The Story: About 1 in 20 deaths around the world result from harmful use of alcohol, according to a new report by the World Health Organization (WHO). This represents more than 5 percent of the global disease burden. What can Christians do about this epidemic?
The Background: The WHO’s global status report on alcohol and health 2018 looks at alcohol consumption and the disease burden attributable to alcohol worldwide, as well as what countries are doing to reduce this burden.
As the report notes, despite some positive global trends in the prevalence of heavy episodic drinking and number of alcohol-related deaths since 2010, the overall burden of disease and injuries caused by the harmful use of alcohol is unacceptably high, particularly in the Americas and Europe.
An estimated 237 million men and 46 million women suffer from alcohol-use disorders, with the highest prevalence among men and women in the European region (14.8 percent and 3.5 percent) and the Americas (11.5 percent and 5.1 percent). Alcohol-use disorders are more common in high-income countries.
Of all deaths attributable to alcohol, 28 percent were due to injuries, such as those from traffic crashes, self-harm, and interpersonal violence; 21 percent due to digestive disorders; 19 percent due to cardiovascular diseases; and the remainder due to infectious diseases, cancers, mental disorders and other health conditions.
“Far too many people, their families, and communities suffer the consequences of the harmful use of alcohol through violence, injuries, mental health problems and diseases like cancer and stroke,” said Dr. Tedros Adhanom Ghebreyesus, director-general of the WHO. “It’s time to step up action to prevent this serious threat to the development of healthy societies.”
What It Means: As this report points out, more than half (57 percent, or 3.1 billion people) of the global population ages 15 years and older had abstained from drinking alcohol in the previous 12 months, while about 2.3 billion people are current drinkers. (Alcohol is consumed by more than half of the population in only three WHO regions—the Americas, Europe, and Western Pacific.)
These groups—let’s call them Abstainers and Imbibers—mirror the evangelical community. A poll taken in 2016 by Barna Research found that 54 percent are Abstainers while 46 percent are Imbibers. (Full disclosure: I’m an Abstainer).
This divide is often reflected in our attitudes and debates about the use of alcohol. For the past 50 years, evangelicals have tended to argue in absolutist terms, either making the case for Christian liberty (Imbibers) or the case for abstinence (Abstainers). If you were to go back to 1948, you’d likely find the same discussions about alcohol that we’re having in 2018. But while the debates are the same, our societal context has changed. Here are just a few examples of why conversations today should be different from ones in the past.
We now consume more of almost everything—including alcohol.
Because the debate about alcohol consumption tends to be binary—consumption is acceptable/consumption is unacceptable—it rarely moves to considerations of how much consumption is acceptable.
In the modern age, food and drink has become both cheaper and also more abundant. This has led to an increase in consumption rates that would astound our ancestors. For example, in 1955, the size of a soft drink at McDonald’s was a mere 7 ounces. By the 1990s, a kid’s size drink was nearly twice that amount (12 oz), and the “Supersize” drink was six times larger (42 oz).
We’ve had similar increases in the consumption of alcohol. Total alcohol per capita consumption in the world’s population older than 15 years of age rose from 186 ounces of pure alcohol in 2005 to 216.4 ounces in 2010 and was still at the level of 216.4 ounces in 2016. The highest levels of per capita alcohol consumption are observed in countries of the WHO European Region.
Current drinkers consume on average 32.8 grams of pure alcohol per day. Consumption is about 20 percent higher (40 g/day) in the African Region and about 20 percent lower (26.3 g/day) in the South-East Asia Region. Drinkers increased their alcohol consumption since 2000 in almost all regions, except the WHO European Region.
Until 2025, total alcohol per capita consumption in persons ages 15 years and older is projected to increase in the Americas, Southeast Asia, and the Western Pacific. This is unlikely to be offset by substantial declines in consumption in the other regions. As a result, total alcohol per capita consumption in the world can amount to 223 ounces in 2020 and 236 ounces in 2025 unless projected increasing trends in alcohol consumption in the Region of Americas and the Southeast Asia and Western Pacific Regions are stopped and reversed.
Both Abstainers and Imbibers should be able to examine the empirical evidence and come to a general agreement on what constitutes imprudent, unhealthy, or dangerous levels of consumption.
Modern wine is much stronger than the wine in biblical times.
For centuries Abstainers and Imbibers have argued about how much alcohol content was in the wine in biblical times. While we can’t know for sure, we can roughly estimate an upper limit of 8 percent to 10 percent alcohol by volume (ABV). The reason is that for most of human history all wine was fermented on “wild yeast” which delivers an alcohol content of between 4 percent to 10 percent.
Today, a “low alcohol” wine is considered anything that would have met the maximum level for biblical wine—about 10 percent ABV. The typical wine sold today is in the range of 11.5 percent to 15 percent ABV, with the strongest wines having 17 percent to 23 percent ABV.
This increase in alcohol content is due to advances in science and technology. As Madeline Puckette notes, in the 1950s the yeast would not survive in alcohol levels too much higher than 13.5 percent ABV. Today however, we’ve developed resilient yeasts that can survive in alcohol levels as high as 16.5 percent ABV.
“It’s not your imagination. Wine really has gotten boozier,” Jennifer Frazer writes in Scientific American. “In the past two decades the maximum alcohol content of wine has crept up from about 13 percent to, in some cases, northward of 17 percent, a side effect of the growing popularity of wines with richer fruit flavor.”
On a single-glass basis the increased alcohol content may not be troubling. But if a person has two glasses a day, he or she is consuming almost 10 percent more alcohol per day than someone in the 1950s—and double the amount of a wine drinker in New Testament times. This also means that “heavy drinkers” (8 or more drinks a week for women and 15 or more drinks a week for men) are consuming significantly more alcohol from fewer drinks than heavy drinkers from four decades ago.
While Imbibers and Abstainers may disagree on how much alcohol content was in the wine at the wedding of Cana (John 2:1-12), we should all agree that the increasing alcohol content of wine can have serious ramifications on the health of society.
Around the globe, alcohol is a significant problem for teens.
The one area where Abstainers and Imbibers can most easily agree is the problem of teen drinking.
Worldwide, more than a quarter (26.5 percent) of all 15- to 19-year-olds are current drinkers, amounting to 155 million adolescents. Prevalence rates of current drinking are highest among 15- to 19-year-olds in the WHO European Region (43.8 percent), followed by the Region of the Americas (38.2 percent) and the Western Pacific Region (37.9 percent).
Results of school surveys indicate that in many countries of the Americas, Europe, and Western Pacific alcohol use starts before the age of 15 years, and prevalence of alcohol use among 15-year-old students can be in the range of 50 percent to 70 percent with remarkably small differences between boys and girls.
Worldwide and in all WHO regions, prevalence of heavy episodic drinking is lower among adolescents (15 to 19 years) than in the total population, but it peaks at the age of 20 to 24 years when it becomes higher than in the total population. Except for the Eastern Mediterranean Region, all heavy episodic drinking prevalence rates among drinkers of 15 to 24 years are higher than in the total population. Young people of 15 to 24 years, when they are current drinkers, often drink in heavy-drinking sessions. Prevalence of heavy episodic drinking is particularly high among men.
It’s no longer enough to tell kids not to drink. We need to find a way to come together and address how and why our culture is enticing teens into early and extreme alcohol consumption.
Good Enough for Jesus
“It is fair to say that both total abstinence and moderate use were acceptable to Jesus,” J. Lawrence Burkholder says. If those positions were acceptable to Jesus, they should be acceptable for us too. But while tolerance of differing opinions about alcohol should be our starting point, we have a duty to consider how our views should be shaped by our cultural context.
The harmful use of alcohol is no longer an issue Christians can ignore. To truly seek the welfare of our cities—and the world—we need to find a way for all believers, whether we’re Abstainers or Imbibers, to find a way to talk about alcohol in a way that better serves our neighbors.