Abstract
BackgroundSocieties tend to accept much higher risks for voluntary behaviours, those based on individual decisions (for example, to smoke, to consume alcohol, or to ski), than for involuntary exposure such as exposure to risks in soil, drinking water or air. In high-income societies, an acceptable risk to those voluntarily engaging in a risky behaviour seems to be about one death in 1,000 on a lifetime basis. However, drinking more than 20 g pure alcohol per day over an adult lifetime exceeds a threshold of one in 100 deaths, based on a calculation from World Health Organization data of the odds in six European countries of dying from alcohol-attributable causes at different levels of drinking.DiscussionThe voluntary mortality risk of alcohol consumption exceeds the risks of other lifestyle risk factors. In addition, evidence shows that the involuntary risks resulting from customary alcohol consumption far exceed the acceptable threshold for other involuntary risks (such as those established by the World Health Organization or national environmental agencies), and would be judged as not acceptable. Alcohol’s exceptional status reflects vagaries of history, which have so far resulted in alcohol being exempted from key food legislation (no labelling of ingredients and nutritional information) and from international conventions governing all other psychoactive substances (both legal and illegal). This is along with special treatment of alcohol in the public health field, in part reflecting overestimation of its beneficial effect on ischaemic disease when consumed in moderation.SummaryA much higher mortality risk from alcohol than from other risk factors is currently accepted by high income countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0189-z) contains supplementary material, which is available to authorized users.
Highlights
Societies tend to accept much higher risks for voluntary behaviours, those based on individual decisions, than for involuntary exposure such as exposure to risks in soil, drinking water or air
Summary: A much higher mortality risk from alcohol than from other risk factors is currently accepted by high income countries
Voluntary risks are dealt with by a variety of means. These include total or partial prohibitions on commerce in risky behaviours, such as no tobacco sold to minors, as stipulated by the Tobacco Framework Convention [4]; heroin production and sale prohibited except for medical and scientific purposes [5]; or a minimal legal purchasing age for alcohol [6]
Summary
If we accept the stated acceptable risk of one in 1,000 deaths, drinking 20 g pure alcohol per day (equivalent to 1.5 to 2.5 standard drinks dependent on the national standard drink: 8 g pure alcohol per drink in the UK, between 10 and 14 g in other European countries) exceeds this threshold, even if only the risk up to age 70 is considered (obviously, the lifetime risks for alcohol-attributable mortality will be considerably higher). Summary Alcohol consumption incurs voluntary and involuntary risks that exceed the risks modern societies in high-income countries are willing to accept for other risk behaviours and factors This acceptance is exemplified by how alcohol is treated within the food legislation, within the international treaties for psychoactive substances and within public health frameworks. RR is a sociologist, who has specialized in analysing the formal and informal impact of society on substance use He is currently working as Director of the Centre for Alcohol Policy Research, Turning Point, Melbourne, Australia, and as Professor of Social Research in Alcohol, School of Population Health, at the University of Melbourne
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