The Post: Why all of us drinking less might help reduce hazardous consumption

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If you raise a glass of wine or beer to your lips this weekend, consider this question: even if you’re only a moderate drinker, should that beverage have been harder to come by in order to combat alcoholism?

This issue was brought to mind by RNZ’s revelation this week that booze lobbyists were consulted by the Ministry of Health on the design of its strategy to combat the harm that drinking can cause. This, inevitably, allowed the industry to make some dubious claims.

Spirits New Zealand’s chief executive, Robert Brewer, appeared to downplay the severity of the issue by arguing that hazardous drinkers constituted “just” 16% of adults. One out of every six would seem like a lot to most people.

The more subtle problem, though, lies in the Brewers Association’s claim that the ministry had erred by proposing “broad-based initiatives”, such as excise taxes and limits on the availability of alcohol, rather than those targeting only “harmful” consumption.

Aiming initiatives only at the worst offenders can, of course, seem sensible. It is also wrong.

To understand why, consider something called the prevention paradox, first identified by epidemiologists several decades ago. The paradox is that, for a given disease, people at high risk of contracting that disease constitute the minority of cases. Most cases – the bulk of the problem, in other words – are contributed by those deemed low-risk.

Take crime as an example. Around 2% of the population is deemed high-risk, and according to a 2018 government analysis, they will commit 15% of all crimes over the next 15 years.

That is massively disproportionate to the size of the group. But it also leaves the vast majority of crimes being committed by people who are not deemed high-risk. The “medium-risk” group are responsible for 28% of crimes, and “low-risk” people the remaining 57% of the total.

The 2018 analysis offers a compelling plain-language explanation: “High-risk people offend more on average, but low and medium risk-people offend more in total because these groups are much larger.” The implication for policy? “Both universal and targeted approaches are needed to prevent crime.”

The same arguments apply in areas like transport. A handful of genuinely dangerous drivers will cause a disproportionately large number of accidents. Overall, though, most accidents will be caused by people who consider themselves relatively good and normal drivers, simply because – once again – those people make up the bulk of the population.

As a result, public health experts argue that among the most effective anti-harm measures would be an overall reduction in car travel, generated by providing better public transport and intensifying cities so that fewer people have to drive to work. And, where people do still need to drive in urban centres, we should shift to lower speed limits for everyone.

This can seem irritating, or jarring: why should you, a “perfectly” safe driver, have to dawdle through town at 30km an hour? Unfortunately, as the prevention paradox tells us, millions of relatively safe drivers will otherwise generate the majority of damaging or even fatal accidents.

As with crime and accidents, so too with the big commercial creators of health-related harm – industries like tobacco, alcohol and gambling. Professor Boyd Swinburn of Auckland University told me this week there’s a “very tight” connection between the average level of consumption of such activities and the proportion of people with high and problematic levels.

Research indicates that if the average alcohol intake was reduced by 10%, the number of heavy drinkers would fall by a quarter. This highlights a second argument for broad-brush solutions.

In a world saturated by alcohol advertising and consumption, it is unsurprising that so many people develop an unhealthy relationship with the substance. If there is simply less of it in their surrounding environment, their exposure – and their likelihood of problem drinking – will probably decline.

One can see the same logic with driving. To some extent, we take our speed cues from those around us, so if relatively safe drivers drop their speeds, at least some of the people tempted to drive recklessly will change their behaviour.

Not all of them, though – hence the crime analysis’ argument that we need targeted as well as universal measures. Nor should we take too hard a line on everyday activities.

Drinking, for instance, and its associated substances like beer and wine, have a long and glorious association with fellowship, entertainment and relaxation. Consuming them in moderation can be one of the great joys of life.

But people should not complain too much about the mild inconvenience of there being fewer liquor outlets, narrower alcohol-purchasing hours, and higher taxes on booze. The bulk of the population might even benefit from consuming slightly less while enjoying it more – and, in the process, creating a social environment that helps those who are most at risk.