New guidelines from the UK chief medical officers aim to provide citizens with accurate information about the risks to health of alcohol, to allow them to make informed choices.1 Will they succeed? Only time, coupled with robust evaluations, will tell.
Might the guidelines also change how much alcohol we consume as a nation to the betterment of our health? Two routes by which guidelines might change actual consumption are a direct one, by persuading drinkers to drink less, and an indirect one, by altering social attitudes towards alcohol, increasing the public’s and in turn the political acceptability of policies that reduce alcohol consumption.
Direct effect on behaviour
There is little direct evidence for any effect of health related guidelines on behaviour, including those on alcohol.2 Any direct effect on behaviour is, however, likely to be extremely limited, for three reasons. Firstly, information on risk is a weak driver of change in behaviour associated with potential longer term harm but immediate, certain pleasure: consumption of alcohol, tobacco, and sugar, for example.3 Secondly, people regulate their drinking to meet social responsibilities that they value, such as work and childcare, rather than to reduce health risks.4 And thirdly, alcohol consumption is strongly influenced by environmental factors such as price, availability, and marketing, often without consumers being aware of the influence.5
But novel information on risk can change behaviour. Smoking rates fell overnight when the Royal College of Physicians published Smoking and Health in 1962, for example, the first unequivocal presentation to the public, as well as doctors, of the health risks of smoking.6 The new UK alcohol guidelines present novel information on the link between alcohol and cancer. The potency of information that links drinking to cancer is reflected in a recent, unsuccessful attempt by the alcohol industry to ban an advertisement making this link explicit.7
In the week after the new alcohol guidelines were published last month, Google Trends showed more searches for “alcohol and cancer” than in the same week in 2015. No similar increase was seen in searches for “alcohol and heart disease” or “alcohol and health.” Although more online searching may not reflect less consumption, strengthening one negative association with alcohol may weaken the influences of the many positive associations forged by alcohol marketing. These include associations between alcohol and sport and comedy, recognised by most 10 year olds.8
Effect of evidence
Few people oppose government intervention to provide information about health risks as a prelude to potential behaviour change.9 Public support then generally ebbs away as interventions become more intrusive, but often more effective—for example, altering the prices and availability of products that can harm health, such as alcohol and sugar.10 Tobacco is an exception: more intrusive policies now receive widespread support.
Resolving tensions between benefits at the individual and population levels is a core role of democratic governments and is made easier when the public embraces population as well as individual perspectives, as in the case of tobacco.
As expected, interventions to cut drinking that are based on pricing policies are less accepted by the public, especially heavier drinkers, than interventions that provide information or reduce advertising.10 11 But people are more accepting of a higher minimum price for a unit of alcohol when they see evidence of its effectiveness at reducing admissions to hospital and crime related to alcohol, an effect seen in other policy areas, such as obesity.12
The new alcohol guidelines are unlikely to cut drinking directly. But they may shift public discourse on alcohol and the policies that can reduce our consumption. As the debate around the guidelines continues, with references to the nanny state and the killing of joy, we should keep in focus the objective of alcohol policies: to reduce the blight without losing the delight that alcohol brings.
I really liked this piece and agree completely!
Edited to add 20th May 2016:
Improving public knowledge about alcohol harm will increase government appetite for regulation, write Sir Ian Gilmore and colleagues in a new Perspectives article published online in Nature Reviews Gastroenterology & Hepatology this week | IAS, UK
This Perspective will outline the scale of the global alcohol problem, the wide-ranging effects of alcohol and the most effective evidence-based strategies to effect a population-level reduction in harm. We will also highlight how clinicians can be good public health advocates and the available downstream strategies they can implement while we wait for governments to take the necessary action | Nature.com, International