Transcript Contribution Mr Spak

Prioritization - a study of alcohol and drug
prevention i Västra Götaland County,
Western Sweden, 2002-2004
Fredrik Spak, Per Blanck
MD, PhD, ass. prof. at Social medicine, Sahlgren
Academy, Göteborg University
Department of Public Health, Västra Götalandsregionen
Prevention activities: alcohol, drugs, program
evaluation, secondary prevention in primary health
care och working life, education
National Action Plan
for Alcohol and Drug Prevention,
areas that concern local municipalities, 2001
Support to risk groups and individuals
with risk behaviours
Support treatment
Restrict accessibility of alcohol
beverages
Competence enhancement
Monitoring trends
Influence public opinion
Method, Västra Götaland
49 municipalities
1.5 million inh.
Municipal size:
475 000
– 5 000
61 % < 20 000
Interview at baseline and 2 year
follow-up
4 municipalities
studied in more
detail
Method
Interviews x 2 in 49 municipalities + 4
townships
Interviews x 2 in 4 municipalities
(deeper studies)
Survey study: contact persons
Document, plans, webb sites
Participating observation
RESULTS
(So far only available in a Swedish– two
articles to appear in J Subst. Use and
Abuse)
Alcohol and other drugs
Gradually the task changed from
implementation of the alcohol problem
prevention plan to implementation of
the alcohol- och drug prevention plans
Concordance with the national
alcohol prevention plan
The plan has target 6 areas.
30 % of the municipalities had activities in
at least 4 areas
>50 % of the municipalities had activities in
at least 3 areas
The most common activies:
1. Opinion making
2. Competence enhancement
3. Work with risk groups
Activities: Substance abuse
prevention groups
Develop and strenghten networks in
and inbetween municipalities
Meetings with substance abuse
coordinators
Meetings för exchanging ideas
Education
Study trips (Denmark, Norway, Stockholm)
Policy programs
39 municipalities
But 27 of these ”outdated”
policy never accepted
policy not known
old
Substance coordinators
In 40 of 49 municipalities,
else public health officers
Common tasks
Monitor substance use
Develop or enforce policy programs
Promote preventive efforts
Unclear expectations, low sustainability
Economy och mandate
First interview:
Freedom
Many interested
Small resources
Second interview:
Mandate unclear
Mandate not
respected
Activities ceased
Small, but increased
resources
Target groups
Almost all
municipalities:
 Youth
or
 Children and youth
Few municipalities:


Adults
Young adults
Arenas
All municipalities:
School
Parents
Fewer municipalities:
(Leisure time)
associations
Work life
Primary health care
Traffic
Education
Efforts in all municipalities
wide variety
usually grade 7-9
Often a part of ”Health promoting
schools”
undocumented
No well documented programs
Information to
teenage parents
Lecture series
Study circles
few
But:
lacks sustainability and large impact
Sales restrictions
Controlling (low alcohol) beer sales
regulation adherence = 50%
Restuarant and bar license increase (per
10.000 inh.)
1998:
9.8
2003:
12.4
Secondary prevention in
health care/
primary health care
New parents
(Mother and
child care)
Early secondary intervention
Yes
No
Activities in the traffic area
Swedish police very active, activities
increasing
No community cooperation
Conclusions





Network building: rather successful
Municipalities adhere to the national alcohol
and drug action plans to some extent
Low sustainability
Too many activities in relation to resource
avialability
Do stakeholders agree on the benefit of the
activities? (different rational fields –
Seedhouse)
Recommendations
More realistic och evaluable programs
Prioritization among the many different
activities
Clearer mandates – allocate resources
More focus on adults as a target group
More focus on structures than on individuals
Sustainability requires political cooperation
Invite implementation specialists
Recommendations
Increase activities aming at reducing
availability – not in the least concerning sales
of alcohol purchased abroad
Promote secondary prevention in primary
health care (mainly concerning alcohol),
(family practice, maternity care and child care)
Support substance prevention in work life
Support well functioning parent programs
General improvement of the school ”milieu”
Alcohol policy in the regions of
Europe – factors to be considered
What is the LEAST we can do to set off an effective
program?
SURPLUS VALUE NEEDED - All resources allocated to
alcohol prevention could have been used for some
other purpose
SMALL EFFECT TO BE EXPECTED - Even if a
municipality does everything correct in working to
reduce demand – this will have less effect than
working with alcohol availability.
Why are so MANY TIRED today?