THE STANDING SENATE COMMITTEE ON SOCIAL AFFAIRS, SCIENCE AND TECHNOLOGY
EVIDENCE
OTTAWA, Thursday, October 23, 2025
The Standing Senate Committee on Social Affairs, Science and Technology met with videoconference this day at 10:30 a.m. [ET] to study Bill S-202, An Act to amend the Food and Drugs Act (warning label on alcoholic beverages).
Senator Rosemary Moodie (Chair) in the chair.
[English]
The Chair: I call this meeting of the Standing Senate Committee on Social Affairs, Science and Technology to order. My name is Rosemary Moodie, I’m a senator from Ontario, and the chair of this committee.
Before we begin, I would like us to do a roundtable and have senators introduce themselves starting with Senator Osler.
Senator Osler: Senator Flordeliz (Gigi) Osler from Manitoba.
Senator Senior: Senator Paulette Senior from Ontario.
[Translation]
Senator Arnold: Dawn Arnold from New Brunswick.
Senator Forest: Good afternoon. Éric Forest from the Gulf division of Quebec.
Senator Boudreau: Good afternoon. Victor Boudreau from New Brunswick.
[English]
Senator Bernard: Wanda Thomas Bernard from Mi’kma’ki, Nova Scotia.
[Translation]
Senator Brazeau: Good afternoon. Patrick Brazeau from the beautiful province of Quebec.
[English]
Senator Greenwood: Good morning, Senator Margo Greenwood from British Columbia.
Senator Muggli: Senator Tracy Muggli, Treaty 6 territory, Saskatchewan.
The Chair: Today, we are continuing our study on Bill S-202, An Act to amend the Food and Drugs Act (warning label on alcoholic beverages).
Joining us today for the first panel, we welcome in person Brandon Purcell, Advocacy Manager, Cancer Prevention and Early Detection, Canadian Cancer Society; and via video conference, Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society; Dr. Alexander Caudarella, Chief Executive Officer, Canadian Centre on Substance Use and Addiction and Lori Ann Motluk, Clinical Director and Former President, Canadian Alcohol Use Disorder Society. Thank you for joining us today.
You will each have five minutes for your opening statement followed by questions from committee members.
Mr. Purcell, the floor is yours.
Brandon Purcell, Advocacy Manager, Cancer Prevention and Early Detection, Canadian Cancer Society:
Members of the committee, my name is Brandon Purcell, Advocacy Manager for cancer prevention and early detection at the Canadian Cancer Society. Joining me by videoconference is Rob Cunningham, Senior Policy Analyst.
We are here today because Bill S-202, at its heart, is about Canadian’s right to know.
Since 1988, the World Health Organization, or WHO, has classified alcohol as a Group 1 carcinogen or cancer-causing substance. That’s the highest-risk category, and it places alcohol in the same group as tobacco and asbestos, substances we know to be toxic and cancer-causing.
Yet despite decades of research and mounting evidence, the link between alcohol and cancer remains unknown to nearly half of Canadians according to our polling.
The links between alcohol and cancer have been proven time and again in studies spanning decades. In fact, alcohol increases a person’s risk of at least nine different cancers, including breast, colorectal, liver and esophageal cancers.
I’d like to provide you with an example of what we think is at stake. Let’s take a 42-year-old woman who abides by Canada’s current low-risk guidelines for alcohol consumption. She drinks a glass or two of wine at dinner each night. What she likely does not know is that consuming just 10 standard drinks per week, she increases her risk of developing colorectal cancer by about 14%; breast cancer by almost 19%, and esophageal cancer by nearly 30%. For her, this is not low risk.
This is why it’s not just important for us to talk about the link between alcohol and cancer, but also how Canadians can measure their own consumption. Wine is the hardest kind of alcohol to self-regulate when it comes to measuring standard drinks, because how many of us realistically know what five ounces looks like in a glass?
All of this demonstrates one unfortunate truth that the industry and lobbyists who stand to profit from alcohol sales want you to ignore: There is actually no known safe level of drinking when it comes to cancer prevention.
This is not just a Canadian concern, it’s a global one. The World Health Organization has been increasingly vocal about the harms of alcohol, calling for stronger public health measures including warning labelling, taxation and marketing restrictions. Countries around the world are grappling with the same challenges, and Canada has a chance to lead by example.
The debate around alcohol and health mirrors the decades-long struggle we’ve seen with tobacco. The alcohol industry has consistently worked to create uncertainty, challenge scientific evidence and delay public health measures designed to protect Canadians and keep them safe. Their efforts are often aimed at delaying, diluting or derailing public health policies that threaten their bottom line. We’ve seen this play out before. We know how it ends, with lives lost, families devastated and billions spent on health care and lost productivity.
In fact, alcohol-related harms cost Canada at least $19.67 billion annually, while government revenues from alcohol amount to just $13.47 billion. That’s nearly a $6.2 billion deficit just to fund the harms that alcohol causes on our society.
Let me be clear. We are not here to tell Canadians how to live their lives or what choices to make. We are here because we believe Canadians have a right to accurate, accessible information about the products they consume that empower them to make informed decisions about their health, especially when those products will increase their risks of cancer and other chronic diseases.
Canadians deserve the same transparency and protection that we now expect with tobacco. They deserve warning labels that clearly communicate the health risks, including cancer, associated with alcohol.
And we know Canadians agree. In a recent Ipsos poll conducted on our behalf, 81% of Canadians supported mandatory health and safety labels on alcohol, including warnings about cancer and other chronic diseases. This is a mandate for action.
Bill S-202 is a key part of this mandate. It offers a practical and balanced step forward, a straightforward transparency measure designed to keep Canadians informed about the cancer risks associated with alcohol consumption.
The Canadian Cancer Society supports Bill S-202 because Canadians have the right to know, and I hope members of the committee will agree with us.
Thank you, and I look forward to your questions.
Alexander Caudarella, Chief Executive Officer, Canadian Centre on Substance Use and Addiction: Ms. Chair, deputy chairs and committee members, thank you for inviting the Canadian Centre on Substance Use and Addiction, or CCSA, here today to discuss Bill S-202, An Act to amend the Food and Drugs Act to include (warning labels on alcoholic beverages).
As you know, alcohol is a leading preventable cause of death and social harms in Canada.
The difference between the profits and the revenues to government and the harms is a $6 billion deficit of backed-up emergency departments, social costs and lost productivity.
Evidence shows that many people in Canada still have a limited understanding of alcohol-related harms, including liver disease, up to nine types of cancer and cardiovascular conditions.
This isn’t a surprise. Even last week, a major Canadian news outlet published an article that tried to minimize the risk between alcohol and cancer. People need clarity to cut through industry-driven messaging and make informed decisions that align with their own personal health and values, not the values of the industry or the values of government.
In 2023, we released Canada’s guidance on alcohol and health. It was updated from the 2011 low-risk drinking guidelines which we also released. It brings together the most recent scientific understanding of alcohol and its effects. Part of this report also found that a particularly effective option for reducing alcohol-caused harms could be alcohol warning labels.
Mandatory health information labels on alcohol that have health warnings, standard drink information and up-to-date national drinking guidance is a really important public health intervention to help consumers understand the risks of alcohol consumption.
[Translation]
Alcohol is not subject to the same stringent labelling requirements as other regulated psychoactive substances, such as tobacco and cannabis.
[English]
The survey conducted by the Government of Canada in 2023 revealed that 60% of people in Canada believe alcohol should not be exempt from these labels. Even a majority of 16- to 19-year-olds feel it would help inform their understanding.
This is not new, though. In 1987, the Parliament Standing Committee on National Health and Welfare went across the country and came back with a series of all-party recommendations on substance use. One of those consensus recommendations was the creation of my organization, CCSA. There was another one, a recommendation that warning labels be affixed to all alcoholic beverages.
Since then, there have been over a dozen attempts to move the alcohol label issue forward via bills, motions and other non-legislature instruments.
The scientific understanding is clear: Public and institutional support is there. We know labels are a cost-effective public health intervention in general. So why are we still having so many debates about their value? What is the perceived risk in moving forward with these kinds of things?
Why is it, in 2025, that Count Chocula has more to tell me about the health effects of his cereal than Budweiser has to tell me about the health effects of their beer?
[Translation]
People in Canada have a right to know.
I’m a family doctor. I see that there is a certain amount of uncertainty these days. People come to my office and to offices across the country because they want to take charge of their health, find solutions and live longer. It is as simple as that. They want hope.
[English]
Information isn’t about alarmism. It’s about hope. It’s about empowerment.
[Translation]
It isn’t about telling people how to live their lives. However, they have a right to know the effects of alcohol on their health and to make decisions that are appropriate for them.
[English]
The U. S. Surgeon General said, 10 months ago, that most people who will get cancer from alcohol do not have a substance-use disorder or addiction, and he was right. That’s why it is so important that whatever we’re doing to communicate this be accessible to everyone.
At CCSA, we get a lot of correspondence from ministers and MPs and lots of wonderful letters. The only thing that’s framed in my office is a letter I got last year from an 8-year-old girl. She talks about how her family has alcohol issues and how it’s information and science and knowing that helps her and her family stay safe.
The onus is on us to collectively and meaningfully ensure that people have clear and simple access to the information they need and want, and to finally move forward with enhanced labels on alcohol containers. Thank you for the invitation to speak today on this important topic. I look forward to your questions.
The Chair: Thank you, Dr. Caudarella.
Lori Ann Motluk, Clinical Director and Former President, Canadian Alcohol Use Disorder Society: Honourable chair, Senator Moodie, and senators, staff and partners, I am honoured to represent the Canadian Alcohol Use Disorder Society, or CAUDS, a non-profit organization dedicated to a future where alcohol use disorder, or AUD, is understood as a treatable medical condition, and it’s approached with compassion. We work across four dimensions: empowering people with lived and living experience, engaging health practitioners, advancing research and mobilizing communities.
Our shared goal is clear — to reduce alcohol-related harm and suffering in Canada. The Canadian Alcohol Use Disorder Society strongly supports the bill to introduce warning labels that communicate the cancer risks of alcohol consumption. Labels like these are more than just information; they are an opportunity to turn awareness into action. Labels like these are more than information; they prompt reflection, conversation and, ultimately, prevention and care.
The need for action is urgent. One in five Canadians will experience AUD in their lifetime, yet fewer than 5% receive treatment. Solutions do exist; they are simply underutilized. Most people, families and clinicians are only aware of crisis or late-stage options, like detox or rehab, once the condition has progressed. Warning labels can help people recognize risks, make personal choices about their consumption and, if required, seek support sooner. Earlier intervention is far more effective than waiting for crisis.
That’s why we advocate for AUD to be addressed in primary care where people already receive support for other health conditions, and for a full range of complementary care options that can be customized to include things like prescription medication, counselling, peer support, and family and elder care, so people can get the right type of help at the right time.
The Canadian Alcohol Use Disorder Society is focused on the “how” and we put into practice two approaches. Our first approach is clinician engagement, with our Approaches and Pharmacotherapies for Patients Living with Alcohol Use Disorder, or APPLAUD.
In health care, we love acronyms.
That is an action series developed in partnership with Health Quality BC. These primary care action teams are composed of nurse practitioners, physicians and clinical staff who deliver transformative, evidence-based care for AUD. It equips them with practical tools for screening, prescribing medications, patient engagement, coordinated referrals and more. As teams implement this model, they have the support from peers, people with lived and living experience, as well as expert faculty. And this model is now expanding across the nation.
Our second approach is our community engagement program that partners with local leaders and organizations to form cross-sector teams who lead grassroots initiatives, campaigns and partnerships to raise awareness of care options and to promote healthier approaches to alcohol.
Just as community programs help people translate awareness into personal action, warning labels can serve as the bridge between risk awareness to hope, prevention and care.
In summary, amending the Food and Drugs Act is an important first step, one that we wholeheartedly support. Once warning labels are in place, CAUDS stands ready to partner with federal and provincial governments, health systems and community organizations to connect people who read these labels with guidance, goal-setting tools and timely access to evidence-based care. Together, we can make awareness a gateway to hope, care and prevention. Thank you.
The Chair: Thank you all for your opening remarks. We will now proceed to questions from committee members.
Senator Osler: Thank you to all the witnesses for being here today. I have two questions. I’ll read them both.
First, for the Canadian Cancer Society, given your experience with tobacco control, what lessons from health-warning-label implementation should inform the roll-out for alcohol, should Bill S-202 be passed, particularly regarding message rotation, evaluation and industry resistance?
The second question is for the Canadian Alcohol Use Disorder Society. Should Bill S-202 be passed, could there be equity or implementation concerns, for example, among people with alcohol use disorder, that policymakers should keep in mind to avoid stigma or unintended harms. Mr. Purcell?
Mr. Purcell: Thank you for the question. I will turn this to my colleague Mr. Cunningham, who has extensive experience with tobacco.
Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society: Thank you, senator, for the question. We know, from decades of experience with tobacco warning labels, they work. They increase awareness of the health effects. They reduce consumption. We’ve had to overcome tobacco industry opposition to these.
In terms of implementation, there would be a transition period for companies to implement these. Warnings are best if they are clear in terms of their appearance. Larger warnings are a bit more effective than smaller warnings. There should be rotation in terms of, ideally, multiple warnings appearing concurrently and, certainly, refreshing over time so that warnings are no longer stale.
There is an international consensus with respect to these principles reflected in guidelines under the international tobacco treaty, the WHO Framework Convention on Tobacco Control, which has minimum global obligations for parties, for more than 100 countries that have ratified this treaty, including Canada. There are global best practices from countries around the world. Canada has been a global leader with respect to tobacco warning labels. We would hope that Canada could do the same with respect to alcohol.
Senator Osler: Thank you. Ms. Motluk?
Ms. Motluk: That’s a very broad question. We do have people with lived and living experience with whom we work. They welcome the labels, from what I hear.
The benefit that we have at this time with the warning labels being implemented is that work is being done on many fronts. We do know that if somebody is struggling, there is now care and hope for managing what they are struggling with.
We also know, as we work at our community-engagement level, that patients and families are not only starting to understand the risks but also where they can get assistance. Certainly, what I’m hearing a lot is people are now able to come forward and talk on a much broader level in these conversations. They are actually getting down to the community level and family dinner tables, so it’s much easier for people to come forward as well.
When it comes to stigma with different age groups and ethnicity, that’s a much more complicated question that I truly can’t answer fully. I think there needs to be some engagement with those groups to really understand if there is an impact, how to mitigate and champion the conversations.
Senator Hay: Thank you to all of you for being here and for the work you do every single day for people across Canada.
I have two questions. One I keep asking, not because I don’t get good answers. When I think of labels, I think of how in isolation, it may not have the impact we want.
What complementary support should accompany Bill S-202 to make sure it doesn’t operate in isolation and that it has maximum impact? In my head, I’m always thinking about how, sure, there is industry, but what about the retailers like the LCBO, Sobeys and WineOnline? I’m curious about that. That’s the first question.
When you’ve done that, I’ll have a follow-up. This could be a free-for-all.
Mr. Purcell: There is a lot that can accompany this bill. What’s at the top of mind is for the Government of Canada to accept Canada’s guidance on alcohol and health. I gave that example of the 42-year-old woman who abides by Canada’s current low-risk drinking guidelines and is at a substantially increased chance of developing a number of different kinds of cancers. That’s one element of the education conversation.
Certainly, there are other ideas that we at the Canadian Cancer Society would look at to decrease alcohol consumption, which is something we would like to see primarily because after tobacco, alcohol is the number one cause of cancer in this country. We hope to see overall consumption reduced as a result. That can include things like taxation and broader education, done either by Health Canada or the provinces and territories. We certainly encourage this committee, when it gets the chance, to pass Senator Brazeau’s other bill on advertising.
Dr. Caudarella: I agree with my colleague here on the points he has raised. The part I would add is that one of the things the Canadian Centre on Substance Use and Addiction has been learning as we’ve gone across the country and looked at knowledge mobilization is that issues with alcohol are often community specific, although there are all these universal truths.
Anything retailers or businesses can do as corporate citizens to engage and enact is really a broader civic challenge. Communities are struggling. They are desperately looking for ways that they can be healthy and safe. There are very few interventions that offer as many benefits to the individual and to a community as even modest reductions in alcohol use in terms of improving health and safety.
I think there are more opportunities to engage directly with communities that want to treat this as a civic challenge, want to build it out, want to look at what it means to tackle this and ask what the issues that are top of mind are. This is a lot of what CCSA has been doing as part of our knowledge mobilization. I think it’s really turning it into those kinds of actions.
Senator Hay: Thank you.
Ms. Motluk: Our work with communities is actually that. As we meet with community members and initiate and support their locally driven projects, the key thing that we’re asking is for them to share the information in grocery store aisles and at their dinner tables. These different local actions and engagements work.
We have seen grocery store aisles increase with non-alcohol items. I come from wine country in southern Okanagan. We’re partnering with different wineries, and we’re invited to the Festival of the Grape to talk, so communities do need to customize their own solution and share it, but we’re seeing real differences.
The Chair: Thank you. I’m going to pass it over to the bill’s sponsor, Senator Brazeau.
Senator Brazeau: Thank you and good morning to all of you. Along with my colleagues, I thank you for the work that you do on alcohol because if it wasn’t for your work, this wouldn’t be possible. Thank you for that.
Next week, we’ll probably be hearing from the alcohol lobby representatives and the industry. When I look at this panel and the next one, here is what I think is going to happen next week. I think the industry is going to come here, and they will try to discredit the scientists who have been working on this for quite a long time. They are going to try to discredit CCSA’s new drinking guidelines. They are going to try to discredit the Canadian Cancer Society’s numbers and ratios in terms of getting cancer with respect to alcohol. They are going to probably say that bills such as these are just for people who have problems with alcohol and nobody else.
If you don’t have time to verbalize your response, I would appreciate if you can write it because I think it would be important to have this on record. What do you say to those individuals, the industry and lobbyists who are against a piece of legislation that would simply give Canadian consumers more access to health information that they are allowed to have so they can make better-informed choices for themselves? There’s nothing about prohibition. It’s about providing Canadians more information so that they can make better-informed decisions for this themselves. What do you say to those lobbyists and those against this bill in terms of your own specific organizations in response to them?
Mr. Purcell: I would certainly encourage members of the committee, when they have the chance, to start by simply challenging the representatives of the industry to justify their opposition and ask them in a straight forward manner, does alcohol cause cancer? See where that conversation might lead.
The senator made a very good case for what this bill is all about to us. It is about education. It is not about telling Canadian what to do. It’s making sure that folks have that information available at their fingertips. Having the information available on the bottle as you’re looking to purchase an item is the easiest and most consistent way for folks to interact with that information, for it to stick in their minds and for it to carry forward into the personal decision making afterwards.
Dr. Caudarella: The reality is it’s just about letting people know what that risk is. When we look, the science is the science. The 2011 guidance and the 2023 guidance had many of the same authors. I don’t know if all of a sudden they thought these people who were trustworthy in 2011 have gone off the rocker in those 10 years. The science is what it is. This is why internationally the World Health Organization and all these organizations are coming to the same conclusions, and attempts to obfuscate it is just not going to work. They don’t appeal to Canadians anymore.
I would invite the industry to participate in trying to help and to help communities in a really meaningful way by answering because consumers are very clear what they want and ask for.
Multinational alcohol companies have a responsibility to shareholders. They have to sell more alcohol. That’s what they have to do. That’s why we have the commercial determinants of health now. As health organizations, we have to look at burdens on emergency departments. We have to look at the broader picture, and I think asking them about those specific things would be helpful too.
Senator Muggli: Thank you all for being here today. I really appreciate it. This question could be answered by all, and Mr. Cunningham might have some experience as it relates to tobacco labelling. Will the impact of labelling be as impactful on those with privilege versus those who are challenged by intersections of classism, racism, ableism, heterosexism? Is there a group in society who is most likely to decrease their alcohol use as a result of labelling? I’m also interested in whether you think labelling will have an impact on underage use.
Mr. Cunningham: With respect to the tobacco experience, it does have an impact on different subpopulations. The amount of the impact depends in part on how large the warning is, the effectiveness of the wording, the contrasting colours, the rotation. All of these things increase impact.
It does have an impact on youth as well, and that’s important because of that age group in terms of the contribution. The warning label can also decrease the coolness factor of the container a little bit.
Senators, just for your information, we do have this report that documents the international experience with respect to tobacco warnings, and that is available to senators.
Senator Muggli: My question is, will we see an equal impact, a reduction of use, for those who are comfortable in our society, versus people who are more challenged? If you were to give a percentage, do you think it as likely that people with all these other challenges will be able to integrate that information and reduce their use as much as people with privilege?
Dr. Caudarella: If I could add a little bit, I was an inner city doctor before this. I was actually a little shocked because I had a patient who was very sick from severe alcohol disuse disorder with all the signs of marginalization. They, probably more than any of my other patients, were so intrigued by the link to cancer. I had kind of dismissed that thought in my mind; I thought they had more acute, urgent needs.
We know now that the only people who are able to make these changes in their lives are the well-to-do. You have to go through three websites. You must have a calculator. You have to do all these different things. The stuff Mr. Cunningham just mentioned are the things that will make it more accessible to the populations you are talking about.
Which percentage exactly? Our organization has engaged in a lot of labelling work in terms of finding the most effective labels and how to do it. That needs to be the ongoing study, with ongoing improvements, but it’s got to be better than what we have now.
Mr. Purcell: Likewise, I don’t think I could provide you with a percentage. Our hope is that by placing this label in a clear way with very clear information available in both official languages, that it will be available to most folks of equal opportunity in that way.
When it comes to young people, they will be most importantly impacted by this broader conversation on the link between alcohol and cancer. We know that younger people are drinking less as it is, which is a great start. Letting them have access to that information earlier in life, whether they are of age or have acquired the alcohol illegally, gives them the information they need to make better decisions later in life. Because we know that two in five cancers can be prevented. As I mentioned, alcohol is the chief cause of cancer after tobacco.
Senator Muggli: Part of my point is that the label won’t remove the external factors that make coping with life difficult for some people. I might see a label, but if I am still faced with poverty and all the other barriers in my life, all I will want to do is numb out for a while. I wonder, will cancer be on the minds of those people as much as on the minds of those who are not faced with those challenges?
Senator Bernard: Thank you all for being here. My question will pick up from Senator Muggli’s, not surprisingly. We are the social workers in the group, moonlighting as senators.
Picking up on that, in terms of knowledge mobilization, how do you get to those communities who are using alcohol to cope with those social determinants of health? How would the passage of this bill help with that? We’re talking about knowledge mobilization to communities and families who are very difficult to reach. They are not part of the mainstream. They are marginalized. Any of you may answer that.
Ms. Motluk: When we’re working is with anyone, clinicians, in the health care system and particularly primary care, it is key that these labels start to bring in acknowledgment and screening by the health care professionals.
Our organization worked with a small pilot within Interior Health in B.C. They started screening in emergency departments. Anyone who screened positive was actually treated and offered support right out of emergency. That rolled out through every emergency department in Interior Health. Any time there is an interface with a health professional, that’s the right door to hold some of these conversations.
As well, when we go into communities, we look for invites from many different sectors, and we look for leaders across the community. That’s been very helpful. We’ve been invited into many different areas with individuals and sectors where we would not have been otherwise, without that door being opened.
Knowledge mobilization is hard. It is one person at a time sometimes.
Dr. Caudarella: A lot of what our organization does is knowledge mobilization. We spend the whole day talking about some of the initiatives. But one thing that labelling has is repeatability, so you’re constantly exposed to it. It’s not just the person; it’s their family members. It’s even their doctors and their social workers. If all these people are constantly being exposed to it, it will be more likely that all of those people in that care team bring this up more frequently for that person. It will be more likely to be a dinner table conversation.
Alcohol thrives in darkness. This is what we’ve learned. The more people talk, the more alcohol use reduces. Getting people talking about it, getting it front of mind, whether it’s the individual, their family or their care providers, will ensure it is screened more, talked about more, done more. It just needs to be more part of the conversation.
Senator Bernard: Thank you. It would be very useful for our committee to have a copy of the CCSA alcohol drinking guidelines as part of our study of this bill. I think that would be useful.
Senator Senior: Thank you for being here. I have two questions.
I would like you to imagine that this bill goes through and it becomes law. I’m taking advantage of Ms. Motluk’s hope message today. What do you expect will be the outcome in your different places where you operate? What would you see as the immediate outcome? What research in support of this expected outcome could you share with the committee?
Mr. Purcell: From our perspective, the outcomes we are looking for will take place over a longer term. It will take time to see a necessary reduction in cancers as a result of alcohol consumption going down. That would be the more long-term impact.
We will see indicators in the near term on what those purchasing habits look like for all generations. What does that consumption look like? What does that awareness look like for the link between alcohol and cancer? Are those numbers changing, and we’ve cited a few different numbers there? We do know that, no matter what, the majority of the population is not aware of that fact. This is a fundamental and easy way of changing that and, as you mentioned, bringing the conversation to the dinner table so that people are more open to having that conversation.
Since CCSA released its original guidance a couple of years ago, even since then, the conversation has changed quite broadly in the public and in the media when we talk about a safe guideline for how much someone can consume.
Dr. Caudarella: We can debate for a while what the end effects might be, but at the end of the day for me, it is about the right to know. It is about having the information in hand. Anything beyond that is great.
We are in a time, post-pandemic, where people have limited trust in governments and agencies and all these things. You should see the looks on patients’ faces when they find out that they have been trying everything to avoid breast cancer, and they didn’t know — despite scientists and clinicians knowing for so long — that alcohol is linked to it. At its heart, it’s really just about informing people what they have the right to know what is in the product and the health effects of what they can do. We can continue to study how to be effective, but that’s really the crux of it, conversations, awareness, knowledge and information.
Ms. Motluk: I want to see people hold those conversations based on the labels and for those that need help that they access care.
Senator Arnold: Thank you for being here. This is the first time I heard “1987.” The first recommendation was 38 years ago. I am assuming that the cancer warning is enough. You made the Count Chocula reference as far as dietary components and other components. I think I’m hearing you are satisfied with the cancer warning alone, is that correct?
Mr. Purcell: There is always more that can be done. The cancer warning is a fantastic starting point. It provides that shock value for people to perhaps take stock and talk about their own consumption habits and really think about that. But what we’ve seen over the years is the alcohol industry has become incredibly successful at making sure that they are the exception to every single rule. They are the only widely available consumable item that doesn’t require any nutritional information, caloric information, let alone the risks that actually come from their products.
Dr. Caudarella: Cancer gets the most attention, but everybody is driven by a different need or desire. Having more health information clearly displayed is better, as is having a way for people to easily access the information about the positivity of the good stuff that can happen if they make changes. That’s why having guidance on products or easily accessible in retail outlets is so key. Your life could be this much better tomorrow. Look what you could do. You don’t need to stop. Even a reduction can help.
This is where the industry could have opportunities to innovate. They could innovate new products, new things. There is a whole market that could expand and grow and tons of new people and consumers who could be reached.
Looking beyond that is key, but cancer is one that gets everyone’s attention, for sure.
Senator Arnold: Mr. Cunningham, it sounds like you were involved in the whole tobacco initiative. Any advice for us going forward? What were some of the biggest learning that you had?
Mr. Cunningham: Well, they work, but we had to overcome years and years of opposition from the tobacco industry, and we’re hearing similar arguments. One of their arguments was, everyone knows the health effects of smoking, but surveys demonstrated that Canadians really underestimated that.
Mr. Purcell earlier referred to such a high proportion of Canadians not being aware that alcohol causes cancer. The industry would object to the costs, yet there are warning labels on alcohol containers in the United States. In terms of cost feasibility, it has been demonstrated nearby. We can anticipate a lot of arguments from the industry, but we had to overcome those and we had success and good public health in the end.
The Chair: Thank you very much.
Senator Greenwood: Thank you to the witnesses for being here today and, of course, for the work that you do for all Canadians.
I have two questions. It follows up on what my social worker colleagues have brought forward. First, do we have disaggregated data by population, by age, by ethnicity, on alcohol consumption? Do any of you have that?
Dr. Caudarella: Yes, we will be releasing a new version of “Canada Substance Use Cause and Harms”, which we collaborate with the University of Victoria to produce. In it, it looks at different jurisdictions, men, women, different age groups. It uses a lot of health data combined with purchasing data and different tools. We can provide a technical briefing on the release to the committee.
Ms. Motluk: And we use their data.
Senator Greenwood: Thank you. That’s important when we think about knowledge translation. Who are we targeting? And to your question, there is a link to the determinants of health for people. When we know who we are targeting, how can we be most effective in knowledge translation if we know that kind of information is always helpful. There isn’t much of a question in that.
In my office, we received a letter from an industry stakeholder who is against the bill. They are making the point that they were looking at the low-risk drinking guidelines report and making statements like, “It is clear that those involved in these efforts believe that less alcohol is still too much alcohol, despite well-established, global evidence that exists demonstrating moderate alcohol consumption may provide some health benefits.”
That’s what is being suggested in the letter, and then they give some examples. The letter also cites the Mayo Clinic and it doesn’t mention the study it was pulled from, and I understand that may have been debunked recently.
My question is, if you were presented with this letter, how would you respond?
Mr. Purcell: This is one of the tactics that I referred to. The industry, like the tobacco industry, works to slander the work of professionals who are involved in their area of focus. I don’t particularly see the issue with someone who focuses on alcohol research doing a paper on alcohol research. If I was having brain surgery, I would not go to my foot doctor, personally speaking. Specialization is important.
We’ve seen this time and time again from the industry. When they do have the chance to appear next week, asking them about the link between alcohol and cancer is something that they should be forced to have a conversation on.
Ms. Motluk: One of the things that has been helpful is that we are not for abstinence only. We promote choice. The industry has ignored people who struggle with alcohol. If they give it any attention, it is within their fault. They have never really acknowledged that there is a population who needs help with their product.
When we address the industry, we talk about hope, care, treatment, acknowledging support for families. It does seem to resonate. We are starting to see, in our area, the ability to partner with industry a little bit. But on a global scale, you’re going to be hard pressed.
Dr. Caudarella: If you read the report, it’s very clear. Any reduction is good. Previously, there was a line drawn in the sand, which was beneficial to industry, because if you are above that line, forget about it. I’m not even going to think about. And it guarantees a kind of safe pass below that line. We don’t offer that safe pass when it comes to hamburgers or anything else. We don’t go around telling people as long as you do this, you’re 100% safe. This is actually much more in keeping with what we’re talking about and when we are out there doing our knowledge mobilization, we are very, very clear that any reduction is good and healthy and in fact, those who drink the most will benefit the most from small reductions.
As for those other pieces around moderate drinking, World Heart Federation, WHO, every big global body has come out clearly, alcohol is not good for your health. We talk about that in the context of a lot of food and other things. Why are we still pretending about this?
The Chair: I know you could go on.
[Translation]
Senator Boudreau: I’d like to thank the witnesses for being here today.
There is no doubt that habits have changed since 1988. As we’ve heard here, there was a period of time when you could safely consume a certain amount of alcohol. Now, it seems we’re being told that no amount is safe.
Pragmatically, I’m trying to understand. When we talk about a bottle of beer, wine or spirits, the alcohol percentage is different. When we talk about labelling, will it be the same regardless of the alcohol percentage? It seems people are saying that no amount is safe. Are we talking about a label that applies to everything or do you think we’re talking about different kinds of labels or different messages on labels depending on whether it’s wine, beer or spirits?
Dr. Caudarella: It depends less on the type of alcohol than on the information. As I mentioned, it’s important to have information on health and alcohol content without needing a calculator, because now there are beers that contain 5% or 7% alcohol and wines that contain 12%.
What can we do? Just because there is no completely safe zone doesn’t mean that a person should never drink. It’s more about what you do with the information depending on the conditions you’re concerned about. What we’ve heard since the pandemic is that people don’t want things spoon-fed to them. They want data, they want information. That’s what we have heard.
I think there is less talk about the type of alcohol and more about the amount of alcohol and its effects on health. Because whether it’s 10 beers or a shot, ultimately, you need to know what your daily consumption is. All of these components contain ethanol, and it’s ethanol and acetaldehyde that are the carcinogens.
[English]
Mr. Purcell: Certainly one of the most important pieces for us is that piece on what is a standard drink and how much standard drinks are in each bottle? That can get confusing for consumers when you are talking about liquor or wine or beer, because it is so different from drink to drink. Having that information on what is a serving size? How many standard drinks are in this bottle of wine or this bottle of vodka? That’s part of the education, that transparency to ensure Canadians have access to that information. As we’ve all been saying, they do have the right to know that information.
[Translation]
Senator Forest: I am trying to replace my colleague Senator Petitclerc here. First of all, I would like to thank Senator Brazeau because personally, it was his battle that brought me to think about the impact of alcohol on health and cancer.
It’s clear that hard alcohol can, for example, have a higher level of alcohol than wine or beer. How can we ensure that a normal person can make the connection between a standard glass from a bottle of gin and a standard glass from a bottle of wine or beer?
Dr. Caudarella: There are several ways, but at the end of the day, you have to know how many standard drinks are in the bottle, not necessarily the volume of alcohol. That’s why in restaurants and bars, you need to know how many standard glasses are in each bottle. This information can be difficult to find.
Sometimes there is an opportunity to clarify things. Many people will say that they don’t drink whisky, just beer. As a doctor, I have seen many more people with health problems related to beer, because it is often cheaper and easier to find than other drinks. The public needs to be educated so that they know that alcohol is alcohol. It doesn’t matter what form it comes in. Many scientists and experts are looking at whether the visual can be an indication of the number. We hope that no one is going to drink an entire bottle of vodka. When you pour the contents into a glass, how many drinks does that represent? How do we communicate that? You’re right: There are proportions to consider. However, the person ultimately needs to know that alcohol is alcohol.
[English]
The Chair: We are at the point of entertaining a second round, but we don’t have the time. We have four senators who went to ask a second question. Can you ask your questions, direct it specifically to one of our witnesses, and we request that you send us a response in writing? That way we will get the questions on the record, and your answers will come in writing. I will start with Senator Hay.
Senator Hay: Thank you. Great idea. I will rapid fire. My question is for you, Dr. Caudarella. I was struck by the notion that information is hope. I will probably say something off, but the power of the alcohol industry lobby appears to me as our Canadian version of the U.S.’s NRA. That might be really off, but my question is, in your opinion, CCSA released the Canada’s guidance on alcohol and health. Why has it not been formally adopted into federal policy? Therefore, I’m worried that, with Bill S-202, An Act to Amend the Food and Drugs Act (warning label on alcoholic beverages) even going right through to the end that it just becomes orphaned, ignored or not actioned.
Senator Muggli: As we are sitting here, I just got CCSA’s report on the people behind the data. Thank you. Timely. With the labelling comes impact, with impact comes someone saying, “Oh, I need to do something about my problem.” What does that person do next with that problem? In my view, with 36 years of experience in this field, we have a severe lack of detox centres, the first entry point where people can actually address medical health issues in order to be safe and well enough to enter any kind of treatment? What role might CCSA be able to play, in promoting — because this is often a provincial health-care issue — that first interaction when people do make that decision?
Senator Bernard: I think my question is directed to Mr. Purcell. I think you used the term commercial determinants of health. I would like to know more about that. I would like to have more information on this term, it is new to me.
Senator Senior: I am interested in the research that you mentioned, Dr. Caudarella, the disaggregated data research. So if you could share that with us? I am wondering if that’s the only research in terms of disaggregated data? You mentioned gender and a couple of other things. Does it also cover the gamut of disaggregated data in terms of all groups?
The Chair: Thank you. Senators, this brings us to the end of the first panel. I would like to thank Mr. Purcell, Mr. Cunningham, Dr. Caudarella and Ms. Motluk for their testimony today. It has been inspiring.
For our next panel, we welcome the following witnesses, joining us by video conference, Sheila Gilheany, Chief Executive Officer, Alcohol Action Ireland; Catherine Paradis, Technical Officer, World Health Organization Regional Office for Europe; Dr. Timothy Naimi, Director, Canadian Institute for Substance Use Research, University of Victoria; and Dr. Tim Stockwell, Emeritus Professor and Scientist, Canadian Institute for Substance Use Research, University of Victoria.
Thank you for joining us today.
You will have five minutes for your opening statements followed by questions from committee members. Ms. Gilheany, please start.
Sheila Gilheany, Chief Executive Officer, Alcohol Action Ireland: Thank you.
Alcohol Action Ireland is a public health advocacy group, working to reduce harm from alcohol.
I am honoured and pleased to be invited to give evidence in relation to the committee’s work on alcohol warning labels. I want to highlight some developments in Ireland in this area.
In 2018, the Irish parliament passed legislation which provided for a range of modest public health measures to address a significant alcohol issue in Ireland. These measures included things like minimum unit pricing for alcohol, controls on alcohol advertising, structural separation of alcohol in mixed retail outlets and health information labelling of alcohol products.
The labelling measure required secondary legislation to give effect to what the label would look like in terms of its size, font and wording.
The Chair: Ms. Gilheany, I am going to ask you if you could slow down just a little, so our interpreters have a better opportunity.
Ms. Gilheany: The secondary legislation was published in 2022. It includes a warning that alcohol causes liver disease, that there is a link between alcohol and fatal cancers and a graphic about not drinking in pregnancy, as well as basic information on the amount of alcohol and energy values in the product, plus a link to a public health website for more information. It was very comprehensive labelling.
That legislation then went through regulatory processes within the European Union. At the end of a six-month process, the European Commission decided that Ireland’s labelling regulations did not constitute a barrier to trade or the single market and, indeed, that they were proportionate to the scale of alcohol issues in Ireland. The regulations were then sent to the World Trade Organization and defended there by the European Commission. It was signed into law in May 2023 with a start date of May 2026.
I will say that this date has now been pushed back to September 2028. However, there are already multiple products carrying this label. Since April 2025, it has been seen on dozens of brands of wine, beer and cider. This week I saw it on some spirits as well.
Just to note, the legislation relates to the retailers of alcohol rather than producers. If a producer does not include the label on the bottle, the retailer can simply add a sticker with the relevant information. This is intended to help small producers and importers.
So why have such labels? We strongly believe that the consumer has the right to know about risks of alcohol. Unfortunately, there is a low level of public knowledge. For example, in Ireland recent research indicates that fewer than 4 in 10 people are aware of the link between alcohol and cancer.
Cancer is now the leading cause of death in Ireland. Each year, there are approximately 1,000 alcohol-related cancer cases. One in eight breast cancers in Ireland is caused by alcohol. The cancer risk arises at even relatively low levels of alcohol consumption, around one to two drinks per day. I won’t go into the evidence on this because you’ve already heard about that in the previous panel.
It is not surprising that there is a low level of public awareness as the alcohol industry has consistently sought to obscure or downplay cancer risks. For example, during the EU notification process, many of the industry’s well-coordinated submissions used what you might call a complexity argument. They argued that the association between alcohol and cancer risk is apparently complex and cannot be adequately explained in a single warning label and that this is a complicated scientific and policy issue that people couldn’t possibly get to grips with by giving them public health information.
In the media, the industry continuously distorted, downplayed and otherwise obfuscated the evidence linking alcohol and cancer through these industry arguments. Indeed, many industry arguments were repeated, like that the cancer warning was inaccurate, unproven and based on false or unsound evidence.
However, the evidence linking drinking and cancer is well established dating back to at least 1988 and has only grown stronger. In 2023, the World Health Organization and the International Agency for Research on Cancer declared in a joint statement that “ . . . no safe amount of alcohol consumption for cancers can be established.”
The alcohol industry also made claims about the costliness of such labels. However, after speaking to The Spirits Business, an international trade magazine, Elliot Wilson, co-founder and strategy director at drinks marketing agency, The Cabinet, admitted that the immediate cost impact on the industry would be limited, saying:
The actual physical cost isn’t going to be prohibitive. People have all sorts of labelling, and it’s a straightforward adaptation to the label . . . .
However, the crux of the matter was revealed by minutes of lobby meetings in Brussels, which show how Europe’s major alcohol producers feared that Ireland’s health labels would set a precedent for other EU members states.
Of course, the root of their concern is expressed clearly by Heineken, the major beer producer, in its annual report to shareholders, which noted that the addition of health information labelling could lead to lower consumption of Heineken.
The Chair: We have run out of time. Ms. Gilheany. I’m sure that you will have the opportunity to finish off your thoughts as senators ask questions.
Ms. Paradis, if you could go ahead. Thank you.
[Translation]
Catherine Paradis, Technical Officer, Regional Office for Europe, World Health Organization: Good afternoon, Madam Chair and honourable senators. Thank you for your invitation.
My name is Catherine Paradis, and I am the Technical Officer at the Regional Office for Europe of the World Health Organization.
Today, I would like to show how Bill S-202 is consistent with the recommendations and scientific data of the WHO.
I have three messages to share with you.
The first message is that the purpose of the bill, which is to reduce alcohol-related harm, is fully consistent with the WHO’s position and its most recent publications.
In Europe, alcohol causes about 656 deaths every day. Among young adults, alcohol is responsible for one in four deaths in men and one in six deaths in women.
Just a week ago, the WHO and the International Agency for Research on Cancer reaffirmed that alcohol is a Group 1 carcinogen and that there is no safe level of consumption that is free of risk of cancer.
Beyond health, premature deaths from alcohol-related cancers result in approximately 4.6 billion euro in lost productivity every year in Europe. These resources could be used to support innovation or education, for example. Reducing alcohol-related harm saves lives and strengthens the economic and social resilience of countries.
The WHO’s work shows that so-called “best buy” policies on the alcohol pricing, availability and marketing are effective in reducing consumption. However, for these policies to be accepted, citizens must first be informed of the real risks. Bill S-202 meets this requirement.
The second message is that the bill’s proposed instrument for informing citizens, which is labelling directly on containers, is fully consistent with the WHO’s position and its most recent publications.
Some will say that there are other ways to inform the public, such as awareness campaigns, warnings on advertisements and education in schools.
In Europe, QR codes are often touted as a modern and effective alternative. However, all studies conducted by WHO/Europe show that this is not the case. Nearly 50% of QR codes tested in 13 European countries redirected users to promotional sites rather than health sites. One survey found that only 27% of consumers would scan a QR code if given the opportunity. In a supermarket in Barcelona, only 0.085% of customers actually scanned a QR code that was available to them.
Let’s be very clear: QR codes serve commercial interests, not public health. Citizens have the right to clear and immediate information directly on the container at the time of purchase. Bill S-202 makes this right a reality by promoting transparent labelling that is accessible to all, in keeping with the spirit of public health advocated by the WHO.
The third message is that the warning proposed by the bill, namely, the causal link between alcohol and cancer, is fully aligned with the WHO’s position and its most recent publications.
In 2024, WHO/Europe demonstrated that labels explicitly mentioning the link between alcohol and cancer were most effective at informing the public and fostering dialogue. A study of 20,000 people in 14 EU countries confirmed that these warnings significantly increased awareness of the association between alcohol and cancer in all countries studied, that these warnings were effective across all socio-demographic groups, and that these warnings generated more discussion and intention to reduce consumption than more general messages.
When a label mentions cancer, it gets noticed, understood, remembered, and it changes perceptions. Bill S-202 follows this logic: It focuses on a clear and factual warning consistent with the latest scientific evidence.
In conclusion, the WHO Global Action Plan and the European framework call for mandatory labelling that is clear and independent of commercial interests. Bill S-202 is part of this global movement toward transparent, science-based information for public health. Well-informed citizens mean a better-protected society.
Thank you for your attention. I will be pleased to answer any questions you may have.
The Chair: Thank you, Ms. Paradis.
[English]
Timothy Naimi, Director, Canadian Institute for Substance Use Research, University of Victoria, as an individual: Madam Chair, I appreciate the opportunity to testify. I am a board-certified physician in both paediatrics and internal medicine. I will make three points and then turn it over to my dear friend and colleague, Dr. Stockwell.
First, the most compelling argument for labelling of alcohol products is to be found on this humble and nutritious can of Canadian-sourced green peas. This can of peas has information on the serving size, the four ingredients contained in the can and calorie information. I am quite confident that if these green peas were a Group 1 carcinogen or the leading preventable cause of intellectual disability among Canadian youth or that if one in four people who begin eating green peas were to develop a pea addiction in their lifetime, the label would probably say that, too.
This fine bottle of whisky, sourced from my own stash, on the other hand, reports that it is “smooth and oaky,” but, other than that, it just says, “40% alc/vol.” What does that even mean to consumers? There is no information that alcohol causes cancers, nor information about the serving size of a standard drink, nor the number of drinks in this container — which happens to be 17 — let alone information about drinking guidance or ingredients.
Second, having been born in the United States, I am very proud to report that I am honoured to have become a Canadian citizen just a few short months ago. Although Canada excels in virtually everything, my one area of regret is that in the U.S., which has far less regulation than Canada, generally speaking, mandatory health information has been provided on alcohol labels for almost 40 years. Canada, you are better than the U.S.
Third, we recognize that alcohol companies have been lobbying furiously around this topic. We, in fact, just published a paper around the alcohol lobby in the period surrounding the release of the Canada’s Guidance on Alcohol and Health. It’s a sad fact that not a single public health organization in Canada has a dedicated in-house lobbyist, let alone one who is detailed specifically to alcohol. Yet, despite this relative lack of lobbying power, the Canadian government has a purpose, a dual mandate, not just to promote commercial interests but to protect the health and well-being of its citizens.
As it is, and as you have heard, Canadian taxpayers bear almost 33 cents per standard drink in excess cost compared to the tax revenue generated from alcohol.
In closing, Canadians have a right to know basic information. The consumers’ right to know and an industry’s duty to inform are not just moral issues; they are legal ones. There is a nascent movement to hold governments to account for failure to disclose even the most basic information about alcohol.
I hope, for everyone’s sake, that the federal government will do the right thing to correct this abrogation of its own standards and fundamental principles.
I’ll turn it over to Dr. Tim Stockwell.
Tim Stockwell, Emeritus Professor and Scientist, Canadian Institute for Substance Use Research, University of Victoria, as an individual: Thank you. I just want to highlight that we’ve done research on this area at the Canadian Institute for Substance Use Research over the last 20 years. I will just highlight three areas, and then we can take questions.
One is on the cost and the harms, where we collaborate with CCSA. I can tell you, in our best estimates, over 3,000 Canadians die each year from alcohol-related cancers, and over 20,000 people are admitted to hospital with alcohol-caused cancers.
We’ve also done research uniquely in collaboration with Public Health Ontario evaluating labels in a real-world study exactly like the labels being proposed in Bill S-202. In the Yukon, labels were introduced with a cancer warning and standard drink information and guidance on low-risk drinking levels. We evaluated them, and we have 12 published papers on those.
Finally, I would highlight that we have contributed to the literature, carefully examining evidence of whether alcohol in moderation is good for health, whether it promotes heart health and the extent to which and how you would balance potential benefits against some established risks, like cancer.
I just have one prop. My colleague had a can of peas. I’ve got a little cannabis product here with a bright yellow warning. There are 14 labels on cannabis products.
I’ll just close by highlighting how our best estimates of the economic cost of alcohol versus cannabis: $20 billion in costs for alcohol a year and just over $2 billion for cannabis; one hundred and eighteen thousand hospital admissions contributed to alcohol each year versus about 8,000 from cannabis; and 17,000 deaths from alcohol per year versus just over 300 for cannabis.
With that disparity, I really hope you would allow that Canadians do have a right to know this.
I have to say that the feedback we had when our study was shut down by the alcohol industry in the Yukon, it was outraged. It was palpable. The level of public support and sympathy for the idea that we need better information, particularly in communities most impacted by alcohol, like in the Yukon, it’s the strongest support for alcohol policy positions I have ever experienced. I’m happy to answer more questions after.
The Chair: Thank you, Mr. Stockwell. Thank you to all of you for your opening remarks.
For this panel, we want to get straight into questions. Senators, you will have four minutes for your question and answer. Please indicate if your question is directed to a particular witness or to all witnesses. The first question will be Senator Osler.
Senator Osler: Thank you to the witnesses for being here today. My first question is primarily to Dr. Stockwell and perhaps Dr. Naimi.
Bill S-202 is about providing people with information. Are you able to quantify the economic benefits, either in reduced health care costs or reduced social costs, of people making informed decisions on their alcohol consumption?
Mr. Stockwell: Yes, we have attempted to do that. The process involves estimating impacts on the level of consumption. For example, in the Yukon, we were able to observe that introducing these rotating labels, consumption — measured through the liquor control agency, the retail alcohol stores — went down 6%. We’re able to estimate what that means in terms of reductions in deaths and lost productivity, reduced hospitalizations and put some economic value to that.
There are assumptions behind all of those, but we have made ballpark figures of what it means to reduce consumption in terms of the economic benefits.
Senator Osler: Are you aware, is there international data that shows there are economic benefits associated with consumers making informed choices?
Mr. Stockwell: They may still decide to drink, of course. So what I was interpreting your question to mean, if people choose to say, for example, avoid cancer or count their drinks more carefully, they might reduce their consumption that way, we can quantify — and it’s being done internationally and in Canada — the health benefits to our population and individuals, both in terms of incidents of harm and the economic costs of those.
Senator Osler: Are you able to provide this committee with that information in a written submission?
Mr. Stockwell: Absolutely.
Senator Osler: Thank you.
Senator Hay: Ms. Gilheany, please give my regards to my friend and former colleague Ian Powers, who is your minister of state at cabinet for mental health.
However, my question is for Ms. Paradis from the World Health Organization. WHO’s European Youth Alcohol Network has rapidly expanded and is now engaging young people in alcohol policy, research, advocacy across 30 countries.
From a policy perspective, what evidence do you have that youth-led initiatives like this can meaningfully shift alcohol-related behaviours among young people, and how should national governments like Canada leverage youth networks to inform and implement effective alcohol harm-reduction strategies?
Ms. Paradis: Thank you very much for this question. Yes, indeed, it has been now close to two years since we launched a youth network across Europe. We now have over 100 young people under 30 years old who take part in this network.
I think one of the greatest benefits has been for them to be very vocal about certain assumptions that are made about what they want and what they like and how they want certain products to be offered to them. These young people have been extremely vocal about saying that they have a right to know, and they want to know what they consume.
But what has been very interesting in this network is that the vast majority of members are actually medical students, residents or young doctors. They all started their career realizing that they were going to be overwhelmed, but that in fact much of their time would be spent doing things that were curing disease and conditions that are entirely preventable. They felt that was just not right.
This is what has led many of them to come forward, to speak not only as young people, but as young health professionals also who have so much to take care of and find that it is really a pity to take care of conditions that are preventable and for which people do not have the information they should have.
Senator Hay: Thank you. Your advice to Canada on youth-led networks?
Ms. Paradis: I think that having the youth voice to take part in any policy discussion is always a marvellous idea. I mean, they are the ones who are going to be living for the longest period of time with the decisions that are being made, so it is definitely in their interests and in the interest of government to consult with youth.
Senator Hay: Thank you.
[Translation]
Senator McPhedran: My question is for Ms. Paradis.
Thank you for that concise presentation. Is there a country that excels at reducing alcohol consumption? And what steps are being taken to achieve those results?
Ms. Paradis: Thank you very much for your question.
Yes, I have an example that comes to mind. In Europe, Lithuania is really the country that currently excels at implementing alcohol-related policies. In recent years, Lithuania has moved forward with so-called “best buy” policies, particularly with regard to the availability of alcohol.
Let me give you a concrete example. They decided to reduce the number of hours that alcohol can be sold on Sundays only. Following the implementation of this policy, they have significantly reduced the number of emergency room admissions on Sunday evenings, as well as the number of deaths related to cardiovascular disease on Mondays. So we can see how a simple small adjustment in alcohol-related policy can lead to immediate results with very significant economic consequences. When you think about the money spent on these alcohol-related admissions and hospitalizations, you can imagine how much of that money can be redirected by a government to areas where it would be far more productive to invest. Lithuania is truly an exceptional model.
Let me give you an example of policy related to availability. What is also very interesting about Lithuania is that their data allow us to see a relative synchronicity between the moment a policy is implemented and the decline in premature mortality, and vice versa. We don’t have to wait years to see this effect. It appears within months of such a policy being implemented.
[English]
Senator Brazeau: Welcome to the panellists. For the benefit of my colleagues, it is primarily because of the three witnesses before us today that sort of helped me and inspired me into introducing this bill, because I had watched a CBC documentary in July of 2021. First reading of this bill, its former iteration, Bill S-254 was done in November of that same year. We’re all here.
So my question to all of you is that obviously you have dealt with Health Canada in the work that you have done. Obviously just with the two Dr. Tims, your work has not gone unnoticed for the last decade. You have dealt with Health Canada. They fund a lot of the work that you have done throughout the years. Unfortunately, Health Canada also doesn’t move forward with a lot of the recommendations that your organizations have sent to Health Canada.
Could you share with us why you think it is that Health Canada is on idle or on park right now, with respect to alcohol policy?
Dr. Naimi: Well, I think that would be best left to Health Canada. I also want to give Health Canada praise for some things. I know Health Canada lives in a political infrastructure as well and is susceptible to heavy industry lobbying. I want to make sure that Canada’s Guidance on Alcohol and Health, which was mandated and funded by Health Canada, convened by CCSA — that is Canada’s guidance on health whether the government chooses to endorse it or not. Health Canada was involved in that effort.
My personal opinion, without knowing the particulars, is that there are a lot of political considerations that go into health policy, and I will leave it at that.
Senator Senior: Thank you all for your testimony. I particularly enjoyed the very pragmatic props and examples. It really brings the issues to light.
One of my questions was answered in terms of the region of Lithuania. That was explained earlier, so thank you for that.
I live in a province where our premier campaigned, in part, on the “Buck-a-Beer plan,” even though I understand that he doesn’t drink. I find that very interesting.
In regions that don’t have labelling, like Canada and others, what is their consumption level per capita compared to regions that have labelling, like the U.S. and Lithuania? I am interested in that perhaps from Ms. Gilheany, and certainly one of the Dr. Tims would be helpful, but also from the WHO.
Mr. Stockwell: Thank you for the question, Senator Senior. The first thing I would say, this is a big issue that WHO Euro has been tackling, because I worked with Catherine Paradis on a technical advisory group to develop an alcohol warning label for Europe. We decided we shouldn’t have false expectations that just putting on these health messages for consumers would change behaviour necessarily. We did, surprisingly, against our strongest expectations, find a reduction in consumption in the Yukon Territory, which has the highest levels of consumption and the greatest suffering from alcohol of anywhere in Canada.
It is possible, but it is more inspired by the spirit of giving consumers information to make choices. We don’t know what they will do necessarily with those choices and whether the Yukon experience can be replicated.
In the world, since WHO gave the advice that alcohol is a carcinogen, as was mentioned, South Korea has introduced a liver cancer warning but it is voluntary. The producers don’t have to use it. Ireland has attempted to introduce a cancer warning, and only about 10% of products have been labelled because it hasn’t been enforced, and it has been delayed because of industry action.
The evidence from the U.S. with their warning label — it’s a dull message that hasn’t changed in about 40 years. People probably don’t notice it; it is so technical and dull. We had colourful rotating messages that we tested with focus groups in rural, remote parts of Yukon, with Indigenous communities and stakeholders, and we found them very impactful. It could be that the well-designed labels in the Yukon were the reason that we found some impact on behaviour.
Ms. Gilheany: To add to that, Ireland’s labelling regulations, as Dr. Stockwell said, are not fully in force yet. They are also linked to another measure within the same piece of legislation, so that when alcohol ads are shown, when it’s fully implemented, they will have to show the same warnings as part of the advertisement. An alcohol ad would require a line saying that there is a link between alcohol and fatal cancers and that alcohol causes liver disease. The same warnings will be on the labels. I think that’s also a sensible thing, to link labelling with advertising.
I, myself, look at labelling as a “consumer’s right to know” issue. Where possible, it should be part of a broader package of measures, which would use the WHO’s “best buys” and controls on price, marketing and, very much, availability, as Ms. Paradis said earlier.
Senator Boudreau: I have two quick questions. With all the information we’ve received on this topic, I have yet to see some actual examples of what these labels could look like. I would be curious if any of the witnesses have some concrete examples of labels to share with the committee, not necessarily here on the spot but as a follow-up or as a takeaway.
Also, following up on my earlier question to the first panel, in your experiences, which are lived ones with some countries where there are labels, are the labels the same for all alcohol products, or do they vary by type if we’re talking beer, wine or spirits? I am curious if there are different labels, or are they the same for all products? Thank you.
Ms. Paradis: I will let my colleagues answer more specifically about the international examples, but I would like to comment on that. In the previous panel, you also asked that question about the different beverage types and whether they require different labels. It is very important for the committee to understand that it is not specific types of beverages that cause cancer and cause harm. It is ethanol, regardless of whether it comes in the form of beer, spirits or wine. All beverage types should have a label informing people about the risk of consuming alcohol.
Then, of course, comes the quantity. We are all aware that different containers contain different quantities of alcohol, and that should be addressed, too. But let me be very clear. There is no need for different warnings for different types of beverages. Ethanol causes cancer.
Mr. Stockwell: Thank you. We submitted a policy brief before the session today, and there are some images of the warning labels used in the Yukon, which, Senator Boudreau, you might find helpful.
But you are quite right, as Ms. Paradis was saying, about standard drink information, which is something I worked on when I lived and worked in Australia. Australia and New Zealand have standard drink labels, and, of course, every product is slightly different. They present the number of standard drinks to within one decimal point. So, with about 10,000 or 20,000 products on the market, each one — well, not each one, but they all gravitate to some similar numbers. So, yes, the standard drink information would be more variable, but it is the ethanol to which the health warning applies, and that’s universal.
The Chair: Thank you.
Senator Bernard: My question is to the two doctors. In the last panel, there was reference to commercial determinants of health. They suggested that you may have done some research in this area. I would be interested in hearing more about the concept of commercial determinants of health and how they fit with this work that we’re doing with this bill.
Dr. Naimi: That’s a great question. Thank you, Senator Bernard. We talk about social determinants. We know, first of all, health, typically in Western countries, is constructed as an individually based thing, right? But we know that, in fact, it is the environment that creates a lot of ill health.
People talk about the social determinants of health, things like poverty or relative lack of education, perhaps. These are social determinants of health, but there is another class of important health factors which are commercial determinants of health. That is to say that the power and the marketing on the pro side and power to thwart common sense interventions are commercial determinants of health. Those relate to things like tobacco, alcohol, sugar-sweetened beverages, these sorts of things, even things around gambling, things that can fuel addictive behaviours. It is a way of recognizing an important class of health risks of which you certainly see a lot of in the alcohol arena.
Senator Bernard: Thank you. Has there been specific research in this area?
Ms. Paradis: I can submit to the committee afterwards, but in June 2024, WHO Europe came out with a report specifically dedicated to the commercial determinants of health, referring to the ways in which the private sector, especially large corporations, produce, market and sell their products in a manner that has a direct impact on the health of populations. I can send that report to the committee.
Mr. Stockwell: If I could add an example of this in practice in Canada. Our Yukon cancer warning labels survived 29 days until legal threats from the Canadian distillers, brewers and winemakers caused the Yukon government — although they said publicly that they supported the initiative and the WHO message, they didn’t have deep-enough pockets to defend themselves legally.
This incident became a news story across Canada and worldwide. There was a lot of public outrage that an industry could behave like this, but it is a very concrete example of how commercial vested interests would try to keep us in the dark, keep consumers in the dark about important information about the products they make so many billions from.
Senator Bernard: Thank you so much.
The Chair: The document Dr. Stockwell spoke to earlier has been distributed and it is posted online under committee briefs if you wish to look at it.
Senator Greenwood: Thank you to all of the witnesses who are here today, and thank you for all the work that you’ve obviously done.
I had a question for Dr. Stockwell, but Senator Bernard just asked it. I was curious about the Yukon study and the power of the alcohol lobby groups to influence, and you just described that in your response. Thank you for that.
My question for Ms. Gilheany is around industry lobby groups. You talked about this as a public health issue in four different areas in which you have addressed alcohol usage. I am assuming that you faced alcohol lobby groups as well. Could you share some of the experience you faced in Ireland?
Ms. Gilheany: Yes, there has been and continues to be enormous levels of lobbying by the alcohol industry, and I can send you reports that detail the very intensive lobbying that there has been. During the passage of that bill that I mentioned, the Public Health (Alcohol) Act, on a daily basis there would have been contact with the politicians’ representatives. There was also very high-level meetings with the Taoiseach of the day, the Prime Minister, the senior members of government. That continues right up to today, because although the legislation passed and we have an implementation date, that has now been pushed back to 2028. That came about because of extraordinary levels of industry lobbying.
You tend to find that this industry is very skilled at what it does. It has multiple different types of representations. You will have producers and their representatives. You will have retailers and their representatives. You will have the advertising industry and their representatives. They will all be seeking meetings with different branches of government. It is not just that they are lobbying the health department. They are lobbying the agricultural department, the economic affairs enterprise. There are many different entry points.
We know, for example, in the first four months of this year that members of the alcohol industry met with senior government members at least seven times in face-to-face meetings. They have a lot of contact and a lot of power, I would say.
Senator Greenwood: Thank you.
Senator Muggli: I think my question is for Dr. Naimi and Dr. Stockwell. Do you know if there are labelling requirements for alcohol-based hand sanitizer?
Mr. Stockwell: No, I don’t.
Senator Muggli: I ask because, if there are, what’s the difference? What’s the relationship? You can drink hand sanitizer. Trust me, I’ve seen many people in the hospital after ingesting hand sanitizer. If it is label-worthy for hand sanitizer, then why wouldn’t bottles of alcohol be label-worthy?
Mr. Stockwell: I believe, and I’m sure this can be easily checked, that they are required to put the percentage of alcohol content on the label. I could be wrong. That applies to rubbing alcohol that you can buy, and that’s misused by people on the street sometimes. If mouthwash has alcohol, it is required to label the amount of alcohol.
There is evidence that people who use alcoholic mouthwash are more prone to getting oral cancers, which is quite a striking thing. There is research on this.
Dr. Naimi: Senator, I have not looked at the bottles of hand sanitizer, but I believe they say it is not for ingestion. Is that not correct?
Anyway, the purpose of the policies pertains to packaged food and beverage products, in which alcohol stands alone in Canada as not requiring any kind of information. I don’t think that hand sanitizer is intended as a packaged food or beverage product. That’s my response to that question. Many products are used in ways in which they are not intended. But we should perhaps add standard drink information on the hand sanitizer as well. It is a good idea.
Senator Muggli: Thank you.
Senator McPhedran: I come from Manitoba, and we have the only remaining independently owned major city newspaper, the Winnipeg Free Press. This morning, the editor Paul Samyn, noted that the ratio between flacks and hacks, the publicist versus the journalist, is now 14:1 in the industry. I note the similarity to comments made from this panel about the massive capacity of the profit-seeking alcohol industry versus the capacity of governments.
Thank you for the clarification that the two-year-plus delay in Ireland seems to be directly attributed to this situation.
My question is whether there is research being done on what I would call intimidation methodology that we see here. We saw very clearly in the many, 20 plus, years trying to bring about reduction in smoking many of the same techniques we are discussing here. That’s quite well documented, the intimidation methodology of the industry.
Is something like that happening anywhere that any of the panellists know about?
Ms. Paradis: My colleagues have referred to a study done in Canada earlier, but from the WHO perspective, in 2024, we published a document entitled the Alcohol policy playbook. It clearly addresses very common questions that people have about alcohol: Does it cause cancer? Who is harmed by it? What effects does it cause? We’ve documented typical answers that the alcohol industry may provide to these questions and then provide the public health response to those same questions.
It is important to point out over here that, whenever you have a question about alcohol that comes from a public health point of view, you need to look at the public health evidence. Why would you ask people from the alcohol industry to inform you about health? Their answer to that will be, “Well, it is our product. It is alcohol and we know it.” I’m sorry, but the issue here is not alcohol. It is public health. And on that topic, they know absolutely nothing. We should stop consulting with them. We need to look at the public health evidence.
This resource, which once again I can submit to the committee, is one that was specifically designed to help policy makers and, journalists to really distinguish when an answer to a question about alcohol is provided to them from a profit perspective or from a public health perspective.
Mr. Stockwell: Mr. Paradis mentioned that they don’t have the expertise. It has not stopped major alcohol groups, including in Canada Éduc’alcool, from producing glossy pamphlets and scientific documents advising whether alcohol is good for your heart — and it would say yes — or whether alcohol causes cancer. It would come up with lots of alternative spins on the existing evidence and give a point of view quite different from the World Health Organization. You will hear that next week. You will hear alternative takes on the science from these groups with a massive, commercial, vested interest.
Ms. Gilheany: One thing that the industry will always argue is some sort of catastrophic effect will come from it, no matter what public health measure is suggested. They will often talk about small producers, and they will say, “This will put this producer out of business.”
One thing that was said very frequently for wine, which is really bizarre, is that because our labels required calorie values to be put on it, it might change from year to year because you would have different vintages and different sugar content, that this would be disproportionate on the wine industry. But chutney and jams are well able to produce different labels with calories and different sugar contents from year to year.
There is always this worst-possible case scenario put forward, but this industry still retains massively high profits, and most of the profits are concentrated in just 10 companies who control the bulk of the alcohol production.
While you hear sob stories or potential sob stories from a small producer, you do have to remember that the thinking on this is coming from the very large producers. There are, as Ireland has demonstrated, ways around things, for example, putting stick-on labels so small producers wouldn’t be disadvantaged.
The Chair: Thank you very much. Senators, this brings us to the end of this panel. I would like to thank all the witnesses for your testimony today. There is no further business.
(The committee adjourned.)