An assessment of federal alcohol policies in Canada and priority recommendations: Results from the 3rd Canadian Alcohol Policy Evaluation Project
Original article
Background
Alcohol harm and costs in Canada
In 2020, alcohol use was linked with over 17,000 deaths and 800,000 hospital visits in Canada. In 2020, alcohol use in Canada cost nearly $20 billion – more than tobacco and opioids combined.
In contrast, government revenues from alcohol sales totaled $13.5 billion in the same year, thus creating a total alcohol deficit of over $6 billion (the equivalent of approximately $0.30 per standard drink sold).
Government measures are crucial to create environments and build communities that support reductions in alcohol use and therefore prevent alcohol-caused harms.
High-impact alcohol policy solutions
Alcohol control policies are the primary modifiable means by which to prevent and reduce per capita alcohol-caused harms. These policies can affect:
- who sells and distributes alcohol (e.g., control systems);
- affordability of alcohol (e.g., pricing and taxation);
- where alcohol is sold (e.g., physical availability);
- who can buy it (e.g., minimum legal age);
- where alcohol is advertised and how it is portrayed (e.g., marketing and advertising controls, health and safety messaging);
- where and when alcohol can be consumed (e.g., liquor law enforcement, impaired driving countermeasures); and
- what supports are available for individuals to reduce alcohol use and harm (e.g., screening and treatment interventions).
Decades of evidence from countries worldwide which have implemented or removed such policies have demonstrated that these measures are a cost-effective component of a comprehensive public health strategy.
Potential for and obstacles to government action
Despite a large international evidence base demonstrating the effectiveness of alcohol policies, implementation is poor and disproportionate to the harms caused by alcohol due to a lack of political will as well as vested corporate interests thwarting government efforts to strengthen alcohol control measures.
Similar to other countries, in Canada, the legislative authority over alcohol policies falls under the purview of both federal and sub-federal governments.
For example, broadcast advertising of alcohol is regulated under federal jurisdiction pursuant to the Canadian Radio-television and Telecommunications Commission (CRTC) code. However, in contrast, provincial and territorial (P/T) governments in Canada control most aspects related to the physical retail availability of alcohol, including the trading hours and allowable density of alcohol retail stores and bars.
In some domains of alcohol policies, federal policies can support or incentivize provincial and territorial-level policies. For example, while the majority of alcohol pricing regulations are currently set by P/T governments in Canada, the federal government could implement federal tax incentives to encourage provincial and territorial governments to adopt policies such as minimum pricing for alcohol. Other policy domains, such as alcohol control systems and alcohol impaired driving countermeasures, have shared jurisdiction across levels of government. Therefore, effective coordination between levels of government is essential for comprehensive policy changes in these domains.
Purpose and genesis of the Canadian Alcohol Policy Evaluation (CAPE)
The Canadian Alcohol Policy Evaluation (CAPE) was developed to provide a comprehensive and systematic assessment of alcohol policy domains in Canada compared with evidence-informed international best practices. Specifically, CAPE evaluates alcohol policy on a range of domains across government sectors engaged in the regulation, distribution, financial supervision, and public health management of alcohol.
The original CAPE methodology was modelled based on international peer-reviewed evaluations of alcohol policies, as well as an approach by Mothers Against Drunk Driving Canada to assess impaired driving policies.
- The first iteration of CAPE evaluated the 10 Canadian provinces across 10 policy domains.
- The second CAPE iteration additionally evaluated the three territories as well as the federal government.
- The third iteration of CAPE evaluated federal and provincial/territorial governments using updated evaluation criteria (e.g., new indicators), based on emerging evidence on alcohol policies.
Each iteration of CAPE represents a point-in-time snapshot of the alcohol policies in place at the time of data collection, and while CAPE can monitor alcohol policy changes, updated evaluation criteria (e.g., new indicators, updated weighting) with each iteration means that evaluation scores are not directly comparable across time.
The purpose of this study is to use the results of the 3rd CAPE to characterize current Canadian federal alcohol policies and to assess them in relation to public health best practices.
Conclusions and significance
This is the first comprehensive and systematic assessment of federal alcohol policy in Canada in the published literature. Alcohol remains a leading preventable cause of health and social problems in Canada.
The study results indicate that the federal government is failing to implement many of the most effective evidence-informed alcohol policies. Importantly, the federal government achieved its lowest scores in the policy domains that, according to scientific evidence, are the most effective policies which can prevent and reduce alcohol harm.
For example, the top three domains (Pricing and Taxation, Marketing and Advertising Controls, and Impaired Driving Countermeasures) all received failing grades, while the two lowest weighted domains (Screening and Treatment Interventions, Monitoring and Reporting) both achieved passing grades.
Further, with respect to the one domain for which the federal government scored 100%, Physical Availability, this was largely due to the limited scope of their controls in this area (i.e., limits on commercial and personal alcohol imports).
These scores demonstrate a need for policy development, with robust public health input, particularly in areas that would have the greatest impact on reducing alcohol harm across the Canadian population (e.g., increasing federal alcohol taxes, strengthening advertising restrictions).
The federal government achieved a similar score in the previous CAPE assessment from 2019. While CAPE scores are not directly comparable over time due to methodological differences, it is not surprising that the scores remained low given the federal government’s lack of adoption of high-impact alcohol policies in the intervening years.
Key policy areas
The current CAPE federal assessment identifies several policy areas that need to be addressed.
- The creation of a federal Alcohol Act, supported by a national alcohol strategy developed free of alcohol industry involvement, would facilitate the implementation of a comprehensive and coordinated public health–focused response to addressing alcohol harms by providing governance and a regulatory structure.
- Given that federal acts for tobacco and cannabis already exist, developing an Alcohol Act would bring greater coherence to the regulation of legal substances in Canada, and serve towards acknowledging and addressing the magnitude of alcohol’s harms.
- To be effective, an Alcohol Act should address the most effective alcohol control policies, even in the face of strong industry opposition (e.g., tax increases, mandatory standard alcoholic drink and health labelling of all alcohol products).
Government inaction despite opportunities to improve federal alcohol policy
There have been several recent opportunities to enact or strengthen alcohol policies where the government has demonstrated inaction. For example, the federal government’s planned inflation-adjusted increase in the alcohol excise tax was reduced from 6.3% to 2%, apparently in response to industry pressure (Woods, 2023). Additionally, federally mandated alcohol warning labels could be enacted as part of an Alcohol Act, if one existed, or by amending the existing Food and Drugs Act. Instead, at the present time, warning labels are having to be pursued through a lengthy and uncertain process of introducing a bill in the Senate, namely Bill S-254 (Parliament of Canada, 2021). Furthermore, the former minister of addiction and mental health appeared to favour voluntary industry labelling in lieu of the proposed mandated labels (Canadian Press, 2023). Also, the federal government has opposed the Republic of Ireland’s move to mandate enhanced warning labels on their alcohol containers (World Trade Organization, 2023). Finally, there has been no formal endorsement of the recently updated Canada’s Guidance on Alcohol and Health, published in 2023.
From an international lens, there is substantial room to strengthen Canada’s federal alcohol policies. Compared to Canada, many countries in the Americas, especially those in Latin America, have higher rates of excise taxes on alcoholic beverages (Roche et al., 2023). Additionally, while there is no federal incentive for minimum pricing in Canada, Scotland implemented a minimum unit price across the country and saw reductions in alcohol purchases, along with a 13% decrease in deaths due to alcohol consumption (Iacobucci, 2023; O’Donnell et al., 2019). In terms of alcohol labelling, Ireland and South Korea have both passed legislation requiring labels with cancer warnings on alcoholic products (World Health Organization, 2023). There are also countries, such as Norway and Lithuania, that have instituted bans on alcohol advertising (Scobie et al., 2022). The Canadian federal government can find many examples of effective, evidence-informed alcohol policies around the world. Key opportunities and corresponding rationales for future Canadian federal alcohol policy development are presented in Table 3. A full list of recommendations for each policy domain can be found elsewhere (Naimi et al., 2023).
Abstract
Objective
To systematically assess the Canadian federal government’s current alcohol policies in relation to public health best practices.
Methods
The 2022 Canadian Alcohol Policy Evaluation (CAPE) Project assessed federal alcohol policies across 10 domains. Policy domains were weighted according to evidence for their relative impact, including effectiveness and scope. A detailed scoring rubric of best practices was developed and externally reviewed by international experts. Policy data were collected between June and December 2022, using official legislation, government websites, and data sources identified from previous iterations of CAPE as sources. Contacts within relevant government departments provided any additional data sources, reviewed the accuracy and completeness of the data, and provided amendments as needed. Data were scored independently by members of the research team. Final policy scores were tabulated and presented as a weighted overall average score and as unweighted domain-specific scores.
Results
Compared to public health best practices, the federal government of Canada scored 37% overall. The three most impactful domains—(1) pricing and taxation, (2) marketing and advertising controls, and (3) impaired driving countermeasures—received some of the lowest scores (39%, 10%, and 40%, respectively). Domain-specific scores varied considerably from 0% for minimum legal age policies to 100% for controls on physical availability of alcohol.
Conclusion
Many evidence-informed alcohol policies have not been adopted, or been adopted only partially, by the Canadian federal government. Urgent adoption of the recommended policies is needed to prevent and reduce the enormous health, social, and economic costs of alcohol use in Canada.