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“The demon drink” – social costs and social responses

Modest alcohol intake seems pretty harmless and maybe even does a bit of good healthwise. However last month's editorial (Gilmore and Sheron 2007) in the Christmas edition of the British Medical Journal drummed in points it's important to remember.

Ian Gilmore is President of the Royal College of Physicians and his co-author, Nick Sheron, is a specialist in liver diseases. In the editorial, they write "Alcohol causes major health problems - the Cabinet Office reported up to 150 000 hospital admissions and 15 000-22 000 deaths overall in 2003. Between 1991 and 2005, deaths directly attributed to alcohol almost doubled. More people are dying from alcohol related causes than from breast cancer, cervical cancer, and infection with methicillin resistant Staphylococcus aureus combined. Furthermore, the recent report from the World Cancer Research fund confirmed that even drinking alcohol within so called "safe limits" increases the risk of cancer of the breast and upper gastrointestinal tract." They go on to make the telling point "The turning point in a similar debate over tobacco control was the effect of passive smoking, yet damage to third parties from exposure to alcohol misuse is far greater. Drinking alcohol is a factor in more than half of violent crimes and a third of domestic violence. Between 780 000 and 1.3 million children are affected by their parents' use of alcohol - 30 to 60% of child protection cases and 23% of calls to the National Society for the Prevention of Cruelty to Children about child abuse or child neglect involved drunken adults. This seems justification enough for society to debate what reasonable and evidence based means could reduce the harm caused by alcohol."

The authors then state "Evidence on alcohol policy has been expertly reviewed for the Academy of Medical Sciences, the European Commission, and the World Health Organization (WHO). The findings were similar in each case-effective measures included increasing prices, controlling alcohol advertising, increasing the minimum age for buying alcohol, and restricting opportunities to buy alcohol. Others were specific measures to reduce drink driving, including lowering maximum blood alcohol concentrations to 0.5 g/l and increasing enforcement with random breath testing of drivers. Some of these specific measures have knock-on effects; French campaigns to enforce drink driving laws reduced wine consumption in restaurants by around 15%, and a combination of lower alcohol limits for drivers and vigorous enforcement in Australia showed wider health benefits. Modelling of these measures by WHO has shown that increasing the price of alcohol is the most effective and cost effective measure. Like any commodity the purchase of alcohol is price sensitive. Increasing prices has the biggest effect on the heaviest consumers and on young people, who spend a relatively high proportion of their income on alcohol. Between 1980 and 2003 the price of alcohol increased 24% more than prices generally, but disposable income increased by 91%, making alcohol 54% more affordable in 2003 than in 1980."

Of course it's crucial that we individually understand and make intelligent lifestyle choices for ourselves, if we want to dramatically increase our chances of leading full, vital, healthy lives. That's only one side of the coin though. The environment we live in (and partly construct) is also hugely important - and this includes the price, availability and legislation governing the sale of healthy and unhealthy foods and drinks.

Gilmore, I. and N. Sheron (2007). "Reducing the harms of alcohol in the UK." BMJ 335(7633): 1271-1272. [Free Full Text]
Alcohol Health Alliance UK www.rcplondon.ac.uk/alcoholalliance Accessed January 18, 2008
Drinkaware Trust. http://www.drinkawaretrust.org.uk/ Accessed January 18, 2008.

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