In 1964 the US Surgeon General released its first report on the health risks of smoking and tobacco use. This turned out to be a landmark move, paving the way for the following decades of progressively more restrictive regulation of public tobacco use and marketing. In 1964 smoking was at its peak in the US, when 42% of Americans smoked. Today the number is down to 11.5%. It’s likely that were it not for the Surgeon General’s warning about tobacco products most Americans would not even know the Surgeon General existed.
Recently the Surgeon General, Vivek Murthy, released a new advisory warning of the links between alcohol use and cancer. It remains to be seen what effect this advisory will have on the culture of alcohol use in the US, and it’s hard to imagine it will be anything like the effects on tobacco use, but it will likely increase public awareness of the true risks of excessive alcohol use. In the announcement the HHS reports:
“Alcohol is a well-established, preventable cause of cancer responsible for about 100,000 cases of cancer and 20,000 cancer deaths annually in the United States – greater than the 13,500 alcohol-associated traffic crash fatalities per year in the U.S. – yet the majority of Americans are unaware of this risk,” said U.S. Surgeon General Dr. Vivek Murthy. “This Advisory lays out steps we can all take to increase awareness of alcohol’s cancer risk and minimize harm.”
Regular alcohol consumption has been linked to cancer of the breast, colorectum, esophagus, liver, mouth, pharynx, and larynx. Alcohol is estimated to cause about 3.5% of all cancers. The amount of alcohol consumption relates directly to cancer risk, but even modest consumption, such as one drink per day, may be enough to increase risk.
The advisory makes several specific recommendations – to change the required labeling of alcoholic beverages to include the warning about cancer risk (much like the mandatory warning on cigarette packages), to increase public awareness of the risk, and to change recommendations for safe amounts of alcohol consumption to include data on cancer risk.
Moderating alcohol consumption can also have other benefits as well. It is estimated that in the US there were 178,000 premature deaths due to alcohol use. The WHO estimates this figure is 2.6 million world wide, or about 5% of deaths. On average this reduces lifespan by 24 years. The causes of death from alcohol include cancer, direct alcohol poisoning, car accidents, heart failure, and liver damage. This is greater, by the way, than all other recreational drugs combined. At the peak of the opioid epidemic in the US in 2022, deaths from opioids were 84 thousand.
There is also a lot of death and social harm from the effects of alcohol use. It is estimated that about 40% of violent crimes in the US are committed while under the influence of alcohol. About 48% of homicides were committed while under the influence. Obviously alcohol use is difficult to disentangle from complex social factors with which it is associated. But at the very least it can be an accelerant to violence.
It is also likely that the negative health effects of alcohol are underestimated by the mortality numbers above. Excessive alcohol use has dramatic negative effects on overall health, often contributing to death from other causes but not listed as a “cause of death”. People with alcohol use disorder have a life expectancy 24-28 years shorter than the general population.
Will the Surgeon General’s advisory have any effect? It is also hard to predict the effect of public health measures. Just giving people information tends to have a modest effect on their behavior. But even modest effects can reduce premature deaths, healthcare costs, and costs to society. There definitely appears to be a knowledge gap.
According to a recent Gallup poll, only 45% of Americans agreed that 1-2 drinks per day (enough to increase cancer risk) is bad for one’s health, while 43% said it made no difference, and 8% said it was good for health. As recently at 2016 these numbers were 26%, 51%, and 19% respectively, so there has been a recent cultural shift. This shift also appears to be generational, with younger populations having a more negative image of regular alcohol use.
As the history with tobacco shows, the US Surgeon General does have a unique position in terms of shaping public perception of health risks. Unlike with tobacco, where there is no safe level of use, just moderating one’s use of alcohol may have significant health benefits. The key seems to be avoiding daily use or binge drinking. This may be the beginning of a cultural shift that reduces overall alcohol consumption, and thereby reducing alcohol related deaths. People should at least know all the risks before they make personal decisions about their own use.
