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Farrell provides a limited view of the potential to intervene to reduce alcohol related harms.1 In reviewing Drinking in Context his premise is that public health approaches to alcohol rely exclusively on reducing total consumption. Drinking in Context was written to show the inadequacy of population level approaches.2 These alone will not tackle the individual, community, and social impacts of drinking alcohol. The book aims to highlight a wide range of opportunities for reducing alcohol related harms that do not require waiting for government action on tax and availability (indeed, barely an option for non-commercial alcohol which accounts for half of global consumption). Arguing solely for population level approaches also inhibits creative and needed local responses: municipalities cannot wait for governments to act, and much can be done now to reduce the impact of drinking and start the long process of cultural change.
It is untrue that the book challenges any emphasis on population measures to reduce alcohol consumption. We clearly state that “a comprehensive alcohol policy needs population-level interventions, but there is also a need to disaggregate populations in order to develop a more nuanced and comprehensive approach to reducing alcohol-related harms.” This wider view of public health is in line with the insights and experiences gained with respect to changing other health behaviours—for example, in HIV/AIDS prevention, population interventions are important, as too are cultural and community level interventions (absent in Farrell's version of public health).
Competing interests: GVS received a fee from the International Centre for Alcohol Policy for editing Drinking in Context. The International Harm Reduction Association has received unrestricted donations from four beverage alcohol companies, and a grant to develop city based alcohol harm reduction interventions.