Public Health and Regulatory Policy: Research Annual Report 2003

Section Heads: Drs. Benedikt Fischer & Jürgen Rehm

Late in 2002, the Public Health and Regulatory Policy Section was established with a broadened focus, emerging from the former Legal Controls and Regulatory Policy Section. The section is co-headed by Drs. Benedikt Fischer and Jürgen Rehm. Over the past few years, our investigators have secured substantial funding for several areas of research, highlighted below.

Social and Epidemiological Studies

Exemplary projects of the section include the CIHR-funded multi-year Interdisciplinary Health Research Team (IHRT) on Illicit Opiate Addiction Research, Treatment and Policy. Led by Dr. Benedikt Fischer, the IHRT convened its first annual all-projects' meeting in September 2002; this meeting offered a forum in which all of the IHRT projects represented by research investigators, staff and students presented research results or plans.

One of the IHRT projects -- the OPICAN multi-site cohort study, headed by Dr. Fischer, on untreated illicit opioid use in five cities across Canada -- featured results from its baseline component.

As select key information, the majority of people from the total OPICAN baseline sample (679 subjects) featured the following characteristics: non-permanent housing, cocaine or crack use in conjunction with opioid use, physical and depression problems, similar use of health or social services and unmet treatment needs. The investigators will follow up with this cohort; our results will inform research and development of more effective interventions.

Drs. Reginald Smart and Robert Mann have received funding from the AUTO21 Network of Centres of Excellence to study antisocial driving behaviour. The Networks of Centres of Excellence program is funded by the Natural Sciences and Engineering Research Council (NSERC), the Canadian Institutes of Health Research (CIHR) and the Social Sciences and Humanities Research Council (SSHRC), in partnership with Industry Canada.

One study focused on the emerging problem of road rage in the Ontario adult population. The investigators found that experiences as a victim or perpetrator of road rage are common; about half of Ontario drivers had such an experience in the past year. More serious road rage cases involving threats or injuries affected nearly one person in ten. Road rage is more common among young, male drivers and people living in larger, urban centres.

The investigators identified a small group of frequent road ragers, with elevated levels of psychiatric distress, who are involved in most of the serious cases. Future studies will focus on ways to prevent road rage, particularly among people who have the most severe problems.

Preliminary results of the Canadian Alcohol Experiences and Nordic Perspectives project, led by Dr. Norman Giesbrecht, indicate that commercial and policy measures that promote drinking and increase overall alcohol consumption (e.g., extended liquor store operations, increased density of liquor outlets and/or liquor price reductions) are not benign. In fact, such measures are associated with risks and costs for the general population.

As a result of such risks, the research team is recommending the promotion of policies that favour low-risk drinking and prevent an increase in aggregate drinking rates.

Activities to promote better policies could include, for example: promoting a better balance between control and trade agendas; developing a monitoring system of changes in alcohol policy; including health and safety experts at the table when plans for changes in retailing are considered; conducting impact assessments before introducing changes in access to alcohol; and increasing public awareness of the risks of higher drinking rates and the relevance of alcohol policies for public health and safety.

Developing and Evaluating Interventions to Reduce Substance-Related Harm

An important area of our research has been to evaluate policies in Ontario and Canada that aim to reduce alcohol-related motor vehicle collisions. This year, Dr. Mann and his team completed the first long-term evaluation of the effects of the legal blood alcohol limit for driving (.08%) in Canada since the limit was introduced in1969.

The investigators analysed alcohol-related driver fatalities in Ontario that occurred between 1962 and 1996, controlling for long-term fatality trends.

They found that the introduction of the legal limit has had a very strong impact on the number of alcohol-related fatalities; the legal limit law has been associated with a sustained reduction of 18 per cent in alcohol-related driver fatalities in the province. Additionally, the analysis demonstrated the impact of other factors on drinking driving fatality rates. In particular, a strong relationship with population alcohol consumption levels was observed, with drinking driving deaths increasing as consumption increased.

Dr. Scott Macdonald and colleagues recently also compiled data on motor vehicle collisions, in which collision rates of people who received treatment for problems with alcohol, cannabis or cocaine were compared with rates of population controls. Both the alcohol and cocaine groups had significant declines in "at fault collisions" after receiving treatment, compared to a control group.

Dr. Jürgen Rehm led the Comparative Risk Analyses for Alcohol within the Global Burden of Disease Study under the umbrella of the World Health Organization. The aim of the study was to quantify and compare the impact of 26 health risk factors on global burden of disease (see graph).

Alcohol was found to be the most important risk factor in developing countries with overall low mortality, such as China, and the third most important risk factor in established market economies, such as Canada (after tobacco and high blood pressure).

Based on these results, in part published in the 2002 World Health Report, several countries have initiated interventions to reduce alcohol-related harm.

Knowledge Transfer: From Research to Policy

Dr. Norman Giesbrecht, as head of a large team studying Canadian alcohol policy, has submitted a book manuscript, Alcohol, Commerce and Public Health -- Agendas in Recent Canadian Policy Experiences, to McGill-Queens University Press for publication. The manuscript has received very favourable reviews, and the author team expects that the manuscript will go forward to publication in 2004.

The book compares seven case studies, showing that a public health and safety agenda is not prominent in most national and provincial alcohol policy deliberations; these deliberations tend to favour commerce, revenue generation, vested interests and ideology.

Research findings and public opinion play some role, but not a critical one, in alcohol policy deliberations. The final chapter of the monograph notes the implications of these developments for research, prevention practice and effective policy.

Commissioned by Health Canada and its project partner organization UNAIDS, Jürgen Rehm and Benedikt Fischer led the development of an international compendium with the working title: "Reducing the Risks, Harms and Costs of HIV/AIDS and Injection Drug Use (IDU): A Synthesis of the Evidence Base for Development of Policies and Programs."

This compendium, the basis for an international policy dialogue co-organized by Health Canada, comprises special topic chapters on the evidence of and best intervention practices for HIV/AIDS and IDU from some 21 expert contributor teams from four continents.

• Print
  Share |