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Despite reductions in consumption, particularly among young people, Australia has seen a rise in alcohol-related harms and avoidable costs. To decrease alcohol’s enormous burden on individuals, families and communities, it is important that all drinkers ease their alcohol consumption, not just heavy drinkers and other risk groups.
According to the World Health Organization (WHO), alcohol consumption plays a causal role in more than 200 diseases, injuries and other health conditions. Moreover, in Australia in 2022/23, alcohol consumption produced $205.5 million of avoidable costs to society each day; an increase of 12.3% since 2015/16 estimations. There are also subjective harms that are difficult to capture on a population level such as weight gain, damaged social relationships, and sexual problems, harms to people other than the drinker such as domestic violence and child neglect, and harms to the environment due to littering, vandalism, alcohol production’s contribution to climate change.
The alcohol prevention paradox states that, although high-risk drinkers have a greater individual risk of harm, the majority of the alcohol-related harms and costs is nevertheless produced by low-to-moderate drinkers because there are so many of them. WHO acknowledges that there is no safe level of alcohol consumption; from the first drink onwards, the risks for various cancers and injuries increase. Already more than a decade ago, meta-analysis including 572 studies has confirmed that alcohol increases the risk of oral cavity, pharyngeal, laryngeal, oesophageal, colorectal, liver (hepatocellular carcinoma), pancreatic, and female breast cancers.
There is also clear evidence that the pharmacological and physiological effects of alcohol use lead to various kinds of injuries including interpersonal violence, suicide and self-harm, road injuries, falls, drowning, burns, hypothermia and death by freezing, and workplace injuries. In Australia, alcohol causes almost 3,500 cancer cases every year and is the top risk factor for disease and injury in men aged 15-44. It is also the second highest risk factor for deaths of all persons in this age group. Thus, in addition to treatment and focussing on high-risk groups such as pregnant women, measures are needed to decrease per capita consumption.
We know what effective population-level strategies to prevent alcohol-related burden are. According to WHO, strategies such as increasing the price of alcohol, reducing its availability, and banning or restricting alcohol marketing and advertising are particularly effective. Unfortunately, these strategies are not implemented as thorough as they should be. One of the main reasons relates to a powerful industry that spends more than $100 million in Australia each year to make us believe how good and enjoyable alcohol is for us. They also aim to make policymakers believe in the virtue of industry self-regulation or any other measure ineffective in decreasing per capita consumption for maximizing profits, because most of their profits come from those drinking in seemingly unproblematic ways.
Alcohol Beverage Australia states: “The Australian alcohol beverage industry believes if people are misusing alcohol, the best approach is to target them and help them, not punish everyone else that enjoys drinking moderately and responsibly. Industry strongly supports government policies targeted at identified problem groups.”
The Australian alcohol beverage industry invest in organisations like DrinkWise Australia, which has a number of initiatives aiming to reduce risky drinking in young people and at-risk groups, and improve parental education. However, programs that are driven at the wider population are rejected in favour of programs that only target risk groups and place the blame on those who ‘misuse’ alcohol. This again reveals the fundamental conflict of interest between the alcohol industry and public health and means that the industry should not have ‘a seat at the table’ where programs and policies to advance community health, safety and wellbeing are being developed, assessed or evaluated.
In order to decrease the enormous burden of alcohol use on individuals, families, communities, and the environment, it is not sufficient to focus on risk groups such as those diagnosed with alcohol dependency or who drinking excessively. Since consuming relatively small amounts of alcohol can be harmful in various ways, reducing all alcohol consumption would be beneficial to Australia’s health. The further distribution of this message to the public (for example, by introducing mandatory cancer warning labels on alcohol beverage containers), may provide a window of opportunity to implement effective alcohol policy measures to improve health, safety and wellbeing such as those described in WHO’s SAFER initiative.
Professor Emmanuel Kuntsche, the Director of the Centre for Alcohol Policy Research (CAPR) and a member of the World Health Organisation (WHO) Technical Advisory Group on Alcohol and Drug Epidemiology, has been trained in Psychology (Universities of Jena and Bamberg, Germany), Sociology (University of Jena, Germany), Public Health (University of Maastricht, the Netherlands) and Statistics (University of Essex, UK). He has received multiple career awards and funding from Australia, Germany, the Netherlands, Switzerland, and the international Kettil Bruun Society.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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