Not so cut and dry July

I don’t believe food virtue gets us anywhere when it comes to healthy dialogue or constructive conversation about the way we consume – whether it’s plant proteins, seafood, MSG or alcohol.

It’s Dry July and the presses are pumping with stories about celebrities ditching alcohol for the month while alternative drinks brands compete for social media posts extolling the virtues of their products. Some would argue that the end justifies the means – that if the overall impact is messaging that supports a reduction in harmful drinking, then anything goes. But I think there’s a demand for more honesty and a more accurate celebration of what we have achieved: significant reduction in harmful drinking over the last 20 years.

When I say Dry July is complicated, often the response I get is one of cynicism or economic sympathy. Surely my spirits-writer pockets are lined with the dollars of Big Alcohol – right? And while I like to imagine how comfortable and warm I’d be in a cosy jacket fleeced with the profits of Big Alcohol – that image couldn’t be further from the truth. And it’s the truth that complicates Dry July.

Here’s an on-brand disclaimer. I like having no and low-alcoholic options in my fridge and at bars to moderate my alcohol intake. Often it has more to do with how long I can enjoy myself in a long conversation, making sure I’m paying for my seat at the bar instead of hooning water like a camel. Occasionally it has to do with whether I’m on a course of antibiotics. After all, there are a lot of reasons we might choose not to consume alcohol throughout the year. I like that I make the choice to drink, instead of the choice not to drink.

I’m a huge fan of Lyre’s – an alternative drinks company who make options for cocktail mixing that are almost as good as the real thing from a flavour perspective. I also enjoy Seedlip and other options. Bars like Auckland’s Clipper are leading the way by producing a menu that encompasses tasty, no and low alcoholic options that are drinkable and free of juice, sugar and unnecessary bubbles. I especially like their groundbreaking menu that lists the standard drinks per serve so both they and their customers are 100% transparent about the limits.

Dry July started as a fundraiser for cancer related organisations but sometimes I wonder if it’s been hijacked. New Zealand has long been in the grip and sway of the Temperance movement – from 1894 to 1987, temperance and prohibition issues appeared in public referendums every election cycle. The temperance movement brought us several wonderful things, including women being awarded the vote. For nearly a century, every three years the movement tried to convince as many New Zealanders as possible that alcohol is a curse on society. So here are my reckons – as someone who sees the brutal profiteering of cheap, gimmicky alcohol in both big and small business (who remembers the F*ck Off 2020 gin?) and the social damage it can do.

The anti-alcohol lobby isn’t wrong. Alcohol is – millilitre for millilitre, the most harmful and easily accessible drug on the market (if we don’t count those hits of social media dopamine). But it’s not necessarily harmful in the ways you may think and just like any political campaign, not everything is as it appears. That’s why Dry July messaging is complicated, because alcohol is complicated.

We’ve got a responsibility to communicate with accuracy.
As food and beverage communicators, we’ve got a responsibility to write and communicate with accuracy and transparency. That means sometimes we need to interrogate the promotional taglines, the campaign rhetoric and the noise of information about health and nutrition – in everything, including alcohol.

Alcohol causes cancer.
Yes, some cancers. It’s been linked to 7 specific cancers. A 2015 research paper stated that alcohol could be linked to approximately 3.6 percent of all cancers, or 389,100 cases globally. The challenge is that finding global statistics is hard – and the source of that data is 20 years old now. Specifically breast and bowel cancer (two of the most common types), liver cancer and cancers of the mouth, oesophagus, larynx and pharynx (upper throat).

But remember that pesky little “one glass of red wine has anti-oxidants for heart health” tag line? For some specific breast cancer strains, non-Hodgkins lymphoma and leukemias, studies show that moderate alcohol intake lowers your risk. Try wrapping your mind around that. You have to quite literally read through thousands of pages of data and look at each cancer type and strain individually to understand the cancer relationships and impacts. But we’ve been consistently told that alcohol causes cancer as a headline.

Photo by Fred Moon on Unsplash

It’s not what we’re drinking, it’s how we’re drinking. Actually, no. It’s the total quantity of alcohol that we consume, not whether it’s all at once or sipped each day that makes the difference. Hence the NZ Heart Foundation were able to release a study last week saying there’s no safe amount of alcohol to consume – because while binging makes a difference to the size of the hangover, studies show more often than not it’s the long-term accumulative consumption that elevates risk of other health issues. And if you think you’re off the hook because you don’t binge drink, research says you’re possibly more likely to consume a greater quantity of alcohol over time if you drink a little every day. But that NZ Heart Foundation press release tried to create a shock headline while neglecting to mention the international long studies that show most consumers of alcohol are likely to live as long or longer than non-consumers of alcohol. Wait, what? So there’s no safe amount, but there’s also minimal risk of impacting the average lifespan?

New Zealand has a problem with alcohol consumption. Yes and no. We have a decreasing problem with alcohol consumption. In 2019, New Zealand scraped into 30th place worldwide, with an average per capita consumption of 10.69l per annum – slightly less than 3 standard drinks per person per day. We were just ahead of Finland and 5 spots ahead of Australia at 10.39l per capita. Unfortunately – while that’s the average across both genders, NZ women only consume 5.23l per annum. It’s ‘Kiwi blokes’ blowing out those averages with a whopping 16.46l per annum. (WHO Global Consumption Data, 2019). Since then, a New Zealand specific study showed that will alcohol consumption increased amongst certain groups during Covid-19 lockdowns, overall it decreased by up to 27% in some cases.

But the crucial data you’re not seeing in the news? That consumption has dropped significantly in New Zealand overall – especially amongst young people. The percentage of secondary school students aged 13-18 who reported ever drinking alcohol dropped from 82 percent in 2001 to 55 percent in 2019, and the percentage reporting binge-drinking in the past month fell from 42 percent to 22 percent. (RNZ, University of Otago study).

The study was done because of the reduction in teenage drinking, with the desire to increase the factors driving that reduction. What did they find? Disconnection between external influences and the changing attitudes towards alcohol perception – a generational shift, where not all the reasons were positive – including increased social isolation which indicates that continuing to reduce alcohol harm is not the only critical issue facing young people.

Doesn’t Dry July just mean Monsoon June? Actually, no. Studies show that even a brief period or attempt at abstinence can support improved health outcomes and changes in drinking behaviour over the long term. There’s a good summary here but it uncomfortably points out a few other truths that don’t sit as pretty – participants in Dry July are likely to be higher risk drinkers and from a higher socio-economic status. Let’s check that for a second: because it’s highlighting a problem. 

Photo by Paulo Silva on Unsplash

So Let’s Talk About Alcohol and the Money:

Instead of running the flag up for Dry July, I’d rather ask the Government why so little of the revenue generated by the HPA levy and alcohol excise tax goes towards actual alcohol harm prevention. I’d be asking for greater clarity on the tax structures and logic behind how those levies are calculated and applied to prevention activity.

You’re likely familiar with the recent excise tax increases – if only seeing it on the price tag. Excise tax rose by another 6c per litre on July 1^st. In 2020, alcohol excise tax was a total revenue of $1.064 billion, and the Health Promotion Agency levy (an additional levy on alcohol products) was approximately $11.5 million (~1% of the alcohol excise revenue). Those taxes and levies have all increased as of the 1st of July. Not so dry July for the Government coffers. But only the HPA levy is specifically earmarked for alcohol harm prevention activities.

Those funds go to Te Hiringa Hauora, the agency that carries out alcohol harm prevention activity from that HPA levy. They’re one of the groups who supported significant changes to the Sale and Supply of Alcohol Bill. Those recommended changes? Increasing excise tax on alcohol by 50% (another 22.5c per litre) and introducing a legislative requirement for a minimum price per standard drink of $1.50 or more to reduce the harm caused by cheap alcohol.

Movendi International is the largest global anti-alcohol lobby group in the world and by their reckoning cheap alcohol is New Zealand’s problem. And they’re not necessarily wrong according to the local lobby groups Alcohol Healthwatch, ActionPointNZ and Alcohol Action NZ. According to the anti-alcohol movement, alcohol misuse is estimated to cost New Zealand society $7.85 billion each year. Their reasoning includes costs resulting from lost productivity, unemployment, as well as justice, health, ACC and welfare costs. It’s important to note there is no official measure for this impact.

So if cheap alcohol is the problem, isn’t that where we should put the levies?

Let’s compare these alcohol costs per standard drink with the associated HPA levy.

• Cost per standard drink according to the 2021 Alcohol Healthwatch study

Now, review what we drink the most of, according to the latest published figures (2020).

293 million litres of beer
113 million litres of wine
89 million litres of spirits and spirit-based drinks.

We consume more than twice the amount of beer as we do wine. And if we lump beer and wine together, it’s more than 4 times the volume of spirits with the lowest HPA levy.

But hold your horsey high-ground, Tash. If we measure the ethanol quantity, these measurements end up just about even across the categories. And for all the positive promotion the New Zealand spirits industry have been doing regarding small craft producers, premium spirits and local economic opportunity – it could come back to bite them, because New Zealanders are starting to consume more spirits.

That’s great news for New Zealand’s blossoming spirits industry until the argument that as premium (by price point at least) spirits producers, they’re not contributing to the cheap alcohol problem. In fact, the SMEs that make up most of the local spirits producers are seeking an excise tax break so they can redirect funds to hiring more staff and greater economic contribution. And after all – at an average price of $75 – $130 per bottle, they’re at the lesser end of the consumption problem, right?

But what if cheap alcohol isn’t really the heart of the problem? Increasing the minimum price per unit and the excise tax significantly is about reducing access to alcohol by way of pricing. If you’re not wealthy enough to afford it, you can’t have access to it. And why take that approach? Because it’s easier to assume and discuss the problem alcohol causes for lower socio-economic groups as a consumption problem, when it’s not the only or the biggest problem.

Wealthier drinkers have greater access to health outcomes and private care at a lower cost impact to the local health system. But that’s not to say it’s not a massive problem. It’s just more invisible than the other alcohol-related problems.

According to WHO, globally it’s adults of higher socio-economic standing are more likely to drink frequently and to harmful excess while adults of lower socio-economic standing are more likely to suffer the negative health effects, five times more likely. WHO notes that it’s because people in lower socio-econonic settings are also more likely to already be at risk of poorer health outcomes and engage in risky health behaviours (poor nutrition, inadequate housing among them).

Not only do Pasifika peoples have lower alcohol intakes per capita here in New Zealand but Māori have only been found as likely to drink as non-Māori. But there are layers of privilege, social norms and permission that mean you’re more likely to see an alcohol problem portrayed on television as a person of colour buying a 12pk of 5% abv beer than a Pākeha businessperson purchasing wine and spirits by the caseload.

Substantially worse health outcomes for Māori, Pasifika and lower socio-economic New Zealanders who drink reflect a range of population health issues including lower quality housing stock reduced access to diverse food sources and increased likelihood of increased work hours. So maybe as a society, we’re not really concerned with alcohol consumption as we are with what it costs the taxpayer.

So many numbers, so many angles. It’s a public relations dream or a nightmare.

Our initiatives and policy around alcohol don’t make for good mathematics on either side of the equation. If the cost of alcohol misuse is really $7 billion, then at least part of the $1billion dollar excise tax revenue should be going directly to alcohol harm prevention instead of the general coffers? Because if the current activity of the Health Promotion Agency has achieved a 20 – 30% drop in drinking among young people in the last 20 years, imagine what they could do with $1 billion instead of $11 million?

I mean, how serious are we really going to be about the problem of alcohol harm? If we were really serious, we’d limit the quantity that all people can purchase and put more barriers on the local wine industry to prevent those cheap supermarket multi-buys.

We’d acknowledge that our HPA levy isn’t doing enough to counter inequitable health outcomes for those in lower socio-economic settings.

We’d demand more transparency of where that excise tax take is going and how it’s being spent to improve health outcomes.

And we’d have to have a conversation about our values as a nation – between social responsibility to care for all people, democracy and freedom of choice, our patriotic pride in our global wine and export market and how we have tough conversations about solving complex problems.