Global Strategy to Deal With Alcohol's Dark Side

Andy Coghlan

Humanity's relationship with alcohol has never been easy. Now it's about to undergo as great a change as our attitude toward tobacco, which has led to a huge decrease in smoking from the height of cool to the lowest of unpleasant habits.

That at least is the hope of the World Health Organization, which, between now and January, will be honing its draft of the first global strategy on reducing health damage from alcohol abuse, the fifth leading cause of premature death and disability worldwide.

Unveiled in October in Geneva, Switzerland, the document is the culmination of talks between representatives from the WHO's 193 member states.

"It is a landmark document," says Peter Anderson, a health consultant and adviser on alcohol to the WHO and the European Union.

Member states will be invited to ratify the finalized version of the document at the meeting of the World Health Assembly in May, 2010, but the document will not be legally binding. Its purpose instead is to raise awareness among governments about the importance of reducing alcohol abuse and to provide data that will persuade electorates that new laws are required -- thereby emboldening governments to take action. The document will also present a menu of legal and governmental strategies that have been shown to work.

"It will provide knowledge and awareness about the size of the problem, and advice about the most cost-effective policies," says Anderson.

The impetus for action is founded on the growing realization that alcohol doesn't just harm those who drink, combined with a better knowledge of intervention strategies. For example, in March, the UK government's chief medical officer, Liam Donaldson, devoted a chapter of his 2008 annual report to "passive drinking," the damage that heavy drinkers wreak on others.

To illustrate the extent of the problem in the United Kingdom, he reported that in 2008, there were 125,000 "alcohol-related instances of domestic violence," that an estimated 6,000 babies are born annually with fetal alcohol syndrome and that in 2006, 7,000 people were injured and 560 killed as a result of drink-driving, not including the drivers.

Sally Casswell of Massey University in Auckland, New Zealand, who helped produce the WHO document, says a focus on passive drinking is key to winning public acceptance for more stringent alcohol legislation.

"It challenges the neo-liberal ideology which promotes the drinker's freedom to choose his or her own behavior," she says.

Persuading governments and citizens of the problem is just the first step, though. What, if anything, can be done to stop people drinking to excess?

To some extent, strategies will depend on location. In rich countries, for example, the focus is likely to be on stopping young people from binge drinking, whereas introducing drink-driving laws may be a priority in rapidly developing countries, where newly acquired wealth is increasing ownership of cars and access to alcohol.

Generally, however, the WHO says the most effective measures are to raise prices through heavy taxation based on alcohol content, and to reduce the availability of alcohol through strict licensing schemes limiting opening times and the number of outlets.

Such strategies may smack of overactive government, but recent findings suggest these measures work. Alex Wagenaar of the University of Florida, Gainesville, and colleagues reviewed 112 studies examining the effects of price and tax on alcohol consumption and found that, on average, a 10 percent increase in the price of beer reduced consumption by 5 percent, of wine by 7 percent and spirits by 8 percent (Addiction).

From another study, in which Wagenaar's team surveyed 800 students leaving a campus bar over four nights, and took breath alcohol readings, the researchers calculated that each 10-cent increase in the cost of a drink, per gram of ethanol, was associated with a 30 percent decrease in the chance that students would leave the bar drunk (Alcoholism: Clinical and Experimental Research).

Meanwhile, at the behest of the Scottish government, Petra Meier of the University of Sheffield, UK, used Scottish data on levels of alcohol consumption and the prices paid by different people for different types of drink to calculate the social effects of introducing minimum prices on alcohol.

She estimates that setting the minimum price at 40 pence per unit of alcohol (a small glass of wine or half a pint of beer), which is still at least twice as expensive as the cheapest alcohol available in Scotland, could save the nation 950 million pounds in healthcare and policing costs over 10 years, and avoid 3,600 hospital admissions and 1100 criminal offences each year.

As for light drinkers who complain they would be unfairly set back by price increases, Meier claims that a 40-pence minimum would hit heaviest drinkers hardest, as they often drink the cheapest booze, costing them 137 extra pounds per year compared with just 11 extra pounds for a moderate drinker.

Of course, taxing booze and restricting its availability are not new ideas and such strategies are already deployed to some extent in most developed countries. But the WHO document argues that many countries don't implement them effectively.

In the United States and the United Kingdom, despite taxes that are heavier than on many other products, alcoholic drinks are still cheaper relative to income, and more widely available today than ever before. This is likely due to government fears of a consumer backlash, huge tax revenues from alcohol, and pressure from the industry to avoid anti-drinking legislation. Meanwhile, poorer countries often don't have any regulations at all.

Predictably, the alcohol industry is not happy with the WHO's focus on reducing consumption through pricing, availability and marketing. It also argues that government intervention isn't the only way to solve the problem.

"Other parties, including industry, can play a role," says Marcus Grant of the International Center for Alcohol Policies, a think tank funded by the alcohol industry, in Washington, D.C.

He cites a collaboration in Kenya to overcome poisoning caused by cheap bootleg beer in which an African brewery produced a safer rival, and the Kenyan government agreed to lift tax on it. The ICAP is publishing a book called "Working Together to Reduce Harmful Drinking" this month (November), co-edited by Grant, that includes a pledge to "take into account" the potential health impacts of products such as alcopops, which appeal to the young, and promotions such as happy hours. Another is to adhere to responsible marketing policies that are monitored by independent consultants.

Others are skeptical of the industry's contribution to the debate. Robin Room of the University of Melbourne, Australia, who studies the legislation on recreational drugs, fears that some parts of the WHO document may already have been watered down to appease the industry, especially those seeking to restrict marketing.

Anderson warns against this: "Price and availability are still the most effective strategies to reduce consumption, but the other thing is marketing, creating a social climate around drinking through sports sponsorship and movies. That has a powerful impact."

Anderson is still optimistic, though. "I don't think alcohol will ever become as socially unacceptable as tobacco use, but societies may adopt a more cautious approach to its supply and marketing, resulting in less harm."

HEALTH & WELLNESS ...

World Health Organization Drafts Global Strategy to Deal With Alcohol's Dark Side