Alcohol Use Disorders (22) Do people understand the harms of alcohol? (2)

6 February, 2024

Q1. Do people understand the health, socio-economic and environmental harms of alcohol? What matters to them? How can they be better informed? How to reduce stigma?  

My Contribution:

There might be emerging evidence that people understand the health, socio-economic and environmental harms of alcohol, that it matters to them, that they are better informed (even though more can be done to improve the communication about the harms and benefit), and drinking less reduces stigma provoked by overuse of alcohol. 

Though the socio-economic and cultural factors that impact alcohol use are well known, including discrimination and stigmatisation of the overusers, the ill-effect on their mental and physical health of abuse, and the ever-rising cost of alcohol, the public health message about alcohol does not seem to have changed for many decades. The message has remained that ‘moderate drinking seems to be good for the heart and circulatory system, and probably protects against type 2 diabetes and gallstones. As recently as 2021 several studies concluded that moderate use leads to lower risk of dementia or decreased cognitive decline over time with mild to moderate alcohol intake, and also to reduced risk of developing gallstones. Other studies point to positive social effects of alcohol because many people ‘perceive it to be a social lubricant that improves mood, reduces self-consciousness and enhances social skills, increased social bonding among strangers’, coping with problems, having fun, looking mature, and social image such as fitting in, being more popular, and looking cooler amongst peers and generally. (The public perception of the risks and benefits of alcohol consumption. 1992 Mar;16(1):38-42.  doi:10.1111/j.1753-6405.1992.tb00023.x.).

It is also true that the long-standing public health message points out the harms, it says that ‘heavy drinking is a major cause of preventable death in most countries. That in the U.S., alcohol is implicated in about half of fatal traffic accidents.’ And that ‘over time, excessive alcohol use can lead to chronic diseases, including high blood pressure, heart disease, stroke, liver disease, and various cancers: breast, mouth, throat, esophagus, voice box, liver, colon, rectum, female gynaeco-urinary organs and male genitourinary organs.

Anecdotes and research findings support this view, for instance the understanding of the health, socio-economic and environmentalharms of alcohol seems to be influenced by generational factors. The public health message has not really changed much, but every younger generation seems to be less inclined to drink alcohol than their older one. Anecdotes from within families and from exchanges with patients, the younger generations tend to drink less than the older ones. For instance 40% of Generation Z (Gen Zers born between 1997 – 2012, aka Gen Z,iGen, or centennials) are being labelled 'the sober curious generation' as they are less likely to drink, when compared to, half of over 65s who did not limit their alcohol consumption in 2023. The Generation Zers follow the millennials, have been raised on the internet and social media, and the oldest finished college by 2020 and entering the workforce. Amongst them health concerns, changing tastes, a lack of effective marketing, and price (cost) are all factors why they drink less alcohol. Other factors include, a reflection of their attitudes towards health and wellness, and they are the fastest growing demographic of non-alcoholic drinks consumers. Gen Zers prioritize healthy eating and regular exercise, their mental health and managing stress, more.

But, sadly, as these younger people are turning away from alcohol and overconsumption, they are turning to cannabis use, according to reports, this switch seems to coincide with increased legalization of cannabis and the feeling of lower risk, in the USA. A discussion topic for another day!

Following the trend the Millennials (born between 1981 and 1996) – are more health-conscious than preceding generations, even though they are seeing their health decline faster than that of their parents as they age. (according to a 2020 study from medical insurer Blue Cross Blue Shield in the United States). In the UK the are among the heaviest generations, at least seven in 10 people millennials will be overweight or obese before they reach middle age, when compared to the Baby boomers rates of five in 10.

However, Baby boomers I and II (born 1946-54;1955-64) are more likely to suffer chronic conditions than earlier and later generations.

As with many other conditions and public health situations, there is a big divide between the Global North (mostly high income countries-HIC)and Global South (mostly lower, low, and middle income countries- LLMIC). In most countries in Africa, for instance, a general perception persists that there are more urgent public health problems than harmful use of alcohol’, even though Alcohol consumption has been identified as the leading risk factor for death and disability in sub-Saharan Africa and the leading risk factor for disability-adjusted life-years (DALYs) among African male adolescents aged 15–24 years. In the North alcohol use is part of the daily life of the people used, especially during everyday meals, in Africa alcohol tends to be used mostly during rituals, marriage ceremonies, clan/family festivities. This may be changing with urbanization and westernization of cultures and attitude.

Therefore, more needs to be done globally but more in LLMIC to re-orientate peoples perception and understanding about alcohol, in communicating facts about alcohol use, benefits and harms, and avoiding alcohol altogether as the default position, because quitting alcohol protects physical, mental and psychological well-being.


(i)       ...

(ii): ›why-gen-z-is-drinkin...                                                                  

(iii) › alcohol › fact-sheets › alcohol-use.                                                                    

(iv) ›millennials-drive.... and 

(v) ›Health-and-Well-Being › S...                                                       


Joseph Ana

Prof Joseph Ana

Lead Senior Fellow/ medicalconsultant.

Center for Clinical Governance Research &

Patient Safety (ACCGR&PS) @ HRI GLOBAL

P: +234 (0) 8063600642


8 Amaku Street, State Housing, Calabar,Nigeria.

HIFA Profile: Joseph Ana is the Lead Senior Fellow/Medical Consultant at the Centre for Clinical Governance Research and Patient Safety (CCGR&PS) with Headquarters in Calabar, Nigeria, established by HRI Global (former HRIWA). He is the Country Coordinator for PACK Nigeria (Practical Approach to Care Kit) which is specifically designed to improve clinical competence (improving accuracy of diagnosis and treatment) in primary health care. He is also a Member of the World Health Organisation’s Technical Advisory Group on Integrated Care in primary, emergency, operative, and critical care (TAG-IC2). As the Cross River State Commissioner for Health (2004-2008), Joseph Ana led the introduction of the evidence based, homegrown quality tool, the 12-Pillar Clinical Governance Programme (12-PCGP) in Nigeria, which also suitable for lower-, low-, and middle income countries (LLMIC) with similar weak health sector and system. To ensure sustainability of 12-PCGP, the ‘Department of Clinical Governance, Servicom & e-health’ was established in Cross River State Ministry of Health in 2007. His main interest is in ‘Whole health sector and system strengthening in LLMICs’. He has written six books on the 12-Pillar Clinical Governance Programme, including the TOOLS manual for its Implementation, currently in its 2nd Edition. He served as Chairman of the Nigerian Medical Association’s Standing Committee on Clinical Governance (2012-2022), and he won the Association’s ‘Award of Excellence’ on three consecutive occasions for the innovation of 12-PCGP in Nigeria. He served as Chairman, Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act 2014. He was Member, National Tertiary Health Institutions Standards Committee (NTISC) of the Federal Ministry of Health, 2017-2022. He is the pioneer Secretary General/Trustee-Director of the Charity, NMF (Nigerian Medical Forum UK) which took the BMJ to West Africa in 1995. Joseph is a member of the HIFA Steering Group; the HIFA working group on Community Health Workers, and the Working Group on HIFA-WHO Collaboration ( Email: info AT and jneana AT