Hong Kong Alcohol Control Legislation Essay

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Identifies the details of policies by using the Health
Policy Triangle Analysis
Identifies the effectiveness and influence of the policies
to different social levels by using the Social Model of

Society have noticed the seriousness of teenage
drinking problem
→ Suggest to have a strict law on the sale of alcoholic

In 30 Nov 2018, the “Dutiable Commodities
Ordinance (Cap. 109) and the Dutiable Commodities
(Liquor) Regulations (Cap.109B)” was carried out
→ to prohibit the sale and supply of intoxicating
liquor to minors (which aged under 18 years) in the
course of business
→ Reduce the chance of teenager buying alcoholic
According to the observations of youth workers in Hong Kong,
the consumption of alcohol is increasing among young people.
Concurrently, data from the Tuen Mun Alcohol Problems Clinic
shows that nearly 80% of patients start drinking before they
reach the age of 20.
Doctors point out that youth alcoholism receives little or no initial
attention, resulting in the fact that many patients only seek
medical help after they have already developed severe physical
and social problems.
In spite of this being a problem with profound implications, there
are few surveys on the prevalence of drinking habits among
youth in Hong Kong.
Situational factors
Structural factors

HKSAR Government
Tobacco and Alcohol Control
Office, Department of Health
Relevant business sectors
• The Proposer of the policy
• Making the main decisions
on the policy
Tobacco and Alcohol Control
Office(Department of
• The Executer of the policy
• Patrol the shops where are
selling alcohol products
• Prosecute offenders
Alcoholic drink supplier
• Affected by the policy
• Targeted group
Situational factors
• The underage drinking is more prevalent
• According to The Legislative Council, 3.4% of Primary
4 students and 12.1% of Secondary 6 students had at
least one experience of binge-drinking
• Moreover, 1.2% of Primary 4 students and 2% of
Secondary 6 students were reported to have binge
drinking as a monthly habit
Structural factors
• Increased demand for alcohol abstinence services
• lead to increasing the burden on Hong Kong’s medical
system in the future
Cultural factors
• Seeking to enjoy
• Socializing
• Relieving stress
▪ The influence of factors from different levels
on Teenagers’ Health
Before implementing the policy:
• The teenagers drinking:
• Trying new things due to curiosity
• Want to relax due to stress
After implementing the policy:
• Prohibit the underage buy the alcoholic
• That’s mean the opportunity for underage
to buy alcoholic drink will reduce
• Result: Effective to reduce the opportunity
of teenagers to buy alcoholic drinks
Before implementing the policy:
• The teenagers drinking due to:
• Peer influence
• Family influence
• Gain acceptance from the friends or
After implementing the policy:
• Prohibit the underage buy the alcoholic
• Effectively prevent teenagers drinking
because of peer influence,
• but difficult to prevent teenagers drinking
because of family influence
• Result: Partially effective in protecting the
health of Teenagers
Before implementing the policy:
• The teenagers drinking due to
• Academic pressure
After implementing the policy:
• Prohibit the underage buy the
alcoholic drink
• Seek for other healthy ways to release
pressure (eg. Doing sports, listening
music etc.)
• Result: Effective to protect the health
of teenagers
Before implementing the policy:
• Alcoholic drink is profitable lead to large
demand of alcoholic drink
• The import of alcoholic drink increase,
• The accessibility to alcoholic drink increase,
• That’s mean the teenagers are easy to buy
After implementing the policy:
• The policy cannot reduce the import of
alcoholic drink
• Result: The policy is not effective in this
▪ This policy is effective to reduce the opportunity
of teenagers to buy alcoholic drinking and
protect their health in
▪ Individual lifestyle factors
▪ Social and community influences
▪ Living and working conditions
▪ Exclude General socioeconomic, culture
and environmental conditions
APSS 4522 Health Policy
Lecture 5 & 6: Health policy making
Dr Judy Siu
Associate Professor
Department of Applied Social Sciences
Faculty of Health and Social Sciences
Policy making process
• Step 1: agenda setting
• What is policy agenda?
– “List of issues to which an organization, usually the government, is
giving serious attention at any one time with a view to taking some sort
of action” (Buse et al., 2012).
• Why the policy agenda is formed?
– Situational factors
~ eg. Infectious disease outbreak, MTR fire incident
– International factors
~ eg. pandemic
– Structural factors
~ eg. Health care system, taxation system

Stakeholders of agenda setting:


Public health care sector

Private health care sector

Mass media
~ information transmission
~ socialization
~ generating mass belief in dominating political economy
~ propaganda
→ media under the influence of political system: state-owned, high censorship, independent
→ media under the influence of commercial companies: eg. pharmaceutical companies

Interest groups
Models of agenda setting
• 1. Hall et al. Model (1975)
– Legitimacy
~ issues with which governments believe they have a right or obligation to intervene
~ what can justify legitimacy?
– Feasibility
~ potential of policy implementation, eg. Have enough capability, knowledge, resources, manpower,
– Support
~ support from public and key interest groups
→ High legitimacy + high feasibility + high support = higher policy agenda
• 2. Kingdon’s Policy Stream Model (2010)
– Problem stream
~ perceptions of problems as public matters requiring government action, eg. Public health emergency
– Policy stream
~ ongoing analyses of problems, proposed solutions, debates and responses of the problems
~ range of possibilities is explored, and progressively narrowed down
~ technically feasible and consistent with social values
– Political stream
~ persons involved in politics and the political environment
→ When the three streams meet (policy window), the issue is more likely to be taken seriously by policymakers
Shiffman and Smith Framework of health
policy priority (2007)
Actor power
Factors shaping policy priority
The strength of the individuals and organizations concerned
with the issue
Policy community cohesion: individual network and
Leadership: the presence of individuals capable of uniting the
policy community
Guiding institutions: effectiveness of coordinating mechanisms
Civil society mobilization: the mobilization of grassroots
The ways in which those involved with the issue understand and
portray it
Internal frame: how much the policy community agrees on the
definitions, causes, and solutions of the problem
External frame: public portrayals of the issue
Issue characteristics
Features of the problem
Credible indicators: clear measures that show the severity of the
problem and that can be used to monitor progress
Severity: the severity of the burden relative to other problems
Effective interventions: interventions to the problem as cost
effective, simple and inexpensive to implement
Political context
Support or not?
Policy window: political moments align favorably for an issue,
giving opportunities for advocates to influence decision makers
Global governance structure: the degree to which norms and
institutions operating in a sector provide a platform for effective
collective action
• Social impact assessment (SIA)
~ includes the processes of analyzing, monitoring and managing the
intended and unintended social consequences, both positive and
negative, of planned interventions (policies, programs, plans, projects)
and any social change processes invoked by those interventions. Its
primary purpose is to bring about a more sustainable and equitable
biophysical and human environment (International Association for
Impact Assessment)
• Health impact assessment (HIA)
Policy research

1. selecting and defining the problem
– aims and objectives
– literature review
– identify variables
– theoretical framework
– formulate research questions

2. selecting research design
– research design, sampling

3. methods
– data collection and analysis

4. data analysis
– findings

5. research utilization
– findings dissemination
– research into practice
– evaluate changes if any
• Step 2: Support building
– Targets for support building:
~ government departments
~ private sector
~ interest groups
1. Government:

Political parties
2. Interest groups
– Outside government
– Pressure groups – involve more in policy (eg. SoCO – Society for Community Organization)
– Civil society groups, such as NGOs
~ may or may not influence policy
– Sectional groups
~ has a productive role in economy → more bargaining power in government policy; eg. HKMA,
~ aim at protecting and enhancing the interests of members (producers)
– Cause groups
~ aim at protecting the interests of service-users
~ eg. Patient self-help groups
• What kinds of interest groups are more powerful in the policy making?
– Depending on social ideology of the government
~ capitalist ideology: business interest groups, followed by labour interest
→How about in the health care policy making? What interest groups are
more powerful in influencing government policy?
– mostly follow the social ideology in understanding hierarchy of the health
care field
3. Private sector:
– Private health care
– Pharmaceutical companies
• Step 3: Policy formulation
– Two approaches:
~ rational: define the problem, identify social values aligned with the
policy goals, cost and benefit analysis, compare and contrast options, select
the most suitable policy
~ incremental: begins with status quo, alter the current policy through a
series of incremental changes in relation to the expressed desire.
→ Drafting policy proposals
• Step 4: Policy implementation
• 1. “Top-down” approach: Buse et al., (2005) citing Sabatier & Mazmanan (1979)

Clear and logically established objectives
Evidence to support the proposed policy can lead to expected outcome
Implementation process that enhances compliance by implementers (incentives and sanctions)
Sufficient administrative and legislative support
Sufficient resources
Clear communication
Support from public, interest groups, government departments (legislative and executive)
Stable socioeconomic conditions
• Central government decision
• From top-down, start at government
• Highly rational process, from problem identification to policy formulation at high
levels, and implement at low levels
• Evaluation based on the extent of attainment of formal objectives, not the
unintended consequences
• Design the system to achieve what central/top policy makers intend, focusing on
structure and management
• 2. “Bottom-up” approach
– Power of “street-level bureaucrats” (Lipsky 1980):
~ front-line staff has the power to reshape policy for their own needs
~ particularly valid for highly professional-skilled staff
• Local implementation actors and networks of relationship
• From bottom-up, can include government and non-government actors
• Interactive process involving policy makers and implementers from various levels of government and outside
• Policy may change during implementation
• Implementers as active participants in policy making
• Implementation process takes account of local voices
• Strategic interaction among multiple actors, focus on culture and relationship between actors

Step 5: Policy evaluation and revision
– Evaluation by research

Able to meet aims and objectives?

Any implementation gap?

Evidence-based policy?

Methods used:
~ quantitative
~ qualitative
→ Is the policy worth continuing, or require modification, or abandonment?
→ Knowledge transfer possibility?
→ Research for policy
• Policy analysis
– Structure, process, outcome (Donabedian 1996)
~ inputs: resources
~ process: activities, measures taken (step 1 – step 4)
~ outcome: short-term, long-term
– Policy output
– Policy impact / effectiveness
– Policy efficiency
• Buse et al. (2012). Chapters 4, 6, 7, 9. Making Health Policy. Open
University Press.
• Porche D.J. (2012). Chapter 9. Health Policy: Application for Nurses
and other Healthcare Professionals. Sudbury, MA: Jones and Barlett

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