Page last updated: Tuesday, March 29, 2005
Drinking and health in whole populations - Benefits not limited to older age-groups
by George Winstanley
Alcohol Policy and the Public Good (APPG) was published in 1994 and the authors intended it to be a major contribution to the development of policies to deal with abusive drinking. The WHO Regional Director in Europe hailed it as providing an ‘objective analysis on which to build relevant [alcohol] policies globally’. The WHO's European Alcohol Action Plan drew heavily on early drafts of this publication. However, APPG, far from having a solid scientific basis is a seriously flawed publication. The panel of soi disant experts who collaborated in its production were disgracefully selective in their presentation of evidence because they were intent on promoting the total reduction of alcohol consumption approach.

Benefits grudgingly dealt with

Nowhere is this more evident than in the way in which the authors deal with drinking and health. They dwell on the harm caused by drinking at inordinate length and sometimes make extravagant claims such as ‘a drinking occasion can make a small contribution to a death from cancer many years later.’ However, the benefits are grudgingly and inaccurately dealt with. The principle conclusion of APPG and its clone publication, the ‘European Alcohol Action Plan’, is that the message to the individual and society is outstandingly clear: less drinking is always better.

Less drinking is not always ‘better’

This conclusion is simply not tenable and there is an abundance of scientific evidence which contradicts it. There is not, of course, a steadily increasing benefit with steadily increasing consumption, but it has been established beyond any doubt that increases in consumption starting from nil decrease the risk of premature death. At higher levels this effect is reversed so that the risk at first becomes equal to the that of abstainers, and then continues to increase as consumption increases: this is frequently referred to a U-shaped relationship.

In its determination to play down the benefits of moderate drinking, the APPG panel contends that it does not result in any substantial reduction in risk in men under 35 years of age and in pre-menopausal women. As such women are concerned, this contention is contradicted by a very large study of nurses' health in the USA. Until recently, very little research had been done on men under 35 years of age and therefore any opinions expressed in the absence of such research were speculative and without any scientific basis.

New research includes younger people

However, this research deficiency has been rectified. There is an on-going study in the UK of all people born in England, Scotland and Wales during one week in March 1958 – usually referred to as the 1958 birth cohort. Research among 9,605 people in this cohort at 23-year and 33-year follow-up has been directed at relating individual health status with alcohol consumption. The recently published results are unequivocal: there are higher rates of ill-health and psychological distress among non-drinkers and heavy drinkers than among moderate drinkers, who were defined as women drinking 6 to 20 units per week, and men drinking 11 to 35 units per week. It would therefore appear that the U-shaped relationship between alcohol and mortality in older age groups which has been extensively proven, is preceded by similar relations between alcohol and ill health evident by the age of 33.

Another nail in the coffin

This important research is another nail in the coffin of those advocacy groups and campaigning organisations which are dedicated to achieving an overall reduction in alcohol consumption. But it is unlikely to shake their conviction that less drinking is always best. They are like the parson in Goldsmith's deserted village who ’e'en though vanquished he could argue still.’ And of course, despite all the evidence, there are still those who believe the earth is flat!

George Winstanley was Director of Strategic Affairs at the Portman Group from 1990 to 1995. He is a member of the AIM Editorial Board

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