Erin Russell is an Assistant Editor working on CMAJ and CMAJ Open
Alcohol is an addictive substance, a cancer risk factor, and a teratogen – yet you can buy a glass of wine at the welcome reception of the Canadian Public Health Association conference. I’m not saying that this is wrong; just interesting.
I attended three sessions related to alcohol at last week’s Canadian Public Health Association conference Public Health 2014. The first was hosted by Ann Dowsett Johnston, author of Drink: The intimate relationship between women and alcohol. Along with a series of articles in the Toronto Star, the book is a product of Ann's Atkinson Fellowship in Public Policy. While the book deals with issues specific to women (i.e., higher risk of depression and anxiety than men, propensity to self-medicate with alcohol), the talk was relatively gender-neutral. The main question, left unanswered, in a room full of public health researchers and practitioners was, "How do we really feel about alcohol?"
In this session, and others that followed, our society was described as 'alcogenic' or simply a 'drinking culture'. A drinking culture because the majority of us (78%) drink. As for society’s alcogenicity, Ann’s book cites social events revolving around drinking, as an example. The alcohol industry no doubt contributes to this culture with its promotion of alcohol as a necessary ingredient for a fun and sexy lifestyle. This drinking culture prevails, despite knowledge of the harms associated with alcohol consumption (i.e., risk of addiction, increased risk of cancer and other chronic diseases, risk of FASD when consumed during pregnancy). Our perception of risk is personal, not evidence-based; even worse, it’s based on outcomes that we can most easily bring to mind. So an individual who’s never personally been affected by alcoholism, but has recently seen a television program that referred to ‘wine therapy’, may (erroneously) assume that alcohol is therapeutic and relatively low-risk. Armed with this understanding of how humans perceive risk, it’s important that public health messaging be visual, relatable, and story-based. Dowsett Johnston has done this with her book; drawing on her personal experiences as a child of two alcoholic parents and her own battles with alcohol dependency in her 50s. Her account illustrates that no one is ever truly free from the risk of alcohol dependency; even those who may have had a relatively healthy relationship with the substance in the past.
On the second day of #CPHA2014, a comparison of provincial alcohol policies was presented. This evaluation of ten policy dimensions across ten provinces produced a final ranking where Ontario, British Columbia and Nova Scotia received the highest scores and Quebec, PEI and Newfoundland and Labrador received the lowest scores. One conference delegate who had lived in both Quebec and British Columbia was quick to point out that this sort of standardized evaluation fails to take into account cultural difference between provinces. In his admittedly-anecdotal observation, despite their relatively lax liquor laws, Quebecers seem to have a healthier attitude towards alcohol than do British Columbians. Presenters agreed that there is no “one-size fits all” policy, and that the existing culture surrounding alcohol should be factored in when making policy decisions.
In a panel on risky drinking by women of child-bearing age, representatives from the Canadian Fetal Alcohol Spectrum Disorder Network, the BC Centre for Excellence for Women’s Health and the Canadian Centre on Substance Abuse described the challenges associated with FASD and the prevention initiatives underway in Canada. One major challenge is that women spend up to 30 years of their lives “of child-bearing age” and may not self-identify as “potentially pregnant”. While most women will stop drinking when they become aware of a pregnancy, high baseline levels of alcohol intake in this population prior to knowledge of conception may be a substantial contributor to the burden of FASD.
Individuals with health problems resulting from alcohol use deserve our understanding and compassion; not our judgment. It is hypocritical to attach stigma to such conditions, while permitting alcohol to play such a major role in our lives. Public values, along with evidence, can affect political change. We have the evidence and tools required to support alcohol reduction policies - Canada’s low-risk drinking guidelines were cited in each of the three presentations I attended – so public values must be to blame for our failure to affect political change. Which brings us back to the question, “How do we really feel about alcohol?”