“The fiduciary responsibilities of all corporations require them to maximize their profits regardless of the consequences to health, society, or the environment and thus to oppose policies that could reduce their profits” (1)

This quote succinctly highlights the conflict between the goals of corporations and that of governments and institutions tasked with promoting and protecting public health. Even after the enormous damage done by the world’s first corporation some 400 hundred years ago, we still find ourselves in a situation where the vested interests of a wealthy minority trump those of the masses. Never is this more apparent than in the influence the alcohol industry has on shaping the narrative about the harm caused by their products.

Some sobering facts: Alcohol consumption is causally associated with at least 43 major categories of disease or injury (2), including cancer of the breast, colon and oesophagus. It contributes to an estimated 3 million deaths globally each year and is the leading cause of death amongst those aged 15-49. While it was once thought that low levels of alcohol intake offered some health benefits, it has recently been shown that any level of alcohol consumption can be harmful for health. While there are evidenced-based policies that can effectively reduce population alcohol consumption (e.g. advertising restrictions, taxation), and therefore reduce the enormous health, social and economic costs it imposes on society, their inconsistent implementation speaks to the power of the alcohol industry in effectively opposing these to protect their profits. Nowhere is this more apparent than in the alcohol industry’s staunch opposition to accurate health warning labels on their products.

Many countries have implemented prominent health warning labels on cigarette packaging, which combined with a range of other measures, have resulted in a dramatic decrease in tobacco use. In contrast, despite it being classified as a Class 1 carcinogen over 30 years ago, only one country, South Korea, has warning labels alerting consumers to the link between alcohol consumption and cancer(2). While other countries do include health warning labels on alcohol products, these typically focus on warnings relating to specific target groups e.g. pregnant women, or around specific contexts such as drinking and driving, reinforcing the industry’s narrative that the harms associated with alcohol relate to drinking patterns, not to alcohol itself . The extraordinary lengths the industry went to to stop a study in the Yukon, Canada, looking at the impact of cancer warning labels on consumption patterns, provides insight into the industry’s efforts to keep the public in the dark about the true health risks associated with the consumption of its products.

In the Yukon study, the Territorial Liquor Authority attached prominent labels on a range of alcohol products, highlighting the link between alcohol consumption and breast and colon cancer, two of the most common cancers in Canada. One month into the planned eight-month intervention, the study was stopped “as a result of complaints made by the Canadian alcohol industry bodies that the labels were “defaming” their products” (2). Despite these claims having no legal basis, the Yukon Government decided to remove the labels, as they simply could not afford a lengthy legal battle. Though the study was cut short, the researchers found that the labels resulted in an increased awareness of the link between consumption of alcohol and the risk of developing various types of cancer, and an overall reduction in sales. You can find a link to the study here.

With regard to legal obligations for health warning labels on consumer products, “a higher standard of disclosure is required if the specified risk is not generally known and the product is mass marketed to vulnerable consumers” ( 2). On the first point, most studies show that the majority of people are not aware of the link between alcohol and cancer. On the second point, alcohol is one of the most heavily marketed products in the world, with the often brilliant and engaging marketing efforts serving to highlight the positive social aspects around consumption, while disregarding the potential harmful effects to ourselves and others. These efforts can be observed through sponsorship of global sporting events, product placement in films, and increasingly targeted advertising through the internet and social media platforms. While nudge nudge, wink wink, alcohol companies may encourage us to drink responsibly or in “moderation”, it’s well known that the industry depends on heavy drinking occasions for a large portion of their profits. As an article in The Economist recently put it “alcohol firms promote moderate drinking, but it would ruin them”.

Alcohol is a Class 1 carcinogen. Full stop. While the risk is greater for certain types of cancer than others, any level of intake will increase risk in a dose-response manner (2). While this risk will be greater for those who drink heavily, smoke, eat a lot of processed red meat and lead a sedentary lifestyle than for people who follow a text book healthy diet, are non-smokers, drink only occasionally and exercise regularly, the risk still exists. The point being that the link should be common knowledge, which it is not. When Don Draper is sipping whisky in his office or Boris Johnson is sipping chardonnay in the backyard at 10 Downing Street, we should be confident that they know they are increasing their risk of developing cancer.

People always have, and will continue to engage in behaviours that they know are harmful to their health. They will continue to smoke, drink pop and eat fast food, drive without seat belts or ride a bike with no helmet. Having accurate warning labels on alcohol products will not stop people from drinking, but it may reduce how often they do it or how much they have when they do.

Conclusion.

For far too long, the real dangers of cigarette smoking were distorted and hidden from the public thanks to the efforts of the tobacco industry wanting to protect their profits. The alcohol industry is working from the same playbook – downplaying the negative health impacts of their products, framing the issue as one of individual responsibility and supporting largely ineffective campaigns encouraging moderation, while at the same time spending millions upon millions in advertising to encourage people to drink more. Combined with other efforts known to be effective in decreasing population consumption, as the Yukon study showed, including clear, prominent, unambiguous cancer warning labels on alcohol products can be an effective means of decreasing population consumption and by extension, decreasing the health and economic burden it imposes on society.

References

1. Anna B. Gilmore, Emily Savell, Jeff Collin, Public health, corporations and the New Responsibility Deal: promoting partnerships with vectors of disease?, Journal of Public Health, Volume 33, Issue 1, March 2011, Pages 2–4, https://doi.org/10.1093/pubmed/fdr008
2. Stockwell T, Solomon R, O’Brien P, Vallance K, Hobin E. Cancer Warning Labels on Alcohol Containers: A Consumer’s Right to Know, a Government’s Responsibility to Inform, and an Industry’s Power to Thwart. J Stud Alcohol Drugs. 2020 Mar;81(2):284-292. PMID: 32359059.