HLTH 8054 Week 5 Alcohol Determinants Argument Example

Beyond the Person Holding the Glass: Alcohol and Cancer in a Fictional City Read Through Dahlgren and Whitehead's Layers and the Commercial Determinants of Health

Student Name

Walden University

HLTH 8054: Lifestyle and Chronic Diseases

Instructor Name

Month Day, Year

Beyond the Person Holding the Glass: Alcohol and Cancer in a Fictional City Read Through Dahlgren and Whitehead's Layers and the Commercial Determinants of Health

Introduction

Alcohol causes cancer, and most public discussion of that fact stops with the drinker: how much a person drinks, and whether the person should cut down. This paper argues that the drinking patterns behind alcohol-related cancer in a city are shaped at least as much by price, outlet density and marketing as by individual choice. It makes that argument for a fictional mid-sized city, here called Harbor City, using a layered model of health determinants and the concept of commercial determinants of health. The city is invented; the evidence on alcohol and cancer, and on price and outlets, is real.

The Health Claim

The link between alcohol and cancer is well established. A dose-response meta-analysis of 572 studies including nearly half a million cancer cases concluded that alcohol increases the risk of cancers of the oral cavity and pharynx, esophagus, colorectum, liver, larynx and female breast, with a clear rise in risk as consumption increases (Bagnardi et al., 2015). Compared with nondrinkers and occasional drinkers, heavy drinkers had a relative risk of 5.13 for oral and pharyngeal cancer, 1.44 for colorectal cancer and 1.61 for breast cancer. The paper takes this evidence as its starting point and does not argue it further. The question is what shapes the drinking that produces the risk.

The Framework

Dahlgren and Whitehead drew the person as a core, carrying age, sex and inherited traits, and wrapped that core in rings. Personal behavior forms the first ring. Friends, family and neighbors form the second. The third holds the conditions of daily life, among them housing, jobs, schooling and health care, and the outermost ring holds the economy, culture and physical surroundings a society shares. Thirty years after first drawing it, the authors described the model as a way of showing that health is shaped by conditions beyond individual behavior, and of directing policy to those outer layers (Dahlgren & Whitehead, 2021). The commercial determinants of health add a specific set of forces to the outer layers. Kickbusch and colleagues defined them as the strategies and approaches used by the private sector to promote products and choices that are detrimental to health (Kickbusch et al., 2016). For alcohol, those strategies include pricing, the spread of places to buy and the marketing that shapes what drinking means.

Harbor City

Harbor City has about 300,000 residents. Its downtown has revived over the past decade, with new bars and restaurants, and its outer neighborhoods have many convenience stores licensed to sell beer, wine and spirits. Supermarkets run weekly promotions on multipacks, and a local brewery sponsors the city's summer music festival. A resident deciding whether to have a drink makes that choice inside these conditions.

Price

Price is the most studied condition. A meta-analysis of 112 studies containing 1,003 estimates found highly significant relationships between alcohol tax or price and consumption, with mean reported elasticities of -0.46 for beer, -0.69 for wine and -0.80 for spirits; price also significantly affected heavy drinking (Wagenaar et al., 2009). In Harbor City, multipack promotions and low-priced spirits lower the effective price of drinking, especially of heavy drinking. A person buying a discounted twelve-pack is responding to a price set by retailers and producers, not inventing a habit from nothing.

Outlet Density

The number of places selling alcohol in an area also shapes consumption. A systematic review for the Community Preventive Services Task Force found that most studies showed greater outlet density associated with increased alcohol consumption and related harms, including medical harms, injury, crime and violence, and concluded that regulating density may be a useful public health tool (Campbell et al., 2009). Harbor City's outer neighborhoods, where convenience stores with liquor licenses cluster, make alcohol easy to buy at any hour. Density is set by licensing decisions made at city hall, not by residents.

Marketing and Sponsorship

The third condition is marketing. The brewery's festival sponsorship links drinking with music, summer and civic pride. Promotions in supermarkets place alcohol near checkout lines and at the ends of aisles. These are the strategies the commercial determinants concept describes: practices that make a product available, affordable and appealing. They operate in the outermost layer of Dahlgren and Whitehead's model, shaping the norms of social networks and the choices of individuals at the center.

Networks and Working Conditions in Between

The middle layers carry these commercial forces into daily life. In Harbor City, after-work drinks are part of how many workplaces build teams, and some restaurant and bar staff are paid partly in shift drinks. Social networks pass on norms about how much is normal, and those norms are themselves shaped by years of marketing. Long or irregular working hours and job insecurity can push some residents toward drinking as a way to manage stress. None of these influences operates alone. Each sits between the outer layer, where prices and licenses are set, and the individual at the center, which is why a policy aimed only at the center reaches so little of the cause.

What the Argument Does Not Claim

This argument does not say that individuals have no responsibility for what they drink. People make choices, and many drink moderately in the same city. The claim is about the pattern across the population. When price falls, outlets multiply and marketing grows, average consumption and heavy drinking rise, and cancer risk rises with them. A city that addresses only individual behavior, through education campaigns urging people to drink less, leaves untouched the conditions that set the population's level of drinking.

Implications for Harbor City

The argument points to policies in the outer layers. The city could restrict multipack discounts and below-cost promotions, limit new liquor licenses in neighborhoods with high outlet density, and require that festival sponsorship not feature alcohol brands. It could also require clear information on cancer risk at the point of sale, since many residents may not know that alcohol causes cancer. Each measure targets a condition rather than a person, and each is within the authority of a city or state.

Limits

The evidence on price and outlets comes mostly from high-income countries and from studies of consumption and general harms rather than cancer specifically. The link from those policies to cancer rests on the dose-response relationship between drinking and cancer, not on trials showing that a pricing policy reduced cancer incidence. Cancers develop over decades, so any effect of policy in Harbor City would appear long after the policy began.

References

Bagnardi, V., Rota, M., Botteri, E., Tramacere, I., Islami, F., Fedirko, V., Scotti, L., Jenab, M., Turati, F., Pasquali, E., Pelucchi, C., Galeone, C., Bellocco, R., Negri, E., Corrao, G., Boffetta, P., & La Vecchia, C. (2015). Alcohol consumption and site-specific cancer risk: A comprehensive dose-response meta-analysis. British Journal of Cancer, 112(3), 580-593. https://doi.org/10.1038/bjc.2014.579

Campbell, C. A., Hahn, R. A., Elder, R., Brewer, R., Chattopadhyay, S., Fielding, J., Naimi, T. S., Toomey, T., Lawrence, B., & Middleton, J. C. (2009). The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms. American Journal of Preventive Medicine, 37(6), 556-569. https://doi.org/10.1016/j.amepre.2009.09.028

Dahlgren, G., & Whitehead, M. (2021). The Dahlgren-Whitehead model of health determinants: 30 years on and still chasing rainbows. Public Health, 199, 20-24. https://doi.org/10.1016/j.puhe.2021.08.009

Kickbusch, I., Allen, L., & Franz, C. (2016). The commercial determinants of health. The Lancet Global Health, 4(12), e895-e896. https://doi.org/10.1016/S2214-109X(16)30217-0

Wagenaar, A. C., Salois, M. J., & Komro, K. A. (2009). Effects of beverage alcohol price and tax levels on drinking: A meta-analysis of 1003 estimates from 112 studies. Addiction, 104(2), 179-190. https://doi.org/10.1111/j.1360-0443.2008.02438.x