The public-private decision for alcohol retail systems: examining the economic, health, and social impacts of alternative systems in Finland

Background: Organising alcohol retail systems with more or less public ownership has implications for health and the economy. The aim of the present study was to estimate the economic, health, and social impacts of alcohol use in Finland in 2018 (baseline), and in two alternative scenarios in which current partial public ownership of alcohol retail sales is either increased or fully privatised. Methods: Baseline alcohol-attributable harms and costs were estimated across five categories of death, disability, and criminal justice. Two alternate alcohol retail systems were defined as privately owned stores selling: (1) only low strength alcoholic beverages (public ownership scenario, similar to Sweden); or (2) all beverages (private ownership scenario). Policy analyses were conducted to estimate changes in alcohol use per capita. Health and economic impacts were modelled using administrative data and epidemiological modelling. Results: In Finland in 2018, alcohol use was estimated to be responsible for €1.51 billion (95% Uncertainty Estimates: €1.43 billion, €1.58 billion) in social cost, 3,846 deaths, and 270,652 criminal justice events. In the public ownership scenario, it was estimated that alcohol use would decline by 15.8% (11.8%, 19.7%) and social cost by €384.3 million (€189.5 million, €559.2 million). Full privatisation was associated with an increase in alcohol use of 9.0% (6.2%, 11.8%) and an increase in social cost of €289.7 million (€140.8 million, €439.5 million). Conclusion: The outcome from applying a novel analytical approach suggests that more public ownership of the alcohol retail system may lead to significant decreases in alcohol-caused death, disability, crime, and social costs. Conversely, full privatisation of the ownership model would lead to increased harm and costs

Laboratory Response to Anthrax Bioterrorism, New York City, 2001

In October 2001, the greater New York City Metropolitan Area was the scene of a bioterrorism attack. The scale of the public response to this attack was not foreseen and threatened to overwhelm the Bioterrorism Response Laboratory’s (BTRL) ability to process and test environmental samples. In a joint effort with the Centers for Disease Control and Prevention and the cooperation of the Department of Defense, a massive effort was launched to maintain and sustain the laboratory response and return test results in a timely fashion. This effort was largely successful. The development and expansion of the facility are described, as are the special needs of a BTRL. The establishment of a Laboratory Bioterrorism Command Center and protocols for sample intake, processing, reporting, security, testing, staffing, and quality assurance and quality control are also described

Exploring the impact of public health teams on alcohol premises licensing in England and Scotland (ExILEnS): procotol for a mixed methods natural experiment evaluation.

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

Alcohol and society 2020: Alcohol, pregnancy and infant health – a shared responsibility.

This report aims to emphasise parenthood and the relationship with alcohol as a shared responsibility and an important equality issue. It is important that everyone involved is fully familiar with the potential risks associated with alcohol to ensure they can take informed decisions. Key recommendations • Policies which reduce the availability, affordability and marketing of alcohol are needed to sustain a low risk environment for alcohol-related birth abnormalities. • There is a shared responsibility for society at large and healthcare providers to raise awareness of the risks of prenatal alcohol exposure and provide support to pregnant women and their partners to manage these risks and their consequences. • Persons planning a pregnancy, women as well as their partners, can improve the probability of a healthy pregnancy outcome by abstaining or minimise alcohol exposure. • It is safest to abstain from any alcohol consumption during pregnancy. Partners may also choose to abstain from drinking during this period, and if they choose to continue drinking they should do so within low-risk guidelines. • It is also safest to avoid alcohol exposure while breastfeeding. Those who choose to drink during breastfeeding should limit consumption to 1 standard drink, consumed 2 hours prior to breastfeeding. • An expert national centre should be established in Sweden charged with developing strategies to reduce prenatal alcohol exposure, monitor prevalence of exposure and provide training in screening and treatment

Alcohol and older people.

Alcohol consumption and alcohol-related harm, whether in the form of chronic disease or acute harm, has increased amongst Sweden’s elderly in recent years. The percentage of the population classified as elderly has increased and will continue to do so. Prevention of disease and harm, including alcohol-related disease and harm, is, therefore, very important – both for all those at risk and for the health and medical care sector. The report addresses the elderly’s increased sensitivity to the effects of alcohol which, in combination with the ageing process, may increase the risk of disease and accidents, even at relatively low consumption levels. It describes the relationship between alcohol and various diseases and problems from which the elderly may suffer, such as cardiovascular disease, diabetes, dementia, and cancer. The report also highlights the significance of lifetime lifestyles for health in old age

Alcohol consumption and mortality from coronary heart disease: An updated meta-analysis of cohort studies

Objective: Previous meta-analyses estimate that low-volume alcohol consumption protects against coronary heart disease (CHD). Potential errors in studies include systematic misclassifica-tion of drinkers as abstainers, inadequate measurement, and selection bias across the life course. Method: Prospective studies of alcohol consumption and CHD mortality were identified in scholarly databases and reference lists. Studies were coded for potential abstainer biases and other study characteristics. The alcohol–CHD risk relationship was estimated in mixed models with controls for potential biases. Stratified analyses were performed based on variables identified as potential effect modifiers. Results: Fully adjusted meta-analysis of all 45 studies found significantly reduced CHD mortality for current low-volume drinkers (relative risk [RR] = 0.80, 95% CI [0.69, 0.93]) and all current drinkers (RR = 0.88, 95% CI [0.78, 0.99]). There was evidence of effect modification by cohort age, gender, ethnicity, and heart health at baseline. In stratified analyses, low-volume consumption was not significantly protective for cohorts ages 55 years or younger at baseline (RR = 0.95, 95% CI [0.75, 1.21]), for studies controlling for heart health (RR = 0.87, 95% CI [0.71, 1.06]), or for higher quality studies (RR = 0.86, 95% CI [0.68, 1.09]). In studies in which the mean age was 55 years or younger at baseline, there were significantly increased RRs for both former (RR = 1.45, 95% CI [1.08, 1.95]) and occasional drinkers (RR = 1.44, 95% CI [1.09, 1.89]) compared with abstainers. Conclusions: Pooled analysis of all identified studies suggested an association between alcohol use and reduced CHD risk. However, this association was not observed in studies of those age 55 years or younger at baseline, in higher quality studies, or in studies that controlled for heart health. The appearance of cardio-protection among older people may reflect systematic selection biases that accumulate over the life course

Alcohol sales in Canadian liquor outlets as a predictor of subsequent COVID-19 infection rates: a time series analysis.

AIMS Government alcohol sales data were used to examine whether age 15+ per capita alcohol consumption (PCAC) (i) changed during COVID-19 (ii) predicted COVID-19 infections 2 to 5 weeks later. DESIGN Interrupted time series analyses were applied to panels of data before and after COVID-19 restrictions were introduced in Canada. SETTING AND PARTICIPANTS The populations, aged 15+, of the provinces of Ontario (ON), British Columbia (BC) and Nova Scotia (NS), Canada. INTERVENTION Expansion of home delivery options and hours of trading for liquor stores while restrictions on travel, social and economic activities were imposed by governments during COVID-19 from March 17, 2020 until March 29, 2021. MEASUREMENTS Weekly estimates of (i) age 15+ PCAC using sales data supplied by provincial government alcohol distributors for liquor stores, bars and restaurants (ii) stringency of public health measures assessed by the Public Health Agency of Canada (PHAC) (iii) new COVID-19 infections reported by PHAC. FINDINGS PCAC increased by 7.10% (p=0.013) during the pandemic versus previous years, with increased private liquor store sales partly offset by reduced bar/restaurant sales. Consumption was positively associated with stringency of public health measures. Weekly PCAC was positively associated with new COVID-19 infections 2 weeks later (+6.34% for a 1 drink/week increase, p<0.001). Lagged associations with COVID-19 infections 2 or 3 weeks later were observed for PCAC from all sales channels, with larger effect sizes per standard drink/person/week increase for on-premise outlets (+77.27% week 2, p=0.009) than government liquor stores (+6.49%, week 2, p<0.001) or private liquor stores (+7.13%, week4, P<0.001). CONCLUSIONS Alcohol consumption increased in three Canadian provinces during COVID-19 to degrees corresponding to the extent of the strictness of measures imposed to prevent viral spread. Increased consumption of alcohol was associated with increased COVID-19 infection rates 2 weeks later

Alcohol and society. Theme 2016/2017: alcohol and cancer.

International research has shown that alcohol can cause cancer, even at moderate consumption levels. This report includes estimates that almost 30% of the cases of alcohol-induced cancer in Sweden are due to moderate or low levels of alcohol consumption, and that the more the individual consumes, the greater the risk