Canada’s Latest David and Goliath Story

Formuch of the twentieth century, Canada’s health representatives faced offagainst a Goliath of industry: Big Tobacco.

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Despitethe odds, in 1988 David was able to fell Goliath and his deep pockets usingonly a sling and stone’s worth of funds. His victory song came in the form ofwarning labels, which were plastered on tobacco products throughout thecountry, leading to greater public awareness regarding the carcinogenicproperties of cigarettes and a significant decrease in smoking rates.

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Decadeslater, Goliath has resurrected in the form of another giant of industry: BigAlcohol.

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InNovember 2017, as part of a Health Canada research project, the Yukon LiquorCorporation began placing warning labels on all alcohol products sold in theterritory, informing customers of the link between alcohol and cancer.

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Yetin a matter of weeks, David was dealt a potentially fatal blow. Facing pushbackfrom Big Alcohol, the labelling initiative was brought to a halt, promptingwhat could become the next big battle between public health and commercialindustry in Canada.  

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Dueto the alcohol industry’s response, we won’t know the results of the Yukonlabelling initiative. But given the similarities between this case and BigTobacco, we might be able to predict where this fight is headed.

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Supportfor tobacco control was expressed in Parliament as far back as 1903, Physicians for a Smoke-Free Canadanotes, and was brought up again in 1971 with the introduction of Bill C-248,which sought to ban advertising for tobacco products. In both cases, however,Big Tobacco was able to walk away relatively unscathed, thanks to its influencein government.  

“Thelesson learned by the tobacco industry was that they need only lobby thegovernment (Cabinet Ministers) to do their will,” writes Neil Collishaw in History of Tobacco Control in Canada.“The government would then lead Parliament to do their bidding.”

Thefight continued throughout the ’70s, which Collishaw calls the “dark days” oftobacco control, when programs that promoted education about the dangers ofsmoking were cut back and cigarette consumption for the average adult remainedat a relatively high 3,700-3,900 cigarettes per year.

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Itwasn’t until the late ’80s that one of David’s stones landed, in the form ofthe Tobacco Products Control Act, which stated that all tobacco sold in Canadahad to be accompanied by a warning message.

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Butthe fight wasn’t over just yet. Since 1988, Collishaw notes, the tobaccoindustry clashed with the government over tobacco control laws. Finally, in2000, David landed a decisive blow, this time in the form of the Tobacco Act,as Canada doubled down on its warning messages by becoming the first country inthe world to put graphic photos on cigarette packages. Partly as a result, tobaccoconsumption has seen a steady decline in Canada, from 2,200 cigarettes per adultin 1996 to 1,700 in 2002, proving that warning messages work. And the researchconfirms it. For instance, a 2013 study by TobaccoControl found that the adoption of graphic warning labels led to a 12.1 percent to 19.6 per cent reduction in smoking rates in Canada.

Whilealcohol may not be as deadly as cigarettes (nearly 1 in 5 deaths in Canada arecaused by smoking each year), it still poses a serious threat to nationalhealth. In fact, alcohol is one of the biggest risk factors for disease inCanada, and the single biggest health risk factor for those among the ages of15 to 49. Alcohol was linked to over 5,000 deaths in Canada in 2015, and led to another 77,000 hospitalizations in 2016. Further, alcohol, like tobacco, has been identified as one of the main causes of preventable cancers.

Alcohol is one of the biggest risk factors for disease in Canada, and the single biggest health risk factor for those among the ages of 15 to 49. Alcohol was linked to over 5,000 deaths in Canada in 2015, and led to another 77,000 hospitalizations in 2016.

AsPublic Health Ontario scientist Dr. Erin Hobin points out, 80 per cent ofadults in Canada consume alcohol, yet awareness of the link between alcohol andcancer is low. Meanwhile, less than 18 per cent of Canadians aged 12 and oldersmoke, yet according to Statistics Canada96 per cent of Canadians are aware of the risks associated with smoking. Itis likely that the difference between the two is warning messages. Canadiansare bombarded with graphic warning labels whenever they go to buy cigarettes,while alcohol products remain label-free.  

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Canadiansare not unfamiliar with the risks associated with drinking alcohol, but arethey aware of all the risks?

“Fewerthan 30 per cent of Canadian adults are aware that drinking alcohol, even smallamounts of alcohol, can cause cancer,” says Hobin, who led the labellinginitiative, which was part of a larger project in collaboration with theUniversity of Victoria.

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Morethan just informing the public about the dangers of drinking, the initiative, whichwas backed by Yukon’s chief medical officer of health, sought to supportconsumers in making more informed and safer alcohol choices.

“Labelscan provide new and potentially useful information at key points of contact -when consumers are buying alcohol in the liquor store and when they are pouringor drinking alcohol,” says Hobin. “Exposing consumers to labels at these keytimes may influence them to rethink how much and how often they are drinking.”

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Theplan was to start in Yukon and potentially introduce the labels to the rest ofthe country, should the initiative prove successful. In that sense, Yukon wouldbe an experiment. And it was a perfect place to start, since drinking rates inthe territory are higher than most of Canada. According to a 2015 Yukon HealthStatus Report, 35 per cent of Yukon men are considered heavy drinkers (10 percent higher than the rest of the country), while 28 per cent of women areconsidered heavy drinkers (roughly double the national average).

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Butthe experiment would prove to be a false start, as Big Alcohol reared itsGoliathan head to bring a premature end to the labelling initiative bythreatening legal action. Further, alcohol, like tobacco,has been identified as one of the main causes of preventable cancers. So whythe pushback? If tobacco comes with a warning, shouldn’t alcohol as well?

YukonLiquor Corporation spokesperson Patch Groenewegen chose not to name thenational brand owners who came forward to complain about the labels, but shedid outline their concerns, including “legislative authority, label placementand trademark infringement, defamation and damages related to messages onlabels affixed to brand-owner products without consent.”

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Inparticular, the companies took issue with the message linking alcohol andcancer, even though, as Hobin points out, “there is strong scientific evidenceindicating a causal relationship between alcohol consumption and at least sevendifferent types of cancer, including breast and colon cancer.” On this matter,the WorldHealth Organization’s International Agency for Research on Cancer, World CancerResearch Fund, and the American Institute for Clinical Oncology all agree.

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Globe and Mail health reporter AndréPicard, believe that, at the end of the day, the alcohol industry is whollyconcerned about their bottom line – not legislative authority or the accuracyof the labels’ messages.

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“Whatthe alcohol industry really fears is that other provinces and territories willfollow suit on the labelling initiative, and start taking the harms of alcoholmore seriously,” writes Picard, who called the alcohol industry’s pushback“shameful.”

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Inother words, for Big Alcohol, liquor sales take priority over public health.

In other words, for Big Alcohol, liquor sales take priority over public health.

Asof now, the labelling initiative has been put on hiatus while the Yukon LiquorCorporation consults with stakeholders affected by the study, but that doesn’tmean proponents of alcohol controls have given up all together.

“Weare disappointed that the project is on hold but we are continuing conversationswith the Yukon Government to decide if and how best to move forward with theresearch,” says Hobin.

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Shouldthe project be revisited, she acknowledges that it would have to go beyondtext-only messages in order to truly change consumer behaviours.

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Studieson the effectiveness of tobacco warning labels have found that the more graphicand emotionally evocative the messages, the better they are at deterring peoplefrom smoking. Hobin also points out that, while they can be effective tools forincreasing consumer awareness of health effects, warning labels have little impacton actual drinking behaviours.

“Itis likely that a suite of interventions that includes labels plus interventionstargeting the price, availability, and marketing of alcohol will be required toeffectively change consumer drinking behaviours,” she says.

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Beforeany of that can happen, Dr. Hobin and others will first have to get past BigAlcohol. If the myth of David and Goliath has taught us anything, it’s that neitherwill go down without a fight.