Alcohol, health, the social licence of drinking and neo-prohibitionism – an important topic for the wine trade to engage with
How much can you drink without damaging your health? Is there a safe level of drinking? Are government guidelines on alcohol consumption based on good evidence? Is wine in danger of a much stricter legislative environment in light of public health authorities trying to make it the new tobacco?
These questions have been in the news again of late as the Canadian Centre on Substance Abuse and Addiction (CSSA) recommended that Canadians should limit their consumption of alcohol to two drinks or fewer per week. This is much lower than previous recommendations and a lot lower than guidelines in other countries. But Canada isn’t alone in changing its recommendations: in 2016 the UK issued new guidelines, taking the recommended weekly units down from 21 for men and 14 for women, to 14 for both. And the message that was issued alongside this was that there was no safe level of alcohol consumption.
I’m old enough to remember people smoking in bars, restaurants and even on planes. Now of course, no one smokes on planes. It just seems a stupid idea. No one smokes in bars. No one smokes in the office. Advertising of smoking is severely restricted in many countries, and the display of cigarettes at point-of-sale is also commonly banned. This is a massive societal change, and from the perspective of me, as a non-smoker, it’s brilliant. Society has quite rightly become very anti-smoking, because there is no safe level of smoking, and if you smoke close by other people you inflict your smoke on them.
Worryingly, though, society has also become somewhat anti-drinking, too. This change is not as dramatic, but for those of us in the wine trade, it’s certainly something we should be concerned about. One argument in favour of treating drinking differently than tobacco is that there is a safe level of consumption, whereas any level of smoking is hazardous. This distinction is one that is now being disregarded in the UK and Canada by public health authorities. They are now saying that any level of drinking carries with it risk. Many in the public health sector would like to do to alcohol what they have done to tobacco, and one way to do this is to spread the message that any level of drinking is harmful.
There is no doubt that alcohol consumption can be problematic, and that’s why there have often been calls to ban it. The Institute of Alcohol Studies published a report in 2015 titled Alcohol’s Harm to Others. This is a quote from it:
‘In the UK, the cost of alcohol’s harm to others was estimated in 2004 at up to £15.4 billion including £1.4-1.7 billion to the health service, up to £7.3 billion in crime and public disorder costs and up to £6.4 billion in workplace related costs. Further, there are costs to family and social networks that cannot be quantified using available data, for example the cost to children affected by parental alcohol problems. More recent figures calculated for the European Union place the societal costs of alcohol consumption in 2010 at € 155.8 billion (£115.4 billion).’
To governments in western nations, figures like this mean that the appeal of restricting alcohol availability through higher taxation, or limiting retailing or advertising, is irresistible. And even prohibition becomes attractive. Back in 1919 the USA instituted prohibition, banning the sale of alcohol and its commercial production. That experiment didn’t end well and prohibition was repealed in 1933. Yet still there is a strong anti-alcohol movement: public health authorities in many countries have booze in their sights.
The big question here is whether there is a safe or even a healthful level of alcohol consumption, and to the annoyance of public health officials, it looks like there is.
There are many studies looking at alcohol consumption and the risk of various diseases, as well as the risk of mortality. The problem here is that it is very difficult to do these studies. The outcomes are often many years away from any exposure and there are lots of confounders. Also, and this is a significant issue, alcohol consumption is based on self-report. If I am a medical person and I ask you how much you drink, it’s hard for you to give an accurate answer. For a start, no one measures their consumption: they estimate it. And no one keeps a record from day to day of how much they drink. Importantly, people either lie (they are slightly embarrassed about how much they drink) or they unintentionally underestimate their consumption.
Confounders in studies on alcohol and health include factors like socioeconomic status (rich people tend to be healthier than poor people, for all sorts of reasons), diet, exercise and smoking status (drinkers are more likely to smoke it seems, and in some countries smoking is much more prevalent than others). All these factors need to be controlled in some way or they will skew the results.
Consistently, though, studies have shown a J-shaped curve when mortality is plotted against drinking. Teetotallers die earlier than moderate drinkers, and moderate drinkers live longer than heavy drinkers. This suggests that there is a healthy level of drinking, and that there’s something about drinking (and some studies suggest wine is more healthful than other drinks) that is protective to some degree. Risk of cancer goes up at higher drinking levels, as does risk of accidents, and then at higher levels there are problems like cardiomyopathy. But drinking seems to protect against cardiovascular disease even at relatively high levels of consumption. Some critics have suggested that this J-shaped curve is an artefact of the control group, and that some of the non-drinkers stopped drinking because of health problems – the so-called ‘sick quitters’. But change this control group to never-drinkers rather than teetotallers and you solve this problem, and the J-shaped curve is still there.
The evidence that alcohol might have some protective effect is reinforced by studies looking at biomarkers of cardiovascular disease. While you can’t lock humans away for 10 years and control their alcohol drinking to measure precisely the effects it is having, you can enroll people in short-term studies where you look at the effect of drinking on biomarkers that are associated with various disease outcomes, and moderate drinking influences many of these in a beneficial way. This also raises the issue of drinking advice being tailored for different population groups. For young men, the risks from alcohol are quite high and there are few health benefits because they aren’t at risk of cardiovascular disease. For men over 40, the advice might be quite different, because their risk of cardiovascular disease is much higher. Women also get some benefit when they are over 40, but because their risk of cardiovascular disease is lower generally, this is less pronounced.
Then there’s the question of safe consumption levels. This is complicated, because all the studies are done on self-report, so it’s likely that the safe level is higher than studies indicate (although, of course, we can’t be sure of this). This is where we run into the problem of risk assessment, something which people are really bad at. We tend to fear things that are actually very safe (flying, for example) and not afraid enough of things that are very risky (like cycling or driving a car). Add to this, the confusion between relative risk and absolute risk. Both need to be known for us to make a sensible decision, but public health officials often just mention the relative risk.
Take shark attacks. They are very, very rare, so your absolute risk of dying from a shark attack is tiny. Perhaps 1 in 30 million. But if you take up surfing your relative risk of being munched by a shark might be 70%. This doesn’t mean that you are likely to be attacked by a shark, just that as a surfer you are more often in the ocean, and a bit further out, so you are substantially more likely to be shark bait (70% sounds alarming), but because the absolute risk is so tiny it’s still nothing to be too concerned about.
Public health authorities make their recommendations based on relative risk, so the devil is in the details: what level of relative risk are they choosing? This is something most people don’t understand, and they accept the recommendations without questioning this choice. The end result is recommendations that might be needlessly cautious (because of, for example, an anti-alcohol agenda), which then scare people about their drinking even if it is perfectly healthy, and these recommendations end up driving legislation. It’s potentially a big problem for the wine industry, and it’s very hard to fight back because wine producers and retailers have a horse in this race, and there’s no denying that alcohol abuse is a societal problem.
Ultimately, though, the answer to abuse is not dis-use, but correct use. Many people derive joy and pleasure from modest drinking at a level that is unlikely to cause any health problems, and which might even be protective. Wine is a beautiful cultural treasure that has stood at the heart of many societies for millennia and is full of all the right sorts of traditions. We should be very wary of those who would like to take this pleasure away from us, even if they are well meaning.
And a big shout-out to Felicity Carter for speaking out regarding this issue
