How many people punched to death by intoxicated thugs or killed by drink drivers is tolerable? What is an acceptable number of unborn children damaged for life by foetal alcohol spectrum disorder? Is there a rate of cancers caused by alcohol that we could view as “OK’?

The fact is all of these tragedies are preventable, and a civilised society does as much as it can to stop them from occurring.  A flat trend in alcohol-related harm would be very welcome, and a downward trend even more encouraging. But when this time comes, neither will be a reason for us to reduce effort, let alone stop entirely from trying to prevent alcohol-related harm.

Bernard Keane has ignored the spiralling rates of alcohol-related harm in Australia, and attempted to obscure this major public health issue by arguing that flat trends in a few selectively-chosen alcohol consumption statistics are proof of a non-crisis.  The truth is, several key trends in risky drinking are far from flat, and indicators of alcohol-related harm are on the rise. Even if Keane’s analysis is correct, the argument that a flat trend equals a non-crisis would suggest that perhaps the people of Honduras — murder capital of the world — should rejoice when their homicide rate begins to plateau.

To properly assess the extent of alcohol-related harm in Australia, it’s important to look at trends in the behaviour that can cause the harm. This means monitoring per capita alcohol consumption, as well as the patterns of drinking by individuals. And contrary to Keane’s omissions, it’s also very important, probably more so, to monitor the actual rates of alcohol-related harm, such as injuries, diseases, and deaths.

In doing so, it’s critical that we interpret the relevant evidence properly and accurately to avoid misleading or erroneous conclusions. Failing to do so can lead to misplaced criticism of evidence-based efforts to prevent alcohol-related harm in Australia. We welcome Keane’s interest in this subject, but respectfully disagree with a number of his claims about the nature and extent of the alcohol problem in Australia.

Claim #1: Per capita consumption in Australia is falling significantly. Incorrect

According to official estimates of per capital alcohol consumption from the Australian Bureau of Statistics, Australians aged 15+ years drink around 10 litres of pure alcohol per year (that is 10 litres of pure ethanol), and apart from some very small up-and-down movements from year-to-year, this hasn’t changed significantly since 1990. As acknowledged by the World Health Organisation, monitoring this trend is important because an increase in per-capita alcohol consumption in a given population is associated with increases in risky drinking patterns, and the prevalence of alcohol-related harm.

Ten litres of pure alcohol is the equivalent of every person aged 15+ years consuming 15 standard drinks every week of the year. This might not seem like a lot to some people. However, we need to consider that about a fifth of the Australian population who are counted in the denominator for per capita estimates don’t actually drink — such as the very young and older Australians, as well as a lot in between. Furthermore, as Keane himself points out, only a small proportion Australians report drinking daily; around 40% do so once a week. In other words, many Australians are consuming a lot more than the “average” 10 litres per year — and are doing so in weekly heavy drinking sessions.

Claim #2: Risky drinking is declining. Incorrect

In 2010, one in five people aged 14+ years consumed alcohol at a level that put them at risk of harm from alcohol-related disease or injury over their lifetime (i.e. more than 2 standards per day on average), and these proportions have remained stable between 2007 (20%) and 2010 (20%). It’s worth noting that the actual number of people drinking alcohol at these risky levels increased from 3.5 million in 2007 to 3.7 million in 2010, due to growth in the population of drinkers. So, we’re not talking here not about a small minority of alcoholics, but a mainstream culture of regular heavy drinking that increases the lifetime risk of injuries and diseases such as road crashes, assault, liver disease, and cancer.

Claim #3: Risky drinking by young people is not on the rise. Incorrect

The proportion of young people of school age who report that they don’t drink has increased in recent years according to Australian Secondary Students’ Alcohol and Drug (ASSAD) Survey. This is welcome news. However, there are still many young Australians that consume alcohol regularly and as a result are exposed to serious health risks such as accidents, injuries — including damage to the developing brain, violence and self-harm. Regular risky drinking at a young age is also predictive of alcohol problems later in life. In light of this, who would argue that we shouldn’t ramp-up efforts to protect young people from the risks of alcohol.

It’s a sad but perhaps not surprising fact that among young people who do consume alcohol, their drinking behaviour is modelled on the predominant adult risky drinking culture in Australia. Among some young drinkers this behaviour is showing no signs of declining. According to the latest ASSAD survey, among 16 to 17-year-old current drinkers, the prevalence of risky drinking (more than four drinks on one occasion in the past seven days) has not changed between the surveys in 2008 (47%) and 2011 (48%).

Worryingly, the ASSAD survey also revealed that 45% of all current drinkers aged 16-17 years say they intend to get drunk on most occasions that they consume alcohol. This may reflect a new culture “determined drunkenness” emerging among our youth, something which has also been observed in other countries recently, where alcohol is cheap and easily accessible, and heavily marketed and promoted to young people.  A Victorian survey of youth alcohol and drug use found that the prevalence of extreme risky drinking (consuming more than 20 standard drinks on at least one day) has been increasing, from 26% in 2002 to 42% in 2009.

Claim #4: The damage from alcohol is not growing. Incorrect.

According to the Australian Institute of Health and Welfare’s annual report on the alcohol and drug treatment service system, alcohol was the most common principal drug of concern for which specialised treatment was sought in 2010–11, accounting for almost half of treatment episodes, such as a period of counselling over several weeks (47%). The trend here is also telling, with treatment episodes increasing from 41,000 in 2001-02 to 68,000 last year.

The AIHW’s triennial alcohol and drug survey of Australian households reveals that the proportion of people being physically abused by a person under the influence of alcohol is also on the rise, increasing from 4.5% in 2007 to 8.1% in 2010.

In New South Wales, alcohol related hospitalisations increased by 58% between 1998-99 and 2010-11, from 31,000 to 49,000.  Hospitalisations of women almost doubled.  In Victoria, alcohol related hospital admissions have increased by almost 50% over the past decade, from around 17,000 in 2001 to over 25,000 in 2012.  The number of alcohol affected people attended to by ambulances tripled over the past decade, and the number of people presenting at emergency departments because they were injured or sick after drinking too much increased by 93%.

Claim #5:  If you don’t drink you miss out on the health benefits of alcohol. Incorrect.

There is substantially more debate about the health benefits from consuming alcohol than what Keane touches on. For example, there is emerging evidence indicating that the cardio-protective effects of moderate alcohol intake among the general population may not apply to overweight people (currently the majority of middle-aged and older adults in Australia).

The NHMRC guidelines to reduce the risks from drinking alcohol provide a balanced consideration of the evidence of health benefits, and evidence on the contrary of no health benefits, from alcohol consumption. They conclude that the extent of risk reductions from drinking is “uncertain” and advise that “the potential cardiovascular benefits from alcohol can also be gained from other means, such as exercise or modifying the diet”.

What is certain, however, and recognised by the NHMRC, is that alcohol is a risk factor for debilitating and fatal conditions such as cardiovascular disease, cancers of the oral cavity, pharynx, larynx, oesophagus, liver, colorectum and female breast, liver disease, diabetes, foetal alcohol spectrum disorder, and mental illness, to name just a few.