Academic journal article Bulletin of the World Health Organization

Developing an Alcohol Policy Assessment Toolkit: Application in the Western Pacific/ Developpement D'un Outil D'evaluation De la Politique En Matiere D'alcool: Application Dans le Pacifique occidental/Desarrollo De Un Conjunto De Herramientas De Evaluacion De Las Politicas Relativas Al Alcohol En El Pacifico Occidental

Academic journal article Bulletin of the World Health Organization

Developing an Alcohol Policy Assessment Toolkit: Application in the Western Pacific/ Developpement D'un Outil D'evaluation De la Politique En Matiere D'alcool: Application Dans le Pacifique occidental/Desarrollo De Un Conjunto De Herramientas De Evaluacion De Las Politicas Relativas Al Alcohol En El Pacifico Occidental

Article excerpt

Introduction

Globally, alcohol consumption contributes to an estimated 9.6% of all disability-adjusted life-years. (1) Fortunately, effective evidence-based policies for alcohol control can protect population health and well-being, save lives, reduce health-care costs and increase productivity. (2-4) Indeed, every European country has some form of national alcohol control policy framework. (3)

Policy development, however, is only one step. The World Health Organization (WHO) and other leading international agencies have repeatedly called for countries to assess, compare and refine their national alcohol control policy frameworks. (3,5,6) There is limited guidance, however, on how these activities should be carried out. A reliable and valid tool for quantifying alcohol policy stringency and enforcement would yield a standardized, succinct summary of a country's policy framework and facilitate investigation of the relationship between alcohol policies and consumption per capita. It would also enable meaningful comparisons across countries and jurisdictions and comparisons within countries over time. Further, it could highlight weak policies and provide estimates of the impact of policy improvements on consumption.

A small number of scales have been developed to assess national alcohol control policies. (7) Although informative, these scales have several limitations. These include the failure to: (i) comprehensively assess enforcement, (7-14) (even though enforcement varies considerably across policies and countries and is likely to impact effectiveness); (15) (ii) demonstrate the scales feasibility through a practical application; (10) (iii) demonstrate the scale's robustness through sensitivity analyses; (7-12) (iv) rank countries according to their degree of alcohol control; (12) (v) relate alcohol policy scores to corresponding per capita consumption estimates (7-12) or adjust for income--which shows considerable between-country variation--in per capita consumption estimates; (13,14) and (vi) provide complete assessment of policies and use up-to-date literature. (13,15,16) We aimed to address these limitations and develop a comprehensive and practical tool to measure the stringency and enforcement of national alcohol control policies.

To demonstrate our tool's feasibility and practical value, we applied it to nine study areas in the western Pacific. Despite recent increases in alcohol consumption in the region, (17) previous alcohol policy scales have been largely applied to Europe. Only two previous studies have evaluated alcohol control policies in the western Pacific and both focused on high-income countries. (12,13) In this paper, we compared the relative strength of national alcohol policy frameworks across a range of developed and developing study areas in the region. We used up-to-date policy data, conducted comprehensive sensitivity analyses to demonstrate the tool's robustness and investigated the relationship between alcohol policy scores and income-adjusted levels of alcohol consumption per capita.

Methods

The assessment tool

We developed the Toolkit for Evaluating Alcohol policy Stringency and Enforcement-16 (TEASE-16), which builds on previous policy evaluation scales. (13) It is the first tool to assess levels of stringency and enforcement comprehensively. As summarized in Table 1, TEASE-16 has five main components: (i) five regulatory domains; (ii) 16 evidence-based alcohol control policies or policy topics; (iii) effectiveness star ratings (i.e. ratings of the effectiveness of the policies in reducing the adverse effects of alcohol, which were based on expert reviews of the literature); (2) (iv) level of stringency; and (v) level of enforcement. Further details on the conceptual framework of TEASE-16 are provided in Appendix A (available at: https://ndarc. med.unsw.edu.au/resource/appendix-tease-16-supplementary-details).

Following Brand et al. …

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