Alcohol and Public Health: Failure and Opportunity

Centennial Issue Public Health

Policy Points:

  • Public health science regarding alcohol consumption and problems, alcohol’s role in equity and social justice, and identification of effective policy interventions has grown steadily stronger in the past 30 years.
  • Progress on effective alcohol policies has stalled or gone backward in the United States and much of the world.
  • Because alcohol influences at least 14 of the 17 sustainable development goals, as well as more than 200 disease and injury conditions, reducing alcohol problems should offer a platform for collaboration across public health silos but will require that public health itself respect and follow its own science.

In 1986, I had dropped out of graduate school and was working as a temporary typist to pay my rent. I happened into a job with an alcohol policies project started by the Trauma Foundation, an injury prevention organization housed at San Francisco General Hospital. That was the beginning of my public health career and my focus on alcohol policies.

From the start, I was driven much more by a desire to create a more just and equitable world than by any particular personal experiences with alcohol. My work on alcohol policy has been less about why I chose alcohol than why I stayed with it: because it touches so many important aspects of human life. I often refer to alcohol as “the great cofactor.” In addition to its more obvious role in disease and addiction, alcohol causes significant social problems for both drinkers and nondrinkers. Alcohol contributes to and worsens interpersonal violence and unintentional injuries such as drownings and falls, is a leading cause of birth defects and developmental delay and a carcinogen, and exacerbates a range of disparities from health outcomes to national development.1–8

Open Access


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  2. Parker RN, McCaffree KJ. 2013. Alcohol and Violence: The Nature of the Relationship and the Promise of Prevention. New York: Lexington Books; 2012.
  3. Cherpitel CJ. Focus on: the burden of alcohol use—trauma and emergency outcomes. Alcohol Res. 2013;35(2):150-154.
  4. Maier SE,West JR. 2001. Drinking patterns and alcohol-related birth defects. Alcohol Res Health. 2001;25(3):168-174.
  5. Goding Sauer A, Fedewa SA, Bandi P, et al. Proportion of cancer cases and deaths attributable to alcohol consumption by US state, 2013–2016. Cancer Epidemiol. 2021;71(Pt A):101893.
  6. Mulia N, Ye Y, Greenfield TK, Zemore SE. Disparities in alcohol-related problems among White, Black, and Hispanic Americans. Alcohol Clin Exp Res. 2009;33(4):654-662.
  7. Room R, Jernigan D. The ambiguous role of alcohol in economic and social development. Addiction. 2000;95 Suppl 4:S523-S535.
  8. Room R, Jernigan D, Carlini Cotrim B, et al. Alcohol in Developing Societies: A Public Health Approach. Helsinki and Geneva: Finnish Foundation for Alcohol Studies and World Health Organization; 2002.

Jernigan DH. Alcohol and Public Health: Failure and Opportunity. Milbank Q. 2023;101(S1): 552-578.