

DATE: 2008, March 27

It is recommended:

1. That the Board of Health endorse the resolutions related to alcohol attached as Appendices A to F to Report No. 026–08; and further
2. That these resolutions be forwarded to the Association of Local Public Health Agencies (alPHa) for consideration for the 2008 Annual Meeting.

Alcohol is prevalent in nearly every aspect of life from the celebration of birth, to the sponsorship of sporting events, to weddings and funerals. Children learn from their environment and from the people around them that alcohol is a fairly innocuous substance. The 2007 Ontario Student Drug Use Survey indicated that 61% of male and female students, between grade 7 and 12, reported drinking. Binge drinking remained elevated especially in the younger grades and this pattern of drinking is associated with injury and death among youth. And while drinking and driving has decreased over the past 30 years, one in eight high school students reported driving after drinking.

According to the World Health Organization, Global Burden of Disease Study, conducted in 2000, alcohol-related death and disability accounted for 4% of the total cost to life and longevity. Alcohol consumption ranked as the 5^th most detrimental risk factor of 26 examined and accounted for about the same amount of global burden of disease as tobacco (4.1%). In developed countries, alcohol was the 3^rd most detrimental risk factor accounting for 9.2% of all burden of disease as compared to tobacco 12.2% and high blood pressure 10.9%.

In Canada, alcohol is a factor in about 6,000 deaths per year. The largest numbers of these alcohol-related deaths are from injuries resulting from falls, drunk driving collisions, assaults and drowning. For example, 1,595 youth aged 15-24 died from injury in Canada in 2001 and about 45% of these deaths involved motor vehicle crashes. Nearly 40% of all fatal crashes are the result of drinking and driving.

The estimated costs of substance abuse in Canada was approximately $40 billion in 2002 or $1,267 for every Canadian. Alcohol accounted for about $14.6 billion in costs representing 36.6% of the total costs of substance abuse. The largest economic costs of alcohol were $7.1 billion for lost productivity due to illness and premature death, $3.3 billion in direct health care costs and $3.1 billion in law enforcement costs. In comparison the costs attributed to illegal drugs were estimated to be around $8.2 billion or 20% of the total costs of substance abuse.

Alcohol use during pregnancy can cause birth defects, Fetal Alcohol Syndrome (FAS), Fetal Alcohol Effects (FAE) and Alcohol-Related Neurodevelopmental Disorders (ARND) that have lifelong consequences for individuals, their families and society as a whole. These physical and mental disabilities related to prenatal exposure to alcohol are grouped under the umbrella term of Fetal Alcohol Spectrum Disorder (FASD).

Public health units have a direct mandate in several key areas related to the use of alcohol and other drugs specifically: chronic disease prevention, injury prevention, Fetal Alcohol Spectrum Disorder prevention, substance misuse prevention and harm reduction. In order to move forward and reduce the incidence of under age drinking, impaired driving, alcohol-related injury, death and economic burden a provincial alcohol strategy must be developed.

To this end, six resolutions have been drafted for submission to the Association of Local Public Health Agencies (alPHa). The resolutions call for:

1. Establish stricter advertising standards for alcohol (Appendix A)
2. Advocacy for an enhanced provincial public education and promotion campaign on the negative health impacts of alcohol misuse (Appendix B)
3. Eliminate the availability of alcohol except in Liquor Control Board Outlets (Appendix C)
4. Advocacy to reduce the legal Blood Alcohol Concentration (BAC) from 0.08% to 0.05% (Appendix D)
5. Advocacy for an increase in the legal drinking age in Ontario from 19 to 21 years of age or enact a zero BAC on drivers until they reach the age of 21.(Appendix E)
6. Support the Ontario Public Health Association in advocating for a provincial strategy for alcohol and other drugs. (Appendix F).

Alcohol as a legal substance used by the majority of the population is an accepted part of our culture and society. The benefits associated with alcohol use include reduced risk of cardiovascular problems, particularly in men over the age of 45, and economic gains to both private industry and governments from the regulated production and sale of beverage alcohol.

At the same time, the harms associated with alcohol consumption have been well documented. The use and misuse of alcohol affects individuals, families and communities and results in considerable social and economic costs related to injury, disease, violence, crime, and mortality. Even low to moderate levels of alcohol consumption can be linked to problems in traffic safety, cancer risks, and workplace performance.

Alcohol is a public health issue. The resolutions put forward would increase public awareness of the negative impacts of alcohol misuse and strengthen regulatory legislation in Ontario. A comprehensive provincial strategy is necessary in order to reduce alcohol-related harm.

This report was prepared by Ms. Mary Lou Albanese, Manager, Chronic Disease and Injury Prevention and
Ms. Jayne Scarterfield, Public Health Nurse, Chronic Disease and Injury Prevention Team.

Graham L. Pollett, MD, FRCPC

Medical Officer of Health

This report addresses the following requirement(s) of the Mandatory Health Programs and Services Guidelines: Injury Prevention Including Substance Abuse Prevention.