Closing the Gap Between Evidence and Action: Lessons From a Dramatic Increase in Access to Alcohol.

Alcohol is a leading cause of death, disability, disease, trauma and social problems. In Canada, alcohol consumption is associated with 17,000 deaths annually, with costs from alcohol exceeding revenues in each jurisdiction. Leading health organisations point to policies shown to be effective in reducing alcohol harms. Yet there is a substantial and growing gap between evidence of effective policies to reduce alcohol harms and actual policies being implemented in Canada and elsewhere. This commentary critically examines one such example: the Ontario government's 2023 decision to significantly expand off-premise alcohol sales, involving up to 8500 new off-premise outlets (+290%). There were several ways in which this decision neglected public health. First, both international and Canadian-based research demonstrates that greater physical access to alcohol is associated with increased chronic disease, acute harms and deaths. However, this publicly available evidence did not appear to inform the Ontario provincial government's plans to dramatically increase alcohol availability, and the government did not appear to conduct a priori estimates of health and social impacts. Second, despite concerns from leading public health associations, the plan was not modified. Finally, the plan proceeded with minimal mitigation interventions and without an evaluation protocol. This illustrative case of evidence-neglect in public health policy can inform policymaking in other jurisdictions. Governments considering changes to alcohol policies should utilise available evidence to conduct an a priori assessment of potential risks and benefits, consult with relevant public health stakeholders, enact a robust, multi-dimensional mitigation plan, and implement an objective and comprehensive evaluation protocol.