If we want to save lives, control alcohol
Dr. Trevor Hancock
3 July 2017
This is not going to make me popular with my beer-drinking Morris-dancing friends, or with a lot of other people I imagine, but we need to put higher taxes on alcohol and implement other proven policies that make it less accessible and less glamorous. This is the conclusion one must come to on reading the report on Alcohol Harm in Canada just released by the Canadian Institute for Health Information (CIHI) and a 2015 report by Canada’s Chief Public Health Officer (CPHO).
What caught people’s attention in the CIHI report was the finding that in 2015-16 there were more hospitalisations due to alcohol than for heart attacks. What perhaps was missed is that they were reporting only on conditions that were wholly attributable to alcohol, mainly the mental health aspects of alcoholism as well as alcoholic cirrhosis of the liver. Moreover, only those over age 10 are reported, so presumably children with fetal alcohol spectrum disorder (FASD) were excluded.
But they did not include conditions partially attributable to alcohol such as various forms of cancer, motor vehicle traffic injuries or heart disease. Had they done so, a study from England suggests, the number of hospitalisations attributable in part or in whole to alcohol would have more than tripled.
Overall, CIHI notes, “Alcohol was the third leading risk factor for death and disability globally in 2010, up from sixth in 1990”. In Canada, alcohol is the top risk factor for disease among Canadians aged 15 to 49, according to the 2015 report from the CPHO. The Canadian Centre for Substance Abuse (CCSA) reported that in 2002 (the last time this seems to have been fully studied, which in itself is scandalous) more than 8,000 deaths in Canada were attibutable to alcohol.
The CCSA also reported that the direct health care costs of alcohol in 2002 was about $3.3 billion, and the total cost was more than $14 billion, almost half due to lost productivity. It is likely more by now; the CPHO noted that the full health and social costs of impaired driving alone in 2010 (including alcohol and other drugs) was more than $20 billion.
These are the latest in a long string of reports that make it clear that governments – both provincial and federal – have been neglecting the health of the public and foregoing significant revenues – revenues that could have been put to good social purpose such as daycare or housing – while pandering to the alcohol industry.
Back in 2008, BC’s Provincial Health Officer updated a cautionary 2002 report that he issued when the new Liberal government was planning to make alcohol more available. He found “the total number of liquor stores in the province increasing from 786 in 2002 to 1,294 in 2008”, while “the economic availability of alcohol appears to have increased, with wine and spirits becoming relatively cheaper over time because of the prices for these products not keeping pace with the cost of living”.
Yet both the CIHI and CPHO reports, and a 2013 report from Toronto’s Centre for Addictions and Mental Health (CAMH), make it clear that alcohol-related harm is directly related to price and availability. Increasing price to at least keep pace with inflation, relating price to alcohol content and reducing availability are among the most effective ways of reducing harm.
The CAMH report noted that “Several provinces, including British Columbia, Alberta, Ontario, Quebec and PEI, have not raised the prices of all their products to match inflation since 2006”. When combined with the increase in the number of outlets noted above, it is not surprising that the CCSA noted in a 2014 fact sheet that in BC “hospitalization rates attributable to alcohol increased from an estimated 361 per 100,000 residents in 2002 to 437 per 100,000 residents in 2011”, while CIHI reported that “British Columbia had the highest provincial rate for hospitalizations entirely caused by alcohol and higher-than-average sales” in 2015-16”.
Clearly, and consistent with their approach in other policy areas, BC’s Liberal government was more interested in protecting and promoting the health of the alcohol industry than the health of the population. Let us hope the new BC government has a more enlightened approach to protecting the health of the public.
© Trevor Hancock, 2017