Alcohol cancer labels: public health measure or scare tactic?

In the second of our series on the implications of the WHO’s ‘no safe level’ agenda, Tom Bruce-Gardyne explores the battle to impose cancer warnings on drinks, and ponders the motives, whether it is really to inform consumers or simply to scare them into drinking less.

In its ‘no safe level’ bombshell of January 2023, the WHO (Europe) specifically called for cancer warnings on all alcoholic drinks. According to surveys, the public was largely unaware of the link to cancer. Therefore, labels were needed to “empower individuals with vital information to make informed choices,” said the WHO’s regional director, Dr Hans Henri Kluge.

But it begs the question why it took so long to propose such warnings if alcohol was designated a type 1 carcinogen back in 1988. The answer must lie to a large extent in that other great ‘vice’ of the time.

“Throughout the 1980s, 1990s and early 2000s tobacco control was consuming enormous public health resources,” says Dr Creina Stockley, co-director of the International Scientific Forum on Alcohol Research. But that began to change once smoking was banned in enclosed public spaces, following Ireland’s lead in 2004. Before long there were plenty of scientists, lobbyists and NGOs in need of a new purpose in life.

The direction of travel was obvious. As Sir Liam Donaldson, England’s then chief medical officer, told the Daily Telegraph under a headline, ‘Fat Binge Drinkers Beware’, in 2007: “Tobacco is a good example of a health problem that is in hand, but when we turn to obesity and alcohol misuse, those are not yet anywhere under control.”

“If you do your research most of the guys now doing alcohol, came from tobacco, and that’s in every country,” says Stockley. Having run what has been called ‘one of the most successful social change campaigns’ against smoking, it was only natural to apply the same tactics to drink given the links to cancer. Clearly part of that is to insist on cancer labels.

A history of warning labels

There have been warning labels on drinks since the late 1980s, and often with a hidden agenda. In 1987, the US became the first country to insist wine labels carry the words ‘Contains Sulfites’, following a bill sponsored by a teetotal Republican senator. As Thomas Pinney wrote in A History of Wine in America, “its object was not to inform but to frighten”.

For years, labels have warned consumers not to drink and drive or drink while pregnant, but the first to mention cancer dates from 2016 in South Korea.

In November 2017, Professor Tim Stockwell and others ran a test case in Yukon, Canada. “We designed this beautiful colourful label,” he told journalist Felicity Carter in a podcast interview, and claimed it caused sales to fall by more than 6%.

Drinks companies, who had not been consulted, disagreed about the aesthetics and, on seeing their brands defaced with a bright yellow warning saying ‘Alcohol can cause cancer’, pressured the Yukon liquor board to drop the trial.

A bill to mandate such labels is presently on its third reading in the Canadian Senate. “From what I hear, it’s not going to go through,” says Professor Dan Malleck of the department of health science at Brock University in Ontario. “It’s a passion project of Senator Patrick Brazeau.”

Ireland takes centre stage

This May, Ireland was to be the first Western country to force all alcoholic drinks to carry cancer labels, as part of its Public Health (Alcohol) Act 2018.

“Ireland needs to be the standard bearer for alcohol just like we were for smoking,” declared Dr Sheila Gilheany of Alcohol Action Ireland. “Other countries are watching Ireland closely on alcohol labelling, ready to follow our lead.”

While some New Zealand wines did appear on Irish shelves carrying the stark warning: ‘There is a direct link between alcohol and fatal cancers’, the new law was postponed until September 2028.
A senior industry source credits the Americans and says: “They saw this labelling proposal as a very clear non-tariff barrier, and they said they would retaliate against any country that did it.”

A European solution?

The industry is hopeful the Irish government will be pragmatic and seek some European solution, in which case the big wine-producing member states like Italy would almost certainly block any mention of cancer.

Gilheany clearly gets this and says, “There’s absolutely no way that we could wait for Europe for a label. What we should do is go ahead ourselves and let Europe catch up with us.”

For now, there is uncertainty. As Ignacio Sanchez Recarte, head of the Comité Européen des Entreprises Vins, says of the Irish postponement: “2028 is tomorrow! Importers and retailers are starting to ask companies not to put the label on, but wine is not a super-fast, rotating product. It’s not an apple or a yoghurt.”

“Our policy-makers are telling us don’t worry, it will never happen,” he continues. “Maybe at a certain point, if national legislation starts to pop up, we’ll be forced to request the EU to harmonise and regulate that.”

Informing consumers or changing behaviour?

The big unresolved issue in all this is what constitutes success.

“If the goal is informed consumer choice, modest labels may be sufficient,” says Dr Stockley. “If the goal is measurable reductions in drinking, the historical trajectory of tobacco control suggests continual pressure for larger, more prominent, and potentially graphic warnings. I consider that distinction may become a central debate in alcohol policy over the next decade.”

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