Alcohol and public health do not mix

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Regardless of their vote, Coloradans should be aware of the broader public health impacts associated with increased access to alcohol.

Amid the debate over the economic impacts of the proposals 124, 125and 126few — if any — experts have discussed the effect passage of these bills would have on Colorado’s public health.

To recap: Proposition 124 would allow liquor stores to apply for and, if approved, increase the number of liquor outlets. Proposition 125 would allow grocery stores and convenience stores selling beer to also sell wine. Proposition 126 would allow third-party delivery of alcohol to grocery stores, liquor stores, convenience stores, bars and restaurants.

Passing these bills would increase access to alcohol for Coloradans. While most Colorado residents consume alcohol responsibly, data shows a strong correlation between alcohol availability and binge drinking in communities.

Heavy drinking is defined as heavy drinking (4+ drinks per occasion for women, 5+ drinks for men), heavy drinking (8+ drinks/week for women, 15 + glasses/week for men), consumption before the age of 21, or any alcohol consumption by pregnant women.

Excessive alcohol consumption 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 ranks first among 4th leading cause of preventable death nationwide, behind tobacco, poor diet and physical inactivity. Colorado has the 8th highest rate of binge drinking between all states and 6th highest rate of alcohol-related deaths.

During the COVID-19 pandemic, alcohol-related deaths in Denver increased nearly 30% in 2020 compared to 2019. The prevalence of alcohol use disorders among Colorado residents is more than 50% of the national average. The state of Colorado has a public health problem with alcohol.

To be clear: we enjoy alcoholic beverages. Our goal is not to defame responsible drinking or revisit failed prohibitionist policies. We recognize the important role alcohol plays in Colorado’s economy and culture, enjoying the jobs and tourism generated by our state’s breweries, wineries and distilleries.

However, it is not a matter of economics or culture. It is a public health issue. The data shows that public health and alcohol do not mix.

Public health experts recommend several ways to reduce the incidence and public health impact of heavy drinking – most of which revolve around limiting access to alcohol. Some proposed community interventions have been shown to be ineffective in preventing excessive alcohol consumption; for example, responsible beverage service training programs do not have sufficient evidence to recommend or not their use at the population health level.

Other Interventions showed worsen excessive alcohol consumption and are actively discouraged. One of these interventions is privatization of liquor retail in settings where the government controls retail sales, leading to increased per capita alcohol consumption – a well-established indicator of excessive drinking. On the other hand, practices such as increasing taxes on alcohol, limiting the days and hours of alcohol sales and regulation of alcohol output density have all been shown to reduce excessive alcohol consumption and its downstream consequences in communities.

These guidelines, created by the non-partisan organization Community Prevention Services Working Groupcomposed of public health experts from across the country convened by the U.S. Department of Health and Human Services, draw evidence-based conclusions and recommendations regarding community-based preventive services, programs, and other interventions aimed at improving the health of the population.

The task force incorporates both public health impact and cost-effectiveness into its recommendations, which are published in The Community Guide, available free online. Its program is to promote healthy communities through science. Science tells us that increased access leads to binge drinking, and binge drinking causes more problems.

This is a subject that has not been discussed in depth, if at all, to inform decisions at the polls. From a public health perspective, increased access to alcohol is generally associated with adverse public health effects. This is not a moralistic or political posturing; that’s what the evidence shows. Given Colorado’s current relationship with alcohol, increasing access by enacting these proposals may worsen public health outcomes associated with excessive alcohol consumption.

The impact on public health of the passages of these proposals is not the only factor to be considered at the polls in November. Nevertheless, we should consider it in addition to the social, economic and cultural forces that drive policy change.


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

Thomas Locke, MD, of Denver, is a resident in preventive medicine.

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