A new President in France: an opportunity for public health policy against alcohol-related harms and deaths?
Authors: Charles Persoz
Journal: The Lancet Public Health (2017)

Public health policy should be evidence-based and should take into account the current state of scientific knowledge. Because prevention represents one major challenge for all public health policy at the global level, it should be addressed comprehensively and take into account all major known risk factors.1Chêne G Prevention of the causes of premature illness and death: making it happen.Lancet Public Health. 2017; 2: e69-e70Summary Full Text Full Text PDF Scopus (1) Google Scholar The election of President Macron in France this month will undoubtedly be an opportunity for French prevention policy to make a fresh start, and to treat alcohol consumption—one of the major risk factors for death and diseases—with honesty. Previous French governments have made substantial efforts on tobacco, nutrition, and physical activity to protect the population from major risk factors for chronic diseases and cancer. However, alcohol consumption continues to be overlooked by French public health policies. This different approach of measures to facilitate prevention and promote population health could be linked more to the particularities of French agriculture and the strength of the French wine industry, as opposed to the reality of the health burden induced by alcohol. Despite having similar mortality rates per year—80 000 deaths per year for tobacco2Ribassin-Majed L Hill C Trends in tobacco-attributable mortality in France.Eur J Public Health. 2015; 25: 824-828Crossref PubMed Scopus (39) Google Scholar and 50 000 for alcohol3Guérin S Laplanche A Dunant A Hill C Alcohol-attributable mortality in France.Eur J Public Health. 2014; 23: 588-593Crossref Scopus (65) Google Scholar—these two products are treated differently in terms of prevention policy. Although very strong fiscal measures are applied to tobacco (inducing an effective price increase for reducing consumption, especially among young people), they remain moderate on alcohol, even though consumption in France remains at a very high level.3Guérin S Laplanche A Dunant A Hill C Alcohol-attributable mortality in France.Eur J Public Health. 2014; 23: 588-593Crossref Scopus (65) Google Scholar Although efforts have been made since the Evin law in 1991 (restricting tobacco consumption in public places and restricting alcohol advertising), an even more important step has been reached on tobacco with the publication of shocking images associated with tobacco consumption-induced diseases (pictures of oral cancer or of patients with chronic obstructive pulmonary disease for example) on cigarette packs, and with the introduction of plain packaging (since Jan 1, 2017, in France). These powerful measures contributed to a decrease of tobacco consumption in France. With 50 000 deaths per year due to alcohol consumption, without reaching the point of publishing pictures of cirrhotic livers on bottles of Champagne, could we not figure out a more ambitious prevention policy in France than the current one? Although perhaps we do not want to do so because the potential consequences for the wine industry, and thus for the French economy, are too important? Is the public health policy being defined by the economic sectors? In 2017, France will be the second largest producer of wines in the World behind Italy (France was first until 2015).4Girard L La France n'est plus le premier producteur mondial de vin. Le Monde Economie.http://www.lemonde.fr/economie/article/2015/10/28/l-europe-conforte-sa-domination-du-marche-du-vin_4798422_3234.html#TXB1HItTJGEcISpq.99Date: 2015Google Scholar France retains its very high reputation on wine, Champagne, and Cognac with consumption and export levels remaining extremely important (largest exporter in value). More than 500 000 direct or indirect jobs exist through vine growing.5Durand A Pourquoi le vin compte autant pour la France, en sept graphiques.http://www.lemonde.fr/les-decodeurs/article/2016/09/14/pourquoi-le-vin-compte-autant-pour-la-france-en-sept-graphiques_4997656_4355770.htmlGoogle Scholar These factors are probably not negligible for policy decisions. If one takes into account the facts and sets aside the economic stakes (and those linked with cultural identity and the territory), there is no objective justification for the kindness granted in France to alcohol compared with tobacco or cannabis. Both alcohol and tobacco induce strong addictive behaviours and the number of associated deaths is comparable. In addition, the effects on mental health or cognitive functions as well as the social effects can be very similar between alcohol and cannabis use, especially among young people.6Britton A Singh-Manoux A Marmot M Alcohol consumption and cognitive function in the Whitehall II Study.Am J Epidemiol. 2004; 160: 40-47Crossref Scopus (91) Google Scholar Consequences of alcohol consumption are clearly associated with important social inequalities in health,7Hall W Socioeconomic status and susceptibility to alcohol-related harm.Lancet Public Health. 2017; (published online May 10)http://dx.doi.org/10.1016/S2468-2667(17)30089-0Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar, 8Katikireddi SV Whitley H Lewsey J Gray L Leyland AH Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data.Lancet Public Health. 2017; (published online May 10)http://dx.doi.org/10.1016/S2468-2667(17)30078-6Summary Full Text Full Text PDF PubMed Scopus (172) Google Scholar inequalities that all French governments tried to reduce unequivocally throughout the country. A reduction in alcohol consumption (the French population remains one of the biggest consumers in the world9WHOGlobal status report on alcohol and health.http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf?ua=1Date: 2014Google Scholar) would reduce the inequalities associated with this substance in France. If the major wine-producing countries, including France, were to overlook the economic stakes, what kind of initiatives could the next French government launch to reduce alcohol-associated mortality in France and show that the prevention policy is not based exclusively on economic issues and on the lobbies power? One can imagine, in addition to new targeted and structured prevention measures, simple regulatory measures that are easy to implement in the short term: first, to reduce the legal blood alcohol level when driving to zero; second, to prohibit distribution of alcohol in events funded by public money (the French National Institute for Cancer [INCa] is already applying this measure); third, to substantially increase taxation on alcoholic beverages to reduce consumption among young people, in particular; and fourth, an explicit statement on the dangers of alcohol going beyond the current promotion for moderate consumption or a small logo for pregnant women. Some of these measures have also recently been proposed by the experts gathered by Santé Publique France and INCa for the report about the public address on alcohol consumption in France.10Santé publique France et INCaAvis d'experts relatif à l'évolution du discours en matière de consommation d'alcool en France.http://www.santepubliquefrance.fr/Actualites/Avis-d-experts-relatif-a-l-evolution-du-discours-public-en-matiere-de-consommation-d-alcool-en-France-organise-par-Sante-publique-France-et-l-IncaGoogle Scholar One can imagine others but the new government will need to rely on the scientific evidence that public health research has provided to reduce the number of deaths from alcohol by half in the next 10 years. The incoming government and parliament should address alcohol consumption with the same vigour as was done for tobacco. “En Marche!” for an ambitious public health policy. I declare no competing interests. The opinions expressed in this article are the author's own and do not reflect the view of Inserm.