Alcohol has had a fairly easy pass from public health authorities – although the World Health Organization (WHO) recently asserted that there is no safe level of drinking, upending many people’s cherished illusion that a glass of alcohol at the end of the day is harmless.

RESET Alcohol, a new public health initiative led by Vital Strategies, aims to tackle alcohol’s ubiquitous influence primarily by working with governments to increase taxes.

The $15 million initiative will focus initially on Brazil, Colombia, Mexico, Kenya, the Philippines and Sri Lanka.

“We were looking for governments that are committed to doing alcohol policy work and could demonstrate that they were willing to go forward and, particularly, raise taxes,” said RESET director Jacqui Drope of the choice of countries. 

Population size and alcohol abuse burden were also factors, she added in an interview with Health Policy Watch.

Most of these countries already have alcohol taxes. In the Philippines, for example, alcohol taxes already help to pay for universal health care, while in Kenya, civil society advocates are fighting to make sure alcohol tax rates keep pace with inflation.

Following the tobacco control example

“The primary focus has always been on increasing alcohol taxation as it’s one of the most effective things you can do,” added Drope, who has a long history in tobacco control.

Cigarette taxes have been shown to curb smoking, particularly in young people. For example, in New York state cigarette taxes are the highest in the US and the state has seen youth smoking rates drop by more than 90% since 2000 as a result. 

RESET Alcohol will work mainly by supporting governments, civil society and research groups to build their capacity to implement and strengthen alcohol policy. 

It will do so in part by mentoring people in policy and regulation development, taxation research, strategic communication and advocacy, and alcohol data and monitoring systems.

Not prohibition

The initiative isn’t about prohibition, Drope stressed: “We’re coming at this from a harm-reduction standpoint. That is why it is about policy and what we can do at the population level. We aren’t working at the individual level and prescribing what individuals do.

“We know this is an unhealthy product, and there’s good evidence from the WHO to show that there is no safe level [of consumption]. What we’re trying to do is reduce the harms through policy, rather than saying that people should never drink again. This isn’t what we’re trying to accomplish.”

‘War of perception’

For adults aged between 25 and 49, alcohol is the leading cause of death and disability globally based on the Global Burden of Disease analysis. 

“Often the underlying connection of alcohol consumption between these deaths – from liver disease, heart disease, cancer, violence, vehicle crashes, falls, tuberculosis, HIV/ AIDS, and other conditions – is overlooked,” according to Vital Strategies.

People calling for more alcohol oversight is “cast as a buzzkill”, according to the global health organisation.

“It’s a war of perception that claims millions of lives each year. Alcohol use remains stubbornly rooted as a cultural norm in most of the world, and few recognise it as a public health threat.”

Drope acknowledged that alcohol is so deeply entrenched that even the health sector has been complicit in perpetuating the notion that moderate alcohol consumption is healthy: “We have a lot of work to do and think about to change norms, and change how we talk about alcohol.”

At risk ‘from the first drop’

Recent data that shows half of all alcohol-attributable cancers in the WHO European Region are caused by “light” and “moderate” alcohol consumption – less than 1.5 litres of wine or less than 3.5 litres of beer or less than 450 millilitres of spirits per week. 

“This drinking pattern is responsible for the majority of alcohol-attributable breast cancers in women, with the highest burden observed in countries of the European Union (EU),” according to the WHO European Region.

“We cannot talk about a so-called safe level of alcohol use. It doesn’t matter how much you drink – the risk to the drinker’s health starts from the first drop of any alcoholic beverage. The only thing that we can say for sure is that the more you drink, the more harmful it is,” explained Dr Carina Ferreira-Borges, WHO regional advisor for alcohol and illicit drugs. 

Globally, the WHO European Region – which includes heavy-drinking countries such as Czechia, Latvia, Lithuania, Russia and Germany – has the highest alcohol consumption level and the highest proportion of drinkers in the population. Over 200 million people in the region are at risk of developing alcohol-attributable cancer.

“Although it is well established that alcohol can cause cancer, this fact is still not widely known to the public in most countries. We need cancer-related health information messages on labels of alcoholic beverages, following the example of tobacco products; we need empowered and trained health professionals who would feel comfortable informing their patients about alcohol and cancer risk; and we need overall wide awareness of this topic in countries and communities,” added Ferreira-Borges.

In early November, WHO Europe Regional Director Dr Hans Kluge and the Director of the International Agency for Research on Cancer (IARC), Dr Elisabete Weiderpass, issued a joint statement to the European Parliament calling for more awareness about the link between alcohol and cancer.

“The contribution of alcohol consumption to cancer incidence and mortality should be clearly recognized without the use of any qualifiers or misleading adjectives such as ‘harmful’ or ‘heavy’ consumption of alcohol or ‘responsible drinking’,” they noted.

“Measures should be taken to clearly inform the public of this risk, which is not well known among the general population,” they added, pointing out that two WHO health plans “recommend the use of health warning labels on alcoholic beverage containers to inform the public about the health consequences of alcohol use”.

Image Credits: Unsplash, WHO .