November 17, 2003

Babor Discusses New Book
On Alcohol Policies Worldwide

Thomas Babor is professor and head of the Health Center's Department of Community Medicine. He and 14 experts from around the world have published Alcohol: No Ordinary Commodity, a book that may become the standard manual for devising and initiating alcohol policy. He was a member of the President's Task Force on Substance Abuse, which recently recommended new University policies on alcohol.

Thomas Babor, head of community medicine at the Health Center Photo by Peter Morenus

He spoke recently wilth Health Center writer Pat Keefe about the new book.

Why did you write this book?
The World Health Organization, the premier public health agency, was concerned about the global burden of disease connected with the misuse of beverage alcohol. The book is a comprehensive review of the literature on alcohol and its effects on human populations. It deals with the scientific basis of the policy-making process, and how good policies can be made with particular attention to reducing the harm alcohol causes.

What can be done?
Two things. First, we need to recognize that alcohol is no ordinary commodity. It is a major health risk factor. WHO reports that of 26 major risk factors including physical inactivity, overeating, high cholesterol, high blood pressure, tobacco smoking, and drug use, alcohol ranks no. 3 in the developed countries. So it is a major risk factor for diseases, injuries, psychiatric problems.

Second, we need to look at effective alcohol policies supported by scientific evidence. Our book reviews the scientific literature on 31 strategies and interventions used around the world to prevent alcohol problems. Interventions with the most empirical support include alcohol taxes, drunk driving laws, age restrictions on alcohol purchases, and limits on physical availability of alcohol.

Isn't alcohol use an elective behavior?
Alcohol is a commodity sanctioned by society, sold openly, and legal for people over 21 in the U.S. The problem is, alcohol use comes with enormous cost. Alcohol produces intoxication, which causes accidents, injuries, and other problems. Alcohol also causes alcohol dependence. If you drink in excess of the moderate guidelines - 14 drinks a week for men, seven for women - over a long period of time, it's possible that you'll develop a syndrome of alcohol dependence.

What is it about alcohol that people find so enjoyable?
Alcohol produces euphoria and cognitive stimulation. It is a social lubricant and in some respects it has positive health benefits, like the reduction of coronary heart disease. Those positive effects, though, are limited to a small segment of the population over 40 who drink very infrequently or in moderation.

The U.S. tried Prohibition. Does this book recommend a new prohibition?
I think some people see any alcohol restriction as prohibitionist. But the truth is, we already have prohibition for people under the age of 21. We have very strong advice against women using alcohol if they are pregnant. What we're talking about in the book is reasonable limitations on the use of alcohol within certain populations at certain times and in certain places.

Does the book prescribe more taxes and regulation?
Taxes are a very effective means not only of limiting alcohol consumption, but limiting alcohol problems. Taxes generate revenues for governments, and they affect alcoholics as much as they affect non-alcoholics. Tax increases on alcohol affect young people, who are prone to get intoxicated, as much as they affect older people; yet they have little financial impact on social drinkers and their ability to enjoy alcohol.

Are the recommendations in the book a combination of Prohibition and the new Puritanism?
Not at all. When you look at alcohol policies, sensible controls on alcohol consumption go back to the Code of Hammurabi in ancient Babylonia more than 4,000 years ago. What we're doing is continuing that tradition and adding to it scientific evidence pointing to the most effective alcohol policies, like controlling the drinking environment, training bar and restaurant people so that they don't serve intoxicated patrons, and introducing drinking and driving countermeasures.

Where does industry stand on regulation?
The alcoholic beverage industry does things that make them appear to be good corporate citizens. We can accept at its face value that they do support some alcohol prevention measures. Unfortunately, they don't pay as much attention to the scientific evidence as they should, and they put their resources into generally ineffective measures like alcohol education in the schools, while they tend to oppose increased restrictions on hours and days of sale, alcohol advertising, drinking and driving countermeasures, and things that are likely to have much more beneficial effects on society.

How has the book been received?
The reception has been very good. Our report has been featured at national policy conferences in Australia, Switzerland, Norway, and the UK. We've received support from members of the scientific community who are responsible for generating the evidence that we hope policymakers will use. Many policy makers will find this book a welcome addition when it comes to passing laws, making regulations, and appropriating funds for different treatment and prevention programs.