Sounding the Alarm on America’s Alcohol Problem

At this point in time, no matter where you live in this country, you are probably aware that we are in the throes of a major opioid epidemic. You may know that drug overdoses are now the leading cause of death among Americans under 50. You may know that in 2016, more than 42,000 people died from an opioid overdose. You may also know, that earlier this month, the United States Surgeon General, Jerome M. Adams, issued a national advisory urging Americans to carry and learn how to use naloxone, a life-saving drug which can reverse the effects of an opioid overdose.

What you may not know, is that we are also in the midst of another deadly crisis: excessive alcohol use. In 2015, more than 33,000 Americans died from alcohol-induced causes, including alcohol poisoning and liver disease. And if this tally included deaths from drunk driving, other accidents, and homicides committed under the influence of alcohol that number swells to 88,000. In fact, today excessive alcohol use is the fourth leading preventable cause of death in the United States. Over the past decade, the alcohol death rate has continually gone up at an average of 4 percent a year with a 40 percent total increase during the 10-year period.

So why is the alcohol crisis, which is responsible for twice as many American deaths as opioid overdoses, less visible? Why hasn’t anyone sounded the alarm?

The truth is drinking is ingrained in our culture. Because alcohol in moderation is not harmful, it has been normalized in our society. For many, turning 21 and gaining the right to drink is on par with getting one’s license or becoming eligible to vote. It’s a rite of passage that anchors many of life’s greatest celebrations. We raise a glass to celebrate a job promotion, we toast to the New Year, we buy beers at baseball games, and knock a few back with each birthday. In addition, alcoholic beverages are promoted through all major media, available anywhere from the grocery store to our favorite restaurants, to the sports arena. In New York City, the City that never sleeps, you can order a drink between 8 am and 4 am—20 hours out of the day.  However, alcohol can be addictive and dangerous if abused.

In 2014, the New York City Health Department found that nearly one third of New Yorkers engaged in high-risk or binge drinking, which is defined as consuming five or more drinks for men or four or more drinks for women, within two hours.

Turns out, the rest of America likes to drink as well.

According to a study published by JAMA Psychiatry, in 2017, the percentage of American adults who consume alcohol increased from 65 to 73 percent from 2002 to 2013. Though the majority of Americans who drink do so without causing significant risks or health problems, this study makes a compelling case that the United States is currently facing a crisis with alcohol abuse that is getting worse. It documents substantial increases in the prevalence of drinking  in general, increases in high-risk (or binge) drinking, and increases in the prevalence of alcohol use disorders (AUDs), with the biggest changes related to AUDs, the most serious condition.

Alcohol Use Disorder, the medical term used by medical professionals to describe someone with an alcohol problem, is diagnosed as either mild, moderate, or severe based on the number of eleven different symptoms an individual has experienced in the past twelve months. According to the study, which reviewed data from two nationally representative surveys of US adults, prevalence of AUDs increased nearly 50 percent during the time period 2001-2002 to 2012 to 2013. The researchers concluded that “substantial increases in alcohol use, high-risk drinking, and alcohol use disorder constitute a public health crisis”. They go on to say that with the increase in alcohol use and abuse, we can expect increases in related and co-occurring chronic disease, especially among woman, older adults, racial/ethnic minorities, and the socioeconomically disadvantaged.

It’s time for a national wake-up call.

It is the role of public health to sound the alarm and to elevate a national conversation around alcohol abuse. We need a national strategy to address the alarming increase in high-risk drinking and AUDs.

It is essential for public health to advocate for policies and programs that support the creation of healthy environments that encourage healthy practices over unhealthy ones. We need to adopt and implement effective messages and programs that help people understand and avoid the dangers. We also need to adopt evidence-based policies that create and support environments where the healthy choice is the easiest. Though certain to elicit resistance  and cause controversy, this may mean closing bars earlier or opening them later in the day,  changing serving sizes, limiting the number of liquor licenses, or increasing the alcohol tax.

This month, when the surgeon general announced the new advisory related to opioid use, he became part of a chorus of public health professionals advocating for different policies and societal behaviors with the potential to upend a deadly crisis.

We should be doing the same thing with alcohol abuse.

New Funding to Support Study on Collaborative Care Delivery in East Harlem

Lack of coordination between health and community service agencies often leads to service duplication and gaps, missed opportunities, wasted resources and poor outcomes for the most vulnerable populations. A place-based model, where providers collaborate in one location to improve the health and well-being of the populations they serve, can help address these challenges.

The Fund for Public Health in New York City has received a $250,000 award from the Robert Wood Johnson Foundation, managed by its Systems for Action national program office. The award supports Partnerships to Encourage Actionable Cultures of Health (PEACH), a study by the New York City Department of Health’s Center for Health Equity.  PEACH will investigate how aligning a city health department, clinical service and cross-sector community organizations with shared governance can improve efficiencies as well as health in the neighborhood.

The research team will examine the Center for Health Equity’s East Harlem Neighborhood Health Action Center, which includes services provided by: the Department of Health; clinical and non-clinical partners; community health workers; faith- and community-based organizations. The Health Action Center keeps a database and referral system that helps connect East Harlem residents to clinical services or non-clinical services (e.g., food pantries, transportation, child care).

The research team will also assess the community health outcomes and satisfaction, partner success in linking clients to needed services and system coordination to improve service efficiency and neighborhood health. The study results will help inform best practices for replicating this model in other neighborhoods across NYC and the U.S.

“This study will help us better understand how to support the integration of health care and social services to address the needs of community residents and improve neighborhood health,” said Sara Gardner, executive director of the Fund for Public Health in New York City. “To achieve neighborhood level impact, work across multiple partners — government and non-government, must be aligned.”

NYC Says It Raised $400 Million to Combat Inequality During de Blasio’s First Term

The Observer

The Fund for Public Health in New York City was one of several city-affiliated nonprofits to help New York City raise more than $400 million in private and charitable funds during de Blasio’s first term for key initiatives seeking to combat inequity in the city, such as housing, immigration, health and workforce development. Read more