Almost nothing has flowed through human history quite as consistently, consolingly, convivially and catastrophically as alcohol.
A year ago, National Geographic magazine published a story noting that the Chinese were making a kind of wine from rice, honey and fruit 9,000 years ago and that grapes grown in the mountains of Georgia and Iran were being put to heady purpose more than seven millennia back.
Along with alcohol’s many salutary effects, however, there has poured with it down all those centuries a social carnage of chronic disease, injury and death, birth defects, motor vehicle accidents, domestic and other violence and crime.
In Canada, the Yukon Territory has seen more than its share of alcohol’s harm. The territory of about 37,000 people has consistently recorded the highest alcohol sales per capita in the country over recent decades. A report by the chief medical officer of health there for 2015 said Yukon had a significantly higher proportion of “heavy drinkers” — both men and women — than Canada as a whole, with all the related health and crime issues.
For Canadian researchers, looking to test ways of reducing that cost through labelling on alcohol products, Yukon was both an attractive ground for study, a jurisdiction aware of alcohol’s harms, and an enthusiastic participant.
So starting in November, after several years of preliminary work, investigators Erin Hobin, a scientist with Public Health Ontario, and Tim Stockwell, director of the Canadian Institute for Substance Use Research at the University of Victoria, launched their study with labels warning of alcohol’s links to several types of cancer, including breast and colon cancer.
“The purpose of our study is to test if alcohol warning labels are an effective tool for both increasing consumer awareness of the health risks of drinking alcohol, specifically cancer, but also to examine whether alcohol warning labels can support consumers in making more informed and safer alcohol drinking choices,” Hobin told the Star.
Their project, funded by Health Canada, aimed to test three labels. The first warned of the link between alcohol and cancer. A second informed consumers of Food Canada’s low-risk alcohol guidelines for men and women. A third would have informed consumers of the standard drink units — as defined in the national guidelines — in whatever container of alcohol was purchased.
The research was hardly up and running, however, before the territory’s Yukon Liquor Corp. pulled the plug and halted the study in December.
Apparently, Hobin and Stockwell had poked the bear that is the alcohol industry and it was growling at the territorial government about legal action.
“When the alcohol producers expressed concerns to us, that conversation left us with the real possibility that we would end up in litigation,” John Streicker, territorial minister responsible for the Yukon Liquor Corp., said in an interview.
“What it really came down to was whether the messages on the labels were harming their brand and whether they constituted defamation.
“We don’t believe that that’s the case,” he said. “But in how we think about this, as a small jurisdiction, we have to decide about whether we would put resources toward a litigation that we believe would be protracted.”
The government has to consider whether such money would be better spent on education or harm reduction, he said.
“That’s the hard choice. In this pause, what we’re trying to do is work to see if there’s some common ground between researchers and producers and if there is a path forward.”
For his part, Stockwell said the researchers have received a legal opinion suggesting any complaint by the industry would be frivolous.
“We’re not giving up,” he said. “We were only told it’s been paused while they consider their options.”
The team hopes the Yukon government will “get more confidence and call the bluff of the liquor industry,” he said.
Stockwell said label tests were important because research suggests Canadians, our national thirst notwithstanding, are remarkably ignorant about alcohol and drinking.
“It’s very clear that when you test people without the standard drink labels they haven’t the first idea,” he said.
“They’re very, very bad at estimating how many standard drinks are in their typical bottle of wines or bottle of spirits and certain high-strength beers.”
Research shows that about three-quarters of the population doesn’t know about the cancer link; about three-quarters doesn’t know about the national low-risk guidelines; and the same percentage do not know about standard drinks, “which you would need to know if you’re going to follow the low-risk guidelines.”
Hobin said Yukon was a keen volunteer for the project when she approached various jurisdictions across Canada about participating.
It was a good candidate for several reasons. Since 1991, Yukon and the Northwest Territories have carried labels on alcohol warning pregnant women of the potential risks of drinking. And the capitals of Whitehorse, as the site for intervention, and Yellowknife, as a control setting continuing with its usual practice, “worked out quite well for a research study.”
Streicker notes that the problem of alcohol abuse is so prevalent that any such research, and the potential legal costs associated with it, might be better borne by the federal government. And on the scope of the issue he’s certainly correct.
A 2017 report by the Canadian Institute for Health Information said there were more hospital admissions the previous year for alcohol-related conditions — alcohol poisoning, alcohol withdrawal, liver disease, chronic alcohol disease — than for heart attacks.
In 2015, the federal chief health officer’s report said 80 per cent of Canadians drank alcohol, that more than three million drank enough to be at risk of immediate harm or injury and that 4.4 million were at risk of chronic health effects, such as liver cirrhosis and various forms of cancer.
The annual cost of alcohol abuse, an estimated $14.6 billion in 2002, is higher than government revenue from the control and sale of alcoholic beverages in almost all jurisdictions in Canada.
And not only is alcohol “way worse than all the illicit drugs put together” when it comes to health and social cost, Stockwell said the alcohol industry “gets off scot-free” when it comes to listing nutritional information and ingredients on packages.
Hobin said: “It is curious to think that almost all — but definitely most — packaged food products are required to include an ingredients label as well as a nutrition facts table. Now, alcohol does fall under different legislation, but it is one of the few packaged food substances that doesn’t include that type of labelling.”
Dr. Brendan Hanley, Yukon’s chief medical officer of health, told the Star he understands the territorial government’s concerns, but was disappointed by the decision and remains “hopeful that we can get this launched again.”
“There’s a dearth of information, certainly at point of sale, either about any nutritional information let alone just some basic, basic advice on what’s a reasonable level of alcohol consumption that will keep you within safe health limits.”
The need to inform consumers and reduce alcohol abuse is “felt here as much or more than anywhere here in Yukon,” he said.
“We’ve known in the community for many years that we have a range of substance-use issues, and alcohol screams as probably the leading substance that produces harms in such a variety of ways.”
Hanley said the project by Stockwell and Hobin was a potentially “ground-breaking study” that gave this “tiny place in the corner of the country” a chance to produce far-reaching benefits.
“I would say jurisdictions around the country, and around the world, are looking at this with a lot of interest because this is a chance to show what the potential role is of warning labels on alcohol containers.”
As for Streicker, he told the Star “I’m not confident that there would be common ground” found between researchers and the industry to resume the research.
But he’s gratified that the little territory of Yukon is “helping Canadians to have this conversation.”
CANADA’S ALCOHOL GUIDELINES
1. Reduce long-term health risks by drinking no more than:
- 10 drinks a week for women, with no more than two drinks a day most days.
- 15 drinks a week for men, with no more than three drinks a day most days.
- Plan non-drinking days every week to avoid developing a habit.
2: Reduce risk of injury and harm by drinking no more than three drinks for women and four drinks for men on any single occasion.
3. Do not drink when:
- driving a vehicle or using machinery and tools.
- taking medicine or other drugs that interact with alcohol.
- doing any kind of dangerous physical activity.
- living with mental or physical health problems.
- pregnant or planning to be pregnant.
- responsible for the safety of others or making important decisions.
4. If pregnant, planning to become pregnant or before breastfeeding, the safest choice is to drink no alcohol at all.
5. If you are a child or youth, you should delay drinking until your late teens. Talk with your parents about drinking. Alcohol can harm the way your brain and body develop.
For these guidelines, “a drink” means:
- 341 mL (12 oz.) bottle of 5% alcohol beer, cider or cooler
- 142 mL (5 oz.) glass of 12% alcohol wine
- 43 mL (1.5 oz.) serving of 40% distilled
- Set limits for yourself and abide by them.
- Drink slowly. Have no more than 2 drinks in any 3 hours.
- For every drink of alcohol, have one non-alcoholic drink.
- Eat before and while you are drinking.
- Remember that age, body weight and health problems that might suggest lower limits.