A brief historical perspective on responding to harmful use of alcohol

The consumption of alcoholic beverages provides pleasure to many people in many different cultures. From a public health perspective, however, this is a very much underrated cause or contributor to a wide variety of serious health issues. 

The focus in responding to health issues associated with alcohol use until relatively recently was on identifying and treating problem drinkers or alcoholics. True enough, they are a great deal of the overall public health alcohol problem. There is however much more to it. After all, not all alcohol related accidents are caused by problem drinkers or alcoholics, nor are all alcohol related violent acts committed by alcoholics; many cancer cases associated with drinking occur in so called social or moderate drinkers and so forth. The harm caused by alcohol to public health goes far beyond problem drinkers or alcoholics. 

Responding to alcohol problems has so far largely been characterized by public and political ignorance about the size and extent of the problem and a concomitant lack of interest to really do something about. Another important factor in this connection is the obvious interest of the alcohol industry and its partners to keep things as they are and /or to promote the idea of the drinker being the one who is responsible for any harm and not the alcohol itself. 

The most effective ways to reduce alcohol related harm to public health (including raising taxes on alcoholic beverages, restricting the physical availability of alcohol and restricting advertising and marketing) have traditionally met with a lack of interest by the general public and by well-organized efforts of the industry and its partners to impede such measures. 

Slowly but surely currently the tide seems to be changing. More and more governments at community, national and international level - often being pushed by evidence from research and by non governmental agencies - have become aware of the serious impact of alcohol on public health and social welfare, and are implementing effective measurers to curb the consumption of alcohol. The health system can and should play an important role in promoting smart public health oriented alcohol policies.

Cornelius (Cees) Goos, honorary public health consultant at the European Centre for Social Welfare Policy and Research in Vienna, Austria, and chair of the Alcohol Policy Network for Europe (APN). Previously worked for the World Health Organization (WHO), mainly at the European Regional Office - and at the Western Pacific Regional Office; for UNESCO and for the Dutch national institute on mental health and addictions.  At WHO respectively program manager alcohol, drugs and tobacco and director a i health promotion and disease prevention; initiated and led the WHO Health in Prisons Project.