“One Bourbon, One Scotch, One Beer”; Changing Recommendations on Safe Levels of Alcohol
Increasing concerns over morbidity and mortality rates from alcohol use, and the cost to the NHS of treating associated problems, has led the UK Chief Medical Officer to propose new guidelines to minimize health and accident risks. The take home message is that there is no longer a “safe” level of alcohol – the implication being that anyone who discloses drinking any alcohol is at risk. Does this mean those who drink alcohol should be treated differently by insurers?
The UK guidelines on alcohol consumption were last updated 20 years ago and during this time increasing evidence has linked alcohol consumption with cancers and diseases of the cardiovascular, neurological and gastrointestinal systems.1 Meanwhile evidence that modest alcohol consumption exerts a beneficial effect on mortality has weakened - a recent review suggests this is largely specific to women over the age of 65.2 In reality few people choose to have a glass or two of wine each night merely in hopes of boosting their health.
The impact on underwriting of such a highly charged public announcement must be considered. This is particularly true when people’s own experience of alcohol varies and the perception of what amounts to problem drinking can be subjective. The main danger is that a “no safe limit” guideline may, in the minds of underwriters, reclassify many otherwise healthy people as hazardous drinkers. This is a potential despite the fact that actual consumption has not changed in the population groups from which the norms are drawn.
To underline the point, the Health Survey for England found 68% of men and 85% of women already drink well below these new limits, whilst 78% of men drink below the previous “safe limit” of 21 units per week.3 The lower limits appear to do little to address the concern that just 20% of the population consumes almost 70% of the total alcohol sold in the UK.4
Recognizing hazardous and harmful drinking at the underwriting stage is not always simple. It appears that people have little concept of their unit intake, prompting major concern about their knowledge of alcohol.5 Regular (i.e. daily) drinkers can underestimate their intake by around 40%.6 Individuals do not always report their alcohol consumption accurately and application form questions rarely address the pattern or consequences of drinking.
Wider reaction to the guidance has been mixed. The drinks industry drew attention to the departure from the norm of recommending higher levels for men but at these low levels there is very little difference in risk between the sexes.7 Other commentators welcomed the announcement as providing accurate and transparent information on the risks associated with alcohol consumption so that people can make their own informed choices.8
For insurers the outcome is less clear. Many will opt to review the alcohol questions on application forms but the levels for which underwriters seek further medical evidence or, more particularly, impose extra premiums need not be reduced.
The revised limit for both men and women of 14 units, spread through a week and with several dry days, is estimated to reduce the lifetime risk of alcohol related death from 4% to just 1%.9 While this does not eliminate all risk, the level is similar to other acceptable risk-taking behaviour such as driving a car.10
For the vast majority of individuals the risks associated with drinking alcohol were already very low and will remain so. If anything, the blip in alcohol media coverage may nudge more non-hazardous drinkers to even greater moderation.