Pills, liquor, and pot:

Hawking heavy drinking

Note from the editor: This is the second instalment in a three-part series. Stay tuned for part three, which will focus on how cannabis is promoted in Canada. The promotion of prescription drugs was discussed in part one.

Canadians love alcohol, to such a degree that our current chief public health officer, Dr. Theresa Tam, has dubbed our use “problematic”. Like most countries in the world, it’s our most-consumed narcotic, and we choose to use it for a wide variety of reasons: when we’re celebrating a milestone, kicking back after a long day at the office, watching a hockey game, or, as the case might be for some 4.7 million Canadians aged 15 and older who are chronic drinkers, subconsciously numbing ourselves to reality.

In his 2015 report on national alcohol consumption, our previous chief public health officer Dr. Gregory Taylor acknowledged in its opening statements that “consuming alcohol is ingrained in Canadian culture”. He claimed it is intrinsic to our existence and a very large part of our identity. One cannot assess our nation’s perception of liquor without recognizing our historical attachment to the once-prohibited substance.

Our entrenched relationship with alcohol began with colonization. En route to what is now known as Canada, European settlers drank not water, which in France and Britain was more often than not unsafe to drink, but beer and wine. Beer has continued to be the alcoholic beverage of choice in Canada, partly because the colonizers who arrived here realized early on that our climate was better suited to growing barley and hops than grapes. Of course, their ships also carried barrels of brandy, rum, and whisky, and eventually, distilleries began to open up in Canada, with the first opening in Quebec City in 1769. Drug policy professor and activist Dr. Susan Boyd writes in her book Busted: An Illustrated History of Drug Prohibition in Canada that beer was considered nutritious, and alcohol was viewed as, “a medicine, a tonic to prevent disease”. Drinking took place at all times of day, and was “particularly for men… an integral part of colonial social life”. Public drunkenness in bars and taverns was not viewed as harshly as it is today, and common among all classes of society.

Public drunkenness was so popular that it began to irritate white, middle, and upper class Christian women who responded by forming temperance alliances and unions across the country. They saw alcohol as a thorn in Canadian society’s side; a substance that caused crime, eroded moral and religious ideals, and stood in the way of economic growth and national unity. Prohibition began in parts of pre-confederation Canada as early as 1864, when the Dunkin Act allowed counties and municipalities to ban the retail sale of liquor with a majority vote. The temperance movement was eventually able to force a national plebiscite on prohibition in 1898, but despite a majority of Canadians voting in favour of prohibition, Sir Wilfred Laurier deemed the passing of a federal law unwarranted.

Alberta Archives, 1912

When the national plebiscite failed, the task of prohibition fell to provincial governments. Bans on liquor were enacted and repealed in each province at varying times, with Prince Edward Island being the first to enact laws in 1901 and the last to give them up in 1948. What complicated prohibition in Canada was the way alcohol-related laws were divided among jurisdictions: the sale and consumption of booze were left up to provinces, while the federal government dealt with manufacture and trade. This meant that the production of alcohol continued even when several provinces had outlawed sale and consumption. (Only during the First World War, when abstaining from alcohol was viewed as patriotic, did the federal government choose to cease the making and importation of liquor.)

It doesn’t matter so much as when or how these laws were enacted, but how Canadians in every corner of the country tried to evade them. While crimes related to public drunkenness declined with prohibition, illicit booze and homebrewed liquor became incredibly popular. Bootleggers sold alcohol illegally while speakeasies sold liquor under the table. Rum running, the act of smuggling liquor into the United States where federal prohibition was upheld from 1920 to 1933, proved to be quite lucrative for Canadian men who weren’t afraid of the violence and ties to the Mafia that came with the job. Since temperance laws still allowed physicians to write prescriptions for liquor, many resorted to faking an illness when they craved a drink—a charade that became wildly popular during the holidays.

By 1925, most provinces had repealed prohibition, though a patchwork of laws remained in Ontario, New Brunswick, Nova Scotia, and Prince Edward Island for several years. Today, a few dry communities remain throughout the country, but it’s safe to assume that alcohol consumption is largely viewed as acceptable by the majority of Canadians, with 78 per cent of Canadians reporting past-year consumption in 2017.

General effects

Our long-running love affair with liquor makes it hard to face the music: the amount and frequency with which we consume alcohol carries tremendous health risks; risks that are often ignored or downplayed thanks to social conditioning and the normalization of drinking.

One reason we’ve become so accustomed to consuming alcohol is the pervasive myth that drinking the right number of beverages can have “positive” health effects. We may no longer consider it on par with a disease-curing tonic, but there are certainly varieties of alcohol we deem healthier or safer than others. Have you ever heard the theory that one glass of red wine a day is good for the heart, or that beer can be as hydrating as water? Even celebrity physician Dr. Oz has advised people to limit themselves “to clear liquor like vodka and gin” to experience less severe hangovers.

These arguments are convenient for those of us who associate drinking with relaxation, increased confidence, fewer inhibitions, or perhaps—remember, this is coming from a writer, and some of the most respected writers of our time were raging alcoholics—a jump in creativity, but as time goes on, the “healthiness” of low to moderate alcohol consumption is being increasingly debated.

Several of the ideas listed above were debunked in a recent report published in The Lancet. The report, which assessed an astronomical 16 years worth of data on global alcohol use, found that only those who drank no alcohol throughout the week minimized harm to their health. That is to say, researchers concluded that no amount of alcohol should be viewed as “safe” to consume. Globally, they found alcohol consumption to be the seventh leading risk factor for death, and the leading risk factor among populations aged 15 to 49 years old. The study’s conclusion puts it plainly:

“Alcohol use is a leading risk factor for disease burden worldwide, accounting for nearly 10 per cent of global deaths among populations aged 15 to 49 years, and poses dire ramifications for future population health in the absence of policy action today. The widely held view of the health benefits of alcohol needs revising, particularly as improved methods and analyses continue to show much alcohol use contributes to global death and disability. Our results show that the safest level of drinking is none.”

According to the World Health Organization (WHO), as many as three million deaths per year are a result of harmful alcohol use. That’s more than five per cent of all annual deaths worldwide. What’s more, alcohol-related illness and disease tend to strike early in life: when adjusted for adults between ages 20 and 39, the number of alcohol-attributable deaths increases to 13.5 per cent worldwide. (Incidentally, this demographic is more often than not both depicted and targeted by marketing campaigns created by alcohol companies because this highly desirable consumer base is thought to be the most willing to try new products.)

Alcohol has proven to be a causal factor in more than 200 different diseases, spanning the spectrum of physical, mental, and behavioural conditions. When judgement is impaired by alcohol, risk of injury, accidents, and incidents of violence increase substantially, especially for moderate and heavy drinkers. Drinking while pregnant can lead to low birth weight and fetal alcohol spectrum disorder. Let’s not forget the detrimental effects alcohol use can have on one’s social life, family life, relationships, career, and financial stability, among other areas.

Still, these facts are not top of mind when we’re a few too many pints deep while cheering on our favourite football team at the local bar, or when we’re being asked if we’d like to partake in our fourth or fifth company-sponsored cocktail at a corporate party.

Sometimes it takes the dreadful effects of the morning after to really consider the impact of alcohol misuse. Even then, we tend to give ourselves a pass—or head to the liquor cabinet for a little hair of the dog—whatever it takes to continue the narrative in our minds that consuming a poisonous substance for fun is worth the detrimental effects to our health and well-being. Not just drinking, but heavy drinking, has become so deeply woven into Canadian society that calling it a cultural norm almost seems too obvious. More than a norm, it’s something we feel entitled to, and, given our past, something we are clearly more than willing to fight for.

How Canadians use alcohol

In Canada, we drink more booze per capita than any other country in both North and South America, taking back an average of 10 litres of pure alcohol per year, according to a 2017 World Health Organization report. That’s 3.6 more litres annually than the world average. Of the list of almost 200 countries included in the report, Canada ranked 40th.

The 2017 Canadian Tobacco, Alcohol and Drugs Survey illustrates more accurately just how many Canadians are not only consuming alcohol, but consuming it heavily. Almost 80 per cent of the population drank alcohol in 2017, with 21 per cent of the population reporting chronic effects of alcohol consumption and 15 per cent reporting acute effects. While men have a higher percentage of problematic drinking (nearly a quarter of men in Canada reported drinking that qualified as “heavy”), the number of Canadian women who have turned to the bottle has increased so substantially in recent years that between 2001 and 2017, the number of deaths caused by alcohol among women increased by 26 per cent, according to Dr. Tam’s 2018 report.

In Canada, we drink more booze per capita than any other country in both North and South America, taking back an average of 10 litres of pure alcohol per year. That’s 3.6 more litres annually than the world average.

Another report on alcohol from the Canadian Centre on Substance Use and Addiction (CCSA) found that an estimated 20 per cent of the population drinks more than what is recommended in Health Canada’s low-risk drinking guidelines. These were released in 2011 after policy makers observed a sharp 14 per cent increase in per capita alcohol consumption beginning in 1996. They suggest that men consume no more than three drinks per day, or 15 standard drinks per week, and women consume no more than two drinks per day, and 10 standard drinks per week, with non-drinking days each week “to avoid developing a habit”. The guidelines also suggest that men and women consume no more than four and three drinks, respectively, when celebrating a special occasion, to reduce risk of injury and harm.

Looking at the provinces and territories, the 2017 CCSA report found that the biggest consumer of alcohol was the Yukon, where roughly 13.5 litres of pure alcohol per capita were consumed between 2015 to 2016. Next were the Northwest Territories (11.5 litres), Newfoundland and Labrador (nine litres), and Alberta (nine litres). Quebec, Saskatchewan, and British Columbia all tied at 8.5 litres, while Prince Edward Island, Manitoba, Ontario, and New Brunswick all came in at eight litres. New Brunswick followed with 7.5 litres, with Nunavut rounding out the group at just 2.5 litres per capita. (The amount of alcohol consumption has since increased in the territory after the opening of the Iqaluit Beer and Wine Store, the first retail alcohol store in Nunavut.)

Obviously all of this alcohol comes at a price. Save for some slight adjustments, the amount of money spent on booze in each province correlates with the numbers above. A report for Statistics Canada found that in 2017 and 2018, Canadians over the age of 19 spent an average of $755 per person on alcohol. The average in the Yukon was $1,261 per person, and on the low end was Nunavut, at $231 per person. Overall, liquor stores, agencies and retail outlets sold $23.2 billion worth of alcoholic beverages in 2017 and 2018, a 3.1 per cent increase from the year previous.

Canadians certainly like to drink, but we also like to lie about how much we drink. This makes one wonder whether all the risk associated with drinking floats around in the back of our minds when we’re softening the truth for our partners or parents the day after a night of heavy drinking—or, as researchers discovered, when we’re answering questions for national surveys about consumption. A study published by the Canadian Institute for Substance Use Research (CISUR) in 2014 compared national surveys with the amount of alcohol actually sold over the course of a year, and found that Canadians only reported about one-third of their total consumption. The centre’s director, Dr. Tim Stockwell, told the Canadian Press after the release of the study that such gross underestimations make it easier for society to ignore the risks of excessive drinking.

Dr. Tim Stockwell (CISUR)

Given the discrepancy between reality and statistics, researchers at CISUR estimate that 40 per cent, rather than 21 per cent of Canadians qualify as “higher risk” drinkers. It’s worth noting that, however accurate or inaccurate we may perceive them to be, the results of these surveys inform the way policy around alcohol is created.

Impacts of alcohol use and misuse in Canada

For years, policy analysts, researchers, and public health experts have sung a similar tune when it comes to regulations around alcohol: we are ignoring the gravity of the harm associated with our most dangerous legal drug.

“We have strong legislation and regulation governing tobacco and cannabis sales, marketing and labelling, but the federal government has been asleep at the wheel for years on alcohol policy,” wrote Stockwell in an October 2019 article for The Conversation. Using a study funded by Health Canada to approximate just how drastic the impact of alcohol is on the healthcare system, he and his team estimated that annually, 15,000 deaths, 90,000 hospital admissions, and 240,000 years of life lost are directly attributable to booze.

Previous research from the CCSA concluded that there were roughly 77,000 hospitalizations entirely caused by alcohol in 2015 to 2016—2,000 more than hospitalizations for heart attacks in the same period. The Canadian Institute for Health Information (CIHI) reported in May 2019 that 75 per cent of the 10 substance-use related deaths that occur in Canadian hospitals each day are tied not to opioids—the subject of a very real public health crisis—but to alcohol.

In Canada, alcohol is one of the top ten risk factors for disease among the entire population, and the leading risk factor for those aged 15 to 49. In 2016, the Canadian Cancer Society estimated that as many as 10,700 Canadians were diagnosed with cancer that was tied to drinking. (Cancer is the leading cause of death in Canada, and is linked to 30 per cent of all deaths). Excessive consumption of alcohol increases risk for colorectal and breast cancer by 50 per cent, and for throat and mouth cancers by five times. Some research shows that even one drink per day can increase a woman’s risk of developing breast cancer.

Approximately 10 per cent of Canadian women consume alcohol while pregnant, leading to an estimated 3,000 cases of fetal alcohol spectrum disorder per year.

Excessive consumption of alcohol increases risk for colorectal and breast cancer by 50 per cent, and for throat and mouth cancers by five times. Some research shows that even one drink per day can increase a woman’s risk of developing breast cancer.

While the study published in the Lancet referenced earlier states that the safest amount of alcohol consumed is none, the harms associated with consumption are absolutely contextual. Several factors play a role in how alcohol affects an individual, including the amount consumed, one’s gender, age, and weight, the speed with which alcohol is consumed, one’s mood, whether or not one has eaten, one’s history with alcohol, any medication being consumed, and one’s overall health.

Drinking too much alcohol can come with a significant list of health effects depending on the factors listed above. The effects near the top of the list below may seem manageable, but we often forget that even one night of excessive drinking can lead to life-threatening consequences, and even death:

  • drowsiness
  • dizziness
  • slurred speech
  • reduced inhibition
  • loss of coordination skills
  • inability to think and judge clearly
  • inability to estimate distances
  • decreased reaction times
  • confusion or memory loss
  • blackouts
  • negative mood states (depression)
  • violence
  • suicide
  • vomiting and choking
  • irregular heartbeat
  • respiratory depression, coma, or death

Those who drink heavily on a regular basis put themselves at risk for more serious health problems, including:

  • brain damage (dementia, difficulties with coordination, and motor control)
  • depression
  • increased risk of suicide
  • increased risk of high blood pressure
  • increased risk of stroke
  • increased risk of heart disease
  • liver damage
  • stomach ulcers
  • blood vessel disorders
  • impotency in men
  • menstrual irregularities in women
  • some types of cancer (ie. mouth, throat, liver, breast, digestive tract)
  • addiction
  • death

Source: Health Canada

We may have become better at disseminating the message that drinking while pregnant is harmful—these days I can’t walk into a washroom in a licensed facility without seeing some sort of warning that I could seriously harm my unborn child if I partake—but according to Stockwell and the team at CISUR, Canada has failed at educating the general population about the very real harms listed above. (Really, in 2019, CISUR graded Canada on the efficacy of its alcohol policy and gave us a “big fat F”.)

“Patently no,” he told Inside the Jar when asked if Canadian consumers were being informed enough of the risks associated with alcohol.

“If you do a survey of the public as to whether they’re aware of very basic things, like whether alcohol can cause cancer, breast cancer, cancers to the digestive system, the majority of people, about 60 to 70 per cent, have no idea. The great majority of Canadians don’t know about some of those serious consequences of alcohol use,” he said.

Stockwell said similar proportions don’t know about the low-risk drinking guidelines, or even what a standard drink is to enable them to count drinks and follow those guidelines. Beverage alcohol in Canada is not required to display any specific labelling or warnings, and Stockwell said public information on risks is not easily found or presented in a user-friendly manner.

Even some of our own politicians aren’t aware of how harmful alcohol is. In an address during the second reading of the Cannabis Act, Conservative MP Joël Godin Portneuf said that Canadians “cannot compare alcohol to drugs, because they do not compare.”

“Alcohol is one element called ‘alcohol’. Drugs are a huge range of products that are toxic and harmful to people's health,” he said.

“With respect to marijuana, it has been shown that there is a risk of permanent damage to mental health, and I do mean permanent. To my knowledge, there are no studies that talk about permanent damage with regard to alcohol.”

Studies showing the link between cancer and alcohol have existed since the early eighties. If an elected official can claim on the floor of the House of Commons that not a single study exists to show that alcohol can cause permanent harm to one’s health, it’s no wonder Canadians are so in the dark about the real and potentially dangerous impacts associated with consumption.

While health providers and policy makers, including Portneuf, fear that cannabis legalization could affect the cognitive function of young people who choose to consume before they are of the legal age, it’s not very often that the issue of underage alcohol consumption and its impacts are discussed in the public forum.

Despite this, it’s likely news to no one that in Canada, underage drinking is rampant. The average teen starts drinking at 13. Nearly 60 per cent of youth aged 15 to 19 reported alcohol consumption in 2017, with 12 per cent exceeding Canada’s low-risk alcohol drinking guidelines. A 2015 to 2016 CIHI study found that as many as six youth between the ages of 10 to 19 were being hospitalized each day in Canada for alcohol use and intoxication. Some may still be of the mind that cannabis is a “gateway drug”, but in recent years studies have shown that alcohol and nicotine are more often than not the first substances a young person consumes.

Scott Bernstein (handout)

Scott Bernstein, a lawyer and senior policy analyst with the Canadian Drug Policy Coalition, pointed out that Canadian culture plays just as an important role for the drinking habits of underage people as it does for those over the age of 19.

“If you look at places like France, kids grow up with alcohol more normalized, and it’s not taboo. To my knowledge, they don’t experience the same binge drinking and excess use of alcohol, because they’re taught social constraints from a very young age,” he told ITJ by phone.

“We’ve always held it out as it being a grown-up thing: ‘whatever you do, don’t try it.’ We know that for young people, [that attitude] makes it like candy to them.”

While numbers associated with alcohol-related disease and underage drinking have remained relatively steady over the last several years, changes to policy around impaired driving have led to a 26 per cent decline in the number of alcohol-related crashes. But even with tougher impaired driving laws in provinces like British Columbia and Quebec, more than 65,000 incidents of alcohol impaired driving occurred in 2017. Impaired driving remains the leading criminal cause of death and injury in Canada.

There is also a very strong association between the overconsumption of alcohol and domestic violence, child abuse, and violent crime, including sexual assault and homicide. According to a 2015 report, an estimated 40 per cent of accused and 32 per cent of victims involved in a homicide in 2013 were under the influence of alcohol at the time the crime was committed.

Let’s not forget that problematic alcohol consumption costs Canadians a substantial amount of money: in 2014, the cost of alcohol misuse was $14.46 billion, with $4.23 billion going to healthcare costs, $5.92 billion to lost productivity, and $3.15 billion to total criminal justice costs, including policing, courts, and corrections. The remaining $1.34 billion was the result of fire damage, motor vehicle damage, employee-assistance programs, workplace drug testing, and workers’ compensation administration.

Alcohol advertising in Canada: a semi-regulated free-for-all

“Our society condones, supports, and in some cases promotes drinking such as through "drink of the day" specials, sale prices on certain brands, and associating alcohol with fun and sophistication.”

That’s in the opening statement of a report on our dire drinking from Canada’s former chief public health officer, Gregory Taylor. Why include a positive note on alcohol within the first three paragraphs of a 76-page report that goes on to discuss many of the harms I’ve mentioned above, but in more explicit detail? It’s just a hunch, but I have a feeling he felt some pressure (whether from industry or politicians eager for liquor taxes, I’m not sure).

For the same reason pharmaceutical companies have been able to get away with breaking the rules around advertising, the multi-national corporations providing us with our favourite liquor have pushed back against every proposed change to regulation, every negative report, every mention that alcohol could possibly be bad for one’s health: power.

Before discussing the intricacies of alcohol advertising in Canada, the regulations for which have not changed since 1996 (yet another example of how powerful the alcohol lobby is), I’ll remind you of a few more recent examples of the liquor industry’s tremendous influence on policy makers.

In an attempt to curb heavy drinking in the territory, the Yukon Liquor Corporation began attaching bright yellow warning labels to all alcoholic beverages in November 2017. They were being used as part of a study to see if warnings would affect the way people consumed alcohol.

“The Chief Medical Officer of Health advises: Alcohol can cause cancer, including breast and colon cancers,” the warning read. “To reduce risks, drink no more than 2 standard drinks a day for women (3 for men); plan two or more non-drinking days each week.”

In less than a month, the threat of legal action from the liquor industry was enough for the liquor authority to give up on its efforts and have the cancer warnings removed. The industry questioned the corporation’s legislative authority, and argued that label placement might be infringing on trademarking. They even argued that the labels could be considered defamation.

“Those terms leave us thinking that litigation is a real risk,” John Streicker, the territory’s minister of community services said at the time.

The study continued with amended labels that showed a standard drink size and the number of drinks a person should have per day, but the cancer warnings were no more.

Stockwell, the lead on the study, told the Yukon News that with the removal of the cancer warning, he wasn’t sure a change in behaviour around drinking would occur. The cancer warning, he said, had the most impact.

“The sad thing is a sovereign government felt that they couldn’t act in the best interest of their citizens and that they were bullied essentially into taking a position which they didn’t think was the best one,” he told the paper.

It’s not just the presentation of liquor that the liquor industry has been able to influence. Remember when representatives from Beer Canada and Spirits Canada made submissions to the federal task force on legalization?

"Things that are not permissible in beverage alcohol shouldn't be permissible in marijuana," Andrew Oland, a board member for Beer Canada and president and CEO of Moosehead Breweries told The Globe and Mail in 2017.

Spirits Canada suggested that cannabis marketing should not "imply directly or indirectly that social acceptance, social status, sexual performance, personal success, or business or athletic achievement" can be associated with cannabis use, or convey that it is "essential to the enjoyment of an activity or event."

If that were actually the case, and cannabis was subjected to “exactly the same” rules and interpretations of those rules, we’d see TV ads depicting people using cannabis in hot tubs with their friends; cheering on their favourite teams with a doob in their hand, and billboards displaying our favourite cannabis brands in cities across the country.

"If you're going to introduce another drug into the marketplace, why would you not subject that to exactly the same kinds of things that have proven to be effective in beverage alcohol?" said Jan Westcott, president and CEO of the industry group to the national paper.

If that were actually the case, and cannabis was subjected to “exactly the same” rules and interpretations of those rules, we’d see TV ads depicting people using cannabis in hot tubs with their friends; cheering on their favourite teams with a doob in their hand, and billboards displaying our favourite cannabis brands in cities across the country. That is obviously not the case. (Even without fancy packaging and total prohibition on advertising on TV and radio, cannabis does seem to be taking (an albeit small) bite out of the liquor market: recent data shows that since legalization, Canadians are drinking three per cent less beer.)

The Canadian Radio-television and Telecommunications Commission, or the CRTC, is responsible for Canada’s code for broadcast advertising of alcoholic beverages. The code applies to TV and radio ads, but has not been updated to reflect the amount of digital advertising Canadians are exposed to. Each province and territory also has its own set of alcohol advertising guidelines that mirror much of the CRTC code, and apply to advertising in addition to TV and radio ads, including liquor licensees like bars, pubs, restaurants, night clubs, retail stores, wineries, breweries, and distilleries. They vary slightly by region. Guidelines are most strict in Nunavut, where all alcohol advertising is prohibited, unless it receives approval by the Nunavut Liquor and Cannabis Board.

As you might expect, the CRTC code prohibits ads that are directed to people under the legal drinking age, as well as endorsements by any person that might be a role model for minors. Advertisers are not allowed to “portray the product… in an immoderate way” or “show use or language that suggests, in any way, product misuse or dependency”; nor should an ad depict a product in a way that it could be associated with operating a vehicle or conveying a certain skill.

There are other aspects of the code that are clearly being broken. For example, alcohol is not to be marketed as a “status symbol”, or a way to “escape from life’s problems”. I’m sure that right off that bat, a few advertisements that do exactly that come to mind—they certainly do for me. Advertisements are also not permitted to “imply directly or indirectly that the presence or consumption of alcohol is, in any way, essential to the enjoyment of an activity or an event”. Policy experts agree that the plain truth is that these areas of the code are being blatantly ignored.

The reasons for this are many: Canadians like to drink, and we like ads for things that we like to drink. The vast majority of Canadians are probably not familiar with what the code has to say about alcohol advertising, and even if they were, the likelihood that anyone would be concerned enough to file a complaint would be slim.

Another crucial parallel between the way pharmaceutical drugs and alcohol are advertised in Canada is that they are both self-regulated. Industry groups like Beer Canada and Spirits Canada each have their own codes for responsible practices in advertising, but pre-clearance of advertisements is not mandatory. While some provincial regulators require prior approval before certain advertising can be posted, TV and radio ads are not required by the federal government to be pre-screened. Advertising Standards Canada (ASC), rather than a branch of the government is responsible for conducting the voluntary screening of advertisements. Only at the request of the advertiser is pre-screening conducted.

This change took place in 1997, when the CRTC disbanded the mandatory pre-clearance process of alcohol advertisements, which until that point had been required by the federal government. It’s now up to provinces, broadcasters, and the industry itself to control the messaging that Canadians receive about alcohol.

Health Canada may be responsible for dealing with complaints pertaining to pharmaceutical drug ads, but when it comes to alcohol, that duty also falls on the ASC, and not a branch of the government. It has been argued that by the time a complaint is made about a liquor ad, it’s too late to prevent harm to public health and safety.

“The current complaint system in Canada can be seen as a band-aid solution and its reliability to prevent the occurrence of inappropriate alcohol advertising is questionable,” wrote Rebecca Heipel-Fortin and Benjamin Rempel in a 2007 paper on the efficacy of Canada’s alcohol advertising control policies.

Studies have shown that self-regulation does not work, and not only that; that exposing young people to alcohol through advertising makes them a) more likely to start drinking at an earlier age, and b) more likely to engage in binge drinking. Yes, levels of government have implemented rules to prevent underage drinking, but practice “has not been supported by policy”.

“It’s like Dracula guarding the blood bank in some ways. They have such a strong vested interest that you can’t expect it to be very effective.”

“The systems in place to regulate advertising have some serious problems—there are major conflicts of interest because the advertising industry has very close commercial links with alcohol manufacturers and retailers,” Stockwell told ITJ.

“It’s like Dracula guarding the blood bank in some ways. They have such a strong vested interest that you can’t expect it to be very effective.”

Stockwell also said that an update to the CRTC code is way past overdue, because it doesn’t apply to modern digital media. He pointed to ads from bars and liquor companies on Facebook and Instagram, which often depict images of young people “getting drunk and having a wonderful time”—something that the code prohibits. It has yet to be published, but in a study of bars and clubs located near college campuses, CISUR found that the less compliant with the CRTC code a bar was, the more popular they were with students, and the more frequently students who attended these bars drank.

“It’s really effective, good business, but it’s really bad for public health and safety.”

Spending on advertising

While recent data on how much money is spent on alcohol advertising in Canada is hard to come by, a literature review published by the Nova Scotia Department of Health Promotion and Protection found that in 2005, the liquor industry spent $2 billion on television, radio, print, outdoor, and newspaper advertisements.

When broken down by category, liquor is among the top 10 global industries for advertising expenditures, allocating more money for marketing than the financial industry, pharmaceutical companies, and apparel brands. In 2016, USD $14.8 billion was spent on advertising by beer, wine, and liquor companies worldwide. That’s almost CAD $20 billion.

A look at the 2018 financial report of AB InBev, the world’s largest brewing company, helps us break it down further. It shows that in that year alone, the multinational corporation spent USD $7.8 billion on sales and marketing expenses, or CAD $10.2 billion.

Why is the amount of money being spent on advertising so important? Research from the United States shows that the more money companies spend on advertising, the more people drink. This might seem obvious, but the numbers associated with this connection are staggering: every dollar per capita spent on alcohol advertising is associated with a three per cent increase in the number of drinks consumed.

On attitudes and giving up benefits

At almost $15 billion in 2014, the cost of excessive drinking was much higher than that of the next most costly substance—tobacco—at $11.97 billion. When it became clear to health experts and politicians that smoking resulted in dire health consequences, changes were implemented: smoking cessation campaigns flooded TV and radio, bold health warnings became a requirement on all cigarette packaging, taxes were increased, and, most recently, plain packaging regulations were put in place. These efforts have all led to a reduction in both negative health effects, as well as tobacco-associated costs to the taxpayer.

This begs the question: why are similar initiatives not being explored for alcohol?

“If alcohol was a newly regulated substance in 2019, we would probably approach it a lot different than we did, but we’re dealing with a bit of legacy… nobody wants their alcohol taken away,” said Bernstein.

Tobacco, on the other hand, is something that after much change in advertising and messaging, “everyone… believes is bad.” For policy analysts like Bernstein, the crux is that we don’t exist in a vacuum: it’s confusing to him that cannabis, “which is demonstrably less harmful than alcohol”, is being made to compete against alcohol, “where there are much looser rules.”

Dr. Cheryl Camillo (handout)

Dr. Cheryl Camillo agrees that changing policy around the messaging of the potentially lethal substance would be incredibly difficult. The assistant professor at the Johnson Shoyama Graduate School of Public Policy at the University of Regina, has spent more than 25 years researching health system reforms and developing policy and governance solutions in North America. She and Bernstein also weighed in on the issue of pharmaceutical drug use and advertising in Canada in the first instalment of this series.

“There’s such a strong social connection to alcohol that there would be resistance by the public, to a greater extent than resistance by the public if pharmaceutical advertising regulations were to change,” she told ITJ by phone.

To illustrate this point, she brought up the Mosaic Stadium in Regina, the home of the Saskatchewan Roughriders. Canadian football has long been marketed as a family-friendly affair, and the team offers packages that encourage fans to “start a new family tradition”.

But Camillo says an entire section of the venue is sponsored by Old Style Pilsner, a popular Saskatchewan-made beer brewed by Molson-Coors Canada Inc., “so even though there are restrictions on the advertising of alcohol in Canada and it’s not meant to be marketed towards youth, you can’t go to a game and not see Pilsner all over that stadium.”

The problem at the stadium—and let’s face it, most other sporting events, whether they are marketed as family-friendly or not—is that despite laws against promoting liquor to those under 19, children and young people are being exposed to ads that encourage them to drink well before they are legally able to.

While we can all collectively agree that exposing young people to alcohol ads well before they are able to purchase it is bad for public health and safety, collective outrage to, say, the removal of the Pilsner-sponsored section would likely be far greater that any frustration resulting from promoting alcohol consumption to youth.

..."One of the main rules of human nature is that humans don’t like to give up benefits… Psychologists have studied this; economists have studied it in their own way; humans react much more strongly to loss than to gain. And so, because so many Canadians have grown up with alcohol being part of their social life, that would be a loss to many, including our politicians.”

“Whether we know it or not, we grow up with the exposure to alcohol infused in our life,” said Camillo.

“A lot of what determines whether policy is made and whether it’s made well or not is human nature. One of the main rules of human nature is that humans don’t like to give up benefits… Psychologists have studied this; economists have studied it in their own way; humans react much more strongly to loss than to gain. And so, because so many Canadians have grown up with alcohol being part of their social life, that would be a loss to many, including our politicians.”

Surely it would be a loss to the social lives of our politicians—but policy experts also argue that the main benefit that keeps the government from reevaluating alcohol regulations has more to do with tax revenue than anything else.

Between 2017 and 2018, a year Canadians spent over $23 billion on alcohol, net income and other government revenue resulting from the control and sale of booze, including excise taxes, retail sales taxes, specific alcohol taxes, and license and permit revenues, totalled $12.2 billion.

Now what?

Given the mountains of data that show alcohol is in fact a harmful narcotic, which can shorten our lifespan and leave us suffering from incurable disease, one would assume that there is at least a slight appetite on the part of the federal government to make some sort of change.

“The case for having tighter regulations around alcohol is very strong,” said Stockwell. “It just depends on how effective, and I suppose, how courageous our policy makers and political leaders are in being willing to address the thing that has had the most impact on health and safety.”

Consider the labelling requirements on every other food and drink product in Canada, including calorie content, serving size, and nutrition information. Think about the bold yellow warning labels that are displayed on tobacco and cannabis products. It may be in fine print, but even in the United States, liquor producers have been required to print warnings on labels since 1989.

An obvious first step in the minds of policy experts including Stockwell is the implementation of a warning label program, not unlike the one that the Yukon tried to put in place in 2017. But scientists have suggested the idea of health warnings to Canadian policy makers since as early as 1990, and attempts to do so have been shot down by industry.

Is it likely that changes to federal and provincial advertising policies will be explored in the near future? I’d like to say yes, but it looks grim. That’s not to say that smaller regulatory bodies aren’t acting on the scientific data that proves how harmful alcohol is: last week, the Fraser Health Authority in B.C. launched an ad campaign across the Lower Mainland warning of the link between alcohol consumption and cancer.

“It’s something that hasn’t come up in our cultural discourse,” Fraser Health medical officer and campaign lead Ingrid Tyler told the CBC. “I really hope this campaign will jumpstart a discussion.”

Stay tuned for part III.