Alcohol consumption is a public health problem because it is one of the main risk factors for health in the world, says Elisabeth Morgans of C3 Collaborating for Health
Alcohol consumption is a public health issue because it is one of the main risk factors for health in the world.
The public health problem
In 2016, it caused an estimated 3 million deaths (5.3% of all deaths) worldwide and 132.6 million disability-adjusted life years (DALYs), or 5.1% of all DALYs that year. 1 In addition, its effects are far-reaching – harmful alcohol consumption has a direct impact on several targets of the Sustainable Development Goals, including maternal and child health, infectious diseases (HIV, viral hepatitis, tuberculosis), non communicable diseases and mental health, injuries and poisonings. 1 These statistics and the direct and indirect effects on other global targets have created a global need to unpack the complexity of the issue, especially for policy makers and health officials. There are several mechanisms by which alcohol directly influences health, including: the cumulative effects of alcohol consumption; acute alcohol intoxication leading to accidents, injuries and poisonings; and effects resulting from alcohol impairment and violence2. But the complexity of understanding the impact of alcohol on health, and subsequently how to design interventions, is amplified by the relationship between alcohol and socioeconomic status.
Alcohol and inequality
According to World Health Organization, in most European countries, the difference in alcohol-related deaths and associated health problems between different socio-economic groups is much larger than the difference in alcohol consumption between these different groups.3 Alcohol can cause harm at all socioeconomic levels. However, when looking at the issue of alcohol and health through the lens of inequality, it is the issue of harm rather than consumption in which a strong social gradient exists.
Indeed, it is widely recognized that low-income people drink less than high-income people, a commonplace and somewhat expected observation given the issue of affordability – a primary driver of consumption. However, people living in deprived areas are much more likely to suffer alcohol-related harm and death.4 In Scotland in 2015, alcohol-related death rates were six times higher in areas the most disadvantaged than in the least disadvantaged regions. – a phenomenon called the “alcohol harm paradox”.5 The complexity of the paradox is reflected in its multiple contributing factors.
A national survey conducted in England in 2013 and 2014 of more than 6,000 adults confirmed strong associations between alcohol consumption and smoking, alcohol consumption and being overweight and generally unhealthy lifestyles. She concluded that since people who exhibit health-threatening behaviors are more likely to reside in disadvantaged communities, higher rates of smoking, unhealthy diets and being overweight are likely to amplify the harmful effects of alcohol.6 This somewhat follows the unfortunately now pervasive social gradient in health observed in deprived areas – the lower a person’s social position, the worse their health7. In fact, research has shown that disadvantaged social groups have more alcohol-attributable harm than individuals from advantaged regions for given levels of alcohol consumption – regardless of different drinking patterns, obesity and smoking at the individual level.8
Poorer communities show higher levels of non-voters, but also higher levels of ‘heavy drinking‘. A recent analysis of six years of national survey data analyzed drinking patterns across socio-economic groups of more than 51,000 adults, in which alcohol consumption was measured against indicators such as income household, education, occupation and neighborhood deprivation. The study concluded that lower socio-economic groups are most likely to consume both below and significantly above recommended guidelines, i.e. to display higher levels of “heavy drinking”. of alcohol”. These heavy drinkers are more likely to experience higher unemployment rates, mental health issues, low resilience, and other adverse life events, further reinforcing the social gradient and lower health outcomes in communities. disadvantaged.9
The availability of alcohol is an important contributor to the paradox. A 2015 analysis of tobacco and alcohol outlets in Scotland found that the most deprived areas and neighborhoods had the highest densities of tobacco and alcohol outlets. In contrast, the least deprived areas had the lowest density of tobacco and alcohol outlets.10
It is essential that the relationship between the drivers of health inequalities and alcohol consumption is considered and recognized by policy makers so that interventions and services can be designed and directed appropriately for the most vulnerable. of the society.
It is undisputed that people with the greatest problems with alcohol are the most price sensitive, and this has steered recent policy towards the issue of cost. Minimum unit pricing is probably the most effective policy intervention for alcohol and its introduction in Scotland in 2018 and more recently in Wales in 2020 has been strongly supported by authoritative voices in the alcohol field and of health. The minimum unit price sets the floor price at which an alcoholic drink can be sold – it has not yet been introduced in England.11
C3 Collaborating for Health
At C3 Collaborating for Health (C3), we seek to prevent non-communicable diseases, which so often coexist with harmful alcohol consumption, by promoting behavioral changes: improving diet and reducing alcohol consumption; increase physical activity and stop smoking. C3’s community engagement program partners with local communities to identify barriers to good health, such as high densities of unhealthy food outlets and lack of space for physical activity, and we use the existing strengths of a community to overcome these barriers. The goal is to make the healthy option the easy option for everyone.
C3 is currently working with seven communities in northern France and southern England through an EU-funded project ASPIRE (Adding to Social capital and individual Potential In disabled REGions). This multi-partner project aims to address the complex issues of obesity and unemployment, which frequently coexist with smoking and higher levels of alcohol consumption.
- Hammer JH, Parent MC, Spiker DA, World Health Organization. State of the World Alcohol and Health Report 2018. Vol 65.; 2018. doi:10.1037/cou0000248
- Griswold MG, Fullman N, Hawley C, et al. Alcohol consumption and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015-1035. doi:10.1016/S0140-6736(18)31310-2
- World Health Organization. Alcohol and inequality.; 2014. http://www.euro.who.int/__data/assets/pdf_file/0003/247629/Alcohol-and-Inequities.pdf.
- Change of alcohol in the UK. Alcohol and inequalities. https://alcoholchange.org.uk/policy/policy-insights/alcohol-and-inequalities. Accessed November 14, 2021.
- Giles L. RM. Monitoring and Evaluating Scotland’s Alcohol Strategy: Monitoring Report 2017.; 2017. http://www.healthscotland.scot/media/1449/mesas-final-report_english1.pdf.
- Bellis MA, Hughes K, Nicholls J, Sheron N, Gilmore I, Jones L. The paradox of alcohol harm: Using a national survey to explore how alcohol may disproportionately impact the health of disadvantaged people . BMC Public Health. 2016;16(1):1-10. doi:10.1186/s12889-016-2766-x
- Marmot M, Bell R. Fair Society, Healthy Lives (full report). Flight 126.; 2012. doi:10.1016/j.puhe.2012.05.014
- Katikireddi SV, Whitley E, Lewsey J, Gray L, Leyland AH. Socioeconomic status as an effect modifier of alcohol use and harm: analysis of linked cohort data. Lancet Public Health. 2017;2(6):e267-e276. doi:10.1016/S2468-2667(17)30078-6
- Lewer D, Meier P, Beard E, Boniface S, Kaner E. Unraveling the paradox of alcohol harm: A population-based study of social gradients across very high drinking thresholds. BMC Public Health. 2016;16(1):1-11. doi:10.1186/s12889-016-3265-9
- Shortt NK, Tisch C, Pearce J, et al. A cross-sectional analysis of the relationship between the density of tobacco and alcohol outlets and neighborhood deprivation. 2015:1-9. doi:10.1186/s12889-015-2321-1
- Alcohol Focus Scotland. Minimum pricing
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