New Research by the Alcohol Policy Network, Ontario Public Health Association

Friday, 23 February 2007

Contents I Introduction: Alcohol and Chronic Disease II An Overview of the Harms of Alcohol III Consequences of Alcohol Consumption in Canada and Ontario IV Proximal and Distal Factors in Alcohol Consumption and Harms V Data Quality and Emerging Challenges VI Recommendations VII Conclusion --by Ben Rempel, Manager, Alcohol Projects, Ontario Public Health Association ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *~ ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *~ I Introduction: Alcohol and Chronic Disease The literature documenting the role of alcohol in multiple chronic diseases continues to grow, but the identification of risk factors and the prevention of alcohol-related chronic disease has not received the full attention it deserves. There is a disjunction between the damage from alcohol and initiatives to control or more effectively manage this damage. Professionals and the population at large are quite aware of the more acute consequences of alcohol intoxication, such as drinking and driving; however, alcohol-related chronic disease has, so far, been second to these. In research, intervention, and policy concentrated on chronic disease, the main attention to date has been on risk factors of tobacco use, physical activity, diet, and unhealthy weight. The overarching purpose of a new research paper by the Alcohol Policy Network is to bring the relationships between alcohol and chronic disease to the forefront, with the goal of informing professional awareness, policy and intervention. This document is a resource for those involved in prevention planning, policy development, and public health advocacy. The paper examines the following topic areas: 1. An overview of the harms of alcohol consumption (chronic and acute) and factors that contribute to these harms 2. Alcohol-related chronic disease in different populations, specifically by age and gender, focusing on data from Canada and Ontario 3. The role of alcohol in specific chronic diseases, including cancers, diabetes, neuropsychiatric conditions, cardiovascular diseases, cerebrovascular diseases, and digestive diseases 4. Implications for policy. While we recognize the role of alcohol in a number of acute health and social consequences, and we do consider these briefly, the primary goal of the document is to examine the role of alcohol in chronic disease and make recommendations for increasing the profile of these relationships and incorporating them further into policy and practice. For the purposes of the paper, we define chronic disease as a malady that generally takes a long time to develop, is recurring or ongoing, and requires multiple management strategies, often without cure. Many injuries also have a chronic aspect to them, in that they can either result in long-term care and rehabilitation demands and/or prolonged trauma associated with an injury can result in chronic adverse effects, either mental or physical. The following summarizes key section of the longer paper. ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *~ II An Overview of the Harms of Alcohol The research paper describes the literature on the harms of alcohol consumption, including the acute and chronic health and social consequences and related proximal and distal factors that can shape the relationship between alcohol consumption and consequences. The paper includes a discussion of data quality and emerging challenges in documenting the links between alcohol and potential consequences. The paper provides an overview of the rationale for examining the role of alcohol consumption on certain chronic diseases such as cardiovascular diseases, cancers, and mental disorders. ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *~ III Consequences of Alcohol Consumption in Canada and Ontario Alcohol use in Canada accounted for over $14 million in direct and indirect costs (37% of the total substance use related costs), representing $463 per capita. The paper details specific data from Canada and Ontario regarding the economic costs and harms of alcohol consumption and includes data on mortality and morbidity rates. ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *~ IV Proximal and Distal Factors in Alcohol Consumption and Harms The consumption of alcohol is not only a matter of personal choice; it is influenced by a range of social, cultural, economic, and environmental factors. Population-level phenomena and individual-level factors are important considerations in understanding the role of alcohol in chronic disease and in developing interventions, explained in detail within the paper. ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *~ V Data Quality and Emerging Challenges The paper identifies and analyzes multiple challenges emerging in understanding the development and impact of alcohol-related chronic disease. These challenges include alcohol consumption patterns, the types of evidence that form the knowledge base of alcohol-related chronic disease, and the current state of integration of alcohol research into chronic disease initiatives. Alcohol-related problems do not result solely from excessive drinking and intoxication. In fact, even low or moderate levels of alcohol consumption can have deleterious effects, including workplace performance, traffic safety, and cancer risk. ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *~ VI Recommendations We see a number of recommendations emerging from the existing knowledge of alcohol-related chronic disease that would be useful for policymakers, practitioners, and others interested in addressing this important health issue. There is a dire need of expansion of efforts, particularly in the following areas: Goal setting: Are there clear goals and are the resources accessible to achieve them? Policy development: Are most effective policies in place, implemented and enforced, and at all relevant levels? Programs: Are most effective best practices the most common? Are there mechanisms in place to facilitate coordination and avoid a duplication of effort? Research: Is there a good mix of multidisciplinary initiatives to assess causation of chronic diseases, and inform and evaluate interventions? Monitoring and surveillance: Is the available surveillance adequate to capture inter-regional differences and sensitive to special populations? Coordination: Are there adequate resources for infrastructure development, training, dissemination of best practices? Is there a clear understanding of who is responsible for what and how? ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ * ~ *~ VII Conclusion In Canada, alcohol is consumed by the majority of the population. Even for those individuals not drinking in a "risky" fashion, the possibility of developing alcohol-related chronic disease still exists. Alcohol consumption and high-risk drinking are increasing in Canada. Both developments are expected to contribute to chronic disease as well as trauma associated with alcohol consumption. In turn, the social, health and other costs are expected to increase. To explore this topic further, the Alcohol Policy Network is co-hosting the Alcohol and Chronic Disease Prevention Forum, on March 22, 2007 in Toronto. For more information on the forum or this research paper, please visit http://www.apolnet.ca.