Matters of Substance

The BC government is the sole wholesaler and leading retailer of alcohol in the province and government revenue from alcohol is carefully tracked year after year. The social costs of alcohol, however, are not reported by government even though they contribute significantly to health care and enforcement costs. This begs the question: How can we make informed decisions about the supply of alcohol if we do not meaningfully include costs in our analyses?

Alcohol is implicated in a host of health and social harms from violence to injuries to many types of cancer to better known ailments such as liver cirrhosis and alcohol dependence (addiction). While the sheer breadth of these harms makes monitoring them difficult, careful methods for assessing the costs of alcohol were developed right here in Canada, and have been applied in several countries around the world. The costs of alcohol are divided into direct costs (mainly for health and enforcement), and indirect costs which account for losses in productivity associated with alcohol-related disability and deaths.

The on-going assessment of alcohol-related costs and harms could help enhance the management of alcohol in several ways. For example, such information could help the government assess the impact of its policies and programs and gauge the impact of changes to policy over time. Yearly estimates of alcohol-related costs and harms could be compared to the revenue and other benefits from alcohol sales, and this could help the government achieve its stated goal of balancing the benefits and costs of alcohol in society. On this point it is worth noting that some policies have the potential to maintain revenue while at the same time reducing risky alcohol consumption. Chief among these are minimum price policies which target heavy and risky drinkers who tend to gravitate toward low cost alcohol.

And just how balanced is the current approach to managing alcohol in BC? The answer is, we don’t know, because recent cost estimates are not available. However, in 2002 (the last year for which data is available) direct revenue from alcohol totaled $852 million and direct costs were estimated at $925 million. Big ticket costs included $550 million for health care and $359 million for alcohol-related enforcement. So the best available data suggests that when direct revenue and direct costs are compared, the province is running a deficit of $73 million dollars.

There are, of course, other benefits besides revenue related to alcohol, and there are many other costs and harms besides provincial budget costs. But given that we do know the direct costs of alcohol outstrip the direct revenue government gains from the sale of alcohol, wouldn’t the ongoing monitoring and reporting of costs be an important part of modernizing BC’s approach to managing alcohol?

Author: Gerald Thomas

While we know that there are individual risks associated with consuming alcohol, such as acute injuries or chronic diseases such as liver cirrhosis, how often do we think about the impact that our own alcohol use has on those around us? Alcohol use has many potential negative secondhand effects including stress to relationships, impacts on other’s health and safety (e.g. on the roads, in the streets late at night, in the workplace), violence and property crime, developmental problems in children and substantial economic costs. For example, in 2012 alone there were 17,888 alcohol-related violent crimes committed in BC.

Looking at the overall impact of all these second-hand effects of alcohol has been an important focus of research in recent years. When smoking was linked with cancer and people became aware of the effects of second hand smoke, we began to see major developments in tobacco policy designed to protect those affected by other people’s smoking. The same is true of changes to drinking and driving policies and to some degree initiatives to prevent Fetal Alcohol Spectrum Disorder (FASD)—when innocent people are harmed it gets people’s attention and this can pave the way for change.

While there is limited data on this specific to Canada, three Canadian studies conducted between 2004 and 2008 found that nearly one in three adults reported experiencing one or more types of harm resulting from someone else’s drinking in the past 12 months. In contrast, according to the Canadian Alcohol and Drug Use Monitoring Survey results for 2010, of those who drank alcohol in the past year fewer than one in ten reported experiencing any harm to self, showing that individuals are much more likely to be affected my others drinking than their own drinking.

Do we need to use a wider-lens when we think about the impact of alcohol use? Would social norms around alcohol use change significantly if we started taking harms to others more seriously? Many individuals are ‘responsible’ drinkers, but others are often not. Moreover, our level of responsibility declines as our level of consumption increases. Liquor laws help protect everyone, drinkers and non-drinkers and we need to carefully consider how access to cheap alcohol affects drinkers and non-drinkers alike.

Now probably the most important question is what can we do about harm to others? There are many specific measures to reduce these harms that can be applied in different contexts e.g. policing late-night drinking venues, deterring impaired driving and also more general measures which target hazardous drinking in the whole population. CARBC research shows that while BC leads in some areas of alcohol policy it also lags well behind in others and, overall is only achieving half its potential for alcohol harm reduction – both for drinkers and those around them.

How important is it that we implement evidence-based policies that can reduce harm for everyone?

Authors: Kate Vallance (pictured), Kara Thompson, Ashley Wettlaufer

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