government
monopolies for off-premises alcohol sales to
allow sales by privately owned enterprises. In the U.S.
and Canada, privatization occurs at the state or provincial
level; in many European nations, privatization may
occur at a national level, currently guided by policies of
the European Union. In the U.S., one alcoholic beverage
may be privatized at a time; for example, wine
might be privatized (i.e., subsequently for sale in commercial
settings) while spirits may not be privatized, or
may be privatized at a different time. Typically, privatization
results not only in a substantial increase in the
number of outlets where alcohol can be purchased but
also in changes in alcohol price, days and hours of sale,
and marketing.21,34 This combination of events limits
the ability to attribute subsequent changes in alcohol
consumption and related harms to changes in outlet
density alone. Nonetheless, because of the impact
privatization generally has on outlet density, the team
concluded that privatization studies were relevant for
assessing the impact of changes in outlet density on
excessive alcohol consumption and related harms.