In December 2012, the medical journal The Lancet released The Global Burden of Disease Study 2010 (GBD 2010). Supported by the Bill & Melinda Gates Foundation, this collection of groundbreaking research studies will help sharpen the global health and policy communities’ awareness of trends in disease, injury, and risk.
The consumption of alcohol is among the top three global risk factors for disease, along with blood pressure and tobacco. CAMH scientists have made significant contributions to GBD 2010, especially in the areas of alcohol use disorder, fetal alcohol syndrome, and the comparative risk assessment for alcohol.
This Q&A with Dr. Jürgen Rehm, Director of Social and Epidemiological Research at CAMH, explains the many health risks associated with heavy drinking and how we can reduce the negative impact alcohol can have on our health.
1. What are the current trends in alcohol consumption around the world? In Canada?
Overall, alcohol consumption rates are lowest in Northern Africa and highest in Eastern Europe. As you might expect, the countries with the highest consumption rates also experience the most harm. In Russia, where per capita consumption is almost 2.5 times the global average, about 20 per cent of male deaths can be attributed to alcohol.
Canada’s per capita consumption is about 1.5 times the global average, similar to other high income countries in Europe and North America. Nationally, alcohol accounts for about seven per cent of deaths among people aged 69 and under. In 2011, the Canadian Centre on Substance Abuse released Canada’s Low-Risk Alcohol Drinking Guidelines to help reduce health risks associated with heavy drinking.
2. Why should we be concerned about alcohol consumption? Compared to other substances, is it really that dangerous?
Alcohol use and misuse is linked to more than 300 different diseases, including various forms of cancer. It is most implicated in cirrhosis of the liver, which is one of the top causes of premature death in Canada. Though alcohol use, especially heavy use, contributes to serious illness, the risks are not all related to disease. Drinking alcohol also increases the risk of death or disability by injury; the higher the blood alcohol level, the more our judgment is impaired and the more likely we are to engage in risky and potentially harmful behaviour; with no lower threshold.
Let’s look at research from Lithuania, a one of the less wealthy member states of the European Union with the highest rate of alcohol use disorders. Most Lithuanian men do not make it to age 64. Many die prematurely due to injury, and the research indicates that a significant number of these injuries happen when too much alcohol is consumed.
During the recent global recession, Lithuania was hit quite hard and the purchasing power of its citizens tumbled by nearly 20 per cent. With this drop, the sale and consumption of alcohol also decreased. During this time, the life expectancy of Lithuanian men actually increased by about four to five years.
Closer to home, there is research looking at the role heavy drinking may play in deaths by suicide. CAMH’s Dr. Norman Giesbrecht is part of a U.S. study that shows a substantial portion of adults who die by suicide are intoxicated at the time of death. Drawing from records of almost 58,000 people over nine years, the research team reported that as many as 30 per cent of men aged 25 to 44 who have died by suicide were legally intoxicated at the time of death.
3. Why is it important to look at alcohol consumption at a global level, as in the Lancet Global Burden of Disease Study?
A global perspective on the impact of alcohol on human health is important for a number of reasons. While the production and sale of beer and spirits is a global industry, the social burden created by alcohol is severe in low- and middle-income countries, with middle-income countries facing the most difficulty. Global studies show that when a country’s population starts to move from low to middle income levels, the rate of alcohol consumption also increases.
Most of these countries struggle to put policies in place fast enough to keep up with the pace of change in income and the corresponding increase in alcohol consumption. So, per liter, alcohol is causing more harm in countries without policies when compared to countries with certain policies in place, like Canada. By working at a global level, we can share current knowledge about the harm related to alcohol and the effectiveness of policies in reducing this harm.
4. In Canada, who is most negatively impacted by alcohol misuse?
There are three groups that are most negatively impacted by alcohol in Canada: men, low-income Canadians and aboriginal communities. Research shows that men are more negatively impacted than women because they drinks more, they are more likely to drink excessively (i.e., have more binge-drinking occasions) and they engage in riskier behaviour, and in combination with alcohol this leads to considerable harm.
Overall, low-income Canadians have several the risk associated with alcohol in comparison to those with higher incomes. This is because if people are already struggling to support their daily living or are food insecure, misuse of alcohol has a more immediate impact on living conditions and health.
In aboriginal communities we see high rates of binge drinking. This increases the rate of death or disability by injury or by violence.
5. In Ontario we’ve been hearing a lot about the possibility of selling alcohol in convenience stores. What kind of health impact might this have?
If alcohol is made available for sale in local convenience stores, there will certainly be negative consequences on the health of Ontarians at an individual and a public level. The exact degree of harm depends on the conditions under which this change might happen. Research tells us that selling alcohol in convenience stores will increase density of alcohol outlets and consequently will increase how much people drink. Even if the dollar price of a six pack of beer is the same in the corner store as it is in the LCBO, the fact that people will not have to make a special trip to purchase the beer reduces the overall cost. So, the convenience of getting alcohol should be factored into how we evaluate the idea of cost.
When alcohol becomes more easily available, there is also a negative impact on communities beyond the risks to individual health through injury and disease. For example, studies in the U.S. indicate that in communities with a high density of alcohol outlets there was a corresponding increase in street violence. Local residents in California therefore lobbied for change in the zoning by-laws to decrease the quantity of stores that could sell alcohol in a particular neighbourhood. After the by-laws were changed, there was a decrease in violence and problems in the streets.
6. What is the single most effective way for a jurisdiction like Ontario to reduce alcohol misuse?
Currently, the most effective approach is to increase minimum prices on beverage alcohol. We have a good sense of the outcomes of minimum pricing policies because almost all jurisdictions in Canada have implemented them. Minimum pricing policies are also a good option because they can be rolled out and enforced with relatively little public expense and can in fact increase government revenues. They are also better supported by the public than taxation increases.
It has been shown, that minimum pricing especially affects heavy drinkers, thus increasing health and life expectancy for the most vulnerable.