Legal and policy approaches can be important tools for achieving healthier communities. A new report—The Role of Law and Policy in Reducing Deaths Attributable to Alcohol to Reach Healthy People’s Substance Abuse Goals in the United States—provides evidence-based information and identifies priority areas that can help communities achieve Healthy People objectives.
Challenge: High alcohol outlet density in Buckhead contributing to violent crime
In the United States, excessive alcohol consumption results in about 88,000 deaths every year, making it a major cause of preventable death in the country. Excessive alcohol use (e.g., binge drinking) is also linked to many other health and social issues—including family problems, unemployment, and violent crime.1
In the Buckhead community of Atlanta during the late 1990s and early 2000s, the number of on-premises retail alcohol outlets, like bars and clubs, grew significantly. At the same time, the neighborhood experienced several high-profile homicides2—and residents complained about noise, litter, traffic, underage drinking, and other problems.3
Strategy: Enforce liquor laws and regulate on-premises alcohol outlet density
In response to alcohol-related problems, a group of Buckhead residents and business leaders pushed for strict enforcement of liquor laws and a reduction in on-premises alcohol retailers in the community.
Among other things, the group requested that then Atlanta Mayor Shirley Franklin and the Atlanta city council enforce laws prohibiting the sale of alcohol to minors and change the last call for drinks at on-premises alcohol retailers from 4 a.m. to 2:30 a.m. Business owners also formed the Buckhead Alliance, which set up security cameras throughout the neighborhood. In addition, city inspectors began aggressively ticketing alcohol-related violations.4,5
This tough stance against illegal alcohol sales in Buckhead helped change the drinking environment in the area. Commenting on these enforcement activities, local business owner Michael Krohngold said the neighborhood went from "zero enforcement to zero tolerance."6
Impact: New research showing a connection between alcohol outlet density and reduced violent crime
The Centers for Disease Control and Prevention (CDC) and the Georgia Department of Public Health evaluated the change in alcohol outlet density and violent crime at the block level between 1997 to 2002 and 2003 to 2007 in the Buckhead area. They also evaluated this change in the Midtown and Downtown neighborhoods of Atlanta, which—like Buckhead—had a high alcohol outlet density. Their research showed a 3% overall decline in alcohol outlet density in Buckhead between these 2 time periods, compared to a 12% increase in alcohol outlet density in Midtown and Downtown. The decrease in alcohol outlet density in Buckhead was, in turn, associated with a twofold greater reduction in violent crime than recorded in Midtown and Downtown.7
Before this study, the Guide to Community Preventive Services (Community Guide) conducted a systematic review of the scientific evidence on the effectiveness of regulating alcohol outlet density for preventing excessive alcohol use.8 Based on that review, the Community Preventive Services Task Force recommended limiting alcohol outlet density through regulation—like licensing and zoning—as a way to reduce or control excessive alcohol consumption and related harms. But the Community Guide review was based mostly on studies evaluating the impact of increasing alcohol outlet density on excessive drinking and related harms.9 The Buckhead study was an important example of the impact of reducing alcohol outlet density on violent crime.
Lesson Learned: Use a comprehensive approach
Dr. Robert Brewer, former director of CDC’s Alcohol Program, was involved with the Community Guide’s systematic review and helped lead the evaluation of the efforts in Buckhead. He noted that the study shows that even small reductions in alcohol outlet density—like the 3% in Buckhead—can go a long way toward reducing violent crime.
According to Brewer, a key part of addressing excessive alcohol use is creating a legal environment that encourages retailers to comply with laws that clearly benefit their communities. These include laws that set a minimum drinking age, ban the sale of alcohol to people who are drunk, and establish commercial host liability—which holds retailers accountable for harms related to alcohol sales. All of these strategies could help reduce excessive alcohol use, alcohol-related harms, or both, and complement the regulation of alcohol outlet density.
Ultimately, Brewer says, the success in Buckhead reinforces the potential of a comprehensive, community-based approach to reduce excessive drinking and related harms, like violence. "Individual-level interventions are important," he says, "But if you really want to move the needle on excessive drinking, you need to change the environment in which people make their decisions about drinking."
About the Law and Health Policy Project
The goal of the Healthy People Law and Health Policy project was to highlight how evidence-based legal and policy interventions and strategies can facilitate progress toward Healthy People 2020 targets by improving community health and well-being. In addition to reports and webinars, the project included "Bright Spots," or success stories, that highlighted successful policy interventions that led to improved health outcomes. The project was a collaboration between the HHS Office of Disease Prevention and Health Promotion (ODPHP), the Centers for Disease Control and Prevention (CDC), the CDC Foundation, and the Robert Wood Johnson Foundation.
Related Healthy People 2030 objectives: