Regardless of how they vote, Coloradans should be aware of the broader public health impacts related to increased access to alcohol.

Amidst the debate around economic impacts of Propositions 124, 125, and 126, few – if any – pundits have discussed the effect the passage of these bills would have on Colorado’s public health.

To recap: Proposition 124 would allow retail liquor stores to apply for and, if approved, increase the number of locations selling alcohol. Proposition 125 would allow beer-selling grocery and convenience stores to sell wine as well. Proposition 126 would allow third-party delivery of alcohol from grocery stores, liquor stores, convenience stores, bars, and restaurants.

These bills’ passage would increase access to alcohol for Coloradans. While most Coloradans consume alcohol responsibly, data show a strong correlation between alcohol availability and excessive alcohol use in communities.

Excessive alcohol use is defined as binge drinking (4+ drinks per occasion for women, 5+ drinks for men), heavy drinking (8+ drinks/week for women, 15+ drinks/week for men), drinking under age 21, or any drinking by pregnant women.

Excessive alcohol use is a public health problem causing approximately 88,000 deaths annually nationwide, including 10% of deaths among adults 20 to 64 years of age. Alcohol consumption ranks as the 4th leading cause of preventable death nationwide, behind tobacco, poor diet, and physical inactivity. Colorado has the 8th highest rate of excessive drinking among all states and the 6th highest rate of alcohol-related deaths.

During the COVID-19 pandemic, alcohol-related deaths in Denver increased by nearly 30% in 2020 compared to 2019. The prevalence of alcohol use disorder among Colorado residents is more than 50% higher than the national average. The state of Colorado has a public health problem with alcohol.

To be clear: we enjoy alcoholic beverages. We do not aim to vilify responsible alcohol use or revisit failed prohibitionist policies. We acknowledge the important role alcohol plays in Colorado’s economy and culture, appreciating the jobs and tourism generated by our state’s breweries, vineyards, and distilleries.

However, this is not about economy or culture. This is about public health. The data show public health and alcohol do not mix well.

Public health experts recommend several ways to decrease incidence of and public health impact from excessive alcohol use – most of which revolve around limiting access to alcohol. Some proposed community-based interventions have shown to be ineffective at preventing excessive alcohol use; for example, responsible beverage service training programs have insufficient evidence to recommend for or against their use on a population health level.

Other interventions have shown to worsen excessive alcohol use, and are actively discouraged. One such intervention is privatization of retail alcohol sales in settings where the government has been controlling retail sales, which results in increased per capita alcohol consumption – a well-established proxy for excessive consumption. In contrast, practices such as increasing alcohol taxes, limiting days and hours of alcohol sale, and regulating alcohol outlet density have all been shown to reduce excessive alcohol use and its downstream consequences in communities.

These guidelines, created by the non-partisan Community Preventive Services Task Force, composed of public health experts around the nation convened by the U.S. Department of Health and Human Services, are drawn from evidence-based findings and recommendations about community preventive services, programs, and other interventions aimed at improving population health.

The task force incorporates both public health impact and cost-effectiveness into their recommendations which are published in The Community Guide, available for free online. Its agenda is to promote healthy communities using science. The science tells us increased access leads to more excessive alcohol use, and more excessive alcohol use causes more problems.

This is a topic that has not been discussed extensively, if at all, to inform decisions at the ballot box. From a public health perspective, increasing access to alcohol is generally associated with adverse public health outcomes. This isn’t moralistic or political posturing; this is what the evidence shows. Given Colorado’s current relationship with alcohol, increasing access by enacting these propositions may worsen public health outcomes associated with excessive alcohol consumption.

The public health impact of these propositions’ passages is not the only factor to consider at the ballot box this November. Nevertheless, we should consider it in addition to the social, economic, and cultural forces that drive policy change.

D. Tyler Coyle, MD, MS, of Denver, is board-certified in both preventive medicine and addiction medicine.

Thomas Locke, MD, of Denver, is a preventive medicine resident.

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D. Tyler Coyle, MD, MS is board-certified in both preventive medicine and addiction medicine.

Thomas Locke, MD is a preventive medicine resident.