For a country whose alcohol consumption is relatively modest (compared to that of most developed nations), the release of Canada’s dramatically lowered national drinking guidelines – issued in January, 2023, generated headlines around the world, many urging a second look at their own nations’ drinking behaviours.
Canada’s Guidance on Alcohol and Health, released by the Canadian Centre on Substance Use and Addiction (CCSA) in January 2023, went right for the jugular by drastically redefining its risk parameters for individual alcohol consumption: Best in the risk level was No Alcohol…zero; Low risk (two standard drinks or fewer per week); Moderate risk (three to six per week); and High risk (seven or more drinks per week). The previous guidelines pegged the long-term health risk threshold at 10 standard drinks a week for women (with no more than two drinks a day most days), or 15 standard drinks a week for men (with no more than two drinks a day most days). Standard drinks means: Beer or cooler/cider 341 ml (12 oz) 5% alcohol; Wine 142 ml (5 oz) 12% alcohol; and Spirits-whisky, gin, etc., 43 ml (1.5 oz) 40% alcohol.
The 89-page report asserts that after cancer, heart disease is the second-leading cause of death in Canada and, although there is a commonly held belief that drinking in moderation protects against coronary artery disease, research affirms that “drinking a little alcohol neither decreases nor increases the risk of ischemic heart disease, but remains a risk factor for hypertension, heart failure, high blood pressure, atrial fibrillation and hemorrhagic stroke.”
Though research entities in many nations have been lowering their risk-level thresholds for alcohol consumption, few have taken the deep dive to assert that there is “no health benefit” from any amount of alcohol consumption. “No matter where on the continuum, for your health, less alcohol is better… It is clear that people should not start to use alcohol or increase their alcohol use for health benefits… Less consumption means less risk of harm from alcohol and, from this fact, it is necessary to promote the message that it is okay not to drink alcohol.” The Guidance was based on meta-analyses of hundreds of studies from within Canada and abroad. It was funded by Health Canada.
However, as befits science, unanimity is unlikely
Just six months earlier, in July 2022, another peer-reviewed meta-analysis published in the highly respected British medical journal The Lancet, posited that although alcohol consumption carried “significant health risks and no benefits for young people; some older adults may benefit from drinking a small amount of alcohol.” Specifically, it noted that “adults 40 and older without underlying heart conditions may see some benefits from small alcohol consumption (between one or two *standard drinks per day), as well as a reduced risk of cardiovascular disease, stroke and diabetes.” *(1) A small glass of red wine; a bottle of beer; a shot of whisky or other spirits.
Generally, The Lancet analysis coincides closely with the CCSA’s overall conclusions about “significant” health risks for the population as a whole and doubles down on “no benefits for young people.” But, in suggesting that some population groups might benefit from alcohol use, it stresses the need to further study the complex relationship between alcohol and health in different regions of the world, as well as by age, sex and underlying health conditions. The Lancet study was part of a more comprehensive Global Burden of Disease initiative funded by the Bill and Melinda Gates Foundation.
What’s to be done?
According to CCSA, changing Canadians’ attitudes and drinking preferences will require a cultural shift that can only be orchestrated by governments (provincial or federal) working in collaboration with employers, health-care providers and community stakeholders to:
- Strengthen regulations for alcohol advertising and marketing;
- Increase restrictions on the physical availability of alcohol; and
- Adopt minimum prices for alcohol.
As a first step, the report recommends replacing the current alcohol-by-volume warning label with a designation listing the number of drinks in each container, so as to give drinkers a clearer picture of how much they’re consuming on any given occasion. (This labelling has already been implemented widely.) The report doesn’t dig deeply into specific advertising and marketing realignments, nor about recent easements on availability of alcohol (beer in parks, open-air festivals, Oktoberfests, sports arenas, etc.).
But the initiative to test-run drinking in selected public parks in Toronto this summer suggests that there will be some give and take in implementing the CCSA recommendations. And the federal government’s cap of two per cent on what was planned to be a 6.3 per cent increase in excise duties on alcoholic beverages soothed some of the anxieties of the beer, wine and spirits industry.
But longer-term adoption of minimum pricing methods as “beneficial to public health” clearly remains on the table. The CCSA had previously staked out a position favouring Social Reference Pricing (SRP), i.e., establishing minimum prices indexed to alcohol volume per drink: a 14 % alcohol red wine should be priced higher than an 11 % white. It’s a strategy gaining ground internationally and is heavily promoted by groups such as the World Health Organization, a staunch promoter of higher alcohol prices worldwide. You will be hearing more about SRP before long.
Moderation by choice?
The paradox in this debate is that Canadians generally are not drinking as much as they did in the 1960s and, since 1980, the trend line is perceptibly lowering, coinciding perhaps with the “fitness” ethos: jogging, running, cycling, gym memberships, weight reduction and healthier living.
According to the World Population Review, in 2019, Canadians older than 15 drank 8.81 litres of absolute alcohol per capita and Americans 9.97; relatively modest, compared to residents of the U.K. (11.45 litres), Spain (12.67), Germany (12.75), France (12.23) and Lithuania (13.22 litres). Data from Statista also show that between 2010 and 2017, Canadians had reduced their consumption by 10.4 per cent, Australia 14.4 per cent, and the U.K. 7.3 per cent.
To date, not all of the provincial or federal governments have rushed to implement additional restrictions on alcohol availability. A spokesperson for Quebec’s finance minister assures media that the province isn’t considering any changes to the provincial liquor corporation’s current practices. “We trust citizens to make the best decisions for their health, in light of the latest knowledge on the subject.”
And there’s the point. Throughout its report, CCSA has reiterated that the guidance presented is based on the principle that people living in Canada have a right to know that all alcohol use comes with risk but that, ultimately, it’s up to them to decide how much risk they’re prepared to take.
By Milan Korcok
© Copyright 2023 Milan Korcok. All rights reserved.
Medical writer Milan Korcok served as Information Officer for the Addiction Research Foundation of Ontario in the early 1970s, when alcohol pricing was a contentious issue. Milan is a dual Canadian/U.S. citizen residing in Florida. He can be reached at email@example.com