Why all population public health strategies on alcohol abuse don't work

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We've run all population programmes in public health around alcohol for some long while. We've raised the price of alcohol, controlled its distribution and imposed a variety of advertising, promotion and other controls. And, in one respect this has worked - alcohol consumption has plummeted, falling by some 18% in the UK over the past decade or so with the biggest falls in among the young.

But, as we're repeatedly reminded by the public health gang, the levels of alcohol harm simply haven't fallen to match this decline in consumption - most to the statistics suggest that, in fact, levels of alcohol admissions to hospital have risen significantly over that same period. Now some of this (a great deal if you ask me, but that's a guess) is down to the way in which statistics are gathered by medical staff in situ but there's still that paradox - we're drinking loads less but there are still plenty of people causing themselves real harm through abusing the booze.

These statistics - for the USA where levels of alcohol consumption are quite a bit lower than in the UK - explain the problem:
 

...the top 10 percent of drinkers account for well over half of the alcohol consumed in any given year. On the other hand, people in the bottom three deciles don’t drink at all, and even the median consumption among those who do drink is just three beverages per week. 

We are setting policies that target 100% of drinkers when we should be targeting about 15% of drinkers. And this is why the all population strategy doesn't work - indeed we are scaring people who are drinking perfectly healthily into reducing their consumption further (because they care about their health and, foolishly, believe the newspapers and TV pundits) while the hardened drinkers carry on sloshing back the pop.

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the top 10 percent of drinkers account for well over half of the alcohol consumed in any given year. On the other hand, people in the bottom three deciles don’t drink at all, and even the median consumption among those who do drink is just three beverages per week. - See more at: http://marginalrevolution.com/marginalrevolution/2014/10/alcohol-inequality.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+marginalrevolution%2Ffeed+%28Marginal+Revolution%29#sthash.ptcipuVR.dpuf