Reversing the Ratchet in Essex County
Sometimes even a small step forward is impressive when it is made against strong headwinds. Such is the case when the Essex County Board of Supervisors voted 15-1 to roll back closing hours* for bars and nightclubs from 4 a.m. to 3 a.m. The New York State Liquor Authority (SLA) will now vote on the measure, following a public hearing. (Typically, the SLA will honor the will of the county board in these matters.)
The vote effectively reverses the Board of Supervisors vote in May of 2005 to extend hours to 4 a.m. Although the measure has been described as “largely symbolic” – since only a few bars in Lake Placid are actually open that late – it functions as a firewall against existing bars or new bars extending their hours past 3 a.m. Currently, the closing hours in adjoining Clinton County are 2 a.m.
Some key takeaways for alcohol policy advocates:
1. When the facts on alcohol policy are presented, most people get it.
When open-minded, disinterested people see the evidence, they usually understand that reasonable controls on the availability, accessibility, and affordability of alcohol are in the public interest. In this case, Mac MacDevitt – Community-Based Prevention Educator for The Prevention Team (and New York Alcohol Policy Alliance stalwart) – presented the considerable body of research about the impact on public health and safety of restricting hours of sale. The Prevention Team provided a resource booklet and guide to each member of the Board of Supervisors, the Lake Placid Village Trustees, the county attorney, local police chiefs and the county sheriff, media reporters and local advocates. Key elements included data showing the disproportionate number of alcohol-related car crashes happening in early morning hours, the Community Preventive Services Task Force systematic review, and specific research linking longer on-premises alcohol business hours in New York State with an increased reported incidence of aggravated assaults and non-gun violence. That research report also found that “the cost of assaults associated with business hours beyond 1 a.m. was $194 million.” Also presented was general information on binge drinking and the public health and public safety impact of alcohol consumption in NYS.
2. Passionate pragmatism wins the day.
The Prevention Team provided close support to Gerry Morrow, the Chesterfield Town Supervisor, who introduced a measure calling for a closing hour of 2 a.m. (in line with the law enforcement truism that “nothing good happens in a bar after 2 a.m.”). After much discussion, well covered by local media, board members settled for the compromise to move the closing hour back to 3 a.m. While opponents of evidence-based alcohol policies prefer to set up a false dichotomy (a “free market” vs. “neo-Prohibitionists”), in reality alcohol control is about negotiation along a continuum. That negotiation requires balancing the economic benefits of businesses and the interests of adults to drink in low-risk ways with the protection of public safety and public health. Well-designed regulations are necessary in order to develop a safe and orderly marketplace. That is the strength of American-style alcohol control systems, which have been steadily eroded by big alcohol producers and retailers, and their allies.
3. The ratchet can be reversed.
Noted international alcohol policy expert Robin Room has aptly described alcohol deregulation as “ratchet mechanism”:
In the absence of strong public sentiment, state regulatory powers tend thus to be a ratchet mechanism, wound in only one direction — in the direction of gradually looser controls — by the vested interests the state has licensed.
In this case, however, the ratchet moved back – thanks to the passionate promotion of the measure by Supervisor Morrow, and the willingness of board members to give the resolution their full consideration. The Prevention Team provided advocacy and technical assistance to the Board of Supervisors, so that the public health and public safety issues impacted by binge drinking could be fully considered in the decision-making process.
* Technically, the limit is on serving hours (“last call”), as patrons are given time to finish their beverages before leaving the establishment.
Risky(er) Business
In the midst of the unsettling events of the past few weeks, former NYC Mayor Rudy Giuliani, in an interview on Hardball with Chris Matthews, made an important point about the relative risk of an American dying from a terrorist attack:
The reality is people in this country do not face – as the greatest risk to them – terrorism. There are far more risks that we face that are much greater than terrorism.
This is reminiscent of an address given by the late C. Everett Koop in 2003:
The mayor of Baltimore, Martin O’Malley, was asked what people could do to protect themselves from terrorism. He answered: ‘To protect yourselves from harm, the most important things you can do are to wear your seatbelts, don’t drink and drive, and don’t smoke.’ I don’t think anyone thought he was trivializing terrorist threats, but it was an important reminder to keep things in perspective.
Putting risks in perspective was the impetus for a display that we assembled for the Alcohol Awareness Event put on by our colleagues at the Partnership for a Healthier New York City. It showed the numbers of deaths in 2009 in NYC attributable to 5 causes: tobacco, excessive alcohol consumption, HIV/AIDS, firearms, and motor vehicle accidents. Of course, some of these causes overlap (e.g., the role of alcohol consumption in HIV/AIDS treatment adherence). But the overall point stands: the greatest threats to the health of New Yorkers (and all other Americans) are behavior-driven and exacerbated by community conditions. Furthermore, in the cases of tobacco and alcohol, some of the most troubling consequences are borne by people other than the smoker or drinker.
And where did the idea for this display come from? Believe it or not, from a display at the Behind-the-Scenes Tour at SeaWorld Orlando showing the relative rarity of deaths due to shark attack in relation to deaths by lightning strike, ski accidents, deer-vehicle collisions, bee stings, and mosquito disease transmission.
Excessive Alcohol Consumption: Dangerously Diverse, Insufficiently Addressed
Back on April 4, CDC Director Dr. Tom Frieden presented on “The Role of Public Health in Preventing Excessive Drinking” during the Luncheon Plenary at the Alcohol Policy 16 conference. In that presentation, he offered a powerful quote from the late, noted epidemiologist Geoffrey Rose. While searching for the source of that quote, I came across this interview with Dr. Frieden on 7/19/2012 at FiveBooks.com.
I’m excerpting the portion of the interview that addresses alcohol, but I encourage everyone to read the full interview here:
According to Dr Rose’s criteria and your own, which diseases does the world community overspend on and which threats to public health are being insufficiently addressed?
I have my underlined copy of Rose in front of me, open to a certain page, which I’ve often thought of because Sir John Crofton mentioned something similar. I underscored a passage where Rose wrote, “Of all the threats to human health, it is alcohol which causes the widest range of injury. It shortens life, being variously held responsible for between 1% and 10% of all adult deaths in industrialised countries. It shrinks the brain and impairs the intellect. It causes failure of the liver, heart and peripheral nerves. It contributes to depression, violence and the breakup of personal and social life. It has been blamed for a quarter of all deaths on the road – divided about equally among drunk drivers, drunk pedestrians and innocent victims.”
Alcohol is a really tough area. Sir John always encouraged me to do more on alcohol control. The issue is problem drinking. In the US, binge drinking causes a huge proportion of the harms. Yet problem drinking is a challenge to address. I think we can at least begin to address this problem with a focus on kids and understanding that you want people to make decisions that are going to affect the rest of their lives when they’re adults, not when they’re kids.
The Unintentional Irony of the Crawl for Cancer
The Crawl for Cancer describes itself as “a fundraising organization driven to plan and host events that support lifesaving research and those affected by cancer while having a little fun doing it! Though not a charity, we are a for-profit company that donates 100% of our profits to the charities we serve.”
Meaning, of course, that it celebrates the excessive ingestion of a Group 1 carcinogen* in order to raise money to “cure” cancer. Awareness of the role of alcohol consumption in cancers of the head/neck, female breast, liver, and colon/rectum is growing – but not fast enough, apparently, to permeate the consciousness of the “philanthropies dedicated to fighting cancer” who receive money from this farce. (Would any source of money be off-limits? Cigarette sales? The Indoor Tanning Association?)
Bar/pub crawls are nothing new, of course, and by their very nature are typically synonymous with binge drinking. (Case in point: the infamous Bridge Street Run in Oswego, NY). They are also sometimes associated with violence and other mayhem, as with recent tragedies and near-tragedies in Chicago and Methuen, Massachusetts.
The Crawl for Cancer itself is no longer welcome in the Bricktown area of Oklahoma City, after its crawlers engaged in verbal assaults on families, public urination, and serious violence.
But the saddest irony of the entire enterprise is nested in its promotion of excessive alcohol consumption for the sake of raising money for a disease whose risk factors include … excessive alcohol consumption. Like with the pinkwashing phenomenon, this is another case of confusing causes of disease with cures for disease.
* The International Agency for Research on Cancer of the World Health Organization has determined definitively that alcoholic beverages are carcinogenic to humans, a designation shared with only 108 other agents – including tobacco, benzene, asbestos, estrogen therapy, wood dust, and certain types of salted fish.
Crawl for What?
Alcohol & the Costs of Chronic Disease
Why do we need a social movement to reduce excessive alcohol consumption in New York State?
Because despite the enormous progress that’s been made over the last few decades with regard to our understanding of what really works to reduce alcohol problems, that knowledge hasn’t yet fully broken through our society’s cultural cognitive dissonance around alcohol.
And that disconnect is alive and well and on display in New York State.
Consider these unavoidably interrelated facts:
1) Runaway health care costs are the biggest threat to the fiscal solvency of New York State and the nation.
As US House of Representatives Majority Leader Eric Cantor (R-VA) bluntly states:
Health care costs are the primary driver of debt … [without restraining these costs] it doesn’t matter what we do with defense spending, Social Security or other government programs; we will have failed to get the deficit under control.
In New York State, similarly, Medicaid spending is “crowding 
out other needs,” according to the State Budget Crisis Task Force chaired by Richard Ravitch and Paul Volcker. Indeed, the NYS Association of Counties has decried the fact that local Medicaid costs consumed nearly one-half of the entire county property tax levy statewide (outside of New York City) in 2010.
Furthermore, it’s unclear whether some of the state provisions to reduce Medicaid spending growth will actually remedy underlying health care costs or rather “simply shift costs to providers, and result in adverse consequences for quality or access to care.”
2) Chronic diseases are the biggest driver of health care costs, with more than 75% of national health care costs attributable to chronic conditions.
New York State is no exception, with conservative estimates that 63% to 69% of NYS’ $160 billion in health care expenditures are due to chronic diseases. Moreover, NYS Medicaid recipients with substance abuse issues and concurrent chronic conditions are especially costly to the health care system (and alcohol is by far the most abused substance in NYS).
According to the Milken Institute, at our current course (calculated in 2007), chronic diseases will cost New York State over $232 billion in treatment expenditures and lost productivity in 2023.
3) The “Big Four” modifiable risk factors for chronic disease are smoking, poor diet, physical inactivity, and excessive alcohol consumption.
In fact, according to the Global Burden of Disease project, alcohol ranks behind only hypertension and smoking as a cause of death and disability worldwide. It kills more people in the U.S. than microbial agents and 5 times as many people as all illicit drugs combined.
Thus, the only rational way to arrest this slow-motion financial death spiral is to embrace evidence-based, population-level prevention strategies to reduce alcohol-related harm and other underlying risk factors of chronic diseases. The Council on State Governments puts it plainly: “without aggressive intervention into the root causes of these chronic diseases and their costs, these trends are expected to continue to worsen.” [emphasis mine]
And yet, many of our leaders in NYS want to treat beer, wine, and liquor as just another easy engine for economic development, as if they were talking about tires and mayonnaise, instead of a commodity that needs to be regulated with special care.
Tinkering around the margins isn’t going to cut it here. The health, safety, and financial future of our state depend on us taking serious action to reduce alcohol-related harm.
Alcohol Policy … Expert?
Image: Fletcher Prince via Flickr
Do you have “Gravitas, confidence and the ability to build relationships and credibility…”?
Are you interested in building the “credibility and authority” of a major brewer as “a contributor to the debate on the role of the brewing industry in managing irresponsible alcohol consumption”?
Would you like a position where you manage the “repercussions to the industry” of the “ongoing alcohol debate”?
And would you like to do this without actually reducing alcohol problems?
If so, then this job is for you!
Alcohol Free Lent: The Social Costs of Alcohol
The following is cross-posted from the Faith In Action newsletter from the General Board of Church & Society of the United Methodist Church:
A great deal of public health research over the past few decades has pointed to the value of control policies in limiting alcohol-related problems. These policies include increasing the price of alcohol, limiting the concentration of outlets, limiting hours and days of sale, enhanced enforcement of underage drinking laws, and others.
And yet, despite the confirmed value of these policy solutions, they are rarely put into practice. Bringing about lasting change is far from easy, due mainly to political resistance from those with a financial stake in keeping things as they are: the alcohol industry and its allies.
The full article is available here
Counting on Impulse
Photo: AllisonKo via Flickr
The forces working to deregulate state alcohol control systems (alcohol producers, big retailers, and their allies) are careful to deemphasize that their business models depend on overall increases in alcohol consumption, which invariably lead to increases in death, disease, and other social problems.
Thus, efforts to expand hours and days of sale of alcohol are presented as modern business practices (increased “convenience”) vs. “archaic,” “Prohibition-era” blue laws. Sadly, many journalists covering these issues are less than diligent and simply follow the industry frame of modern business vs. religion. There is a nary a mention of the public health impacts of such deregulation, despite the fact that the Task for Community Preventive Services has found that increasing hours or days of sale leads to a host of problems, including increases in alcohol-related traffic accidents.
Occasionally, however, reality pokes through, as in an article in the Atlanta Journal-Constitution about the dubious benefits of Sunday sales in Georgia:
Jay Hibbard, vice president of government relations for the Distilled Spirits Council of the United States, said that overall those are positive results. Counting on more impulse buys, his organization predicts Sunday sales will increase statewide liquor taxes by 5 percent to 7 percent, translating to an additional $3.4 million to $4.8 million. [emphasis mine]
Do we as a nation really want to facilitate the “impulse buying” of hard liquor, or any alcohol for that matter? Should alcohol be treated like chewing gum at a supermarket checkout aisle? Not if we value the health and safety of our communities.
Bruni on the Great American Disconnect
In yesterday’s New York Times, Frank Bruni elegantly described our nation’s collective cognitive chasm between the harms caused by alcohol and the meager effort and resources devoted to truly reducing those harms:
Wrongly, perilously, we tend not to attribute the same destructive powers to it that we do to powders, capsules and vials … Because drinking is legal for adults, safe in moderation, the rightful font of epicurean reveries and the foundation of a multibillion-dollar industry with lobbyists galore, it gets something of a pass. Many of us like it — no, love it — too much to survey the damage it can do, look at ways in which our society could work to curb that and acknowledge that the effort isn’t so very vigorous.
What’s more, as the former restaurant critic for the Times, Bruni can’t be brushed aside as a neo-Prohibitionist by the alcohol industry PR machine.
Bruni’s full piece 
is available here: http://www.nytimes.com/2012/02/19/opinion/sunday/bruni-whitney-houston-and-alcohols-toll.html
Lessons on Bingeing from Buffalo
In an editorial for the Buffalo News, Megan Kunecki, Community Educator for the Erie County Council for the Prevention of Alcohol and Substance Abuse (ECCPASA) makes several important points about adult binge drinking in Western New York and the rest of NYS.
Three points that particularly stand out:
1) Forget the stereotypes: Binge drinking is not a “poor person’s problem”
The income group containing the most binge drinkers, at 20.2 percent, is those whose annual income is more than $75,000. However, the income group that binge drinking affects most often is those who make less than $25,000 a year.
This means that the contention made by alcohol interests and their allies – that alcohol taxes are unfairly regressive – is neither accurate nor honest. Wealthier people are more likely to binge drink, while low-income people are often forced to bear the brunt of alcohol-related harm due to the concentration of alcohol outlets in the most deprived neighborhoods and other factors.
2) The data demand a closer look
Although New York State wasn’t recognized as one of the highest states in terms of percentage of adults who binge drink, it doesn’t mean it’s not a problem here. The CDC study identifies a percentage ranging from 18.7 percent to 25.6 percent as having the highest proportion of binge drinkers per state. A study by Excellus BlueCross BlueShield found that the Western New York region has about a 22 percent binge drinking rate. When comparing the CDC data to the data here in Western New York, we would fall under the ‘high binge drinking’ category.
If we look only at NYS averages we miss the fact that some areas – most notably large swaths of Western NY and the North Country – are closer to high-binge states (such as those in New England and the Upper Midwest) in their binge drinking rates.
3) It’s time for full-cost accounting on alcohol
Binge drinking, or drinking at all, might not seem like a problem or cause for concern to many people, but when data suggests that each year 80,000 Americans die because of alcohol, or that that drinking costs an already-suffering economy $223.5 billion, we all should be concerned.
Many times our notions of economic development are short-sighted at best, self-defeating at worst. Unless we carefully analyze the health impacts of our policy decisions, we actually risk making the economic conditions of our neighborhoods worse. Considering the role of excessive alcohol consumption in chronic diseases and admissions to Level-1 Trauma centers, and the burden of Medicaid costs on state and county budgets, we can’t afford get-rich-quick schemes which threaten the health and safety of our communities.
