A complex picture.

This paper examines access to alcohol, trends in consumption, drinking patterns, damage from alcohol, and developments in prevention and alcohol policy - focusing on the Canadian experience over the last two decades. Consumption, as measured by official sales, declined initially and then has increased since 1996. During this time there was a gradual increase in access to alcohol, with steeper increase in some jurisdictions undergoing partial or full privatization of retail alcohol sales. According to survey data, the proportion drinking in a high risk manner is greater among youth and young adults, and the trend in the proportion of high risk drinkers does not necessarily follow the trend in alcohol sales. In light of intensive and multi-dimensional efforts to curtail drinking and driving, these rates have gone down during the period under study. Several provinces have introduced alcohol strategies and a national strategy introduced in 2007 is being implemented. Nevertheless there are ongoing challenges of getting alcohol on the broader public health agenda, even though it is major contributor to disease and disability. The rising consumption and increased access to alcohol, combined with intensive marketing, represent a major public health challenge. It is unlikely that there will be significant strides in reducing the damage from alcohol to Canadian populations, unless there is a substantial change in the status quo involving implementation of the most effective policies and prevention strategies. [ABSTRACT FROM AUTHOR]