It’s a Sisyphean task: debunking myths around alcohol and longevity. Nearly 20 years after researchers found that “moderate drinking” has no health benefits, we still want to believe a glass of wine is good for us, and flawed studies prop up this illusion.
Enter heavy lifters such as scientist Prof Tim Stockwell from the Canadian Institute for Substance Use Research, and Stellenbosch University’s Prof Charles Parry, chief specialist scientist in the Mental Health, Alcohol, Substance Use and Tobacco Research Unit at the SA Medical Research Council. They are not prohibitionists. They understand that the pleasure of low and moderate drinking may outweigh potential health risks for people but they want to raise awareness about the facts, despite a mountain of scepticism from the public.
Here is a fact: alcohol use was the leading risk for death and disability among 15 to 49-year olds — 12% of male deaths and 3.8% of female deaths — according to the Global Burden of Disease Study 1990-2016 across 195 countries. For people 50 years and older, alcohol increased the risk of fatal cancers: 27% of female cancer deaths and 19% of male deaths, the study found.
And South Africans drink on average 27.2g of pure alcohol (just more than two standard AA drinks of 12g) per day, according to the latest World Health Organisation (WHO) report. “There is a straight line showing an increased risk of mortality for drinkers when you look at high quality studies and get rid of bias,” Stockwell said in an interview this week, ahead of research to be published on Thursday in the Journal of Studies on Alcohol and Drugs.
Alcohol still seen as ‘an elixir’
Findings like these are highly contested, said Stockwell, who has co-authored multiple systematic reviews and meta-analyses since 2006, when he was on a team which busted the fallacy that a-glass-of-wine-is-good-for-health. In the public imagination, even in journals, alcohol is commonly seen as “an elixir”, he said.
Of the world's population older than 15 live with alcohol use disorders, an estimated 400 million people, reports the World Health Organisation in June 2024.
— 7%, one in 14
The upcoming journal report analyses the drinking habits and longevity of people based on 107 published studies, said Stockwell, and finds that the studies linking moderate drinking to longevity are badly designed. In them, older, often unhealthier, people who quit drinking, or drink occasionally, are typically counted as “abstainers” and, by comparison, make light to moderate healthy drinkers look good, he said. “Genetic studies show no benefit from alcohol... We are waking up to the extent of the problem but have not yet fully realised it,” he said
Parry is concerned about trends in South Africa that are making drinking more accessible and affordable, such as the rise of online alcohol sales, home deliveries and the size of containers. “Size matters. The containers for wine and beer are getting ever larger and cheaper per unit, and now there are sachets for spirits which are cheaper,” he said.
The availability of ready-to-drink alcoholic beverages, like cocktails, is another recent trend attracting young people and more women to drink because of their convenience and taste.
“Generally it is not good for your health to drink [and] we do all live with a bit of risk but alcohol consumption in South Africa remains alarmingly high,” said Parry.
Cancer, disabilities and deaths higher among drinkers
The 2024 WHO global status report on alcohol and health and treatment of substance use disorders, released in June, attributed 2.6-million deaths worldwide in 2019 to alcohol, with men and younger adults most vulnerable. There was a slight decrease globally in drinking and alcohol-related deaths.
The WHO African and Europeans regions had the highest level of alcohol-attributable deaths per 100,000, with 52.2 deaths for Africa. The International Agency for Research on Cancer has warned that alcohol plays a causative role in seven types of cancer — oral, pharyngeal, laryngeal, oesophageal (squamous-cell), liver (hepatocellular), colorectal and breast cancer — and classified alcoholic beverages as carcinogenic to humans in a special report in the New England Journal of Medicine in December 2023 found.
“Alcohol plays a causative role in so many diseases,” said Parry. “The links between drinking and non-communicable diseases like cancer, cardiovascular and liver diseases and pancreatitis are being given greater recognition. NCDs [non-communicable diseases] are now a greater threat to health in the country than infectious diseases, [so] we would do well to pay attention to this.”
Alcohol, meanwhile, is a pathway to TB and HIV infection, with the increased risk of being in confined spaces or having unsafe sex. Parry said: “Once someone has TB or HIV, alcohol consumption weakens the immune system and speeds up progression of the disease. People are more likely to go off meds or skip hospital visits if they have drinking bouts. The health outcomes of a drinker are worse.”
Researcher Mafuno Mpinganjira found that drinking was associated with HIV multimorbidity (living with two or more chronic illnesses) among 59.6% of participants in the Health and Ageing in Africa study, within the South African Medical Research Council/Wits-Agincourt Unit in Mpumalanga. “Reported alcohol use was common and associated with HIV multimorbidity and multimorbidity without HIV among older adults in rural northeast South Africa,” Mpinganjira, first author of the 2023 study, reported.
The team recommended screening, brief interventions and referral for alcohol treatment for patients to prevent and treat multimorbidity. Risky and heavy drinking extends across urban and rural South Africa, crossing age and class barriers. Mpinganjira was also the co-author on a 2023 study that reported alcohol use and risky drinking were common among undergraduate students at Wits University.
Specific groups of young people from 15 to 29 years old, including university/college students and sex workers, have high rates of reported drinking, noted the researchers. “Disposable income, peer pressure, exposure to advertisement, multiple substance use, family and siblings’ alcohol use, living arrangement, for example staying on campus, religion and religiosity [fuelled their alcohol use and risky drinking],” they reported.
South Korea has a warning label on liver cancer and Ireland plans to introduce a warning label next year
Time for change
South Africa has good researchers in this field and the voice of civil society is growing stronger, for example, with the launch of the Southern African Alcohol Policy Alliance, said Parry. “We need to focus on understanding alcohol use disorders, increasing access to prevention and treatment systems and particularly addressing the upstream drivers of alcohol use and associated harms: price, availability and marketing,” he said.
Attempts by the government to limit marketing and trading hours and reduce the blood alcohol limits for drivers are among the initiatives which have been squashed, Parry said. In South Africa there are small label warnings — for example, “Alcohol is addictive” — on products, not prominently displayed. As the evidence about health risks mounts up, countries around the world are stepping up their health warnings on alcohol products.
For example, Stockwell said: “South Korea has a warning label on liver cancer and Ireland plans to introduce a warning label next year.” This will resemble the label on cigarettes stating: “There is a direct link between alcohol and fatal cancers.”
Parry said the 164 days of temporary liquor sales bans during the Covid-19 lockdown reduced trauma admissions and deaths related to drinking. “During Covid-19 we learnt there could be a different normal ... but an alcohol ban is like using a hammer to kill a fly,” he said, calling for a more nuanced approach to regulation.
Advocating for changes in policy and action, Parry said: “Looking back at the last 10 to 15 years we have tried a lot but not achieved much. At this stage we know a lot and we have a strong case for action.”
Gen Z rebelling, leading the way?
On a personal level, youngsters from Gen Z seem globally to be shifting away from drinking “in favour of clean living alternatives”, the futurists at Flux Trends reported years back. “The percentage of young people who do not drink any alcohol at all has risen by 32%,” Flux stated in the report Teetotalism — Why Generation Z is Choosing Good, Clean Fun, noting that the stigma around not-drinking has abated among members of this health conscious generation.
“Not only is Generation Z drinking less than their parents’ generation did as teenagers, they are drinking less alcohol than their parents are drinking today. In the UK, a 40-year old is more likely to commit a drunk driving violation than an 18-year old. In many ways, Generation Z is pushing back at the generations before them by rebelling against rebellion,” the report suggested.
In South Africa, the rise of the mindful drinking and the “sober curious” crowd is reflected in the increasing availability of low- and nonalcoholic beverages and the explosion of options, 40 of which were available at South Africa’s first mindful drinking festival in 2019 at Kirstenbosch National Botanical Garden. “Mindful drinking is for people who want to improve their relationship with alcohol,” the event organiser and podcaster Sean O’Connor said at the time.
South Africans need to know how much they are drinking, Parry recommended. “We need to do a reality check on how much we are drinking and the risks we are taking as a result.”
WHAT HEALTH ADVICE TO BELIEVE?
Contradictory: Vaping is ‘not 95% safe’
Vaping is marketed as a safe alternative to smoking and a form of harm reduction, which is true. The misinformation is that vaping is “95% safer” than smoking based on sketchy data. “It is not completely safe,” said UCT pulmonologist Prof Richard van Zyl Smit. He said vaping was safer than smoking tobacco, but there have been reports of health risks, from acute lung injury to possible cancer risks and cardiovascular risks.
“Our major concerns are with the adolescent brain which is developing and particularly susceptible to chemicals like the nicotine in vapes. This can have a significant effect on the brain which is laying down long-term pathways,” said Van Zyl, who is leading a countrywide study on this.
Contentious: Why do you need to nap?
“The average Joe should not be napping,” said Dale Rae, an associate professor of sleep science at UCT. “You should be getting all your sleep at night-time. But some people get ‘nap licences’, like shift workers and new parents, whose sleep is out of their control, or athletes who need more sleep.” Also the director of sleep science at the Sports Science Institute of South Africa, Rae asked: “If healthy people need a power nap in the daytime, my question is why?”
UCT associate professor of sleep science Gosia Lipinska said daytime napping could be counterproductive if it delays falling asleep at night. “This can mean, not only do you potentially get less sleep but that the sleep you get is of poorer quality.” People who are knackered may benefit from short naps (20 minutes or less), particularly from about 1pmto 4pm, to reduce fatigue and improve alertness, memory and mood. But Lipinska added: “Frequent and long daytime napping can, however, be a symptom of many medical and psychological difficulties, including depression.”
Confounding: Loneliness worse than smoking
US surgeon-general Vivek Murthy declared loneliness the latest “public health epidemic” ahead of the US summer holidays last year, warning about the health risks of this condition. Prolonged social isolation and loneliness pose as much of a danger for longevity — as do well-established risk factors like smoking up to 15 cigarettes a day — a 2010 study in the online journal PLOS Medicine found. “The influence of social relationships on the risk of death ... exceed the influence of other risk factors such as physical inactivity and obesity,” the authors stated.
Loneliness can affect people’s mental health, risk of developing heart disease, stroke, type 2 diabetes and dementia. Long after Covid restrictions had lifted, Murthy made the declaration, saying: “We now know that loneliness is a common feeling that many people experience. It’s like hunger or thirst. It’s a feeling the body sends us when something we need for survival is missing.”
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