Toronto, September 29, 2014 - Dr. Jürgen Rehm is the director of the CAMH Institute for Mental Health Policy Research. He is also co-author of the just released World Health Organization report on trends in alcohol consumption and attributable mortality in Europe between 1990–2014. We spoke to him about the WHO report and its implications for public policy around the world.
Q: Why is the study of alcohol and its effects in the WHO European Region important?
A: Over the past decades, WHO European Region has been the region of the world with the highest alcohol consumption. Alcohol consumption is not only one of the four major risk factors for non-communicable diseases (such as cardiovascular disease, cancer and gastrointestinal disease), but also linked to infectious diseases and all sorts of injuries.
Q: The level of alcohol consumption seems to have decreased in Europe. Is it still a problem?
A: Even though there had been an overall decrease in the level of alcohol consumption in the last 25 years, alcohol-attributable mortality increased slightly. This was in part, because some of the highest consuming countries increased their level of alcohol consumption, and in part, because countries with pronounced binge drinking habits neither decreased their consumption nor showed any signs of changing their pattern of drinking. Overall, alcohol consumption still is a major health problem in Europe.
Q: Is alcohol consumption really causing cancer?
A: Alcohol has been clearly established as a carcinogenic substance, and there are clear established biological pathways which explain how alcohol can cause various cancers. This refers mainly to body parts and organs touched by alcohol: the mouth, larynx, pharynx, esophagus, liver, colon and rectum. Level of consumption as small a one drink per day has been shown to significantly increase the risk of certain cancers such as breast cancer.
Q: What about injury fatality rates?
A: Overall, injury fatality rates in the Europe are among the highest in the world, and alcohol consumption plays a major role here. This is true for intentional and unintentional injury. The high rates of alcohol-attributable injury are not tolerable as there are good policies to reduce these injuries, including specific programs such as to reduce drunk driving or to prevent alcohol-attributable injuries at the workplace.
Q: What are the main policy conclusions from the study?
A: Policies should be put in place to reduce the level of alcohol consumption, and consequently alcohol-attributable harm. This is especially true for Europe, where consumption is the highest in the world. The WHO has indicated effective and cost-effective ways to reduce alcohol-attributable burden of disease (i.e., morbidity, disability and mortality), which are unfortunately not very popular with many governments: increasing taxation and thus the price on alcohol, a ban of advertisement and marketing, or a reduction of availability. The truth is that alcohol has become more available and relatively cheaper over the past decades in almost all countries of the WHO European Region, especially when compared to average salaries and available income.
Given this situation, alcohol policies may have to become more creative in finding other ways to reduce alcohol-attributable harm. Minimal pricing policies seems to be an instrument, which could work; increasing situational abstinence for operating any machinery another; and reducing the alcoholic strength of beverages may be another tool. Finally, increasing health care interventions for heavy drinking and alcohol use disorders have been clearly shown to reduce consumption and harm. All alcohol policies should be carefully evaluated to measure if they are indeed associated with the intended effects.
In sum, any alcohol policy needs to show that it can reduce alcohol-attributable harm.