Dealing with two epidemics

As we emerge from COVID-19, effective action for preventing alcohol harms can be part of a new policy mix that helps businesses recover while not further compromising our health. It is challenging at the best of times to persuade governments to take action on the mostly hidden epidemic of alcohol-caused harm – an epidemic of equal or greater scale to COVID-19 in many developed countries. However, alcohol policies have mostly become more relaxed as governments have prioritised protecting businesses that sell alcohol e.g. by reducing liquor licence fees, extending hours, permitting home deliveries.

Alcohol-related businesses can be sustained in a post-pandemic world in ways that reduce rather than increase alcohol consumption and related harms. In many countries where alcohol sales have been classified as “essential” during COVID-19 lockdowns, consumption has increased. This has not only placed additional strain on health services, but increased risk of new infections e.g. by reducing social distancing.

Challenges to action on alcohol

Scientific evidence for effective policies that reduce alcohol harms has accumulated in recent decades. Higher prices, reduced availability and restrictions on marketing are key ingredients of effective action and are promoted by the World Health Organization. Unfortunately, as recently discussed elsewhere, challenges to getting policymakers’ attention include:

  • Low awareness of alcohol-caused harms, a situation perpetuated by the lack of health warnings in most countries. Only South Korea presently mandates alcohol cancer warnings.
  • Governments and international health bodies devote far fewer resources to alcohol-caused harm than tobacco or illicit drugs for example.
  • There is no international treaty on alcohol, again unlike tobacco or illicit drugs.
  • Alcohol industries command vast lobbying resources and are skilled at influencing hearts and minds.

The need for specific, actionable policies

There is growing evidence, however, that effective action is possible and strategies are available to encourage governments to take alcohol problems seriously.

Part of the problem we suggest lies with the public health community e.g. anti-cancer agencies collaborating with alcohol producers on breast cancer prevention campaigns, a practice known as “pink washing”.

Alcohol policy advocates have focused mostly on very general objectives (e.g. simple exhortations to raise prices and reduce availability) rather than specific policy actions.

The Canadian Alcohol Policy Evaluation (CAPE) project recently identified and assessed 250 specific indicators of effective government action on alcohol. For example, whether a comprehensive Minimum Unit Price (MUP) of at least CA$1.75 per standard drink was implemented. Or whether a government restricted the density of alcohol outlets below specific levels per 10,000 residents. CAPE gave Canada an overall failing grade (F) across 11 areas of effective alcohol policy.

However, nearly all the recommended best practices were found in at least one of the country’s 10 provinces and three territories. Had these policies been implemented consistently, Canada would have received high marks with an A grade. Some provinces and territories have been systematically working through the recommended, actionable policies to improve their grades before their next assessment.

Increasing awareness of alcohol harms

The public health community has tended to downgrade the importance of educational strategies for raising awareness of harms, worried this distracts from the need for directly effective policies. However, without such awareness there is limited appetite for these effective policies.

A recent Canadian study found that cancer warning labels on alcohol containers increased awareness of risks and support for effective policies while reducing consumption. The public health community has also often published substantial underestimates of alcohol-attributable harm. New free, web-based resources like the International Model for Alcohol Harms and Policies (See: www.InterMAHP.CISUR.ca) are now available to help researchers make more complete estimates. In Canada, for example we now know that close to 20,000 premature deaths per year are attributable to alcohol. For decades, however, health warnings on tobacco packets sold in Canada have falsely claimed there were only 1,900 deaths per year from alcohol versus 45,000 for tobacco.

Helping the alcohol industry make money selling less alcohol

The effectiveness of Scotland’s 2018 MUP (50p per unit or 8g ethanol) in reducing consumption and deaths has stimulated other countries to follow suit. MUP helps businesses make more money while selling less ethanol. MUP’s other virtues include reducing health inequalities by providing greater benefits for low-income communities. Additionally, a modest increase in alcohol taxes would complement the public-health effectiveness of MUP and ensure increased revenues, much needed at the present time.

We urge the public health community therefore to get behind calls for the implementation of a comprehensive MUP and restrictions on alcohol outlet density as part of “building back better”. These strategies would not only improve health outcomes but also reduce inequalities, protect health services and help create favourable conditions for some struggling businesses.

Written by Dr Tim Stockwell and Kate Vallance, Canadian Institute for Substance Use Research, University of Victoria

All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies