Alcohol in the city: It’s everywhere, all the time

Bars, grocery stores, restaurants, terraces, smoke shops, supermarkets, convenience stores, terraces, more terraces... We can buy alcohol in all these places that characterize daily life in our cities. In the summertime, alcohol consumption and pressure to drink increase even more.

Along with smoking, poor diet and sedentary lifestyle, alcohol is one of the four main factors in morbidity and mortality from non-communicable chronic diseases, such as cancer and cardiovascular diseases. In addition, alcohol is the most consumed psychoactive and addictive substance in the country, both among the adult population and in young people; it is followed by tobacco. The scientific evidence is increasingly clear and convincing: there is no safe level of consumption for our health. Alcohol is an addictive substance that can create dependency and is associated with over 200 different diseases. For this reason, we want to know how those four factors affect life in our cities and neighborhoods.

Alcohol is present in every corner of our urban environment. Alcohol is omnipresent; it is a part of our culture and a fundamental element of our socialization at home, at work, and with friends in our youth, adulthood and old age. And let’s not forget that alcohol’s presence generates a lot of profits. In cities, alcohol’s availability and advertisements for it have been normalized in such a way that we no longer even see them. A colleague who is a research sociologist and professor of epidemiology in the U.S. explained how context must always be seen from the outside: “A fish doesn’t know what water is. If we have been living in the same city for years, generations, we don’t know what our own urban context is like.” And nowadays, it so happens that we have normalized and socially accepted the presence and consumption of alcohol; that is also why it is so hard for us to see it, study it, measure it and accept that it is everywhere, all the time.

A few years ago, when we started to study the urban environment’s relationship with alcohol in Madrid (which had not been done before in a scientifically valid and systematic way), we designed an instrument to measure the availability, advertising and signs of alcohol consumption. We started in a city square. We thought that the two researchers in the group could measure the whole square in a couple of hours. It took them two whole days to be able to measure just that one square. This research, led by Xisca Sureda and carried out in Madrid’s different neighborhoods, served to create and validate the OH Cities measurement tool, which has also been used in Barcelona.

Studies in Madrid and Barcelona

Using the OH Cities tool, we have studied the availability, promotion and signs of alcohol consumption in both Madrid and Barcelona according to the socioeconomic level of the neighborhoods. The results from both cities showed that the urban environment is characterized by the inclusion of elements that promote alcohol consumption. Our findings also revealed that there is an unequal distribution of these elements across the cities, depending on the socioeconomic level and the activities oriented to tourism and leisure in our neighborhoods.

The urban process of touristification is associated with different health impacts; one of them is clearly the availability of alcohol and advertising for it. We studied the association between tourist pressure and the urban environment related to alcohol in 170 census sections (an urban area where about 1,500 people live) in 73 Barcelona neighborhoods. Barcelona averaged 8.18 places to buy alcohol and 7.59 alcohol advertising items per 1,000 inhabitants. Census tracts with greater tourist pressure had 2.5 times more places to buy alcohol and 2.3 times more alcohol advertising per 1,000 inhabitants than in areas with less tourist pressure.

Led by fellow sociologists, we also conducted a qualitative study on alcohol consumption in unlicensed public spaces in Madrid neighborhoods with different socioeconomic statuses. Residents highlighted non-compliance with existing restrictions on the sale of alcohol at night in convenience stores, including the sale of alcohol to minors. They also mentioned alcohol-related littering, nuisance noise and episodes of violence, which were disproportionately felt in the most disadvantaged neighborhoods. This article is currently under scientific review.

Spain’s National Plan on Drugs financed a study on alcohol in cities, to be conducted in Madrid and Barcelona; it included the participatory methodology Photovoice. The 26 participants who worked on the project for months in two Madrid neighborhoods of different socioeconomic levels emphasized the following issues: the important role that alcohol plays in our current socialization processes, the negative effects of alcohol consumption in public spaces, the diversity of prices and supply of alcohol for all people to consume and, finally, the fact that the sale of alcohol is a big business.

The less alcohol, the better

But what we studied in Madrid and Barcelona happens in similar ways in Glasgow, Buenos Aires and Bogotá. It occurs in most of our cities; it plays out in different ways in different neighborhoods depending on their socioeconomic level. Alcohol is a fundamental part of the commercial determinants of disease. The SPECTRUM research consortium (Shaping Public Health Policies to Reduce Inequalities and Harm) in the United Kingdom understands this and studies it. The main causes of disease and health inequalities include the consumption of unhealthy products such as tobacco, alcohol, high-fat foods, salt and sugar. We know perfectly well that these exposures are preventable. The problem is that these products are highly profitable and, in many cases, we have normalized them.

In December 1995, the World Health Organization (WHO) organized a conference in Paris called “Alcohol: The Less, the Better.” Twenty-eight years later, scientific evidence is mounting to confirm that idea and promote a paradigm shift. Our cities should be part of this change.

All this evidence and scientific knowledge about alcohol in our cities suggests different measures, strategies, and interventions for regulating the promotion of alcohol, its availability and its consumption in public space to change social perceptions about alcohol and decrease its use. Public health and preventive medicine are always about taking care of the entire population: in this case, it means taking care of those people who already consume a lot of alcohol by reducing their consumption of it; taking care of those people who still do not drink means ensuring that they continue down that path. This is undoubtedly a social and economic challenge.

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