Media reactions to the recently published WHO 2019 Status report on alcohol consumption, harm and policy responses in EU Member States, Norway and Switzerland demonstrated again that published evidence and data are always at risk of receiving partial, or misleading, interpretations.
The report provides a good snapshot of alcohol consumption, alcohol-related harm and alcohol policy responses in 30 European countries and is part of monitoring efforts under the European action plan to reduce the harm of alcohol 2012-2020. National regulators and public health institutions look to this report for guidance on trends to inform their policies. But some will always choose to cherry-pick or misinterpret the data to make recommendations that are simply not supported.
For example, Leonid Bershidsky, in an opinion column “Europe Needs to Cut Back on the Booze”, analysed the report and concluded that governments should focus on policies that penalise consumption of spirit-based drinks rather than beer or wine. However, his conclusion is not supported by the evidence in the report (or anywhere else).
The fact is that the health impact of drinking beer, wine or spirits is identical. As the US Center for Disease Control says: “it is the amount of alcohol consumed that affects a person most, not the type of alcoholic drink”. Many (but not all) of the countries in Europe where spirits form a higher percentage of overall consumption have a few other significant things in common: they are less economically developed, consumption is more concentrated among a smaller population of heavy drinkers, consumption is more concentrated among men, health systems are weaker and overall mortality is higher.
The countries at the top of Mr Bershidsky’s ‘spirits league table’ have something else in common: they are prime destinations for cross-border shopping (and smuggling) due to the huge differentials in excise taxes across the European Union. This distorts their statistics dramatically. As long as EU rules allow countries to set zero excise rates on wine (which 14 of 28 countries do), very low rates on beer and punitive rates on spirits, such distortions are inevitable.
Given these distortions, it is not surprising that beer and wine are much more widely consumed than spirits among youth in Europe(1).
Demonising one form of alcohol distracts us from addressing the serious social problem of harmful drinking. There is much more to do but it is disappointing that progress made to address this problem, proven by WHO’s own data in a recently published modelling study, remains poorly recognised by the media(2).
Looking at the 2019 status report, we can welcome several positive trends which have remained obscured by misinterpretation. Heavy episodic drinking among adults (+15) was reduced by almost 11% (10.7%) between 2010 and 2016. During the same period, alcohol attributable mortality rates decreased by 14.1% per 100, 000 people. Most impressively, alcohol attributable mortality rates among 15-to-19 year-olds fell by astounding 31.2%, and by equally impressive 29.6% among 20-24 year-olds.
If we’re serious about tackling alcohol-related health issues, we should first acknowledge that all drinks are equal from a health perspective and potential harm they can cause if consumed in an irresponsible way. Then let’s work together to continue the positive trends of declining harmful drinking.
(1) European School Survey Project on Alcohol and Other Drugs, http://www.espad.org/report/home.
(2) Manthey et all, Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study, The Lancet, May 07, 2019 DOI:https://doi.org/10.1016/S0140-6736(18)32744-2.
