Understanding Health and Drinking: The Case of France
Many people have heard of the "French Paradox". It is a term applied to countries such as France that have high per capita alcohol consumption (usually wine) but appear to have low rates of coronary heart disease relative to their level of consumption of animal fat.*A 2000 study (European Comparative Alcohol Study (ECAS)) compared six countries-Finland, Sweden, Germany, Great Britain, France and Italy. It, as well as other reports, highlight some of the things we read in the news really need more context.
First of all, alcohol consumption has diminished dramatically in France for the past four decades. It went from 17.5 litres per capita in 1960 to 13.3 litres in 1985 to 11 litres in 2000. The group that already have been at the lowest level of consumption--the middle class--has reduced their consumption further and the other socio-economic groups in the country have followed them. (Sulkunen,1989)
Interestingly, even though the average level of consumption has decreased in France over the decades, the mortality rate for cardiovascular diseases has also decreased. For example, it was 330/ 100,000 for men in 1986 and 231/100,000 for men in 1999. It was 206/100,000 for women in France in 1986 and decreased to 130/100,000 in 1999 (Institut national d'études démographiques). Some of this may reflect medical improvements, but there are likely other factors too such as changes in level of people's activity, smoking and heavy drinking. Between 1970s and mid 199os, the rate of liver cirrhosis and alcohol dependence both decreased substantially in France, reflecting the reduction in the per capita consumption. (WHO)
There are other changes happening too. Currently, among six European countries, the average consumed quantity per drinking occasion is highest in Finland, Sweden and the UK. It is the lowest in France and Italy. The youngest people show the highest quantity per drinking occasion in most countries. (Heifman, 2002)
Here are some questions and answers for your consideration:
1. What is the current level of drinking in France?
People often assume that most people in France drink. That may be the case for men, but not women. In the study, France and Italy actually had the highest proportion of non-drinkers among women aged 18-64 (27 and 22% respectively). The term non-drinkers here means, they did not drink any alcohol in the past year.
2. Do people in France drink every day?
No. According to the study, only 22% of the men and 9% of the women drank every day. About one quarter (23%) of the men in France drank only once a week; another 19% were drinking 2-3 times a week.
For women, 27% never drank in the past year, 26% drank only once a month or less in the year. 10% were drinking 2-3 days a week, and 16% were drinking only once a week. Only 3% drank 4 or 5 times a week.
The study does say that the older generation (those aged 50-64) was more likely than younger people to drink daily. But again, the amounts on each occasion were much lower for "the old folks" than for the younger adults, and at all age groups men consumed on average, 2 to 3 times as much alcohol as women did.
3. Where did France rank compared to the other countries in weekly heavy drinking?
French showed the lowest rates among the six countries of weekly heavy drinking. Italy and United Kingdom had the highest.
4. Where does most drinking in France occur?
Most (80%) of the "drinking occasions" in France is with lunch and dinner.
5. Do some French drinkers develop alcohol-related problems?
Yes, absolutely, even though most drinking moderately.
It has been suggested by some in France, that people there have often turned a blind eye to problem drinking both at a policy and resource level. Craplet (2001) for example, points out that "a problem drinker is considered badly in France and that alcohol-related problems become taboos in families, work places and nations. " Craplet goes on to note:
"We can point to the example of Princess Diana's death on the Paris streets: many observers were surprised that the driver of a royal princess could take the wheel while intoxicated. We can say now that this man had a chronic problem and that he was obviously drunk on the night of the accident, but nobody stopped him because of the taboo in French society, and particularly in the hospitality sector where he worked."
Craplet also says of alcohol policy in France:
"We could truly say, to put it crudely, that the premature deaths of thousands of 50-year-old heavy drinkers, who had been good workers and good citizens all their lives, did not disturb society as much as the deaths of a small number of young adults on the road. It seems that the change in the consequences of drinking patterns, with a shift from medical to social damage, is a strong motivation for public authorities to implement a more aggressive alcohol policy. It seems that most of the time we win only half of the battles ... or, should I say, of the bottles. Nevertheless, the public health situation is improving. "
The World Health Organization (1999) notes that the resources in France for helping people with drinking problems have been relatively limited:
"Alcohol units are available in general hospitals, and other health centres and general services, but these are developing very slowly. Outpatient and inpatient units of psychiatric hospitals are often poorly adapted to the treatment of alcohol dependent patients. There are some inpatient homes (cure establishments). Post-cure (rehabilitation) is carried out in post-cure centres, sometimes with the help of associations of treated alcohol dependents, of which there are 15, that work with a network of regional and local delegations. Legal provisions exist for the protection of the families of heavy drinkers, and alcohol dependents may be placed in institutions under a legal order as an extreme measure."
6. Do People in France Live Longer?
No. People's longevity depends on a lot of diffent factors, and whether they drink and how much they drink are only two factors among many others.
The average life expectancy in France is 79.05 years (2002) compared to 79.69 years for Canada. For women in France, the average life expectancy is 83.14 for woman (83.25 Canada); in men, it is 75.17 years in France (76.3). ( Geography IQ)
Summary and Conclusions
So, what do all these figures mean, for people working with adults in Canada and the United States?
1. We need to help people better interpret the news they are getting about drinking and health, for example about which countries "drink healthy".
2. We need to put information in context. It can be helpful to let people know that if they are considering the route of drinkers in other countries such as France, that people there on the whole drink moderately (small amounts), and certainly not every day. This is particularly the case for women. This is important information because some North American research has suggested that people benefit by drinking every day.
3. We need to emphasize that the amounts that older adults drink in any occasion is much lower than younger adults (about 25% lower for men, and 30% for the women, who are already drinking very little).
4. Also, we need to emphasize that eating and drinking activities going together are likely to be better health-wise than drinking separately from eating.
* First raised in the mid 1970s, the French Paradox finding has been questioned on many bases- including the possibility that much of the heart disease deaths in France and other Mediterranean countries was not being recorded as coronary heart disease CHD such but in more ambiguous ways.
Craplet, Michel. Alcohol problems: is there a specifically French view? Addiction; Jun 2001, Vol. 96 Issue 6, p805, 3p
Geography IQ, www.geographyiq.com/countries/abc/f.htm
Institut national d'études démographiques. www.ined.fr/englishversion/figures/france/mortality/causedecA.htm
Leifman, Hakan. A comparative analysis of drinking patterns in six EU countries in the year 2000. Contemporary Drug Problems; Fall 2002, Vol. 29 Issue 3, p501, 48p
Sulkunen, Pekka. Drinking in France 1965-1979. An Analysis of Household Consumption Data. British Journal of Addiction; Jan 1989, Vol. 84, Issue 1.
World Health Organization, Global Status Report on Alcohol, 1999
Page last updated: 31/10/2004