The wait is over. Last week the National Health and Medical Research Council (NHMRC) released the updated guidelines to reduce health risks from drinking alcohol.
Informed by the best available evidence, the guidelines recommend:
- To reduce the risk of long-term health impacts, such as cancer, healthy men and women should have no more than 10 standard drinks a week.
- To reduce the risk of injury, healthy men and women should have no more than 4 standard drinks in one day.
- Anyone under the age of 18 should not drink any alcohol to reduce the risk of injury and other harms to health.
- Women who are pregnant, planning a pregnancy or breastfeeding should not drink alcohol to prevent harm to their baby.
Australia’s Acting Chief Medical Officer, Professor Paul Kelly, explained that, “Following the guidelines keeps the risk of harm from alcohol low, but it does not remove all risk. Healthy adults drinking within the guideline recommendations have less than a 1 in 100 chance of dying from an alcohol-related condition.”
The guidelines were last updated in 2009 and in the intervening 11 years the body of evidence on the risks related to alcohol use has continued to grow. The evidence has become clearer that even low levels of alcohol use increases cancer risk. The more you drink, the greater your risk of developing an alcohol-caused cancer; however, any amount of alcohol increases your risk of cancer.
Another change is the increased doubt about the evidence of possible protective effects of low levels of alcohol use on some health conditions. Newer studies benefit from improved research designs and lend weight to uncertainty over the existence or extent of any possible protective effects.
Children and young people are particularly vulnerable to harms from alcohol, including from injury, risk taking, alcohol poisoning, and impacts on brain development. Starting to drink at an early age can also put young people at greater risk of developing harmful drinking patterns later in life. This evidence, combined with the precautionary principle, informed the guidance that the risks and harms are lowest when those under 18 years of age do not drink alcohol.
The guideline related to pregnancy and breastfeeding is focused on reducing the risk of harm beyond the person drinking; that is, risk to the fetus or baby. Alcohol use at any stage during pregnancy can have lifelong consequences for the developing fetus, including by interfering with normal brain development. The available evidence does not identify a no-risk level of alcohol use during pregnancy; therefore, the guideline takes a precautionary approach in recommending not drinking alcohol at all.
The updated guidelines were welcomed by leading health organisations, including those with a focus on reducing the impacts of alcohol on the community. PHAA CEO Terry Slevin commended the NHMRC and emphasised that “The community has a right to know how to stay at low risk of harm from alcohol. A well-informed and supported community will be better able to play an active role in reducing the harm caused by alcohol”. Clare Hughes from Cancer Council Australia said, “If Australians reduced their alcohol intake in line with the new guidelines, this would make a big impact in reducing the 3,500 cancers currently caused by alcohol across the nation each year”. These sentiments were echoed in statements by FARE, the Alcohol and Drug Foundation and the National Alliance for Action on Alcohol, which also called for governments to protect children from alcohol advertising in order to reinforce the NHMRC recommendations.
The NHMRC’s rigorous evaluation of the evidence and careful development of the guidelines were no doubt important, but it is what happens next that really matters. The need for sustained government investment to build public awareness and understanding of the guidelines was recognised by many groups in welcoming the new guidelines. This need was even acknowledged by NHMRC itself: “The success of the guidelines in improving health outcomes is entirely dependent on their successful dissemination, public communications and ongoing community awareness-raising about the guidelines (including to health professionals), for which the Australian Government is responsible.”
The absence of an effective national education strategy to communicate the 2009 guidelines was noticeable. The exception is in WA, where the State Government has consistently invested in public education about the guidelines via the Alcohol.Think Again campaign, with surveys showing a positive return on investment with higher levels of awareness of the guidelines in WA than in other jurisdictions.
Predictable criticism from the alcohol industry got a bit of airtime following the release of the guidelines, with an alcohol trade association seeking to push their own ‘analysis’ of the evidence and argue for their inflated view of health benefits from drinking. Just a week earlier the alcohol industry was congratulating itself for developing a ‘moderation message’ (“Choose to DrinkWise”) to be displayed in liquor retailers’ premises. It’s hard to imagine that this wasn’t timed to pre-empt the NHMRC guidelines, and stands in stark contrast to the clear guidance needed to inform and empower the community to reduce their risk of harm.
Updating the guidelines is a big undertaking, and the thorough approach of the NHMRC and its expert advisers should be recognised. Now the focus turns to building community awareness and understanding of the guidelines and encouraging governments to adopt the policy solutions that will reduce alcohol-fuelled harm.
Julia Stafford is a co-convenor of the PHAA Alcohol, Tobacco and other Drug special interest group. Julia is also the Alcohol Program Manager at Cancer Council WA, which partners with the WA Government Mental Health Commission to deliver the Alcohol. Think Again program.