The new American Public Health Association (APHA) Press’s book, Preventing Alcohol-Related Problems: Evidence and Community-Based Initiatives, focuses on bridging the gap between research, information, and knowledge to find effective ways to address alcohol-related problems. ARG scientists contribute their expertise on alcohol’s role in developing chronic diseases, government control versus privatization of alcohol sales, and how alcohol policies can help reduce health disparities.
Alcohol as a Risk Factor for Chronic Diseases
Scientific Director and Senior Scientist Thomas K. Greenfield and Associate Scientist Priscilla Martinez contributed a review that describes the evidence-to-date of alcohol’s role in developing chronic conditions such as liver disease, hypertension, heart disease, Type 2 diabetes, cancer, and mental health disorders.
Alcohol-related liver cirrhosis is responsible for an estimated 493, 000 deaths per year in the U.S., and with early stages being reversible, the authors call for increased screening protocols. With research identifying alcohol’s role in at least seven different cancers, including esophageal, breast, and liver, it’s estimated that between 18.2K and 21.3K cancer deaths are attributable to drinking. For people with hypertension, 16% of global cases are associated with alcohol consumption, and with evidence that shows drinking less lowers blood pressure, indicating a dose-response relationship, it is clear that strategies are needed to reduce consumption.
Greenfield and Martinez suggest preventative measures such as effective policies that limit alcohol’s availability, along with regular screening and early interventions to identify and reduce problem drinking, could curb or possibly prevent chronic diseases from developing. As an integral part of any treatment plan, physicians and health care providers need to talk with their patients about their drinking and become more aware of the potential risks and harms associated with alcohol consumption, especially those associated with hypertension, heart disease, and cancer.
Alcohol Retailing Systems: Private Versus Government Control
In their review of how various jurisdictions manage alcohol sales, Center Director and Senior Scientist William C. Kerr and Associate Scientist Sarah Beth L. Barnett, compare regions where the government controls – fully or partially – alcohol pricing, retail sales, and its distribution to open or less restricted private systems. In assessing the aspects of each system, from price setting to the number and location of stores, the authors provide the most recent research on the relationship between alcohol policies and its availability, consumption, and related harms.
Evidence-to-date suggests that privatization tends to increase alcohol consumption, but the unique details of each privatization are important to consider. There is also a lack of understanding of how differences within the system influences consumer behavior. For instance, how does store type – grocery stores, gas stations, convenience stores, department stores, or take-away outlets – affect drinking rates, and does selling alcohol alongside tobacco and marijuana produce other kinds of problems?
Knowledge gaps also exist in how government control systems – which features or aspects – help mediate alcohol consumption and possibly prevent its related problems. In the U.S., where there are 18 monopoly jurisdictions, the most common regulated beverage is spirits.
With increased pressure to privatize government control systems, and because privatization is difficult to roll back once in place, it is critical that future research focuses on the potential harms and public costs of lifting alcohol sale restrictions so that policymakers have the needed evidence and knowledge to resist such changes.
Alcohol Policy: A Tool for Addressing Health Disparities?
Recognizing significant racial/ethnic and socio-economic disparities in alcohol-related problems, diseases and mortality in the U.S., ARG Scientist Nina Mulia and Rhonda Jones-Webb, Professor at the University of Minnesota’s School of Public Health and ARG Center Advisory Board member, argue that alcohol policies can be effective strategies to reduce and prevent alcohol-related health disparities between populations.
While many national studies find the highest heavy drinking prevalence rates among whites, there is longitudinal research that shows more frequent heavy drinking and greater alcohol problems among Latinos and African Americans compared to whites, particularly after young adulthood. Disparities are also present in alcohol treatment where racial/ethnic minorities access services less often than whites at a given level of alcohol dependence.
With reference to both upstream alcohol policies that help prevent problems from occurring, and downstream policies to mitigate problems once they happen, Mulia and Jones-Webb argue that efforts to address disparities must consider whether alcohol pricing, taxes, availability, and treatment access policies have differential impacts on racial/ethnic and socio-economic groups’ consumption, alcohol-related harms and access to care.
The authors call for future studies to consider these differences and the conditions in which policies are most effective in reducing, not increasing, disparities between racial/ethnic and social-economic groups. They also suggest a more inclusive, collaborative process in which the communities affected play an integral role in policy development.
Greenfield, T.K., Martinez, P. (2017) Alcohol as a risk factor for chronic disease: raising awareness and policy options, in Preventing Alcohol-Related Problems: Evidence and community-based initiatives, Giesbrecht N, Bosma LM eds, pp 33-50. APHA Press, Washington, DC.
Kerr, W.C., Barnett, S.B.L. (2017) Alcohol retailing systems: private versus government control, in Preventing Alcohol-Related Problems: Evidence and community-based initiatives, Giesbrecht N, Bosma LM eds, pp 137-150. APHA Press, Washington, DC.
Mulia, N., Jones-Webb, R. (2017) Alcohol policy: a tool for addressing health disparities? in Preventing Alcohol-Related Problems: Evidence and community-based initiatives, Giesbrecht N, Bosma LM eds, pp 377-395. APHA Press, Washington, DC.