Stemming the Rise in Global Alcohol-Related Deaths

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One in 25 deaths around the world is caused by alcohol consumption, and booze is now as damaging to global health as tobacco was a decade ago, according to a new study in the British medical journal the Lancet.

The last global statistical analysis of the damage caused by alcohol, undertaken in 2000, found that 3.2% of deaths worldwide were the result of alcohol consumption. The new study, part of the Lancet's "Alcohol and Global Health" series published last Saturday, used the same statistical tools as the previous one, and found that for 2004 the figure had increased 0.6%. Alcohol-related causes of death include accidents, violence, poisoning, mouth and throat cancer, colorectal cancer, breast cancer, suicide, stroke and many others.

Lead author Jürgen Rehm of the University of Toronto tells TIME that the increase was primarily the result of more women taking up drinking. He says the increase in the rate of alcohol-related deaths is particularly troubling because the researchers took into account the cardiovascular benefits of moderate drinking and because the majority of the world's population currently abstains from alcohol. But that is likely to change as India and China become wealthier and their citizens find themselves with more disposable income, he says. That, in turn, is likely to further increase the death rate unless steps are taken to combat the trend. "Alcohol consumption, particularly among women, is linked to economic growth," says Rehm. "In countries like the U.K. and Norway, you have women consuming over 30% of [all the alcohol consumed]. In India, on the other extreme, women consume less than 5%. The higher the wealth of a country, the higher the percentage of women drinking alcohol."

As an example of how damaging alcohol abuse can be, a separate study in the Lancet found that drinking caused more than half of the deaths among adult Russians between 1990 and 2001, in the unstable years following the collapse of the Soviet Union. That study of some 60,000 residents in three Russian cities found excess mortality (i.e., a larger than expected number of people dying from a certain disease) not only with obvious alcohol-related illnesses such as liver cancer but also tuberculosis and pneumonia, which the study's authors say may be partly a result of weak immunity caused by excessive alcohol consumption.

Globally, average alcohol consumption per person is the equivalent of about 1.6 gallons (6.2 liters) of pure ethanol a year, or about 12 units a week. Annual consumption per person was found to be highest in Europe, where it equals 3.1 gallons (11.9 liters) of ethanol (21.5 units a week). That compares with 2.5 gallons (9.4 liters) a year (18 units a week) in North America and 0.2 gallons (0.7 liters) a year (1.3 units a week) in the eastern Mediterranean, which has the lowest levels. Those figures, according to Rehm's study, mean that "globally, the effect of alcohol on the burden of disease is about the same size as that of smoking in 2000." In fact, despite the prevalence of tobacco use in the developing world, the study shows alcohol as the No. 1 risk factor in 27 emerging economies.

The article did include a hopeful caveat to this dire picture, however. As Rehm says, "We [now] know more than ever about which strategies can effectively control alcohol-related harms." The most cost-effective of these methods, he says, is simply to raise the price of alcohol. There's already evidence that this works. In France and Italy, for example, alcohol consumption has steadily plummeted over the past 25 years as the price of drinks has gone up relative to income compared with other countries. "Despite all stereotypes, Italy now has the lowest consumption of any European country," Rehm says. "And it's largely because alcohol is relatively expensive."

Rehm also says that governments put too much faith in treatment programs for alcoholics as a way of combating excessive alcohol consumption. "If you start pumping money into treatment systems, that's helpful for those with alcohol-abuse disorders, but that group is a very small minority of those who suffer as a result of alcohol," he says. "If you die of alcohol-related breast cancer, you may never have been an alcoholic, but still it's an alcohol-related disease."

Rehm adds that while an end to deaths and disability caused by alcohol is in sight, it is a frustratingly difficult goal to reach. "The solution can only be to reduce the overall amount of drinking," he says. "But that's pretty hard to do — to get humanity to learn to drink one or two units a day, and never more."