Alcohol and public health do not mix well

No matter how they vote, Colorans must be aware of the broader public health implications of increased access to alcohol.

Amid the debate about the economic implications of Propositions 124, 125, and 126, few, if any, experts have discussed the public health impact of the passage of these bills in Colorado.

To summarize: Proposition 124 would allow retail liquor stores to apply and increase the number of places that sell alcohol if approved. Proposition 125 would allow grocers and grocery stores that sell beer to also sell wine. Proposition 126 would allow third parties to deliver alcohol from grocery stores, liquor stores, convenience stores, bars and restaurants.

The passage of these bills will increase access to alcohol for Coloradoans. While most Colorados consume alcohol responsibly, data show a strong association between alcohol availability in communities and excessive alcohol use.

Excessive alcohol use, excessive alcohol use (4+ drinks every chance for women, 5+ drinks for men), binge drinking (8+ drinks/week for women, 15+ drinks/week for men), drinking under 21 years of age, or pregnant women by any drink.

Excessive alcohol use is a public health problem, causing approximately 88,000 deaths per year nationwide, including 10% of deaths among adults aged 20 to 64. Alcohol consumption is the 4th leading preventable cause of death nationwide, after tobacco, malnutrition and physical inactivity. Colorado has the 8th highest rate of binge drinking and 6th highest alcohol-related death rate among all states.

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Alcohol-related deaths in Denver during the COVID-19 pandemic increased nearly 30% in 2020 compared to 2019. The prevalence of alcohol use disorder among Colorado residents is 50% higher than the national average. The state of Colorado has an alcohol-related public health problem.

To be clear: we enjoy alcoholic beverages. We do not aim to disparage responsible alcohol use or reconsider failed prohibitive policies. In appreciation of the employment and tourism created by our state’s breweries, vineyards, and distilleries, we recognize the important role alcohol plays in Colorado’s economy and culture.

However, this is not about economy or culture. It’s about public health. The data shows that public health and alcohol don’t mix well.

Public health experts propose several ways to reduce the incidence and public health impact of excessive alcohol use, many of which revolve around limiting access to alcohol. Some proposed community-based interventions have been found to be ineffective in preventing excessive alcohol use; for example, responsible beverage service education programs do not have sufficient evidence to recommend for or against their use at the public health level.

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Other interventions have been shown to worsen excessive alcohol use and are not actively recommended. One such intervention is the privatization of retail alcohol sales in environments where the government controls retail sales, resulting in increased per capita alcohol consumption – a well-known representative of overconsumption. Conversely, practices such as raising alcohol taxes, limiting alcohol sales days and hours, and regulating alcohol sales intensity have all been shown to reduce excessive alcohol use and its negative consequences for communities.

These guidelines, created by the impartial Community Preventive Services Task Force, made up of public health experts convened nationwide by the U.S. Department of Health and Human Services, include community preventive services, programs, and other interventions aimed at improving population health.

The task force includes both public health impact and cost effectiveness in its recommendations, published in the Community Guide, available free of charge online. Its agenda is to promote healthy communities using science. Science tells us that increased access leads to more alcohol use, and more alcohol abuse leads to more problems.

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This is an issue that has not been discussed much to shed light on the decisions taken at the ballot box. From a public health perspective, increased access to alcohol is often associated with negative public health outcomes. This is not a moral or political stance; evidence shows this. Given Colorado’s current relationship with alcohol, increasing access by implementing these recommendations could worsen the public health consequences associated with excessive alcohol consumption.

The public health impact of passages from these propositions is not the only factor to be considered at this November’s ballot box. Still, we must consider this in addition to the social, economic and cultural forces driving policy change.

D. Tyler Coyle, MD, MS, of Denver, is board-certified in both preventive medicine and addiction medicine.

Thomas Locke of Denver is a preventive medicine resident.


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