Ireland was this week given the green light from the EU to mandate strong health warnings on alcoholic beverages from 2026. According to the state-funded pressure group Alcohol Action Ireland, which lobbied for the policy, the warning labels will ensure that “consumers are informed about the health risks of products they are considering purchasing”. Who could object to that?

Quite a few people, as it happens. Some of the EU’s wine-producing countries are livid. One of Italy’s farmers’ associations has described the policy as “terrifying” and “completely improper”. Forza Italia MEP Raffaele Nevi said it is “totally wrong and generates unfounded alarm among consumers.” An undersecretary at Italy’s agriculture, food sovereignty and forestry ministry, said the warnings will set a “dangerous precedent” and has accused the Irish of “criminalising individual products”.

Although some of these remarks were overwrought and it is easy to imagine them being accompanied by gesticulations, they should not be dismissed out of hand. Few people would object to consumers being better informed but it is not clear that the new warnings will achieve this. It is questionable whether that is even the intention.

Epidemiological evidence on the risks and benefits of alcohol consumption is complicated

Epidemiological evidence on the risks and benefits of alcohol consumption is complicated and a short warning can only convey so much information. To be useful, a warning label needs to give consumers an accurate impression of the science in a brief sentence. The exact wording has not been finalised but two warnings have been proposed: “Drinking alcohol causes liver disease” and “There is a direct link between alcohol and fatal cancers”. Both of these statements are scientifically defensible and yet they are misleading because they omit important information. By ignoring any mention of excessive consumption, they imply that any amount of drinking causes these diseases. That is simply untrue of liver disease, which requires sustained consumption at quite high levels, and is debatable in the case of cancer. Although temperance campaigners are insistent that there is “no safe level” when it comes to drinking and cancer, the evidence for this is weak. 

Moreover, there is no mention of which cancers are associated with alcohol consumption. According to Cancer Research UK, there are seven alcohol-related cancers. Five of them are so rare that they are unlikely to give drinkers sleepless nights. Of the two more common types, colorectal cancer is only associated with alcohol consumption among heavy drinkers. This leaves breast cancer as the only common cancer associated with moderate drinking, although the magnitude of the risk is small — similar to that associated with taking the contraceptive pill — and the survival rate is high.

Given the countless risks that life throws at us, I suspect that nearly every drinker who was made aware of these facts would conclude that they are quite happy to take their chances and carry on drinking as they did before. But the Irish warning labels are not making drinkers aware of these facts. They are telling people that “there is a direct link between alcohol and fatal cancer”. While this is not a lie, the signalling effect is likely to make consumers over-estimate the health risk and worry more than they should. 

Many things have been classified as carcinogens, including hot drinks, red meat, bacon, salted fish and the aforementioned contraceptive pill, but tobacco is the only consumer product that has a cancer warning. Without proper context, the Irish warning labels will give the impression that alcohol has a similar risk profile to cigarettes, and yet the cancer risk from smoking is so much greater that it shouldn’t be mentioned in the same sentence. Heavy drinking increases the risk of colorectal cancer by 25 per cent. Heavy smoking increases the risk of lung cancer by 3,000 per cent. 

It could be argued that some people are completely unaware of the link between alcohol and cancer and deserve to be educated. But if people’s behaviour wouldn’t change if they were better informed, it is doubtful whether such education serves a useful purpose. In any case, is a short message on a bottle really the best way to inform the public? An advertising campaign would be more educational and would probably be more effective. Most public health messages manage to reach the public without labels being put on products.

… moderate drinking reduces the risk of heart disease, stroke and overall mortality

If making consumers fully informed was the real purpose of this policy, one of the mandatory messages would explain that moderate drinking reduces the risk of heart disease, stroke and overall mortality. Many people are unaware of this fact despite the evidence for it being considerably more robust than the evidence that light drinking causes breast cancer. There is, of course, no chance of the Irish government doing this because it might encourage people to drink. That is the opposite of what the government is trying to do. It is not interested in educating the public. It just wants them to drink less.

As for the neo-temperance groups that have spent years lobbying for the new warnings, it is an important symbolic victory. They have created the illusion of parity between alcohol and tobacco as products which cause cancer and are so dangerous to health that they require the nuclear option of a warning label. They are gleefully aware that warnings on cigarette packs were the regulatory breakthrough that began a process of “denormalisation” that led, decades later, to politicians openly talking about prohibition. 

Drinkers, you have been warned.