Exploring the impact of alcohol policies on global cancer outcomes
In this interview, we engage with Dr. Luis Antonio Diaz and Dr. Juan Pablo Arab, esteemed researchers from the Pontificia Universidad Católica de Chile and Observatorio Multicéntrico de Enfermedades Gastrointestinales (OMEGA) in Santiago, Chile. Dr. Arab further brings his experience from the Division of Gastroenterology at the Schulich School of Medicine, Western University & London Health Sciences Centre, and the Department of Epidemiology and Biostatistics at Western University in Canada. Drawing on their extensive study published in the Journal of Hepatology, the conversation delves into the significant findings linking alcohol policies with cancer, liver disease, and cardiovascular disease outcomes globally. Their combined expertise from diverse academic and research backgrounds provides a comprehensive understanding of how public health policies on alcohol can influence health outcomes, particularly in relation to cancer.
Dr. Juan Pablo Arab
Dr. Luis Antonio Diaz
AlcoholAndCancer: Could you summarize the key findings of your study regarding alcohol and cancer outcomes?
Dr. Juan Pablo Arab and Dr. Luis Antonio Diaz: The study established the Alcohol Preparedness Index (API) to evaluate the strength of alcohol-related public health policies across 169 countries, finding a significant inverse relationship between a country's API score and its rates of alcohol use disorder, liver disease mortality, cancer mortality, and cardiovascular disease. Higher API scores were associated with better health outcomes, underscoring the long-term benefits of robust alcohol policy frameworks. These associations were particularly strong in the Americas, Africa, and Europe and grew stronger over time, suggesting that sustained policy efforts are crucial. The study advocates for the global enhancement of alcohol-related public health policies, emphasizing their effectiveness in reducing the burden of alcohol-related diseases and providing a compelling evidence base for policymakers to prioritize such initiatives to address the long-term harmful effects of alcohol misuse.
Could you explain the Alcohol Preparedness Index (API) and its role in your study?
The API is a metric developed by us to measure the robustness of alcohol-related public health policies in different countries. It is scored from 0 to 100, with higher scores indicating more comprehensive and strong policies (we thought of this as a percentage). In the study, the API was used to correlate the strength of a country's alcohol policies with health outcomes, including cancer incidence and mortality. The API includes five policy dimensions: national policy, control over production/pricing/taxes, marketing and access restrictions, drink-driving countermeasures, and monitoring/surveillance.
How does alcohol consumption and cancer risk association differ across countries?
We reported regional variations in the association between alcohol consumption and cancer risk. In the Americas, Africa, and Europe, stronger associations were observed, suggesting that the impact of alcohol consumption on cancer outcomes can differ significantly across regions. These differences could be due to various factors including the strength and type of public health policies implemented, regional drinking patterns, economic development levels, healthcare systems' effectiveness, and social and cultural attitudes toward alcohol consumption. For instance, the study noted that Europe achieved the highest scores on the API, indicating that European countries might have the most comprehensive alcohol policies, potentially leading to better cancer outcomes relative to regions with lower API scores like Africa. However, the study also implies that even within high-scoring regions, there can be significant heterogeneity, and thus regional comparisons should be approached with an understanding of each region's unique context.
Which public health policies on alcohol were most effective in reducing cancer incidence?
We found that some policies, such as taxes, minimum unit pricing (MUP), and restrictions on alcohol marketing and access, were among the most effective in reducing cancer incidence related to alcohol consumption. These policies likely work by reducing overall alcohol intake in the population, which in turn reduces the incidence of alcohol-related cancers.
What are the main challenges in implementing effective alcohol control policies?
Challenges include the variability of policy implementation and effectiveness across different countries, cultural attitudes towards alcohol, accurate reporting by countries on policy establishment, and the potential for underreporting of alcohol-attributable conditions. Economic factors, such as the influence of the alcohol industry, and political will also play significant roles in policy implementation.
What long-term impacts on cancer rates do you foresee if current alcohol consumption trends continue?
Our study suggests that without strengthening alcohol control policies, the burden of alcohol-related cancers will likely continue to grow. This is based on the demonstrated association between lower API scores and higher cancer mortality rates. Continued or increased alcohol consumption without robust PHP could lead to higher incidence and mortality from alcohol-associated cancers.
What recommendations would you make to policymakers for reducing alcohol-related cancer risks?
Policymakers should prioritize the development and implementation of stringent alcohol-related public health policies. This includes higher taxes on alcohol, establishing minimum unit pricing, enforcing marketing restrictions, enhancing drink-driving countermeasures, and improving monitoring and surveillance of alcohol consumption and related health outcomes. Additionally, policies should be culturally tailored and consider socioeconomic factors to be more effective. Adopting a comprehensive approach aligned with the WHO SAFER initiative is also recommended.