New York Alcohol Policy Summit: Expanding Public Health Protection

In the United States today, much of the focus on alcohol problems is limited to the issues of underage drinking and drunk driving, with both narrowly defined in terms of the problem and the acceptable solutions.  To expand this frame, several organizations including the New York Alcohol Policy Alliance (NYAPA), the New York State Public Health Association (NYSPHA), and the Council on Addiction of New York State (CANYS) met at the New York Alcohol Policy Summit in Syracuse October 6.

About 200 participants – including faith leaders, police officers, pediatric nurse practitioners, prevention educators, research scientists, coalition members, public health practitioners, policy analysts, university faculty, registered nurses, and suicide prevention advocates met to consider the health and social consequences of excessive alcohol consumption and to propose new policy approaches to reduce the adverse consequences of alcohol use in New York State.

Alcohol Harms

The starting point for the Summit was the many serious health problems associated with current patterns of alcohol use.  These include:

Suicide. Alcohol has been found to “increase the lethality of suicide attempts in individuals with mood disorders,”[1] with a CDC analysis of suicide victims finding one-third testing positive for alcohol in their systems.[2] Furthermore, age of drinking onset among young people has been linked to risk of lifetime suicide attempt (i.e., the earlier the age of drinking onset, the greater chance for a suicide attempt later in life).[3]

Cancer. Alcohol is a recognized carcinogen, which has been connected to cancers of the head and neck, liver, female breast, & colon/rectum.[4] [5] It is estimated that alcohol is responsible for 5% of the preventable cancer cases worldwide.[6]

HIV/AIDS. Excessive alcohol consumption has been shown to worsen the severity and progression of HIV through impacts on the immune system and adherence to medication.[7]

Fire Safety. Research has found that from 15-40% of decedents of residential fires are alcohol impaired.[8] Several mechanisms have been cited for this relationship, including impaired judgment, reduced ability for detection, reduced ability to escape, compromised caretakers, burn severity, and suppressed cough reflex. [8]

Gun Violence.  Alcohol has been shown to be significant factor in violence in general, but particularly related to gun violence through off-premise alcohol outlet density.[9]

And the economic consequences are just as staggering, with the CDC just releasing a study reporting that excessive alcohol consumption costs the US $224 billion a year, or approximately $1.90 per drink. [10]

Making Alcohol Policy Health Policy

With this in mind, it is apparent that those engaged in alcohol policy – and the broader public health community – need to recognize the multiple pathways of alcohol-related harm, and the parallel need to implement effective policies to stem those harms. This will require proactive media advocacy, dynamic professional education, and strategic countering of alcohol industry attempts to frame the problem – the goals of the October 6 Summit.

The plenary sessions of the Summit focused on the big picture, including the larger socioeconomic context and the state-of-the-science in alcohol policy, while the panels and workshops drilled down to the specific effects of alcohol consumption on particular health and social issues and populations. The Summit sessions were designed to break through the artificial barriers which tend to marginalize alcohol policy concerns (in prevention, treatment, and recovery) from mainstream public health concerns.

Noted attorney and alcohol policy expert James Mosher, JD was the Summit keynote speaker. He appealed to Martin Luther King, Jr. and the broader socioeconomic climate to demonstrate the need for public health advocates to embrace the opportunity of alcohol policy advocacy and work to place people ahead of profits.

Other Summit plenary speakers and their topics included:

Stacy Carruth, MPH (Regional Center for Healthy Communities, Cambridge, MA) spoke on the efforts in Massachusetts to remove alcohol advertising from the public transportation system, and the need for regional cooperation and collaboration among New York and the New England states.

Michele Simon, JD, MPH (President, Eat Drink Politics; Author, “Appetite For Profit”) described the disturbing (and sometimes amusing) parallels between the deceptive marketing practices of the food and alcohol industries;

Donald W. Zeigler, PhD (Director of Prevention & Healthy Lifestyle, American Medical Association) discussed the work of the Task Force on Community Preventive Services and the necessity of prevention advocates in engaging with medical professionals; and

Robert Lindsey (MEd, CEAP) (President/CEO, National Council on Alcoholism & Drug Dependence) described the challenge of engaging individuals in recovery in policy efforts, in light of the paradox between the personal, emotional nature of recovery and the public health population-level paradigm.

In addition, Arlene González-Sánchez, Commissioner of the New York State Office of Alcoholism and Substance Abuse Services and Pamela J. Westlake, Director of Enforcement for the New York State Liquor Authority, offered an overview of the problem of underage drinking in New York State and the ongoing efforts of their agencies to combat that problem.

Summit workshops addressed the issues of suicide, gun violence, child maltreatment, cancer, HIV/AIDS, fire safety, gambling, eating disorders, and on alcohol policy impacts on special populations, including rural communities, Native Americans, seniors, and the military (active duty and veterans).

The Summit also tackled two issues which are explicitly alcohol-related but which are rarely addressed in the context of alcohol policy: Fetal Alcohol Spectrum Disorders (FASD) and Treatment & Recovery. FASD sometimes tends to be defined, with limited goals of educating individual women to refrain from drinking during their pregnancy. While those educational efforts are necessary, they are not sufficient, considering that states with higher rates of binge drinking among women of childbearing age have higher rates of alcohol-exposed pregnancies.  This points to a need to bring drinking rates down among all women of child-bearing age, and to push back against alcohol industry attempts to target women as a growth market.

In the longer term, Summit organizers hope to catalyze action in these specific areas of alcohol policy, rather than function as one-and-done educational event.  In addition, the Summit and its aftermath may suggest directions for other advocates for more health-oriented alcohol policy for how best to expand policy advocacy from local and national arenas to a statewide focus.

 

References


[1] Sher, L., Oquendo, M. A., Richardson-Vejlgaard, R., Makhija, N. M., Posner, K., Mann, J. J., & Stanley, B. H. Effect of acute alcohol use on the lethality of suicide attempts in patients with mood disorders.  Journal of Psychiatric Research, 2009; 43(10), 901-05 .doi:10.1016/ j.jpsychires. 2009.01.005

[2] MMWR. Toxicology testing and results for suicide victims -13 states, 2004. Morbidity and Mortality Weekly Report, 2006; 55(46), 1245-1248.

[3] Bossarte, R. M., & Swahn, M. H. The associations between early alcohol use and suicide attempts among adolescents with a history of major depression. Addictive Behaviors,2011;  36(5), 532-535. doi:10.1016/j.addbeh.2010.12.031

[4] Allen, N.E., Beral, V., Casabonne, D., Kan, S.W., Reeves, G.K., Brown, A., et al.. Moderate alcohol intake and cancer incidence in women. Journal of the National Cancer Institute,2009;  101(5),296-305.
[5] Boffetta, P., Hashibe, M., La Vecchia, C., Zatonski, W., & Rehm, J. The burden of cancer attributable to alcohol drinking. International Journal of Cancer,2006;  119(4), 884-887.
[6] Danaei, G., Vander Hoorn, S., Lopez, A.D., Murray, C.J.L., Ezzati, M., et al. Causes of cancer in the world: Comparative risk assessment of nine behavioural and environmental risk factors. Lancet, 2005; 366, 1784–1793.

[7] Shuper, P. A., Neuman, M., Kanteres, F., Baliunas, D., Joharchi, N., & Rehm, J. Causal considerations on alcohol and HIV/AIDS–a systematic review. Alcohol and Alcoholism (Oxford, Oxfordshire), 2010; 45(2), 159-166. doi:10.1093/alcalc/agp091.

[8] U.S. Federal Emergency Management Administration. Establishing a relationship between alcohol and casualties of fire. Report. National Fire Data Center, United States Fire Administration.  Arlington, VA:  TriData Corporation, 1999. Retrieved on June 12, 2011 from http://instruct1.cit.cornell.edu/Courses/arch465/arch465f06-firesafety/alcohol-fire.pdf

[9] Branas, C. C., Elliott, M. R., Richmond, T. S., Culhane, D. P., & Wiebe, D. J.  Alcohol consumption, alcohol outlets, and the risk of being assaulted with a gun. Alcoholism, Clinical and Experimental Research, 2009; 33(5), 906-915. doi:10.1111/j.1530-0277.2009.00912.x

[10] Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic Costs of Excessive Alcohol Consumption in the U.S., 2006. American Journal of Preventive Medicine, 2011; 41(5), A4. doi:10.1016/S0749-3797(11)00692-1]

 

Image Credits:

  1. Turtlemom4bacon via Flickr
  2. Cle0patra via Flickr