Inserm, the French public research organization dedicated to health, released a collective expert opinion on the alcohol problem in France on June 4, 2021.
Mortality attributable to alcohol is higher in France than elsewhere in Europe,” recalls the report by Inserm, as per Le Monde.Inserm
The report first presents current statistics about the French alcohol problem.
- 41,000 French people died due to alcohol in 2015. This amounts to 7% alcohol-related mortality out of the 580,000 total deaths in that year, making alcohol the second largest cause of preventable death.
- Out of the 41,000 alcohol deaths,
- 16,000 deaths were due to cancer,
- 9,900 deaths were due to cardiovascular disease,
- 6800 deaths were due to digestive diseases,
- 5400 deaths were due to external causes such as accidents or injury, and
- 3000 deaths were due to another disease including mental health issues and behavioral disorders.
- The French government suffers a €3 billion deficit when health and prevention costs of alcohol are set against the tax collected from alcohol products.
Even though France saw a decrease in annual mortality caused by alcohol between 2009 to 2015 (from 49,000 to 41,000), researchers warn to not attribute that development to reduced consumption. It was mostly due to advancements in medicine.
Alcohol remains the second largest cause of preventable death in France behind tobacco. It caused 7% or 41,000 of the total 580,000 deaths in France in 2015.
Pervasive alcohol norm, ubiquitous alcohol harm
France has a pervasive alcohol norm and ubiquitous alcohol harm. This is in part due to its history as a wine producing country. And it is due to the alcohol industry. The “French Paradox” presented in 1992 only made matters worse. This paradox suggested low-dose alcohol use had protective effects on the heart. It has now been debunked. Already in 2006, a meta analysis proved that the “French Paradox” was a result of methodological bias which arose from including people who used to consume alcohol or occasionally consume alcohol in the abstinent group.
Since then continuous scientific evidence has been proving that there is no safe or healthy level of alcohol consumption.
Vulnerable groups: Women and young people
Alcohol harm is disproportionately higher for French women and youth. These are two groups specifically targeted by the alcohol industry to drive profits and hook new consumers.
Inserm reports that women are biologically more vulnerable to alcohol. This is because women absorb and metabolize alcohol differently than men. Women’s blood alcohol concentration goes higher than men’s for the same amount of alcohol consumed. Therefore, women are more vulnerable to organ damage from alcohol. They are also more vulnerable to other forms of alcohol harm such as trauma caused by violence and traffic accidents. Any alcohol is also harmful during pregnancy for the woman and the fetus.
French young people are also at high risk. For instance, a 2017 ESPAD survey showed,
- 44% of underage French youth (17-year olds) reported a binge alcohol episode within a month, and
- 3 in 10 say they were never asked for age verification when purchasing alcohol.
According to the Weekly Epidemiological Bulletin (BEH) in February, 2019, young people between the ages of 18 to 24 years have fewer occasions of alcohol use but consume more alcohol in one occasion. Over half (54%) report a binge alcohol occasion within a month.
The French binge alcohol use problem
France is also showing that the “mediterranean way” of consuming alcohol is more an alcohol industry myth than reality. Heavy episodic alcohol use is a major problem in the country. For example, binge alcohol use is one of the leading causes for hospitalizations in France. And it affects people of all ages.
- A study published in the Inpes Health Barometer 2014 reported that 14% of 15 to 24 year olds and 10% of 25 to 34 year olds engage in heavy episodic alcohol consumption. It appears younger people binge on alcohol more than older adults.
- However, older adults (average age 43 years) are the ones hospitalized more due to acute alcohol intoxication which is a result of binge alcohol use.
COVID-19 worsens alcohol problems in France
COVID-19 has led to a plethora of problems around the world. For the French the increased stress, lack of a routine, insecurity about the future and isolation is leading to rising self-medication with alcohol.
- A CovidPrev survey for Public Health France (SPF) in May 2020 reported 65% of the French people who consume alcohol maintained stable levels in the first lockdown.
- A quarter reduced their alcohol use and 11% increased their alcohol use.
- The predictions are that the second lockdown affected the French people more negatively. The latest data from the CovidPrev survey reported in January 2021 that anxious and depressive states remain at a high level.
- Addiction care, support and prevention center (Csapa) reports requests from women have sharply increased during the pandemic.
The first lockdown was rather very well supported by the majority of young people. On the other hand, since the second lockdown, we have observed more binge eating attacks, addictive behaviors with a high level of anxiety, ” said Xavier Pommereau, Psychiatrist responsible for the day hospital for 16 to 25 year olds at the Béthanie clinic in Bordeaux, as per Le Monde.
The stress induced by the health crisis may have revealed vulnerabilities and exacerbated weaknesses.”Xavier Pommereau, Psychiatrist, Béthanie clinic, Bordeaux
Some help is available to those who are facing alcohol problems, remotely during the pandemic. For instance, Csapa offer both on-site and remote consultations. They also partnered with a start-up, Oz Ensemble, to launch an app for addiction support. The app provides the possibility of obtaining an online consultation within 48 hours. It has faciliate better outreach to younger people, and specifically women, whose alcohol use problems have not progressed to severe dependence.
AddictElles, an organization which supports women to recover. also host remote group sessions via video conference.
However, with young people, too few are seeking and receiving help for their alcohol problem. Consultations for recovery support for youth such as at consultations for young consumers (CJC) remain very low.
State of French alcohol policy and future recommendations
In the Inserm opinion, published in early June 2021, the authors point out the disintegration of the Evin Law since 1991.
In 1991, France was a pioneer. But since then, there have been a lot of abuses and the law has been considerably weakened,” said Professor Karine Gallopel-Morvan, from the School of Advanced Studies in Public Health (EHESP) in Rennes, as per Le Monde.
Other countries, like Lithuania and Ireland, are now much more advanced than us.”Professor Karine Gallopel-Morvan, School of Advanced Studies in Public Health (EHESP), Rennes
As early as 1994, the ban on display advertising in public places was lifted. Then, in 2009, the internet (still in its infancy in 1991) was included in the list of authorized media for alcohol advertising. While some restrictions were included, the nature of online marketing has made it hard to regulate digital alcohol advertising. For example, influencer marketing is very difficult to track and is used by the alcohol industry prolifically.
As recently as last year the Evin Law was again attacked. Some parliamentarians were suggesting on behalf of the alcohol industry to weaken the law to “help” the sports industry during the pandemic.
The authors of the Inserm opinion make three main recommendations:
- Improve regulations,
- Intensify prevention messages, and
- Systematically screen, with better monitoring.
1. Improving alcohol policy regulations
The public health experts call for improved regulations of alcohol advertising, including for online adverting with greater transparency, control and surveillance.
Inserm also recommends either implementing a minimum unit price or increases of alcohol taxes to reduce the affordability of alcohol products. Alcohol taxation is recommended to be levied per gram of pure alcohol.
2. Intensifying alcohol prevention messaging
The experts also highlight the need for intensifying alcohol prevention messages – specifically for women and young people.
For children, psychosocial skills must be developed from elementary or middle school. This will enable them to better resist social pressure, refuse endangerment, and to become aware of the pitfalls of marketing.
Notably, the Inserm report also emphasizes the importance of alcohol-free challenges, such as Dry January, as another means of action. Going alcohol-free for a month has been found to have lasting effects on the reduction and quitting of alcohol consumption. In turn, this boosts the health and well-being of participants.
3. Better screening, brief interventions and treatment
Finally the authors call for prevention to be coupled with systematic screening for alcohol problems. Any primary health caregiver can be trained to screen for alcohol issues among patients and provide brief interventions. Screening and brief interventions help those who are at risk of developing an alcohol issue. These brief interventions take a motivational approach and provide personalized advise to the patient. Those presenting with alcohol problems can be referred to specific treatment and care.
Many of the recommended solutions are part of the World Health Organization’s alcohol policy blue print, SAFER. Especially addressing alcohol affordability through taxation and improving France’s alcohol advertising ban are two of the three alcohol policy “best buys“, according to the WHO. Improving screening, brief interventions and treatment provision for people with alcohol use problems is also part of the SAFER blue print, as one of the two “good buys”.
A recent modeling study predicted that if the current alcohol use and obesity trends continue in France, over the next decade, thousands of French people’s lives will be lost in addition to the already high death toll. If urgent action is taken to prioritize alcohol policy solutions, thousands of lives can be saved.
Le Monde: “How Inserm wants to reduce the burden of alcohol in France, whose “mortality is higher than elsewhere in Europe”” [Translated from French]
Le Monde: “Alcohol-related mortality is on the decline” [Translated from French]
Le Monde: “Binge alcohol use affects all generations” [Translated from French]
Le Monde: “Alcohol, tobacco, drugs and medication … Addictions, another collateral damage of Covid-19” [Translated from French]
The Conversation: ““French paradox”: moderate alcohol consumption has no protective effect“[Translated from French]