Lessons from Ireland, the first country to put health warnings on alcohol: ‘Many people drink without being aware of the risk’

Ireland will be the first country in the world to provide labeling that clearly links alcohol consumption to cancer. To be introduced in 2026, it is being viewed as a “promising” measure that will reduce consumption and encourage other European countries to follow suit, according to experts from the World Health Organization (WHO) in a recent report.

Ireland’s labels will give scientific evidence that alcohol causes cancer and liver disease — evidence that the industry wants to play down because, as happened with tobacco, sales are likely to fall as public awareness rises. There is plenty of room for improving awareness: according to a study published in July, almost half of Europeans do not know that there is a link between alcohol consumption and the possibility of suffering seven types of cancer, while only 15% know that drinking is linked to breast cancer.

“At the moment what we know is that many people drink without being aware of the risks,” says Dasa Kokole, a consultant at the WHO Regional Office in Europe and co-author of the report. At the World Cancer Congress organized by the International Union for Cancer Control (UICC) in Geneva, Kokole explained to EL PAÍS that the Irish legislation could have a major impact on European public health if other countries see that it as successful and easy to implement. “My personal opinion is that this is why the alcohol industry have objected so strongly to the Irish label, because they know it is just a first step,” she says.

Katherine Paradis, another WHO alcohol expert for the European region, added that several studies in Canada show that “once people are exposed to labels and understand that alcohol can cause cancer, they are significantly more likely to support other alcohol policies, such as tax measures to increase prices or the restriction on advertising or hours of purchase.”

Meanwhile, Irish Cancer Society President, Averil Power, is encouraging organizations in other countries to mobilize. “There are cancer leaders from around the world here [at the UICC] and I hope that the Irish initiative can give them confidence to do move on this. If it is possible in Ireland, it is possible in France, Italy and in any other alcohol producing country. But I think we need to have a big campaign and a broad alliance of social and health groups to make it happen, because the backlash from the industry will be massive,” she explains.

Of course, it wasn’t easy to get the scheme off the ground in Ireland either. “We’re talking about a place where every milestone in life, from birth to death, is celebrated with alcohol. Even the brand of alcohol most associated with Ireland has the ‘Guinness is good for you’ slogan attached to it, suggesting that drinking is healthy. It’s embedded in the Irish psyche,” says Power, who added that 80% of Irish people do not know that alcohol leads to breast cancer and 60% are unaware of the link to bowel cancer, according to studies carried out by the Irish government.

Power believes that there have been three keys to implementing the measure in Ireland: “The first was to provide evidence of alcohol’s impact on health; the second was political leadership; and the third was a powerful civil society campaign. We put pressure on the politicians, but we also supported them when they faced resistance from the industry, and we made sure that they stood by us,” she explains.

In Ireland, around 60 organizations came together under one umbrella platform, the Alcohol Health Alliance. “There were groups in the alliance representing everything from medical professionals to the interests of children and young people,” she explains. “Each organization used its own network to rally support. Of course, the industry reaction was really strong, but what was the government going to do — it couldn’t actually go against the views of 60 of the most respected social organizations in the country, could it?”

Another key to getting such a scheme implemented is being prepared to respond to pressure, according to Power. “The industry will talk about the economic benefits, the amount of national revenue that comes from alcohol, as well as employment in production and distribution. But we had strong evidence that the economic value was largely going to private companies while the cost to public health of alcohol-related issues was huge — €2.3 billion [$2.56 billion] in health care, lost working hours, violence and hospital admissions.”

The economic cost of premature cancer deaths in 2018 was estimated at €52.9 billion in the EU, of which €4.58 billion ($5.10 billion) was linked to alcohol.

Alcohol consumption is thought to be linked to as many as 111,300 new cases of cancer in the EU (4.1%). The majority of cancers caused by alcohol in the EU were colon or rectum (36,900 cases), followed by breast (24,200 cases), and oral cavity (12,400 cases).

To date, the European Commission has not reached a decision on how to include warnings on drinks. In 2017, it invited the industry to include the information voluntarily, but the sector failed to step up.

Regardless of what the Commission decides, WHO experts seek to support countries in implementing anti-alcohol strategies. According to Dasa Kokole, inaction is not only due to commercial constraints. “Sometimes, there are simply too few people working in health and they are underfunded and under-resourced, so they don’t have the space or capacity to prioritize alcohol,” she explains.

However, Kokole notes that the solutions for staying informed go far beyond labeling. “Sometimes doctors forget to mention alcohol when referring to cancer risks,” she says. “That is also a major reason why there is currently little awareness.”

Regarding Spain’s government campaign targeting drinks masquerading as alcohol for young people, Kokole says: “Underage people are a gateway, because everyone wants to protect them from danger and harm.”

The World Cancer Congress has made the need to tackle alcohol consumption a significant focal point. “We know that cancer would be reduced if we acted against tobacco and alcohol, and worked on exercise and nutrition,” says Jeff Dunn, President of UICC. “We have the information and the evidence and now we need commitments.”

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