More alcohol will mean more injuries

Alcohol policy is a fraught area. Like most people, I enjoy a drink or two, but unwise alcohol use does considerable harm, and some form of regulation is needed.

The era of prohibition has taught us that banning alcohol entirely is bad public policy, but we have to strike the right balance between alcohol use and public safety. This is especially important for those who are put at risk of harm by the behaviour of others; the evidence suggests we don’t have the right balance at present.

A 2011 study of alcohol-related deaths in Canada from the Centre for Addictions and Mental Health in Toronto suggested that alcohol contributed to many unintentional-injury deaths (almost one in four poisoning deaths, 22 per cent of drowning deaths, one in five fire deaths, one in seven motor-vehicle crash deaths and 13 per cent of deaths from falls), as well as many intentional-injury deaths (more than a quarter of homicides and suicides).

Importantly, while some unintentional-injury deaths occur to the person who is consuming alcohol — which is a form of voluntary risk — others occur among those who are put at risk by people who are drunk, which is involuntary risk. These are vital distinctions, because we are more tolerant of voluntary or selfimposed risk than we are of involuntary risk.

In a seminal article in 1969, Chauncey Starr, then dean of engineering at the University of California at Los Angeles, reported that people were willing to accept voluntary risk (skiing injuries, for example) at a level roughly 1,000 times greater than their tolerance for involuntary risks, such as exposure to environmental pollution.

In general, people seem to be willing to accept a lifetime risk of death from involuntary or imposed risk, such as exposure to environmental pollutants, of about one in a million. This suggests that an acceptable level of lifetime voluntary or self-imposed risk is about one in 1,000.

Thus there are two aspects of alcohol use and injury to consider; how to protect people from self-harm, and how to protect people from being harmed by drunks. I am most concerned with protection from those who are drunk, and agree with a team of researchers, also from CAMH, who suggested in a 2015 report that such involuntary risk “could be used as a benchmark for national alcohol policies.”

They reported that a 2008 Australian study found that the risk of death caused by other people’s drinking was higher than one in 100,000, more than 10 times the one-in-amillion rate usually deemed acceptable. Since the main causes of involuntary risk to others from drinking are due to alcohol-related traffic injuries, workplace injuries and violence, the study suggested these are the areas to focus on.

Thus it is good news that federal Justice Minister Jody Wilson-Raybould has suggested reducing the blood-alcohol limit from the current 80 milligrams to 50 milligrams.

She noted that the fatal-crash risk “is almost double at 50 mg, almost triple at 80 mg, and rises exponentially above that level” and pointed to experience in Ireland, where such a reduction, “combined with obligatory testing for alcohol, produced a 50 per cent reduction in deadly road accidents.” Sounds good to me.

But we have to do more than that. A recent report by a team based at the Centre for Addictions Research of British Columbia at the University of Victoria looked at the health and safety benefits of the Swedish government’s alcohol monopoly, and the potential impacts of deregulation and privatization. One scenario involved opening 1,200 private liquor stores, the other involved allowing alcohol sales in 9,600 grocery stores.

They found the first scenario would likely result in a 34 per cent increase in drunk driving, 21 per cent more assaults, 22 per cent more hospital stays and 41 per cent more deaths. The second scenario was worse, with 58 per cent more cases of drunk driving, 34 per cent more assaults, 33 per cent more hospital stays and 66 per cent more deaths.

Clearly, deregulation and privatization are bad for health; sadly, we are already too far down that path, and many innocent people are injured as a result. It is time to reverse course and make alcohol less accessible and more expensive.

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.