Reducing Alcohol-Related Harms and Costs in Saskatchewan: A Policy Review

Saskatchewan he Provincial and Territorial Alcohol Policy Evaluation (CAPE) project is a rigorous assessment of whether evidence- Population (2016) 1,098,352 based alcohol policies were implemented within each Tand territory in 2017. A comprehensive alcohol policy framework was Per capita alcohol 9.0L pure ethanol** developed, containing gold standard best practices across 11 different consumption age 15+* policy domains. The first seven domains have evidence of effectiveness as Overall alcohol harm costs $563M means of directly reducing population level consumption of alcohol and/ (2014) or related harms. The last four domains are composed of evidence-based revenue from alcohol $391M strategies that more indirectly facilitate implementation of the first seven (2014)*** domains. See Stockwell et al, 2019¤ for the full methodology and findings. Type of alcohol retail Mixed government/ The scores presented in this summary reflect the degree to which system private system Saskatchewan has implemented these gold standard best practices captured in the alcohol policy framework. Overall, Saskatchewan scored 46% in 2017, which is just 2% above the 44% average for the rest of (excluding Saskatchewan).

Domain scores, Saskatchewan vs rest of Canada, 2017

Saskatchewan Pricing and Taxation 52.3% 34.4% Rest of Canada Physical Availability of Alcohol 45.0% 43.1% (excluding SK) Impaired Driving Countermeasures 67.5% 54.4% Marketing/Advertising Controls 51.7% 51.1% Minimum 60.0%

Direct Domains 50.8% Screening, Brief Intervention and Referral 18.9% 26.9% Liquor Law Enforcement 90.0% 58.4% Alcohol Control System 17.5% 35.9% Alcohol Strategy 50.0% 42.5% Monitoring and Reporting 50.0% 63.9% 19.5% Indirect Domains Health and Safety Messaging 26.2% Total Policy Implementation Score 45.9% 43.6% 0% 20% 40% 60% 80% 100%

Promising practices in Saskatchewan • Saskatchewan has minimum prices for alcohol sold both in off-premise retail stores and on-premise establishments. The minimum prices for off-premise alcohol sales are set to partially reflect the volume of alcohol in the beverage. Further, sales taxes on alcohol sold in Saskatchewan are 4% higher than the PST on other consumer goods. • The hours of operation for on-premise establishments and off-premise retail stores are provincially regulated. • Regulations in Saskatchewan allow restrictions to be placed on the number of liquor licenses of each type. There are also retail density restrictions imposed in the Northern Saskatchewan Administration requiring retail stores to be placed at least 40 km apart. • Saskatchewan's interlock program meets gold standard best practices as it applies to all Criminal Code impaired driving offenders, is extended for participants who violate the program in the last 3 months of participation and gets progressively longer for repeat offenders and for those who have a BAC of .16% or higher.

*Adjusted to account for unrecorded alcohol consumption. **Equivalent to 530 standard drinks (1 standard drink contains 17.05mL of pure alcohol and is equivalent to 341mL of 5% beer; 142mL of 12% wine; or 43mL of 40% spirits). *** Net income of liquor authorities, total taxes, and other revenue. See CAPE report for full list of data sources.¤ INDIRECT DOMAINS DIRECTDIRECT DOMAINS DOMAINS Implementation Score Policy Domain Total Policy Total Policy Enforcement Liquor Law Age Drinking Legal Minimum Controls Advertising and Marketing measures Counter- Driving Impaired Availability Physical and Taxation Pricing Referral vention/ Brief Inter- Screening, Messaging Safety and Health Reporting and Monitoring Strategy Alcohol System Control Alcohol

Strengthening alcoholpoliciesinSaskatchewan

Score C 52% 68% 46% 20% 50% 50% 18% 90% 19% 60% 45% 52% D- D- D- D- C- A F F F F F + Assignan content restrictionspriortopublication. Require and illicitsubstances Introduce program toaminimumof3years. start ageto16years Strengthen thegraduatedlicensingprogram(GLP)fornewdriversinSaskatchewanby establishments suchasrestaurantsorbars. Limit theavailabilityofalcoholbyreducingtradinghours Administration district. of thefullCAPE report A comprehensive listofgoldstandardbestpractice alcoholpoliciesisavailablein AppendixC retail storesincludea Ensure thatlegislatedhealthandsafety messagesdisplayedinallon-premiseestablishmentsandoff-premise rotating messagesthatareaccompanied bypictorialimages. messages, standarddrinkinformation, andnationallow-riskdrinkingguidelines;labelsshouldhaveprominent Implement legislatedenhancedalcohol labelsasamanufacturerrequirement system related morbidity,mortalityandcrime)are Ensure thatthe facilitate implementation,andsystemsinplacetomonitorimplementation andeffectiveness. Ensure thestrategyhas health policiesandis Develop an that thereare Ensure thealcoholretailerandregulatorreporttoa outlets, whichencouragethebulksaleofinexpensivealcohol. privatisation ofoff-premiseretailstores In ordertoretainastronggovernmentalcoholcontrolsystem,atminimum, enhancing thesafetyofdrinkingenvironments. (SIRS) to2yearshelpensurethosesellingalcoholarekeptup-to-datewithcurrentlawsandbestpracticesfor Decrease therecertificationperiodofresponsiblebeverageserviceprogram with morefrequentchecksbasedonrisk. Both on-premiseestablishmentsandoff-premiseretailstoresshouldbe Implementation ofSBIR toolsshouldbetracked younger populationsorthosenotaccessinghealthcareinaclinicalsetting. resource developedbytheCollegeofFamilyPhysicians.Onlinetoolscanincreaseaccessibility,especiallyamong guidelines andtoolstobeimplementedinahealthcaresettingonline Collaborate withhealthcareprofessionalstodevelop settings betweentheagesof19and21. phased-in legalaccesstoalcoholbylimitingtheamountandtypeofthatcanbepurchasedinspecific Increase the Consider placingacaponthenumberofdrinksthat establishments). (i.e. before11:00am)orlate-nightsalesafter8pmforoff-premiseretailstoresand1amon-premise Expand the become lessexpensiverelativetoothergoodsovertime. Update allalcoholpricesannually after taxeswithnoexceptions(*2019prices). standard drinkforoff-premiseretailstoresand$3.50*peron-premiseestablishments Ensure minimumpricesaresetatarateperstandarddrink(e.g.17.05mLpurealcohol)ofleast inordertosupporteffectivemonitoringoftrendsconsumptionand harms. mandatory pre-screeningforallalcoholads nighttime drivingrestrictions independent authoritytoenforceadvertisingrestrictions legislated restrictionsonoutletdensity alcohol-specific governmentendorsedstrategy minimumlegaldrinkingage legislated earmarkedfundstosupportpreventioninitiativesandhealth messaging alcohol consumptionandharmindicatorsthataretracked developed independentlyfromthealcoholindustry. even for those who have participated in driver education courses, and lengthening the evenforthosewhohaveparticipatedindrivereducationcourses,andlengtheningthe variety ofhealth-focusedmessages forGLPdrivers. dedicated funding,anidentifiedleaderwithapublichealthand/or safetyfocus ¤ . Selected recommendations to reflect Saskatchewan-specific inflation rates to ensure alcohol does not to reflectSaskatchewan-specificinflationratesensurealcoholdoesnot forstage2driversandintroduce and phase out liquor delivery services; prohibit ferment on premise andphaseoutliquordeliveryservices;prohibitfermentonpremise made publicly available at least annually through a centralized made publiclyavailableatleastannuallythroughacentralized ; giveconsiderationto ministry withamandatetoprotecthealthand/orsafety inordertoinformfutureSBIRactivities. to areas beyond the Northern Saskatchewan toareasbeyondtheNorthernSaskatchewan screening, brief intervention and referral (SBIR) practice screening, briefinterventionandreferral(SBIR)practice by an independent authority to confirm compliance with byanindependentauthoritytoconfirmcompliancewith patron canbeservedatonetime . ; do not allow early morning alcohol sales ; donotallowearlymorningalcoholsales that includes a range of evidence-based public that includesarangeofevidence-basedpublic graduated drinkingpolicies inspected a minimum of once per year inspectedaminimumofonceperyear inSaskatchewan. zero tolerance rules for cannabis zero tolerancerulesforcannabis place a moratorium on further place amoratoriumonfurther (e.g. alcoholconsumption,alcohol- or consider adopting the SBIR orconsideradoptingtheSBIR with health and safety withhealthandsafety Serving It Right Saskatchewan Serving ItRightSaskatchewan increasing the minimum increasing theminimum at on-premise aton-premise that grant thatgrant $1.75* per $1.75*per .

to to and and , Saskatchewan minimum prices per standard drink, 2017

Saskatchewan: Off-premise alcohol retail stores

$2.50 selected Recommended min. price of $2.00 $1.71 for 2017

findings, 2017 $1.50 $1.52 $1.45 $1.38 $1.28

$1.00

$0.50

$0.00 Beer Wine Spirits Coolers (price per standard drink for an average strength beverage) Saskatchewan alcohol retail stores, 2017 On-premise establishments 5.1% (restaurants, bars, etc.)

$5.00 Recommended $4.50 min. price of $4.00 $3.42 for 2017 $3.50 $3.38 $3.00 $2.50 $2.09 $2.00 $1.68 $1.61 94.9% $1.50 $1.00 $0.50 $0.00 Beer Wine Spirits Coolers Government retail stores Private retail stores (price per standard drink for an average strength beverage)

Note: On-premise minimum beer price shown here is an average of two Best practice is 100% government-run alcohol retail stores minimum beer prices.

Domain scores, Saskatchewan, 2012 vs 2017

2012 score Pricing and Taxation 76.3% 52.3% 2017 score Physical Availability of Alcohol 35.0% 45.0% Impaired Driving Countermeasures 36.0% 67.5% Marketing/Advertising Controls 50.0% 51.7% Minimum Legal Drinking Age 80.0% Direct Domains 60.0% Screening, Brief Intervention and Referral 60.0% 18.9% Liquor Law Enforcement 40.0% 90.0% Alcohol Control System 37.5% 17.5% Alcohol Strategy 50.0% 50.0% Monitoring and Reporting 50.0% 17.5% Indirect Domains Health and Safety Messaging 19.5% 0% 20% 40% 60% 80% 100%

Note: policy indicators may have changed between 2012 and 2017 thus scores reflect best practices at the time of data collection. How does Saskatchewan stack up against other and territories? Even though the provinces and territories scored poorly Total policy implementation scores by province and territories, 2017 overall in relation to gold 100% standard best practices, many examples of strong alcohol 90% policy components were found 80%

across Canada. In fact, if a 70% 64% province or territory chose 58% 57% 56% 60% 53% 55% 55% 55% 50% 49% 50% 48% to implement all of these 49% 47% 48% 50% best current practices that 46% 43% 44% 41% 41% 40% 38% 40% 38% were identified they would 35% 34% 33% have scored 87% (Grade A). 30% Based on these best current 20%

practices identified across 10% all jurisdictions, the scores 0% were scaled up to show how BC AB SK MB ON QC NB NS PEI NL YT NT NU the provinces and territories compared to gold standard best practices comparedcompared againstto best best Canadian current current practice practice in Canada measure up against best (Average: 44%) (Average: 51%) current practices in Canada (green bars).

Next steps for reducing alcohol-related harms and costs in Saskatchewan • In light of the substantial and increasing harm from alcohol use, give greater priority to funding and implementing effective alcohol policies such as those outlined in this summary and in the full report¤. • Position liquor boards within ministries directly concerned with health and safety rather than with finance and economic development. • Reconsider the treatment of alcohol as an ordinary commodity to be sold by private retailers as this leads to greater consumption and related harm. • Learn from other provinces' and territories' experiences with successful implementation of effective alcohol policies (see Best Practice Leaders identified on P11 of the full report¤). • Government should take action in concert with NGOs and other stakeholders to implement a combination of population level policies prioritising the first seven policy areas as identified in this summary • Inform the public about the risks of alcohol, including the comparative risks of alcohol and other substances, to create a more supportive climate for enacting effective policies. This can be achieved with initiatives such as mandatory warning labels on all alcohol containers and clear and consistent public health messaging on a range of health topics. • Carefully document policy changes and regularly monitor and evaluate alcohol-related public health and safety outcomes to better inform future policy development.

Suggested citation: Wettlaufer, A., Vallance, K., Chow, C., Stockwell, T., Giesbrecht, N., April, N., Asbridge, M., Callaghan, R., Cukier, S., Davis-MacNevin, P., Dube, M., Hynes, G., Mann, R., Solomon, R., Thomas, G., Thompson, K. (2019). Reducing Alcohol-Related Harms and Costs in Saskatchewan: A Policy Review. Victoria, BC: Canadian Institute for Substance Use Research, University of Victoria. Acknowledgements: Thank you to all of the provincial and territorial stakeholders who provided valuable feedback for this project as well as assisting with data collection and validation activities. We gratefully acknowledge MADD Canada for permitting us to use materials from their 2017 legislative review. Thanks also to our three external expert reviewers, Robyn Burton, Toben Nelson and Tanya Chikritzhs and to all of the extended members of the project team. This study was funded by Health Canada's Substance Use and Addictions Program. The views expressed herein do not necessarily represent the views of Health Canada or the other organizations acknowledged. ¤ To learn more about the Canadian Alcohol Policy Evaluation Project, read other jurisdictional summaries and download the full federal and jurisdictional reports, visit alcoholpolicy.cisur.ca or email [email protected].

cisur.ca UVic.CISUR UVic_CISUR