Many of us welcomed in the New Year with a glass of our favourite alcoholic beverage, even if in muted celebration this year. Alcohol is an ubiquitous and accepted part of our culture, associated with times of festivity, socializing with friends and family and relaxing after a hard day at work.
While there are social, psychological and economic benefits to the consumption of alcohol, the problems caused by alcohol are also undeniable. According to the World Health Organization, more than 200 disease and injury conditions are caused by alcohol with both immediate and chronic consequences such as fractures, head injuries, heart disease and liver failure. In Canada, almost 15,000 people die from causes attributed to alcohol each year.
The economic and societal costs of alcohol are also steep: lost productivity at work, damage to property, family violence and increased crime including homicide and sexual assault. About 20 per cent of violent crimes are associated with alcohol use and crime rates are higher in places with increased alcohol availability and lower pricing.
Alcohol is the most commonly used substance in Canada, and in 2017, the economic costs of alcohol-related harm totalled $16 billion dollars. Governments bear direct costs within the health care and criminal justice systems, but indirect costs are largely borne by employers and family members. For most adults, alcohol poses a bigger risk to health than other drugs and many of the previously touted health benefits of moderate drinking have largely been disproven.
According to Statistics Canada, a quarter of Canadians have reported an increase in their alcohol consumption during the pandemic. Hospitals are seeing an increase in younger patients with alcohol-related liver disease, and alcohol treatment and rehabilitation programs are experiencing an increase in demand for their services – a need that they are largely unable to meet.
Alcohol, being a legal psychoactive substance, needs a well-regulated and government-controlled system of sales and distribution. Publicly owned and controlled liquor retail outlets can minimize alcohol-related harms while recuperating some of the societal costs of alcohol through taxation.
All provinces, except Alberta, have some degree of public ownership and operation of alcohol retail outlets. Even relatively small changes in who sells alcohol can have negative consequences. Ontario witnessed an increase in hospitalizations when it expanded alcohol sales into grocery stores. And Alberta made a big mistake in the 1990s by privatizing all liquor sales, causing rates of alcohol consumption to increase in Alberta when consumption in the rest of the country was in decline.
Privatization also led to more drunk driving charges in Alberta and to reduced government revenues. Excess capacity in the system created by privatization caused alcohol prices to increase and the government felt that it had to cut taxes on alcohol to bring liquor prices more in line with the rest of the country. Government costs for regulation and enforcement also went up. Effectively, taxpayers were subsidizing the private companies that were now tasked with selling alcohol in the province.
Data shows there is increased consumption of alcohol in geographic areas with a high density of liquor stores, and this is particularly true for younger people. Some of the most effective methods for minimizing the negative health consequences of alcohol involve restricting access to minors and reducing the number and hours of operation of retail outlets. Limiting alcohol licences and the density of retail outlets in municipalities reduces drinking and its harms.
This is exactly what the City of Edmonton did when presented with data from the Edmonton Police Service that showed increased criminal activity in areas with a high density of liquor stores. The City of Edmonton brought in a bylaw requiring liquor retail outlets to be at least 500 metres apart within municipal limits.
Other high impact alcohol policies are related to price control and marketing. Setting a minimum unit price on alcohol – not a buck-a-beer – and adding taxes, increases the price of alcohol and reduces demand and consumption. Also, people drink less when they are exposed to fewer advertisements that promote drinking as a desirable social activity.
A variety of treatment approaches are known to help people living with alcohol use disorder: medications such as naltrexone, behaviour change strategies and mutual support groups. However, governments need to provide ready and equitable access to these services. Currently, many Canadians experience barriers to accessing treatment. These include a lack of detoxification and rehabilitation beds, a lack of services in rural areas and a lack of culturally appropriate treatment services for diverse populations.
Given how pervasive alcohol is in our society, it is easy to get lulled into a sense of complacency about its effects. But the harms alcohol causes to individuals and society are real. We need to give the issue the attention it deserves and advocate with municipal, provincial and federal governments to put in place progressive policies that will keep us all safe.
Vamini Selvanandan is a family physician and public health practitioner in Alberta. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles like this, visit: www.engagedcitizen.ca.