Alcohol worsens disadvantages

With a welcome spotlight being shone on rising inequality this week it is worth noting that alcohol makes it harder for poorer people to succeed in a game already heavily weighted against them.

This fact is not as widely acknowledged as it should be. A large charity told me to call elsewhere because it focuses on poverty not alcohol. Of course, specialism is necessary, but not when it means neglecting clear links. Luckily it seems they will not be ignored much longer.

On the radar
“One cause for concern is a rise in ‘deaths of despair’” said the IFS Deaton Review, launched in the UK this week, referring to deaths from suicide, drug and alcohol overdose and alcohol-related liver disease. They have overtaken deaths from heart disease in recent years (see chart).

Of course death is the most stark outcome. With luck, the review’s army of sociologists, demographers and epidemiologists will also shed light on a myriad more nuanced inequalities to which alcohol contributes. As the Alcohol Change UK campaign pointed out alcohol harms poorer people more in many other ways.

Poorer people tend to live with fewer healthcare facilities, more crime, more stress and higher levels of alcohol availability, so slipping more easily into heavy drinking. The middle classes have their difficulties, but generally nothing to compare with the perils faced by people struggling to get by.

A dicey game
The board game snakes and ladders, or chutes and ladders in the US, can help picture how circumstances alter our chances of success or mishap. Each player moves along the board and when landing on a ladder takes a big step up and when they land on a snake they slip a long way down.

But, crucially, we do not all play on the same board. Poorer people start further away from the giddy heights of their terrain. And, to reflect their less fortunate circumstances, they face more penalties and fewer bonuses, so fewer and shorter ladders, and more, longer snakes. Consequently a smaller percentage of poorer people make as much progress.

To make it more realistic we should test a skill to decide whether we necessarily slide down a snake or climb a ladder. Maybe we have to answer an exam question or, something silly like catch a ball in a cup, anything really to mimic a real life test. Adding this extra obstacle simply multiplies the extra difficulties faced by poorer people.

Now, finally, we can add another level of realism to the model, alcohol. Consuming alcohol impairs our skills, judgement and planning, so meaning we fall down even more snakes and can take advantage fewer lucky breaks. Adding alcohol to the equation tips the balance of an unfair game even further against poorer people.

At the same time advertising relentless associates alcohol with success and winning, deliberately obscuring the fact that it is far more likely to increase our chances of losing.

Clear, not less subtle
The “alcohol paradox”, the name often given to the way alcohol disproportionately harms poorer people is unhelpful, adding intrigue to something which is not mysterious. It is not paradoxical that poorer people are harmed more It is simply a testament to the combined effect of more challenging circumstances and substance blunting our abilities.

It is, of course, vital for the review unveiled this week to go beyond this simplistic model and to shed light on the details. But, as a starting point, the reason alcohol tends to compound inequality can be an unfortunate effect everyone can readily understand and find ways to avoid. With luck, more policies will emerge to make it easier. ■