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1.
Artigo em Inglês | MEDLINE | ID: mdl-31408935

RESUMO

BACKGROUND: Alcohol use is a major risk factor in premature death and disability, especially among youth. Evidence-based policies to prevent and control the detrimental effect of alcohol use have been recommended. In countries with weak alcohol control policies-such as Lebanon, stakeholder analysis provides critical information to influence policy interventions. This paper assesses the views of stakeholders regarding a national alcohol harm reduction policy for youth. METHODS: We interviewed a total of 22 key stakeholders over a period of 8 months in 2015. Stakeholders were selected purposively, to include representatives of governmental and non-governmental organizations and industry that could answer questions related to core intervention areas: affordability, availability, regulation of marketing, and drinking and driving. We analyzed interview transcripts using thematic analysis. RESULTS: Three themes emerged: Inadequacy of current alcohol control policies; weak governance and disregard for rule of law as a determinant of the status quo; and diverting of responsibility towards 'other' stakeholders. In addition, industry representatives argued against evidence-based policies using time-worn strategies identified globally. CONCLUSIONS: Our findings indicate that alcohol harm reduction policies are far from becoming a policy priority in Lebanon. There is a clear need to shift the narrative from victim blaming to structural conditions.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Redução do Dano , Política de Saúde/legislação & jurisprudência , Adolescente , Cerveja , Dirigir sob a Influência , Órgãos Governamentais , Humanos , Indústrias , Líbano , Marketing , Organizações , Participação dos Interessados
2.
BMC Public Health ; 19(1): 665, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146724

RESUMO

BACKGROUND: Public health policy is inevitably associated with either a strong presence or lack of public support. We investigated factors associated with both the public support of and opposition to health taxes and the media regulation regarding advertising harmful products in Korea. METHODS: We interviewed 1200 respondents that were recruited using an equal-probability sampling method in accordance with the 2016 Korean census. Our investigation examined the extent of support and opposition towards health taxes and the media regulation of advertising that targets the consumption of tobacco, alcohol, and unhealthy foods according to socioeconomic characteristics, health habits, body mass index (BMI), and exposure to the advertising of harmful products. The study was conducted using a univariate and stepwise multivariate regression analysis. RESULTS: The majority (71.8%) of the respondents were supportive of imposing health taxes in general. Despite a high prevalence of tobacco and alcohol consumption among the respondents, they strongly supported media regulation of tobacco (72.3%), alcohol (63.7%), and eating broadcasts (51.9%) food advertising (44.0%). Those that were non-smokers, earned a high-income, were married, or had a child were likely to support at least one kind of regulation regarding alcohol and smoking related advertising. An exposure to excessive advertising of unhealthy products was associated with increase of respondents supporting the media regulation. Those who regarded the media as being influential seemed to be more supportive of health taxes or media regulation. CONCLUSION: Our results indicated strong public support among the respondents for health taxes and the media regulation regarding the advertising of unhealthy products. Based on our data, we are optimistic that countries whose population show a high rate of tobacco, alcohol or unhealthy food consumption may launch public policy in addressing these factors.


Assuntos
/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Meios de Comunicação de Massa/legislação & jurisprudência , Opinião Pública , Impostos/legislação & jurisprudência , Adulto , Bebidas Alcoólicas/efeitos adversos , Bebidas Alcoólicas/economia , Feminino , Alimentos/efeitos adversos , Alimentos/economia , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Produtos do Tabaco/efeitos adversos , Produtos do Tabaco/economia
3.
BMC Public Health ; 19(1): 810, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234812

RESUMO

BACKGROUND: Harmful alcohol use is a modifiable risk factor contributing to the increasing burden of non-communicable diseases and deaths and the implementation of policies focused on primary prevention is pivotal to address this challenge. Policies with actions targeting the harmful use of alcohol have been developed in Nigeria. This study is an in-depth analysis of alcohol-related policies in Nigeria and the utilization of WHO Best Buy interventions (BBIs) and multi-sectoral action (MSA) in the formulation of these policies. METHODS: A descriptive case study design and the Walt and Gilson framework of policy analysis was utilized for the research. Components of the study included a scoping review consisting of electronic search of Google and three online databases (Google Scholar, Science Direct and PubMed) to identify articles and policy documents with no language and date restrictions. Government institution provided documents which were not online. Thirteen policy documents, reports or articles relevant to the policy formulation process were identified. Other components of the study included interviews with 44 key informants (Bureaucrats and Policy Makers) using a pretested guide. The qualitative data were coded and analyzed using thematic analysis. RESULTS: Findings revealed that policy actions to address harmful alcohol use are proposed in the 2007 Federal Road Safety Act, the Non-communicable Diseases Prevention and Control Policy and the Strategic Plan of Action. Only one of the best buy interventions, (restricted access to alcohol) is proposed in these policies. Multi-sectoral action for the formulation of alcohol-related policy was low and several relevant sectors with critical roles in policy implementation were not involved in the formulation process. Overall, alcohol currently has no holistic, health-sector led policy document to regulate the marketing, promotion of alcohol and accessibility. A major barrier is the low government budgetary allocation to support the process. CONCLUSIONS: Nigeria has few alcohol-related policies with weak multi-sectoral action. Funding constraint remains a major threat to the implementation and enforcement of proposed policy actions.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Formulação de Políticas , Prevenção Primária/legislação & jurisprudência , Política Pública , Humanos , Nigéria , Doenças não Transmissíveis/prevenção & controle , Fatores de Risco
4.
BMC Public Health ; 19(1): 490, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046718

RESUMO

BACKGROUND: On 6th April 2018, the UK Government introduced the Soft Drinks Industry Levy (SDIL) as a mechanism designed to address increasing prevalence of obesity and associated ill health by reducing sugar consumption. Given that the successful introduction of upstream food and nutrition policies is a highly political enterprise involving multiple interested parties, understanding the complex network of stakeholders seeking to influence such policy decisions is imperative. METHODS: Media content analysis was used to build a dataset of relevant newspaper articles, which were analysed to identify stakeholder agreement or disagreement with defined concept statements. We used discourse network analysis to produce visual representations of the network of stakeholders and coalitions evident in the debate as it was presented in UK newspapers, in the lead up to and following the announcement of the Soft Drinks Industry Levy in the UK, from May 2015 to November 2016. RESULTS: Coding identified 3883 statements made by 214 individuals from 176 organisations, relating to 47 concepts. Network visualisations revealed a complex network of stakeholders with clear sceptical and supportive coalitions. Industry stakeholders appeared less united in the network than anticipated, particularly before the SDIL announcement. Some key industry actors appeared in the supportive coalition, possibly due to the use of corporate social responsibility rhetoric. Jamie Oliver appeared as a dominant stakeholder, firmly embedded with public health advocates. CONCLUSION: This study highlights the complexity of the network of stakeholders involved in the public debate on food policies such as sugar tax and the SDIL. Polarisation of stakeholders arose from differences in ideology, focus on a specific policy and statements about the weight of evidence. Vocal celebrity policy entrepreneurs may be instrumental in gaining public and policy makers' support for future upstream regulation to promote population health, to facilitate alignment around a clear ideology.


Assuntos
Bebidas Gaseificadas/economia , Meios de Comunicação de Massa/tendências , Política Nutricional/economia , Obesidade/prevenção & controle , Açúcares/economia , Bebidas , Defesa do Consumidor/economia , Governo , Humanos , Política Nutricional/legislação & jurisprudência , Saúde Pública/métodos , Impostos/economia , Reino Unido
5.
Health Res Policy Syst ; 17(1): 46, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036004

RESUMO

BACKGROUND: South Africa is considered to have the highest prevalence of fetal alcohol spectrum disorder (FASD) globally. Nevertheless, the extent to which the South African government has responded to the high FASD prevalence at the policy level is unclear. Herein, we aimed to identify targeted and generic clauses that could be attributed to the prevention and management of FASD in relevant South African policy documents. METHODS: We conducted a search of two search engines (PubMed and Google) and the websites of South African national and provincial departments from January to April 2018. A total of 33 policy documents were included in this review. Using content analysis, we sought documents that mention the terms 'fetal alcohol syndrome' and 'fetal alcohol spectrum disorder'. The Framework method was also used to thematically identify specific and generic clauses attributed to the prevention and management of FASD in South Africa. RESULTS: The content analysis indicated that 12 policy documents contained the searched terms. Findings from the thematic analysis showed that targeted and generic clauses for FASD exist in various policy documents. Some of the generic clauses focused on the regulation of liquor outlets, enforcement of liquor laws, and the general management of persons with mental and educational challenges. Specific clauses focused on creating platforms to improve the awareness, screening, identification and support for individuals with FASD. CONCLUSIONS: There is a noticeable increase in the number of policy documents that considered elements of FASD enacted in the last decade. Although this study revealed the existence of targeted and generic clauses that could be attributed to the prevention and management of FASD, the sustained high prevalence of FASD in South Africa, as reported in the literature, calls for more holistic and comprehensive approaches to tackle the FASD problem in South Africa.


Assuntos
Documentação , Etanol/efeitos adversos , Transtornos do Espectro Alcoólico Fetal/terapia , Governo , Política de Saúde , Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/complicações , Comércio/legislação & jurisprudência , Deficiências do Desenvolvimento/terapia , Feminino , Transtornos do Espectro Alcoólico Fetal/diagnóstico , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Regulamentação Governamental , Humanos , Transtornos Mentais/terapia , Gravidez , África do Sul/epidemiologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-31141952

RESUMO

Scotland has been ambitious in its policy and legislative efforts to tackle alcohol-related harm, efforts which include the innovative feature of a 'public health objective' within local alcohol licensing. However, the persistence of alcohol-related harms and inequalities requires further examination of both the overarching Scottish alcohol strategy and its specific implementation. A qualitative case study was undertaken to explore how alcohol policy is implemented locally in Scotland, with data generated from (i) documentary analysis of 12 relevant policies, legislation, and guidance documents; and (ii) a thematic analysis of semi-structured interviews with 54 alcohol policy implementers in three Scottish localities and nine national-level stakeholders. The data suggest there is a tension between the intentions of licensing legislation and the way it is enacted in practice, and that accountability emerges as an important factor for understanding why this occurs. In particular, there are a lack of accountability mechanisms acting upon Scottish Licensing Boards to ensure they contribute to the public health goals of the Scottish alcohol strategy. From a public health perspective, this has perpetuated a system in which Licensing Boards continue to act with autonomy from the rest of the alcohol policy implementation system, creating a challenge to the achievement of public health goals. Alcohol policy in Scotland is likely to fall short of intended goals as long as the tension between licensing legislation and enacted licensing practices remains.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Licenciamento/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Política Pública , Etanol/efeitos adversos , Política de Saúde/legislação & jurisprudência , Humanos , Administração em Saúde Pública/legislação & jurisprudência , Pesquisa Qualitativa , Escócia , Responsabilidade Social , Fatores Socioeconômicos
7.
J Public Health Policy ; 40(1): 66-75, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30546111

RESUMO

Cross-sectional, longitudinal, and experimental studies have found a link between youth exposure to cigarette marketing and youth initiation of smoking. These decisive research findings led to regulations of cigarette marketing to youth-including no television or radio ads, prohibitions on the use of cartoons, bans on transit and billboard advertisements, and disallowing tobacco brand sponsorships of sporting events or concerts. Similar products that may cause more harm than benefits include alcohol, electronic cigarettes, and opioids. We review the evidence linking problematic use of these products with exposure to marketing and discuss standards for assessing the potential harmfulness of marketing. We next address how public health agencies might apply regulatory principles to these harmful products similar to those applied to cigarette advertising, in the advancement of public health.


Assuntos
/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/prevenção & controle , Bebidas Alcoólicas , Administração em Saúde Pública , Prevenção do Hábito de Fumar/legislação & jurisprudência , Adolescente , Regulamentação Governamental , Política de Saúde , Humanos , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/métodos , Produtos do Tabaco/legislação & jurisprudência , Vaping/legislação & jurisprudência , Vaping/prevenção & controle
8.
Drug Alcohol Rev ; 38(1): 25-33, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30588675

RESUMO

INTRODUCTION AND AIMS: The recognition of the association between the use of alcohol and negative health outcomes have led to the endorsement of the World Health Organization's global strategy to reduce the harmful use of alcohol. Given the capacities, capabilities and sociocultural contexts of Thailand, this study aims to examine the Thai alcohol policy against the global strategy's recommended policy measures for marketing control and identify areas for further policy development. DESIGN AND METHODS: Semi-structured interviews were conducted with the stakeholders from three sectors: the government, academia and civil society. Their perceptions of the Thai alcohol policy in regulating alcohol industry's commercial strategies and activities were discussed. Audio data were transcribed verbatim, systematically coded and thematically analysed. RESULTS: Although the Thai Alcohol Control Act meticulously regulates the content of direct alcohol marketing, the volume of marketing and indirect alcohol marketing have become problematic and difficult for the government to address. The industry has worked to normalise the consumption of alcohol through repetitive brand exposure and their suggestion that drinking was integral for socialisation. The control of alcohol sponsorship was politically sensitive and legally ambiguous because alcohol sponsorship seemed to provide economic and social benefits and further reinforced the industry's positive image. DISCUSSION AND CONCLUSIONS: Despite the strict alcohol policy, gaps in the marketing regulations exist. Future policy development should place greater emphasis on alcohol sponsorship and branding through evidenced-based interventions. The interactions between the government and the industry should be monitored and restricted. Rigorous regulations, as seen for tobacco, are encouraged for alcohol marketing.


Assuntos
/legislação & jurisprudência , Bebidas Alcoólicas/economia , Política de Saúde/legislação & jurisprudência , Saúde Pública , Humanos , Formulação de Políticas , Tailândia
9.
BMC Public Health ; 18(1): 1400, 2018 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-30577827

RESUMO

BACKGROUND: Government alcohol monopolies were created in North America and Scandinavia to limit health and social problems. The Swedish monopoly, Systembolaget, reports to a health ministry and controls the sale of all alcoholic beverages with > 3.5% alcohol/volume for off-premise consumption, within a public health mandate. Elsewhere, alcohol monopolies are being dismantled with evidence of increased consumption and harms. We describe innovative modelling techniques to estimate health outcomes in scenarios involving Systembolaget being replaced by 1) privately owned liquor stores, or 2) alcohol sales in grocery stores. The methods employed can be applied in other jurisdictions and for other policy changes. METHODS: Impacts of the privatisation scenarios on pricing, outlet density, trading hours, advertising and marketing were estimated based on Swedish expert opinion and published evidence. Systematic reviews were conducted to estimate impacts on alcohol consumption in each scenario. Two methods were applied to estimate harm impacts: (i) alcohol attributable morbidity and mortality were estimated utilising the International Model of Alcohol Harms and Policies (InterMAHP); (ii) ARIMA methods to estimate the relationship between per capita alcohol consumption and specific types of alcohol-related mortality and crime. RESULTS: Replacing government stores with private liquor stores (Scenario 1) led to a 20.0% (95% CI, 15.3-24.7) increase in per capita consumption. Replacement with grocery stores (Scenario 2) led to a 31.2% (25.1-37.3%) increase. With InterMAHP there were 763 or + 47% (35-59%) and 1234 or + 76% (60-92%) more deaths per year, for Scenarios 1 and 2 respectively. With ARIMA, there were 850 (334-1444) more deaths per year in Scenario 1 and 1418 more in Scenario 2 (543-2505). InterMAHP also estimated 10,859 or + 29% (22-34%) and 16,118 or + 42% (35-49%) additional hospital stays per year respectively. CONCLUSIONS: There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Alcoólicas , Alcoolismo/epidemiologia , Comércio/organização & administração , Privatização , Política Pública , Adolescente , Adulto , Idoso , Bebidas Alcoólicas/economia , Bebidas Alcoólicas/provisão & distribução , Comércio/legislação & jurisprudência , Feminino , Regulamentação Governamental , Humanos , Masculino , Pessoa de Meia-Idade , Suécia/epidemiologia , Adulto Jovem
10.
BMC Med Res Methodol ; 18(1): 123, 2018 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-30400776

RESUMO

BACKGROUND: Recent regulatory changes in the system by which premises are licensed to sell alcohol, have given health representatives a formal role in the process in England and Scotland. The degree to which local public health teams engage with this process varies by locality in both nations, which have different licensing regimes. This study aims to critically assess the impact on alcohol-related harms - and mechanisms - of public health stakeholders' engagement in alcohol premises licensing from 2012 to 2018, comparing local areas with differing types and intensities of engagement, and examining practice in Scotland and England. METHODS: The study will recruit 20 local authority areas where public health stakeholders have actively engaged with the alcohol premises licensing system (the 'intervention') and match them to a group of 20 lower activity areas using genetic matching. Four work packages are included: (1) Structured interviews and documentary analysis will examine the type and level of intervention activity from 2012 to 2018, creating a novel composite measure of the intensity of such activity and will assess the local licensing system and potential confounding activities over the same period. In-depth interviews with public health, licensing, police and others will explore perceived mechanisms of change, acceptability, and impact. (2) Using longitudinal growth models and time series analyses, the study will evaluate the impact of high and low levels of activity on alcohol-related harms using routine data from baseline 2009 to 2018. (3) Intervention costs, estimated National Health Service cost savings and health gains will be evaluated using the Sheffield Alcohol Policy Model to estimate impact on alcohol consumption and health inequalities. (4) The study will engage public health teams to create a new theory of change for public health involvement in the licensing process using our data. We will share findings with local, national and international stakeholders. DISCUSSION: This interdisciplinary study examines, for the first time, whether and how public health stakeholders' involvement in alcohol licensing impacts on alcohol harms. Using mixed methods and drawing on complex systems thinking, it will make an important contribution to an expanding literature evaluating interventions not suited to traditional epidemiological research.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Licenciamento/normas , Saúde Pública/normas , Política Pública , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Bebidas Alcoólicas/normas , Inglaterra , Promoção da Saúde/métodos , Promoção da Saúde/normas , Humanos , Licenciamento/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Saúde Pública/estatística & dados numéricos , Reprodutibilidade dos Testes , Escócia , Inquéritos e Questionários
11.
Int J Drug Policy ; 62: 78-85, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30368102

RESUMO

Restrictions on the supply of alcohol are amongst the most effective and cost effective interventions to address harmful use. However, despite international human rights bodies recognising that self determination must be pre-eminent in efforts to improve Indigenous health, little is known about the role of Indigenous communities in designing and implementing alcohol controls as well as the degree to which government resourcing and/or regulation is utilised. This commentary explores Australian examples of the governance models used to ensure Indigenous participation and leadership when developing regulatory interventions for alcohol control within communities. We identify four models of Indigenous governance: alcohol control interventions that were community conceived and implemented, government-facilitated community-led, community coalitions backed by government intervention and government initiated community partnerships. Each model is underpinned by specific governance arrangements which incorporate rules and processes that determine authority, accountability and Indigenous participation in decision-making. The aim of this paper is to benchmark these models of governance along a spectrum of community engagement beginning with forms of non-participation and ending with full citizen control. In addition, we put forward recommendations for governments at all levels to facilitate culturally acceptable and robust models of Indigenous governance that have the potential to improve health and social outcomes.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/prevenção & controle , Serviços de Saúde do Indígena/organização & administração , Grupo com Ancestrais Oceânicos/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/etnologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/etnologia , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Austrália/epidemiologia , Assistência à Saúde , Regulamentação Governamental , Redução do Dano , Política de Saúde , Promoção da Saúde , Humanos
12.
BMC Public Health ; 18(Suppl 1): 957, 2018 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-30168398

RESUMO

BACKGROUND: Harmful use of alcohol is one of the most common risk factors for Non-Communicable Diseases and other health conditions such as injuries. World Health Organization has identified highly cost-effective interventions for reduction of alcohol consumption at population level, known as "best buy" interventions, which include tax increases, bans on alcohol advertising and restricted access to retailed alcohol. This paper describes the extent of inclusion of alcohol related "best buy" interventions in national policies and also describes the application of multi-sectoral action in the development of alcohol policies in Malawi. METHODS: The study was part of a multi-country research project on Analysis of Non-Communicable Disease Preventive Policies in Africa, which applied a qualitative case study design. Data were collected from thirty-two key informants through interviews. A review of twelve national policy documents that relate to control of harmful use of alcohol was also conducted. Transcripts were coded according to a predefined protocol followed by thematic content analysis. RESULTS: Only three of the twelve national policy documents related to alcohol included at least one "best buy" intervention. Multi-Sectoral Action was only evident in the development process of the latest alcohol policy document, the National Alcohol Policy. Facilitators for multi-sectoral action for alcohol policy formulation included: structured leadership and collaboration, shared concern over the burden of harmful use of alcohol, advocacy efforts by local non-governmental organisations and availability of some dedicated funding. Perceived barriers included financial constraints, high personnel turnover in different government departments, role confusion between sectors and some interference from the alcohol industry. CONCLUSIONS: Malawi's national legislations and policies have inadequate inclusion of the "best buy" interventions for control of harmful use of alcohol. Effective development and implementation of alcohol policies require structured organisation and collaboration of multi-sectoral actors. Sustainable financing mechanisms for the policy development and implementation processes should be considered; and the influence of the alcohol industry should be mitigated.


Assuntos
Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/prevenção & controle , Formulação de Políticas , Política Pública , Humanos , Malaui , Política Pública/economia , Setor Público/organização & administração , Pesquisa Qualitativa , Organização Mundial da Saúde
13.
Int J Health Policy Manag ; 7(8): 696-698, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30078289

RESUMO

As taxation is one of the key public policy domains influencing population health, and as there is a legal, strategic, and programmatic basis for health impact assessment (HIA) in Finland, we analyzed all 235 government bills on tax legislation over the years 2007-2014 to see whether the health impacts of the tax bills had been assessed. We found that health impacts had been assessed for 13 bills, bills dealing with tobacco, alcohol, confectionery, and energy legislation and that four of these impact assessments included impacts on health inequalities between social classes. Based on our theoretical classification, the health impacts of 40 other tax bills should have been evaluated.


Assuntos
Comércio/legislação & jurisprudência , Regulamentação Governamental , Governo , Avaliação do Impacto na Saúde , Política de Saúde , Promoção da Saúde/métodos , Impostos , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Finlândia , Indústria Alimentícia/economia , Indústria Alimentícia/legislação & jurisprudência , Equidade em Saúde , Humanos , Saúde da População , Produtos do Tabaco/economia , Produtos do Tabaco/legislação & jurisprudência
14.
Health Policy Plan ; 33(7): 786-800, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-29931204

RESUMO

Alcohol is a major contributor to the Non-Communicable Disease burden in South Africa. In 2000, 7.1% of all deaths and 7% of total disability-adjusted life years were ascribed to alcohol-related harm in the country. Regulations proposed to restrict alcohol advertising in South Africa present an evidence-based upstream intervention. Research on policy formulation in low- and middle-income countries is limited. This study aims to describe and explore the policy formulation process of the 2013 draft Control of Marketing of Alcoholic Beverages Bill in South Africa between March 2011 and May 2017. Recognising the centrality of affected actors in policy-making processes, the study focused on the alcohol industry as a central actor affected by the policy, to understand how they-together with other actors-may influence the policy formulation process. A qualitative case study approach was used, involving a stakeholder mapping, 10 in-depth interviews, and review of approximately 240 documents. A policy formulation conceptual framework was successfully applied as a lens to describe a complex policy formulation process. Key factors shaping policy formulation included: (1) competing and shared values-different stakeholders promote conflicting ideals for policymaking; (2) inter-department jostling-different government departments seek to protect their own functions, hindering policy development; (3) stakeholder consultation in democratic policymaking-policy formulation requires consultations even with those opposed to regulation and (4) battle for evidence-evidence is used strategically by all parties to shape perceptions and leverage positions. This research (1) contributes to building an integrated body of knowledge on policy formulation in low- and middle-income countries; (2) shows that achieving policy coherence across government departments poses a major challenge to achieving effective health policy formulation and (3) shows that networks of actors with commercial and financial interests use diverse strategies to influence policy formulation processes to avoid regulation.


Assuntos
Bebidas Alcoólicas/efeitos adversos , Política de Saúde , Entrevistas como Assunto , Marketing/economia , Marketing/legislação & jurisprudência , Formulação de Políticas , Emprego , Regulamentação Governamental , Humanos , Indústrias/economia , Pesquisa Qualitativa , África do Sul
15.
Curr Opin Psychiatry ; 31(4): 342-347, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29746422

RESUMO

PURPOSE OF REVIEW: This review is a critical reflection on the effectiveness of evidence-based alcohol policies and their implementation, based on studies and observations that have arisen in recent years. RECENT FINDINGS: This article covers themes in recent literature of: the relationship between alcohol consumption and harm, the variability of country contextual factors and the interactions of both country contexts and alcohol policies on changes in alcohol consumption and harm. SUMMARY: These recent observations imply that alcoholic beverage policies and programmes should focus on contextual determinants in each country and community, and address targeted problems (like problem drinking) and harm (such as liver cirrhosis, cancer and road accidents), rather than consumption per se.


Assuntos
Consumo de Bebidas Alcoólicas , Bebidas Alcoólicas/efeitos adversos , Política Pública/legislação & jurisprudência , Controle Social Formal/métodos , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Consumo de Bebidas Alcoólicas/prevenção & controle , Humanos , Avaliação de Programas e Projetos de Saúde
16.
Curr Opin Psychiatry ; 31(4): 294-299, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29708894

RESUMO

PURPOSE OF REVIEW: The current article reviews recent research (from 2016 onward) on drinking behaviors and alcohol-related problems among young people in Asia with an emphasis on population-based evidence. RECENT FINDINGS: Recent evidence concerning underage drinking in Asia was limited to certain countries and societies with most data derived from cross-sectional surveys. Measures of alcohol drinking or problems were less sophisticated. The prevalence of recent alcohol drinking varies widely with the highest estimates reported in Hong Kong and Korea (∼21%). Certain emotional, behavioral, and cognitive characteristics have been linked with increased drinking behaviors, including internalizing or externalizing problems. Parents (or family) are the most studied predictors within the domain of socioenvironmental characteristics, whereas little attention has been paid to the macro environments (e.g., media, alcohol advertisement, and alcohol control policy/regulations). SUMMARY: Research on underage drinking behaviors in Asia is urgently needed, particularly in some emerging markets. Follow-up studies with longitudinal measurements and large diverse samples will provide a better understanding of developmental stage-dependent and ever-changing macroenvironmental factors, as well as possible mechanisms.


Assuntos
Consumo de Bebidas Alcoólicas , Comportamento Problema , Controle Social Formal/métodos , Consumo de Álcool por Menores , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/psicologia , Ásia/epidemiologia , Humanos , Prevalência , Meio Social , Consumo de Álcool por Menores/legislação & jurisprudência , Consumo de Álcool por Menores/prevenção & controle , Consumo de Álcool por Menores/psicologia
17.
Int J Drug Policy ; 56: 144-152, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29459211

RESUMO

BACKGROUND: Drug policy, whether for legal or illegal substances, is a controversial field that encompasses many complex issues. Policies can have effects on a myriad of outcomes and stakeholders differ in the outcomes they consider and value, while relevant knowledge on policy effects is dispersed across multiple research disciplines making integrated judgements difficult. METHODS: Experts on drug harms, addiction, criminology and drug policy were invited to a decision conference to develop a multi-criterion decision analysis (MCDA) model for appraising alternative regulatory regimes. Participants collectively defined regulatory regimes and identified outcome criteria reflecting ethical and normative concerns. For cannabis and alcohol separately, participants evaluated each regulatory regime on each criterion and weighted the criteria to provide summary scores for comparing different regimes. RESULTS: Four generic regulatory regimes were defined: absolute prohibition, decriminalisation, state control and free market. Participants also identified 27 relevant criteria which were organised into seven thematically related clusters. State control was the preferred regime for both alcohol and cannabis. The ranking of the regimes was robust to variations in the criterion-specific weights. CONCLUSION: The MCDA process allowed the participants to deconstruct complex drug policy issues into a set of simpler judgements that led to consensus about the results.


Assuntos
Consumo de Bebidas Alcoólicas , Cannabis , Controle de Medicamentos e Entorpecentes , Legislação de Medicamentos , Uso da Maconha , Política Pública , Consenso , Técnicas de Apoio para a Decisão , Assistência à Saúde , Humanos
19.
Int J Drug Policy ; 54: 77-86, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29414489

RESUMO

On a Northern Plains reservation where alcohol was prohibited, we investigated community members' views on the impacts of alcohol availability. Our methods combined elements of Tribal community participatory research with qualitative inquiry to elicit these perspectives. We used rapid appraisal techniques to conduct confidential interviews with 31 key leaders representing 7 relevant major community systems, and representing a variety of perspectives. Topics included respondents' understandings of the current systems of alcohol availability and use on the reservation, the impacts of these systems on reservation residents, and possible ways to measure these impacts. Respondents reported impacts on individuals, families, and the tribe overall. Alcohol-related problems shaped and were shaped by a constellation of social-ecological conditions: kinship, housing, employment, public/social service capacity, and the supply of alcohol in nearby off-reservation areas, as well as inter-governmental relationships and the spiritual life of reservation residents. A variety of social-structural determinants magnified alcohol impacts, so that the problem drinking of a small number of individuals could have broad effects on their families and the entire community. Our participatory qualitative methods enabled us to directly include the voices as well as the personal experiences and expertise of community members in this presentation. These methods may be broadly applied within policy analysis to identify ways to reduce harms related to alcohol and other drugs for Indigenous communities.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Participação da Comunidade , Índios Norte-Americanos/psicologia , Formulação de Políticas , Meio Social , Humanos , Pesquisa Qualitativa
20.
Drug Alcohol Rev ; 37 Suppl 2: S18-S26, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29314356

RESUMO

INTRODUCTION AND AIM: To report data on the implementation of alcohol policies regarding availability and marketing, and drink driving, along with ratings of enforcement from two small high-income to three high-middle income countries, and one low-middle income country. METHOD: This study uses the Alcohol Environment Protocol, an International Alcohol Control study research tool, which documents the alcohol policy environment by standardised collection of data from administrative sources, observational studies and interviews with key informants to allow for cross-country comparison and change over time. RESULTS: All countries showed adoption to varying extents of key effective policy approaches outlined in the World Health Organization Global Strategy to Reduce the Harmful Use of Alcohol (2010). High-income countries were more likely to allocate resources to enforcement. However, where enforcement and implementation were high, policy on availability was fairly liberal. Key Informants judged alcohol to be very available in both high- and middle-income countries, reflecting liberal policy in the former and less implementation and enforcement and informal (unlicensed) sale of alcohol in the latter. Marketing was largely unrestricted in all countries and while drink-driving legislation was in place, it was less well enforced in middle-income countries. CONCLUSION: In countries with fewer resources, alcohol policies are less effective because of lack of implementation and enforcement and, in the case of marketing, lack of regulation. This has implications for the increase in consumption taking place as a result of the expanding distribution and marketing of commercial alcohol and consequent increases in alcohol-related harm.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Dirigir sob a Influência/prevenção & controle , Política de Saúde , Consumo de Bebidas Alcoólicas/prevenção & controle , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Bebidas Alcoólicas/economia , Comércio/estatística & dados numéricos , Comparação Transcultural , Coleta de Dados , Dirigir sob a Influência/legislação & jurisprudência , Humanos , Marketing/legislação & jurisprudência , Fatores de Tempo
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