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Professor S. Refienberg International Development in Practice November 13th, 2013 Report for The Last Mile Project Addressing Lifestyle Challenges in Marginalized Communities: Methodology of Policy Development The following is a report designed to assist the Last Mile Projects aims to successfully address alcohol abuse and its correlated effects within communities that have a history of marginalization. In these pages, I will provide a comparative analysis of the World Health Organizations recommendations concerning the reduction of the harmful effects of alcohol abuse, and the Aboriginal Community Alcohol Harm Reduction Policy Project conducted in Canada. The goal of this essay is to demonstrate a methodology of framing social policy which may assist The Last Mile Project as it begins to place focus on addressing lifestyle challenges. Because the Last Mile Project has only recently begun to consider combatting alcoholism, the provided analysis emphasizes principles with which to approach the problem and methodology for constructing a preventative policy specific to culture and setting. First and foremost, if the Last Mile Project is to quantitatively assess the condition of alcohol influence within its targeted population, a means of measurement is necessary. In 2001, The World Health Organization (henceforth referred to as WHO) produced a metric called the AUDIT (Alcohol Use Disorders Test) which sought to identity persons with hazardous and harmful patterns of alcohol consumption. The published manual which introduces the AUDIT proposes screening techniques which may serve as a useful evaluation of the individual. 1 However, the WHO acknowledges that the negative consequences of alcohol abuse are
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Babor, Thomas F and others, AUDIT The Alcohol Use Disorders Test: Guidelines for Use in Primary Care

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manifested not only in the individual, but in the environment and community. Understanding alcohol-related problems as part of social and economic systems and of physical and cultural environments broadens the scope for and can increase the effectiveness of interventions (See Figure 2.1 in Appendix for model of alcohol abuse and its social relations) 2. In an attempt to address these effects, the WHO published the Alcohol in Developing Societies Summary in 2010. 3 This document prescribes recommendations for the proper manner of reducing harmful effects of alcohol within the developing community. In regard to developing societies, the WHO cites preventionin comparison to treatmentas a more successful method of addressing alcohol-influenced lifestyles in developing communities. It overwhelmingly endorses expansive government regulation in the form of high taxation, licensing mandates, limits on numbers of outlets within a region, and times/condition of alcoholic sales. The WHO presents several instances in its 2010 Summary of local policy formation in Australian Aboriginal and Brazilian societies which mirror its ideology, yet recognizes the failures and limitations of these cases especially in regard to social alternatives and insulating use from harm.4 However, the organization maintains that the formation of a culturally specific preventive social policy is the most effective means of combatting alcoholic tendencies and harmful results. Other methods such as educational interventions and awareness campaigns facilitated through local media were found to be largely short-lasting and ineffective by both the WHO and research conducted by the Alcohol and Public Policy Group. 5 An example of successfully creating a methodology for implementing the WHOs referrals may be found in the Aboriginal Community Alcohol Harm Reduction Policy Project. Observing limitations of educational intervention and alcohol prohibition in marginalized
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Alcohol and Public Policy Group, Alcohol: No Ordinary Commodity Jernigan, David. Alcohol in Developing Societies: A Public Health Approach 4 Jernigan, David pp. 22-23 5 Alcohol and Public Policy Group, pp. 774-776

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communities, the ACAHRP Project implemented a new social policy program aimed at approaching alcoholism and its effects using public health as its point of departure. Throughout the 1990s, the ACAHRP Project developed Alcohol Management Policies which served as local control options to manage alcohol use in recreational and leisure areas. Cultural-specific social policies were constructed and implemented by the Moose Cree First Nation, the Unceded Aboriginal Reserve of Wikwemikong, Mattagami First Nation, and Aamjiwnaang First Nation dwelling within the Providence of Ontario. The inspirations behind the formation of these Alcohol Management Policies and regulatory action may be articulated by Table 1 6 of the Appendix. To couple the Alcohol Management Policies, the ACAHRP Project prescribes a Policy Development Model which consists of a twelve step process (see Figure 2.2 in Appendix for specific outline). 7 By adhering to these principles and guidelines, the ACAHRP was able to enact a policy which resulted in a decrease of the harmful effects of alcohol abuse. In a survey conducted in all four communities, respondents indicated that the policy was successful in encouraging an environment which was less negatively influenced by alcoholism. The respondents mean scores indicate a substantial reduction of the perception of action affected by alcohol from the time prior to the intervention to the years following its inaction (Specific data may be found in Figure 2 of the Appendix) 8. Indeed, attention may be drawn to the quantitative limitations of a respondents perception of change in his or her community. Granted, the ACAHRP Project does not employ a specific metric comparable to the AUDIT. However, the Project cites social psychologists Lewin and Grabbe and advocates that the behavior of individuals, and therefore the community, is
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Gliksman, Louis. Aboriginal Community Alcohol Harm Reduction Policy (ACAHRP) Project: A Vision for the Future pp 1855 7 Gliksman, Louis,. pp 1856 8 Gliksman, Louis,. pp 1861

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highly influenced by the perception of surroundings. 9 Therefore, while the perceptions reported are not derived from a more rigorous research methodology, their importance to promoting change in a community should not be underrated. In specific relation to the Last Mile Project, the ACAHRP Project, when coupled with WHO research in developing communities, illustrates a successful framework of social policy formation. The example does not prescribe specific regulations of alcohol, but this ought not be seen as an inadequacy. The described Alcohol Management Policy and Policy Development Model are applicable to the Last Mile Projects mission to properly address lifestyle challenges if (and only if) cultural knowledge is coupled with its method of policy formation. The model is dependent on the partnership and efficacy of local management to combine ideologies and social norms most relevant to the target population with the twelve step process. The Last Mile Project has only recently focused its attention on interrupting the harmful effects of alcohol abuse in communities in Kerala. This report provides social policy prevention at the community level as the most successful means of addressing alcoholism and offers the ACAHRP methodology as a possible manner of composing such policy.

Gliksman, Louis,. pp 1862

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Appendix

Figure 2.1

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Figure 2.2

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Figure 2

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Works Cited

Alcohol and Public Policy Group, Alcohol: No Ordinary Commodity a summary of the second edition Addiction, 105: 769779. doi: 10.1111/j.1360-0443.2010.02945.x (2010). Babor, Thomas F., John C. Higgins-Biddle, John B. Saunders, and Maristela G. Monteiro. AUDIT The Alcohol Use Disorders Test: Guidelines for Use in Primary Care. N.p.: World Health Organization Department of Mental Health and Substance Dependence, 2001. PDF Gliksman, Louis, Margaret Rylett, and Ronald R. Douglas. "Aboriginal Community Alcohol Harm Reduction Policy (ACAHRP) Project: A Vision for the Future." Substance use misuse 42.12-13 (2007): 1851-66 Jernigan, David and others. Alcohol in Developing Societies: A Public Health Approach. N.p.: World Health Organization, 2010. PDF.