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Public health sector warned against mixing alcohol with tobacco

Recent Croakey posts have drawn attention to the similarities between the tobacco and alcohol industries’ corporate strategies.

Health policy consultant Jennifer Doggett doesn’t think these comparisons are particularly useful for formulating policy responses. She writes:

“The tactics being used by public health advocates to paint a picture of the tobacco and alcohol industries (and perhaps also the fast food industry) as a public health axis of evil could easily backfire if taken seriously by government.

In fact, comparing the ‘tactics’ of the alcohol and tobacco industries in combating public health measures is irrelevant to developing a policy response to these two substances. This is because it ignores the very different risk profiles of alcohol and tobacco – a critical factor in developing effective harm minimisation strategies.

For example, any credible policy response to the health problems associated with risky alcohol use must deal with the fact that – unlike tobacco – alcohol can have both positive and negative impacts on health.

Put simply, while some forms of alcohol use are undeniably risky, people who drink at low levels live longer than those who don’t drink at all.  In 2003, according to the Australian Institute of Health and Welfare (AIHW), 3430 deaths were caused by alcohol use and 2346 were prevented. (AIHW The burden of disease and injury in Australia 2003)

There is a large body of research showing that low to moderate alcohol use confers health benefits to many groups in the community. Here are two recent examples:

The Atherosceloris Risk in Communities study is a 10 year project following over 7 697 people between the ages of 45 and 64 and focussing on factors affecting cardiovascular health. The study authors concluded after four years ….”a substantial cardiovascular benefit from adopting moderate alcohol drinking in middle age appears supported by the current study”. (King D E, Arch G. Mainous A G, Geesey M E Adopting moderate alcohol consumption in middle-age: subsequent cardiovascular events The American Journal of Medicine 2008 121)

The Australian Longitudinal Study on Women’s Health is a large scale survey of over 12 000 women aged 70 and older. In its 2007 report it found that…. “Being a non-drinker of alcohol was associated with greater risk of death and poorer health-related quality of life. Results for other levels of intake were consistent with current Australian alcohol consumption recommendations for women and indicated that moderate alcohol intake may carry some health benefits for older women in terms of survival and quality of life”. (Byles JE, Young AF, Furuya H & Parkinson L. A drink to healthy ageing: The association between older women’s use of alcohol and their health-related quality of life. Journal of American Geriatric Society, 2006 54(9))

The risks associated with alcohol are also much more dependant upon circumstances and environment than those associated with tobacco. The person drinking a couple of glasses of scotch occasionally at home is at much less risk of harm than the person drinking the same amount of alcohol when out and behind the wheel of a car.

If tobacco-control measures – such as health warnings – were to be applied to alcohol products they would need to take this research into account in order to accurately inform consumers of the health risks and benefits of alcohol consumption.

In that case we could expect to see such messages as “Moderate consumption of alcohol can reduce your risk of heart attack and stroke” or “Abstaining from alcohol can reduce your quality of life” or even “Over 70? Drinking alcohol in moderation can help you live longer” on the labels of alcohol products.

If this prospect makes public health advocates nervous, they should carefully consider their tactic of putting alcohol in bed with tobacco and arguing for the transfer of health and regulatory polices from one substance to another.

It is undeniable that alcohol misuse causes serious health and social problems. However, risky alcohol use is a complex behaviour that requires its own complex policy response, not a hand-me-down suite of policies from a very different substance area.

Everybody loves a battle between good and evil but demonising alcohol producers and retailers for promoting their products will not assist in developing the targeted and evidenced-based strategies required to minimise alcohol-related harms in our community.”

Disclaimer: Jennifer Doggett has previously worked for government in developing alcohol policies, on public health alcohol harm minimisation campaigns and for alcohol industry bodies.

Post Script from Croakey: My own view on the often-promoted health benefits of alcohol is that they tend to be over-stated and don’t take account of the broader social costs, or are based on observational studies with so many confounders that it is impossible to draw any conclusions about cause and effect.

Who can forget the observational studies which led us so astray by suggesting health benefits from antioxidants, or cardiovascular protection from hormone replacement therapy? For those interested in these matters, Drug and Alcohol Review published a paper last year, titled A healthy dose of scepticism: Four good reasons to think again about protective effects of alcohol on coronary heart disease. (The lead author, Tanya Chikritzhs, is one of the contributors to the new paper on the shared tactics of tobacco and alcohol industries.)

And of course, one reason we’ve heard so much about the “health benefits of alcohol” is that many of the studies hitting the headlines have been funded and promoted by the industry. I’ve always thought too that there might be an interesting analysis to be done on the number of doctors with vineyards…

Comments 6

  1. Gavin Mooney says:

    Yes I agree Jennifer but taking a slightly different angle.

    If the messages about X being bad for our health turn out to be ‘wrong’ or all too blunt or end up being perceived as wrong or all too blunt, my worry is that this can adversely affect the messages that are ‘right’. “If they got it wrong on X, why should I believe them on Y or Z?” Is there research on this ‘externality’?

  2. Jennifer Doggett says:

    I agree that isolating the effects of alcohol (or any single risk factor) in the context of a long-term study is difficult. However, the problems associated with confounders are equally applicable to the negative effects of alcohol use as to the positive ones.

    As for vested interests, yes it is important to take these into consideration but again there are vested interests on both sides of the debate – alcohol industry representatives are not the only ones with a stake in a specific research outcome.

    In terms of social costs – I agree that from a policy perspective it is crucial that the social costs (and benefits) of alcohol use are taken into consideration. However, it is not relevant to include these in every research project looking at alcohol use. I don’t see any problems at all with a research project that focuses on the health impact of alcohol use across a specific population – where health is narrowly defined – and does not include broader social or economic costs. In the same way, it is important to know what the health risks and benefits are of a screening test – such as a mammogram – before assessing the broader social and economic costs of implementing a screening program across a population.

    Of course it is also crucial that economic analyses which look at the overall costs and benefits of alcohol use are undertaken. However, studies which purport to evaluate the overall ‘costs’ of alcohol (or other drugs) on our community often completely ignore the social benefits of alcohol use and include only the costs. For example, Collins and Lapsley’s series of studies in this area – the latest one can be found at:

    http://www.health.gov.au/internet/drugstrategy/publishing.nsf/Content/34F55AF632F67B70CA2573F60005D42B/$File/mono64.pdf

  3. Doctor Whom says:

    “My own view on the often-promoted health benefits of alcohol is that they tend to be over-stated and don’t take account of the broader social costs, or are based on observational studies with so many confounders that it is impossible to draw any conclusions about cause and effect.”

    C’mon Ms C, ever been to a wedding, party or funeral without alcohol?

    The only thing worse would be going to a music gig or trying to dance with Bob Brown or Clive Hamilton

  4. Croakey says:

    I guess it depends what circles you move in, Dr W. Try sharing a train with late night revellers, or post-footy inebriates. Not much fun at all…

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women's health
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Indigenous health
#CTG10
#NTRC
Acknowledgement
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WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
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air pollution
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COVIDwrap
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Health in All Policies
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Media Doctor Australia
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences