Tis the Season To Be (Not Too) Merry - Safe Levels of Alcohol
We often link alcohol abuse with liver damage but it’s also associated with cancers and diseases of the cardiovascular, neurological and gastrointestinal systems.1 While past research pointed to the beneficial effects of light-moderate, non-binge consumption, such arguments have been weakened by more recent findings.2,3
Problems occur when alcohol is used at levels that cause psychological, physical or social harm. Significant geographical differences exist for the impact of alcohol on mortality, which isn’t surprising given the wide variation in the level and pattern of alcohol consumption, as well as the rates of deaths from other risk factors.
Much policy debate and media coverage is concerned with a culture that normalises extreme levels of consumption, drunkenness and the negative effect of excessive binge drinking on future health.
Government advice is often based on safe limits of consumption measured by units of alcohol. In the UK, for example, the concept of units is not generally understood - meaning regular (daily) drinkers can underestimate their intake by around 40%.4 As a result, the UK Chief Medical Officer issued lower recommended daily limits in January 2016 to reflect increasing concerns. The accompanying message was there is no “safe” level of alcohol. To insurers this implies that anyone disclosing any amount of alcohol consumption is at risk.
The focus on “sensible” levels assumes that comprehension of the amounts will reduce irresponsible consumption, yet there seems little evidence that such population-wide interventions actually work to reduce harmful levels of drinking. Even so, many hailed the Chief Medical Officer’s advice as providing accurate and transparent information on the risks so that people can make informed choices.5
For insurers the implications are less clear. Many will opt to review the units of alcohol printed on forms but the levels for which underwriters seek further medical evidence or, more particularly, impose extra premiums need not be reduced.
Application form questions may not be especially effective in obtaining accurate alcohol disclosure. Underwriters encounter subtle difficulties identifying at-risk individuals who remain secretive about their uncontrolled drinking or consumption of alcohol in excess of recommended levels. Patterns of drinking are as important to long-term health outcomes as the amounts consumed.
It’s a time of year when some people will drink far more than is normal or is good for them. The rest may raise a small glass in toast to Oscar Wilde who said “everything in moderation, including moderation.”
- www.gov.uk, “How to Keep Health Risks From Drinking Alcohol to a Low Level”; Public Consultation on Proposed New Guidelines, Department of Health, 2016.
- Collins,M. et al “Alcohol in moderation, cardioprotection and neuroprotection: epidemiological considerations and mechanistic studies.” Alcoholism: Clinical and Experimental Research 2009, (33) 2, 206-219.
- Knott, S et al (2015) All-cause mortality and the case for age specific alcohol consumption guidelines: pooled analyses of up to 10 population cohorts, BMJ2015; 350 doi: http://dx.doi.org/10.1136/bmj.h384.