Good practice principles low rik drinking EU RARHA

Executive summary
The present publication synthesizes work done in the EU co-funded Joint Action on Reducing Alcohol
related Harm (RARHA) to identify good practice principles for the use of low risk drinking guidelines as
a public health tool. The current guidelines in European countries show considerable variation in the
quantity of alcohol consumption considered low-risk. Work was carried out in RARHA to shed light on
the factors behind the divergence and explore whether some degree of consensus could be achieved. It
is hoped that the principles and conclusions arising from this work are found helpful to inform future
action and policy development.
Low risk drinking guidelines and other kinds of consumer information on the health aspects of
alcoholic beverages do not provide a magic wand for reducing alcohol related harm. There is
compelling evidence that measures to control the availability, affordability and promotion of alcoholic
beverages are the most effective policies to reduce harm for alcohol consumers, for people around
them and for the wider society. Nevertheless, information about the risks related to alcohol
consumption and about ways to avoid risks contributes to higher awareness about the need for
individual action and public policy – and failing to provide accurate and reliable information would be
highly unethical.
Towards a common criterion for defining low risk from alcohol consumption
Low risk drinking guidelines have been introduced in European countries individually, without
coordination. Although the national health bodies issuing them have drawn upon the internationally
shared knowledge on the risks and effects of alcohol, they have come to somewhat different
conclusions when formulating national guidelines. The main reason is that there is no straightforward
method for deriving low risk alcohol consumption levels from the scientific evidence; expert judgment
is always required. To inform recent reviews of drinking guidelines in Australia, Canada and in the UK,
quantitative pooling of risks from various causes of death at different levels of alcohol consumption was
used to help identify criteria for weighing risk of health harm. Such summarizing of quantitative data
does not replace expert judgment but provides a transparent approach for justifying experts’ choices
around alcohol intake levels to be included in national guidelines.
In Joint Action RARHA, the lifetime-risk of alcohol attributable mortality was calculated for seven
countries, following the approach adopted in Australia. Lifetime risk of mortality is a common standard
for assessing risk from external factors, such as toxins in food or environment. Expressing risk as the
number of deaths per persons exposed illustrates its magnitude and enables different types of risks to
be put into perspective alongside one another. The calculations were done for the countries separately
in order to explore the extent to which variation in drinking cultures and mortality structures is reflected
in the risk levels. The results show that, despite differences between countries, the lifetime risk of
alcohol attributable death would remain below 1 in 100 in all countries at an average lifetime level of
consumption of 10 grams of pure alcohol per day. In some of the countries current guidelines for low
risk drinking are consistent with or slightly below that level, while in others the risk level associated with
current guidelines is above 1 in 100.
This exercise demonstrated that the cumulative lifetime risk of death from alcohol-related disease
or injury can be used as a common metric for assessing the risks from alcohol at country level and that
the results can inform discussion about the level of public health protection associated with drinking
guidelines. Research carried out in the past decade has unequivocally ascertained alcohol as a risk
factor for some types of cancer and increased understanding of the cardioprotective effects of alcohol.
In accordance with new evidence, recent reviews of national drinking guidelines have reduced the
amounts not to be exceeded in order to reduce risk of harm. In light of the results of the calculations
done in RARHA, the risk level of 1 in 100 alcohol attributable deaths could be considered a maximum for
“low” risk, which would require a downward revision of low risk drinking guidelines in some European
countries. Alternatively, national bodies formulating guidelines could adopt a more cautious stance and
choose a level where the number of alcohol attributable deaths would be lower. Choosing a level of 1
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Good practice principles for low risk drinking guidelines