How Well Do Canada’s Alcohol Policies Support Public Health?

The Canadian federal government has not adopted (or has only partially adopted) many evidence-informed alcohol policies that could avert or reduce major health, social, and economic costs linked to alcohol use, according to a new study.

Researchers found that the Canadian federal government scored 37% across 10 policy domains related to public health best practices on alcohol. The three areas that have the greatest influence on public health received some of the lowest scores, including pricing and taxes, marketing and advertising controls, and impaired driving countermeasures.

“Alcohol harms are high in Canada. Alcohol kills over 17,000 Canadians annually and costs the government more than tobacco and opioids combined,” lead author Elizabeth Farkouh, a research assistant at the Canadian Institute for Substance Use Research at the University of Victoria in Victoria, British Columbia, Canada, and medical student at the Mayo Clinic Alix School of Medicine, Rochester, Minnesota, told Medscape Medical News.

“We’ve also seen a significant increase in harms in recent years,” she said. “A large portion of these harms and costs are preventable through effective public policies.”

The study was published online on May 13 in the Canadian Journal of Public Health.

Canada’s Alcohol Policy Scores

Farkouh and colleagues used data from the third Canadian Alcohol Policy Evaluation to analyze federal government policies based on updated criteria from new studies. Although broadcast advertising of alcohol is regulated at the national level in Canada, provincial and territorial governments control most aspects related to retail availability, density of alcohol retail stores and bars, and alcohol pricing regulations.

Overall, the federal government received top marks for physical availability policies and passing marks for monitoring and reporting. However, the government received a zero for not having a minimum legal age and low marks for impaired driving countermeasures, a national alcohol strategy, and a national control system.

Notably, the research team pointed out the low scores for policies that make a big difference in consumer behavior — with Canada’s low federal alcohol taxes, lack of mandatory health warnings or labels on alcohol containers, and outdated alcohol marketing restrictions that rely on self-regulation by the industry.

“We were surprised how the lack of effective policies spanned multiple policy domains,” Farkouh said. “While the current alcohol policy environment is not in alignment with public health best practices, there is opportunity for improvement.”

Farkouh recommended that Canada implement an alcohol act like those for tobacco and cannabis. Such an act would raise taxes, implement marketing controls, and require health risk information on labels, including a cancer warning.

High Alcohol Consumption

“Canada continues to be a high alcohol-consuming country, relative to the rest of the world, and alcohol causes a high economic and health burden in our country,” said Erin Hobin, a senior scientist with Public Health Ontario. Hobin, who wasn’t involved with the study, has researched the efficacy of enhanced alcohol labels.

Nearly 80% of patients aged 15 years and older in Canada use alcohol, she noted, and 40% drink at levels associated with high risks. Studies show that many Canadians aren’t aware of the substantial health risks, such as cancer and heart disease, she added.

However, awareness is beginning to shift. The first national conversation about alcohol and health in Canada took place in 2023 after the release of Canada’s Guidance on Alcohol and Health, which has helped change public perception. Calls for appropriate federal policies have grown urgent, particularly because alcohol use and related morbidity and mortality increased during the COVID-19 pandemic, said Hobin.

“A large body of published research clearly indicates the effectiveness of strengthening alcohol policies for reducing the prevalence of alcohol use disorder, alcohol-associated liver disease mortality, cancer mortality, cardiovascular diseases, and mortality related to motor vehicles,” she said. “Some countries are taking action to develop and implement high-impact, evidence-informed policy solutions.”

Political Action Required

In 2020 alone, alcohol use was associated with more than 17,000 deaths and 800,000 hospital visits in Canada. During that year, alcohol use cost the country nearly $20 billion, while government revenues from alcohol sales totaled $13.5 billion, according to Statistics Canada.

“The federal government, like the others, earns a failing grade. That’s the bad news. The good news is that the study provides direction on a range of policy improvements that could mitigate the significant harms of beverage alcohol,” said Peter Butt, MD, associate professor of family medicine at the University of Saskatchewan in Saskatoon, Saskatchewan, Canada. Butt, who wasn’t involved with the study, researched substance use disorders and has contributed to Canada’s national drinking guidelines.

“The action required is now political,” he said. “The federal government has repeatedly caved in to alcohol industry lobbying, most recently on pausing beer tax increases and opting for voluntary labeling.”

Incremental change will likely occur, mirroring the evolution of tobacco policies in recent decades, said Butt. In the meantime, significant industry resistance, class action lawsuits, and ongoing detrimental health outcomes are likely.

However, some policy changes could be easier to achieve than others, he said, such as labels with health warnings, standard drink information, and harm reduction guidance. Minimal pricing and taxation based on ethanol content could also level the playing field across alcohol beverage categories, with potentially less political fallout, he added.

“More can and should be done to recognize and diminish the alcohol deficit. Taxpayers should not support the industry by carrying the burden of the costs and harms, nor should people suffer from the health effects without being informed,” said Butt. “All consumers have the right to know, and indeed, most other industries are held to their responsibility to inform consumers of any potential product harm.”

The study was funded by Health Canada, Public Health Agency of Canada, co-investigator institutions, knowledge users, and government stakeholders. Farkouh, Hobin, and Butt reported no relevant financial relationships.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.