Friday 8 February 2019

Why aren't alcohol-related deaths falling?

At the Spectator, I ask why alcohol-related deaths haven't been falling despite alcohol consumption falling sharply since 2005.

This poses a problem for the modern ‘public health’ lobby for whom it is axiomatic that a decline in overall consumption must lead to a decline in alcohol-related deaths. This axiom was first proposed by the French mathematician Sully Ledermann in the 1950s and was endorsed by the epidemiologist Geoffrey Rose in the 1980s when he developed his ‘single distribution theory’. In his 1992 book The Strategy of Preventive Medicine, Rose claimed that ‘from the average alcohol intake of a population one can predict precisely the number of heavy drinkers’.

It is difficult to exaggerate the influence of Rose’s ideas on the public health movement. Put simply, the single distribution theory asserts that the amount of excessive or dangerous consumption in a society is directly linked to the level of average consumption. The behaviour of those at the extreme end (or tail) of the distribution is dictated by the behaviour of those in the middle. Successful prevention therefore calls for a whole population approach in which the entire distribution (or bell curve) is shifted to the left. There is little point in focusing efforts on the minority of consumers who are at high risk. What is needed, wrote Rose, is to ‘change the majority, which means redefining what is to be regarded as normal.’

Do read the rest.

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