Wine, health, and society responsibility

1. Wine, health, andsociety responsibility Creina Stockley Health and Regulatory Information Manager

2. Counter balance?

3. Contents • Science • Operating environment • Government responses • Industry responses • AWRI responses • How we need to respond now

4. 1. Science

5. J-shaped curve Adapted from Boffetta and Garfinkel (1990) Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology 1:342–8. A reduced risk of death from all-causes (by ~ 10%) wasassociated with consumption of 1-2 glass/day of wine compared with lifelong abstainers An increased risk of death from all causes with regular consumption of more then 2 glasses/day of wine compared with life-long abstainers

6. Extended J-shaped curve cognitive decline - 20% dementia – 50% diabetes - 30-40% certain cancers - 20-40%

7. Evidence? Available evidence? Population studies Animal and test tube studies Limited human clinical studies

8. Excerpt from: Klatsky, A.L., Friedman, G.D., Armstrong, M.A., Kipp, H. Wine, liquor, beer and mortality. Am. J. Epidemiol., 158:58595; 2003. Adjusted risk of death through 1998 for selected diagnoses per day per week of wine, spirits and beer intake in Northern California, USA Group (no. deaths in drinkers Wine SpiritsBeer drinking >once/month) All causes (n = 11,542) 0.96***1.01 1.01 Non-cardiovascular disease (n = 7,306) 0.97*** 1.01 1.00 All cardiovascular disease (n = 4,236) 0.95*** 1.00 1.00 Coronary heart disease ( n = 2,025) 0.94*** 1.00 0.98 Cancer (n = 3,453) 0.98* 1.00 0.99 (*** P < 0.001)

9. Evidence? Available evidence? Population studies Animal and test tube studies Limited human clinical studies Evidence missing? Large double-blind placebo-controlled human clinical studies both in healthy and diseased populations to verify the relationships between wine consumption and the effects of the wine-derived phenolic compounds

10. And then there is this ‘evidence’… Alcohol’s Good for You? Some Scientists Doubt It Published: June 15, 2009 By now, it is a familiar litany. Study after study suggests that alcohol in moderation may promote heart health and even ward off diabetes and dementia. The evidence is so plentiful that some experts consider moderate drinking — about one drink a day for women, about two for men — a central component of a healthy lifestyle. But what if it’s all a big mistake? For some scientists, the question will not go away. No study, these critics say, has ever proved a causal relationship between moderate drinking and lower risk of death — only that the two often go together. It may be that moderate drinking is just something healthy people tend to do, not something that makes people healthy. “The moderate drinkers tend to do everything right — they exercise, they don’t smoke, they eat right and they drink moderately,” said Kaye Middleton Fillmore, a retired sociologist from the University of California, San Francisco, who has criticized the research. “Moderate drinkers tend to be socially advantaged in ways that have nothing to do with their drinking,” said Dr. Naimi of the C.D.C., who did a study looking at thecharacteristicsof moderate drinkers and abstainers. “These two groups are apples and oranges.”

11. Extended J-shaped curve Health harms + social harms cognitive decline - 20% dementia – 50% diabetes - 30-40% certain cancers - 20-40%

12. Social costs? Collins and Lapsley (2008) “social cost of alcohol in Australia is $15 billion/year” “alcohol tax revenue exceeds the alcohol-attributable costs borne by the public sector by $1.42 billion/year” FARE (2010) “social cost of alcohol in Australia is $36 billion/year”

13. Evidence missing? Other evidence missing on the role of alcohol, and specifically wine, in abuse and short and long-term harms (both health and societal) and associated costs in Australia? An analysis of wine’s role in health and societal harms - including crime and domestic and other violence (law enforcement) and casualty/hospital admissions An analysis of wine’s role in youth binge drinking Price sensitivity of ‘at-risk’ consumers including youth, women and the elderly A comparison of the relative benefits and risks for wine compared to other alcoholic beverages.

14. 2. Operating environment

15. Global ALCOHOL environment Globalised alcohol markets, and multi national and multi beverage companies

16. Globalisationmulti-national, multi-product companies Spirits Beer Wine Wine

17. Pernod Ricard Premium spirits Premium Champagnes Premium wines

18. Global ALCOHOL environment Globalised alcohol markets, and multi national and multi beverage companies Homogenised drinking cultures – amounts, patterns and products

19. WHO Global Status Report on Alcohol and Health 2011

20. WHO key assumptions on alcohol Alcohol = alcohol = alcohol & Per capita consumption predicts level of problems

21. Global ALCOHOL environment Globalised alcohol markets, and multi national and multi beverage companies Homogenised drinking cultures – amounts, patterns and products Increased awareness of health and nutrition, as well as the importance of exercise and fitness in diseases and disease prevention

22. The ALCOHOL industry The “alcohol” industry Distributors bars, clubs, pubs, bottle shops Producers beers, spirits and wine Wine

23. AND… WHO WTO OIV FTA Australian Government Bi and Multi Lateral Agreements SAWIA Codex AWRI SA State Government NAAA DrinkWise Australia Australian Marketplace WFA Australian Wine Industry NAAA

24. National Alliance for Action on Alcohol (NAAA) consists of 44 organisations from across Australia: NAAA Addiction Journal; Alcohol and Other Drugs Council of Australia (ADCA); Alcohol Education and Rehabilitation Foundation (AERF); Alcohol Policy Coalition (Vic) Anglicare Australia; Australian Drug Foundation (ADF); Australian Health Promotion Association; Australian Medical Association (AMA); Australasian Faculty of Public Health Medicine (AFPHM); Australian Health Promotion Association (AHPA); Australian National Council on Drugs (ANCD); Australian Research Alliance for Children and Youth (ARACY); Cancer Council Australia; Cancer Council Victoria; Diabetes Australia; Drug Arm; Local Government Association Northern Territory (LGANT); Kidney Health Australia; McCusker Centre for Action on Alcohol and Youth (MCAAY); National Drug and Alcohol Research Centre (NDARC); National Drug Research Institute (NDRI); National Heart Foundation; National Indigenous Drug and Alcohol Committee (NIDAC); National Local Government Drug and Alcohol Advisory Committee (NLGDAAC); Network of Alcohol and Other Drug Agencies (NADA); Public Health Advocacy Institute (WA); Public Health Association of Australia (PHAA); Queensland Network of Alcohol and Drug Agencies (QNADA); Royal Australasian College of Physicians; South Australian Network of Drug and Alcohol Services (SANDAS); Sydney South West Area Health Service; Ted Noffs Foundation; Telethon Institute for Child Health Research; The University of Newcastle; The University of Southern Cross; The University of Queensland; The University of Wollongong; Turning Point Alcohol & Drug Centre; Uniting Church in Australia; Victorian Alcohol and Drug Association (VAADA); VicHealth; Western Australian Local Government Association (WALGA); Western Australian Network of Alcohol and other Drug Agencies (WANADA), Western Regional Alcohol and Drug Centre (WRAD).

25. “Drinking alcohol, even in moderation, 'a dementia risk’” Drinking even "moderate" amounts of alcohol increases dementia risk, US research suggests. These findings, presented at an international conference, challenge the notion that some alcohol could be good for ageing brains. People who stick to recommended alcohol limits are still at risk, as well as bingers and heavy drinkers, according to the work. “Myth busted: red wine no magic remedy for heart disease” Coinciding with today’s United Nations (UN) meeting on non-communicable diseases, the Alcohol Policy Coalition (APC) has released a paper challenging the commonly-held belief that red wine is beneficial for preventing cardiovascular disease. Misinformation Cherry picking!

26. Misinformation “Alcohol is as bad for you as asbestos and tobacco” EVEN a daily tipple is dangerous and can cause cancer, warns one of the country’s leading health agencies. The Cancer Council is advising Australians that alcoholic drinks are carcinogenic to humans, with no safe drinking levels. Cancer Council Australia Professor Ian Olver said Australians need to be aware that alcohol was as bad for their health as asbestos and tobacco.

27. Misinformation

28. 3. Government responses

29. 2008 World Health Assembly Resolution To prepare a draft global strategy to reduce harmful use of alcohol that is based on all available evidence and existing best practices and that addresses relevant policy options. & To collaborate and consult with Member States as well as consult with intergovernmental organizations, health professionals, nongovernmental organizations and economic operators on ways they could contribute to reducing harmful use of alcohol.

30. Key WHO references Babor TF et al. (2010) Alcohol: no ordinary commodity. 2nd Edition. Oxford, Oxford University “From a public health perspective, alcohol is no ordinary consumer product. On a global level, it is a major contributor to disease, disability, and premature mortality. It also has an adverse impact on many aspects of social life.” “The tendency has often been to treat alcoholic beverages more and more as an ordinary commodity, overlooking the very serious health and social problems related to alcohol consumption…There has been a growing contrast between the treatment of alcohol in trade agreements and disputes as an ordinary commodity and the more restrictive treatment of such other commodities as tobacco and pharmaceuticals, which also entail public health risks. In a globalising world of common markets and trade agreements, alcohol policy is thus no longer only a national or sub-national matter. To reverse the trend, a new international agreement on alcohol control, along the lines of the Framework Convention on Tobacco Control, is needed…”

31. The Federal government responded by introducing New Australian alcohol guidelines New Preventative health agency New National alcohol strategy New alcohol nutrition labelling provisions New alcohol health warning labelling provisions

32. New Australian alcohol guidelines GUIDELINE 1 To minimise risks in the short and longer term, and gain any longer-term benefits Next revision of Australian alcohol guidelines has been delayed until approximately 2014.

33. “While there is a substantial literature on protective effects of light drinking for ischemic heart disease and some other conditions, the extent of the effects is contested” (Fillmore et al 2006). Australian Guidelines TO REDUCE HEALTH RISKS from Drinking Alcohol

34. Lifetime risk of death from alcohol-related diseaseper 100 drinkers Standarddrinks per day

35. Lifetime risk of death from alcohol-related injuryper 100 drinkers Standarddrinks per day

36. Total risk of alcohol related death Standard drinksper day

37. New Preventative Health Agency (ANPHA) The fight against preventable diseases has been given a boost after the Parliament passed the historicAustralian National Preventive Health Agency Bill 2010. The Agency will lead Australia’s fight against preventable diseases through campaigns targeting obesity, along with alcohol, tobacco and other substance abuse. The Agency will be critical in combating preventable diseases, which affects the lives of millions of Australians. "We know that preventative health measures work and that’s why we sought to establish the Agency so for the first time in Australia, we will have one independent body to coordinate prevention campaigns across the country.“ National binge drinking strategy Minimum floor pricing Alcohol advertising – effectiveness of current codes

38. New National Alcohol Strategy On 24 April 2009, the Ministerial Council on Drug Strategy approved an extension of the term of the current National Alcohol Strategy 2006-2009 until 2011. “The annual cost to the Australian community of alcohol-related social problems was estimated to be $7.6 billion in 1998-99. Globally, alcohol-related death and disability accounts for 4.0% of the total cost to life and longevity (compared to 4.1% for tobacco), even after factoring in any health protective effects of alcohol consumption.” Next revision of National alcohol strategy has commenced.

39. New nutrition labelling (FSANZ) Standard 1.27 Nutrition, health and related claims Health claims prohibited on alcoholic beverages >1.15% abv Nutrition content claims only for energy, carbohydrate and alcohol content

40. New alcohol labelling recommended Recommendations • Mandatory pregnancy warning labels on all alcoholic products • Health warnings labels used as part of multi-faceted broader health campaigns • Energy content mandated similar to other ‘food’ products • Minimum font size and style, contrast levels and boldness for warning messages and allergen labelling • Alcohol is exempted from ‘front-of-pack’ nutritional information panels or ‘traffic-light’ labelling

41. NAAA – part of their proposed solution

42. 4. Industry responses

43. Industry is responding by introducing New WFA wine and health working group New WFA wine and health action plan 1. Implement wine specific activities including Commitment to Community actions Campaign to support a responsible cellar door experience 2. Identify and execute a strategic research agenda Gap Analysis – undertake a literature review of research on wine’s role in alcohol abuse in Australia Develop strategic capability with AWRI to address key knowledge gaps and shape public commentary 3. Explore pan-Industry opportunities with the broader alcohol industry 4. Advocacy and communications Including revise www.wfa.org.au and www.BeWineWise.org.au websites

44. AWRI has responded by initiating Research projects • Effects of wine-derived resveratrol on risk of colorectal cancer (Royal Melbourne Hospital & AWRI) • Effects of wine-derived resveratrol on risk of cardiovascular disease in an elderly population (University of Aberdeen, Rowett Institute of Nutrition and Health & AWRI) • Effects of wine-derived resveratrol on risk of cognitive function/dementia in an elderly population (Brain Sciences Institute at Swinburne University & AWRI) • Tracking the metabolome of grapes into wine (Edmund Mach Foundation, Trento, Italy & AWRI) • Analysis of the health and social benefits of wine in moderation • An investigation into the price sensitivity of ‘at-risk’ alcohol and wine consumers

45. Current funding opportunities in Australia National Health & Medical Research Council (NHMRC) • In 2011, 771 studies funded, only 2 addressed alcohol • 1 public health + 1 preventative medicine • In 2010, 683 studies funded, only 9 addressed alcohol • 2 public health + 7 preventative medicine • In 2009, 688 studies funded, only 5 addressed alcohol • 1 was specific to wine and beneficial effects • In 2008, 664 studies funded, only 4 addressed alcohol • In 2007, 789 studies funded, only 5 addressed alcohol

46. Summary • Health warning labels • Taxation $ • Advertising • Sponsorship • Research $

47. How we need to respond Source latest evidence of relationships between wine and health – both positive and negative to enable informed balanced debate Engage with all other stakeholders • based upon the evidence • capture evidence • collaborations to generate evidence

48. We want to make wine an ordinary commodity…part of an every day diet and lifestyle Room R, Babor T, Rehm J. (2005). Alcohol and public health. Lancet,365(9458):519-530. “A pattern of … regular low to moderate alcohol consumption is associated with physiological mechanisms linked to favourable cardiac outcomes. Another drinking pattern that seems to have a role in the cardioprotective effect is drinking with meals; such an effect also has plausible physiological pathways. For a specific country, however, the net effect of alcohol on CHD will depend on the distribution of drinking patterns in a society.”

49. Mediterranean diet food pyramid

50. WineHealth 2013International wine and health conference