More alcohol means more injury
Dr. Trevor Hancock
13 August 2017
Alcohol policy is a fraught area. Like most people, I enjoy a drink or two, but unwise alcohol use does considerable harm and some form of regulation is needed. The era of prohibition has taught us that such an approach is bad public policy, but we have to strike the right balance between alcohol use and public safety. This is especially important for those who are put at risk of harm by the behaviour of others; the evidence suggests we don’t have the right balance at present.
A 2011 study of alcohol-related deaths in Canada from the Centre for Addictions and Mental Health (CAMH) in Toronto suggested that alcohol contributed to many unintentional injury deaths (almost 1 in 4 poisoning deaths, 22 percent of drowning deaths, 1 in five fire deaths, 1 in seven motor vehicle crash deaths and 13 percent of deaths from falls), as well as many intentional injury deaths (more than a quarter of homicides and suicides).
Importantly, while some unintentional injury deaths occur to the person who is consuming alcohol – which is a form of voluntary risk – others, more seriously, occur among those who are put at risk by people who are drunk, which is involuntary risk. These are vital distinctions, because we are more tolerant of voluntary or self-imposed risk than we are of involuntary risk.
In a seminal article in 1969, Chauncey Starr, then Dean of Engineering at UCLA, reported that people were willing to accept voluntary risk (skiing injuries, for example) at a level roughly 1,000 times greater than their tolerance for involuntary risks such as exposure to environmental pollution. In general people seem to be willing to accept a lifetime risk of death from involuntary or imposed risk, such as exposure to environmental pollutants, of around one in a million. This suggests that an acceptable level of lifetime voluntary or self-imposed risk is about 1 in a thousand.
Thus there are two aspects of alcohol use and injury to consider; how to protect people from self-harm and how to protect people from being harmed by drunks. I am most concerned with protection from those who are drunk and agree with a team of researchers, also from CAMH, who suggested in a 2015 report that such involuntary risk “could be used as a benchmark for national alcohol policies”.
They reported that a 2008 Australian study found that the risk of death caused by other people’s drinking was higher than 1 in 100,000, more than ten times the 1 in a million rate usually deemed acceptable. Since the main causes of involuntary risk to others from drinking are due to alcohol-related traffic injuries, work place injuries and violence, the study suggested these are the areas to focus on.
Thus it is good news that the federal Justice Minister, Jody Wilson-Raybould, has suggested reducing the blood alcohol limit from the current 80 milligrams to 50 milligrams. She noted that the fatal crash risk “is almost double at 50mg, almost triple at 80mg, and rises exponentially above that level” and pointed to experience in Ireland, where such a reduction, “combined with obligatory testing for alcohol, produced a 50 per cent reduction in deadly road accidents”. Sounds good to me.
But we need to do more than that. A recent report by a team based at the Centre for Addictions Research of British Columbia at UVic looked at the health and safety benefits of the Swedish government’s alcohol monopoly, and the potential impacts of deregulation and privatization. One scenario involved opening 1,200 private liquor stores, the other involved allowing alcohol sales in 9,600 grocery stores.
They found the first scenario would likely result in a 34 percent increase in drunk driving, 21 percent more assaults, 22 percent more hospital stays and 41 percent more deaths. The second scenario was worse, with 58 percent more cases of drunk driving, 34 percent more assaults, 33 percent more hospital stays and 66 percent more deaths.
Clearly, deregulation and privatization is bad for health; sadly, we are already too far down that path, and many innocent people are injured as a result. It is time to reverse course and make alcohol less accessible and more expensive.
© Trevor Hancock, 2017