Sally Casswell

Alcohol: No ordinary commodity research and public policy

From a public health perspective, alcohol is a major contributor to morbidity and mortality. This book describes recent advances in alcohol research which have direct relevance for the development of effective alcohol policies at the local, national and international levels. The central purpose of the book is to empower those responsible for public health and social welfare.

Priority actions for the non-communicable disease crisis

The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis--leadership, prevention, treatment, international cooperation, and monitoring and accountability--and the delivery of five priority interventions--tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US

Profits and pandemics: prevention of harmful effects of tobacco, alcohol and ultra processed food and drink industries

9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.

Reducing harm from alcohol: call to action

The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.

Socio-economic status predicts drinking patterns but not alcohol-related consequences independently

Despite clear evidence of the major contribution alcohol makes to the global burden of disease and to substantial economic costs, focus on alcohol control is inadequate internationally and in most countries. Expansion of industrial production and marketing of alcohol is driving alcohol use to rise, both in emerging markets and in young people in mature alcohol markets. Cost-effective and affordable interventions to restrict harm exist, and are in urgent need of scaling up. Most countries do not have adequate policies in place. Factors impeding progress include a failure of political will, unhelpful participation of the alcohol industry in the policy process, and increasing difficulty in free-trade environments to respond adequately at a national level. An effective national and international response will need not only governments, but also non-governmental organisations to support and hold government agencies to account. International health policy, in the form of a Framework Convention on Alcohol Control, is needed to counterbalance the global conditions promoting alcohol-related harm and to support and encourage national action.

FORMATIVE AND PROCESS EVALUATION OF HEALTH PROMOTION AND DISEASE PREVENTION PROGRAMS

AIM To identify independent relationships between socio-economic status and drinking patterns and related consequences and to identify socio-economic groups at risk for heavier consumption. DESIGN AND SETTING Three comparable national telephone surveys were utilized: 1995, 2000 and 2004. The respondents were aged 18-65 years. Contextual information includes that a number of liberalized alcohol policy changes occurred over the time of the surveys. RESULTS Educational qualification, income and occupation were associated independently with alcohol consumption. There were indications that the different dimensions of drinking (quantity and frequency) had different relationships with socio-economic status (SES). For example, lower SES groups drank heavier quantities while higher SES groups drank more frequently. SES, however, did not play a major role predicting drinking consequences once drinking patterns were controlled for, although there were some exceptions. It was the lower-to-average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population (as they had sustained increases in the quantities they consumed over time where other SES groups did not). CONCLUSION Socio-economic status was related independently to drinking patterns and there were indications that SES interacted differently with the different dimensions of drinking (quantity and frequency). For the most part, socio-economic status was not related independently to the experience of alcohol-related consequences once drinking patterns were accounted for. It was the lower-to-average SES groups that were at greater risk for drinking heavier quantities compared to other SES groups in the population.

Occupational level of the father and alcohol consumption during adolescence; patterns and predictors

This article discusses the concepts of formative and process evaluation, and their application in the field of health promotion and disease prevention. Process evaluation fulfills the need for information on program implementation, which is important in interpreting program outcomes, and informing future efforts in similar areas. Formative evaluation aims to help develop and improve programs from an early stage, when opportunities for influence are likely to be greatest. Greater application of formative and process evaluation to such programs in thefuture has the potential to lead to better designed and more effective programs, and improved understanding of the factors influencing program outcomes.

Community prevention of alcohol problems

Study objective: This paper describes and attempts to explain the association between occupational level of the father and high alcohol consumption among a cohort of New Zealand adolescents from age 11 to 21. Design: Data were obtained from the longitudinal Dunedin multidisciplinary health and development study. At each measurement wave, those who then belonged to the quartile that reported the highest usual amount of alcohol consumed on a typical drinking occasion were categorised as high alcohol consumers. Potential predictors of high alcohol consumption included environmental factors, individual factors, and educational achievement measured at age 9, 11, or 13. Longitudinal logistic GEE analyses described and explained the relation between father’s occupation and adolescent alcohol consumption. Setting: Dunedin, New Zealand. Participants: About 1000 children were followed up from birth in 1972 until adulthood. Main results: A significant association between fathers’ occupation and adolescent alcohol consumption emerged at age 15. Overall adolescents from the lowest occupational group had almost twice the odds of being a large consumer than the highest occupational group. The association between father’s occupation and high alcohol consumption during adolescence was explained by the higher prevalence of familial alcohol problems and friends approving of alcohol consumption, lower intelligence scores, and lower parental attachment among adolescents from lower occupational groups. Conclusions: Socioeconomic background affects adolescent alcohol consumption substantially. This probably contributes to cumulation of disadvantage. Prevention programmes should focus on adolescents from lower socioeconomic groups and make healthier choices the easier choices by means of environmental change.

Alcohol : No Ordinary Commodity – a summary of the second edition

List of Tables - List of Illustrations - Foreword - Acknowledgements -Notes on the Contributors - Introduction M.Holmila - PART 1: LOCAL PREVENTION IN CONTEXT - Alcohol Policy, the State and the Local Community J.Simpura & P.Sulkunen - Constructing Alcohol Problems in the Locality J.Simpura - Alcohol and the Imperative of Health in Mass Society: Images of Alcohol Policy Among the Local Elites P.Sulkunen - PART 2: REFLEXIVE INTERVENTION - The Educational Activities M.Holmila - Brief Intervention in Primary Health Care P.Sillanaukee - Responsible Service and Drinking Environments M.Holmila & K.Haavisto - The Young and Alcohol M.Holmila & K.Haavisto - Family and Other Close Persons M.Holmila - PART 3: ASSESSING THE UTILITY - Process Evaluation M.Holmila - Outcome Evaluation M.Holmila & J.Simpura - PART 3: CONCLUSIONS: LOCAL COMMUNITY IN PREVENTIVE ACTION M.Holmila - Appendices - References - Index

The extent and nature of televised food advertising to New Zealand children and adolescents

This article summarizes the contents of Alcohol: No Ordinary Commodity (2nd edn). The first part of the book describes why alcohol is not an ordinary commodity, and reviews epidemiological data that establish alcohol as a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. This section also documents how international beer and spirits production has been consolidated recently by a small number of global corporations that are expanding their operations in Eastern Europe, Asia, Africa and Latin America. In the second part of the book, the scientific evidence for strategies and interventions that can prevent or minimize alcohol-related harm is reviewed critically in seven key areas: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drink-driving countermeasures, restrictions on marketing, education and persuasion strategies, and treatment and early intervention services. Finally, the book addresses the policy-making process at the local, national and international levels and provides ratings of the effectiveness of strategies and interventions from a public health perspective. Overall, the strongest, most cost-effective strategies include taxation that increases prices, restrictions on the physical availability of alcohol, drink-driving countermeasures, brief interventions with at risk drinkers and treatment of drinkers with alcohol dependence.