Country Profile - Health in France: 1994 General Report

French High Committee on Public Health Declares Reduced Alcohol Consumption a Priority

The High Committee on Public Health was created by decree in December 1991 for the purpose of "advising the Minister for Health and providing information on which to base decisions aimed at improving the public health."

The High Committee plays a special role in providing information on alcohol-related problems and publishes a three monthly review.

In its report on the state of public health for 1994*, the High Committee identifies priorities for health promotion, of which alcohol is one.

Specific targets for important determinants

The important determinants for which specific targets are proposed were selected according to the following criteria:

  • impact on health: demonstrated relationship between the determinant and one or several health problems;
  • frequency: frequency of the determinant in the population;
  • feasibility: possibility of intervening on the determinant.

The selected priorities are as follows:

  • alcohol consumption;
  • smoking;
  • social vulnerability, integration and health;
  • difficulties in access to care and prevention.

Alcohol consumption

Objective

By the year 2000, to reduce by 20 % the average consumption of alcohol by people over 15; to reduce the impact of alcohol on society and health; to reduce regional disparities by bringing all regions to the level of those with the lowest consumption.

Size of the problem

Since 1970, alcohol consumption has fallen in France from 22 litres of pure alcohol per person over 15 years of age, to 17 litres in 1989, nevertheless placing France at the "top" of the European league.

Moderate alcohol consumption in appropriate circumstances is socially acceptable and does not inevitably harm health. Epidemiologists have shown that alcohol consumption is potentially harmful beyond three glasses a day for men and two glasses for women (this threshold can be lower as it varies according to individual sensitivity).

An estimated five million drinkers are at risk of medical, psychological and social problems, and two million people are dependent on alcohol.

Excessive alcohol consumption is responsible for many health problems (damage to the peripheral and central nervous systems, liver, cardiovascular system and the unborn child). It is a determining factor in many social problems, ranging from job problems to criminal behaviour (violent attacks, rape, child abuse and marital violence). In some circumstances, such as driving, alcohol consumption considerably increases the risk of accidents.

The report states that smoking and alcoholism are responsible for 100,000 deaths a year, a fifth of all deaths (smoking 60,000, alcohol 40,000).

The report also states that:

  • There are 1,000 cases of foetal alcohol syndrome each year
  • 15-35% of emergency service and hospital beds are taken up by victims of alcohol abuse, this apart from psychiatric beds
  • 29.5% of men and 11.1% of women seen by general practitioners are excessive drinkers (over 28 drinks per week for men and 14 drinks per week for women) who are at risk of alcohol -related disease or already ill.

In 1991 excessive alcohol consumption directly led to the deaths of 11,910 people through "alcoholism, alcoholic psychosis and cirrhosis". Moreover, 10, 233 people died of alcohol-related cancers of the upper airways and digestive tract. More than a third of road deaths are thought to be due to alcohol, together with other violent causes of deaths (suicide, homicide, occupational accidents and domestic accidents).

The excess mortality observed in France before 65 years of age, particularly in men, is largely linked to alcohol consumption.

The current situation remains unacceptable and major efforts must be made. Reducing alcohol-related damage and helping people with drinking problems should be public health priorities in France.

If there is a close relationship between the number of excessive drinkers and average alcohol consumption, a reduction in global consumption would have to entail a reduction in excessive consumption and its social and health consequences.

Influential factors

Personality disorders are not the only determinant of excessive drinking.

Alcohol has strong symbolic value, explaining why health policies differ from one country to the next and even from region to region.

Alcohol consumption starts relatively early among young people. It increases with age, and is greater among boys than girls. Young people have a greater tendency to drink occasionally, but to excess. Sex-related differences persist into adulthood, in terms of both drinking habits and the volume consumed.

While there is no direct relationship between employment category and drinking, some social groups are particularly vulnerable. The undeniable weight of social factors interferes with other factors such as those of a biological, psychological and cultural nature, whose multiplicity calls for diversified measures adapted to specific situations.

Essential measures to reach targets:

  • To act on alcohol abuse
  • To update regulations and legislation on alcohol consumption (notably drink-driving laws).
  • To ensure coherence between information campaigns and local actions in schools, the workplace, and leisure spaces.
  • To promote and improve the image of people who drink non-alcoholic beverages.
  • To develop all means of helping people with drinking problems
  • To redefine the missions of anti-alcohol units and to harmonise their methods.
  • To create or develop the other structures necessary to manage people with drinking problems, such as alcohol research centres; post-withdrawal centres; hospital-community networks; shelters for alcohol-dependent women with children; and sheltered accommodation and rehabilitation units.
  • To promote networking among specialised services, hospital structures, GPs. social workers. etc.
  • To develop actions in specific settings
    • in the workplace;
    • promoting social integration by those on the minimum welfare
    • actions targeting pregnant women, etc.
  • To design and implement regional programs
  • To begin with regions where alcohol consumption and its consequences are the most serious.
  • To increase the number of people with training in alcoholism
  • To promote the teaching of alcohol-related problems to GPs, nurses , social workers, etc.
  • To increase the number of people working in this area.

Research priorities:

  • To construct instruments to determine the importance of excessive drinking and its trends.
  • To give regional health surveillance centres responsibility for following indicators on alcohol consumption.
  • To develop fundamental research.
  • To develop clinical and epidemiological research as well as research in the social sciences.
  • To conduct epidemiological studies of the prevalence of the various forms of alcohol-related disease in different populations (general hospitals, psychiatric hospitals, GPs clientele, etc.)
  • To develop research into ways of modifying behaviour.
  • To evaluate regularly the functioning and results of interventions with people with drinking problems.

Indicators
Alcohol Consumption

Average alcohol consumption by people over 15 fell from 22 litres per capita in 1970 to 17 litres in 1989. The target for the year 2000 is 11.3 litres.

Comment: this indicator does not reflect the importance of alcoholism (excessive alcohol consumption), but rather trends in alcohol consumption, as it is calculated by dividing the total mass of "taxed" alcohol divided by the number of potential consumers. It concerns alcohol sold in franchises, and includes an assessment of undeclared home consumption (wine and eau de vie only). Possible variations of stocks are not taken into account. The trends are valuable as these parameters vary little.

Trends in Excessive Consumption by Adults (% of the population)

3-4 drinks per day
5-8 drinks per day
9 drinks or more
1980-1981
Women
7.3
2.1
0.0
Men
22.9
16.8
4.8
1986-1987
Women
4.1
1.1
0.2
Men
20.2
15.4
3.7
1991-1992
Women
4.1
0.9
0.1
Men
20.2
112.7
3.2

Interpretation: in 1987, 4 % of women drank three or four glasses of alcoholic beverages daily, compared with 7 % in 1981.

Comment: excessive drinkers are defined as people who state they drink more than three glasses of alcoholic beverages daily. The results were obtained by interviewing a representative sample of the population as part of the population survey (the 1991 10-year health survey covered 7,666 people over 18 years of age). It is likely that declared alcohol consumption is underestimated, despite global questions on daily consumption, but the trends remain reliable.

Between 1981 -1991, alcoholism and cirrhosis (15-64 years) fell by 33% in men and by 36% in women; deaths from road accidents (5-64 years) fell by 14% and cancers of the upper airways fell by 19% in men, but rose by 8% in women.

The report states that these improvements are mainly linked to the decline in alcohol consumption over the last generation but adds that "alcoholism remains a particularly French problem".

Other Relevant Issues

The report states that overall the health of the French population is good and has improved over the last ten years. In 1935, life expectancy at birth was 55 years for men and 61 years for women. By 1991 the figures were 73 years and 81 years. Between 1981 and 1991 there was a particularly steep decline in mortality in the 35-64 age group.

According to the 10- yearly health surveys, the prevalence of all forms of cardiovascular disease rose (from 28.8 per 100 in 1980 to 38.5 in 1990). The report attributes this increase to a `greater tendency to report' and to improved diagnosis.

Mortality from cardiovascular disease has fallen:

  • Deaths from Myocardial Infarct (35-64 years) 1971-1991
    • Men - fell by 32%
    • Women- fell by 48%
  • Deaths from cerebrovascular and hypertension diseases (35-64 years) 1971-1991
    • Men - fell 58%
    • Women - fell 63%

The health target is to reduce deaths from cardiovascular disease by 20% among the under 75's by the year 2000. The report states that the following measures should be encouraged:

  • a balanced diet, with control of excess body weight through reduced calorie intake (including alcohol), control of the overall contribution of fat, saturated fatty acids, dietary cholesterol and salt, and an increase in vegetable oil, fish, fruit, vegetables and fibre-rich cereals
  • the fight against smoking
  • regular physical activity

*Health in France: 1994 General Report. High Committee on Public Health. Ministry of Health and of Social and Urban Affairs. Paris 1996.

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