Assessing, Evaluating and Strengthening Effective Country-level Alcohol Policy
As part of Dr. Jernigan's work as an expert advisor to the Pan-American Health Organization, the student will assist in the assessment and evaluation of existing alcohol policies in-country, potential for alcohol policy reform, alcohol industry and other key stakeholder involvement in alcohol policy-making, and available data that may be used to evaluate and/or strengthen alcohol policies. Costa Rica is an important leadership country in Latin American alcohol policy. It still has a relatively strong state alcohol monopoly, and its policies have traditionally been relatively protective. However, the pressures to liberalize policies in Costa Rica are symptomatic of trends across the continent. This in-country assessment will serve not only Costa Rica but will also provide insight into pressures to weaken and effective responses regarding evidence-based alcohol policies. Specifically, student duties may include: 1) development of a case study of alcohol policy-making in Costa Rica, mapping out key players and responsibilities; 2) evaluation and identification of weaknesses in country-level alcohol-related policies in a low or middle income country; 3) assisting Dr. Jernigan in making recommendations on how to strengthen the existing policy structure and how to fill in any gaps, 4) as part of the case study research, assessing the influence of economic operators such as the alcohol industry as well as other key stakeholders on alcohol-related policies, 5) analyzing available country-level data and proposing ways of presenting it for policy purposes, and 6) assisting in the development of translational tools such as training workshops on alcohol policy, alcohol marketing or alcohol advocacy.
David H. Jernigan, PhD
Costa Ricans are very early risers. I had read this multiple times in the various resources I drew upon to ready me for my two month research excursion, but it stood out only as an interesting factoid. Within 3 days of arrival, I was up at 5, breakfasting by 6, out in the streets on the way to work by 6:30, and out the door again at 3pm sharp. Lying near the equator, there are only 12 hours of sunshine a day, and Ticos (as Costa Ricans call themselves) have learned how to maximize that time.
Costa Ricans are also some of the friendliest people on earth. They are number one in the World Database of Happiness and when calculating “happy life years.” For most, this may only be translated to a brief interaction with employees at a surfing resort or beachside restaurant, but I had to live, eat, work, and breathe in the “real world” for weeks on end and found no reason to argue with these findings.
I walked the 2 miles to my temporary office or spent 50 cents on the bus that ran every 30 seconds around the corner. Walking was an interesting public health challenge as there were two ferocious intersections to be negotiated with nary a crosswalk. Pedestrians have the highest rates of traffic-related morbidity and mortality in the country, above both motor vehicles and motorcycles, and the round-a-bout the size of a circus tent that I had to run across daily was a living testament to these data. Motorcycle injuries and deaths come next on that list, and watching the lack of a requirement to even use a proper lane in traffic also made it easy to understand these statistics.
What is the point of these reflections? I have traveled to a number of diverse locations across the globe and have had a wonderful array of experiences. To live within a country for two months, however, offers a completely different perspective. You are no longer a tourist. You have a place to call home and a neighborhood that becomes familiar. Your computer wifi “remembers” the password at the local university library because you go there to study and take some evening language lessons. You spend 5 minutes trying to parse out the Spanish for “you didn’t give me enough change” at the farmers market because you’re not on vacation and you need that extra dollar to buy dinner. And you get to go back to that farmers market weekly and demonstrate your dedication to improving your language skills and to benefit from the encouragement of said farmers who appreciate not having to mime half a conversation. And you get to see data and statistics come to life. A young man was hit by a train and died in the early morning hours of a Saturday only three doors up from where I was staying. I found out this was a fairly common occurrence, but easily explainable by the complete lack of gates that block the road or lights that flash when a train approaches. Researching train-related morbidity and mortality would be incomplete without a visual of missing track barriers.
My project was to research a case study on alcohol policy in Costa Rica and develop a set of recommendations based on the findings. While much of this was dedicated to reading policy documents in Spanish and seeking out as many in-country data resources as possible, I was also able to immerse myself into the culture and experience it firsthand. What does alcohol advertising look like in the city? What types of brands really are available at the grocery store? The corner store? What does a night out at a dance club look like? These were invaluable in crafting the full story for my case study and created an understanding of the obstacles, boundaries, and building blocks that were truly available.
Mountain - Costa Rica is known for its lush vegetation and beautiful flowers, as seen here near Poás Volcano:
Edificio de Correos - The main post office in San Jose is a beautiful example of much of the architecture from the turn of the 19th century:
Monkey - White-faced capuchin monkeys can be seen in many areas around Costa Rica and are thoroughly unimpressed with their human observers:
AA-CR - "If you think you have problems with your drinking, here is your solution":
Street - This is a typical intersection with no traffic signals or pedestrian walkways. Traffic comes from three directions along with a train that cuts through several times an hour: