Alcohol issues are a cause today for intense public health concern in most countries of the world. That assertion is valid for rich nations whose encounters with drink have long histories, and poorer regions where the adverse consequences of alcohol may begin to threaten national development.

Within the modern Public Health perspective, alcohol, the commodity itself, is an issue of concern as well as the problems which drinking generates. The reason for taking this position is the overwhelming strength of the research evidence showing that the more an individual drinks, the greater the risk of that person sustaining alcohol-related harm. Similarly, the higher the national per capita alcohol consumption, the greater will be the alcohol-related burden of costs and damage for that society.

The Public Health perspective is also illuminated by studies which demonstrate the immense variety in types and degree of the problems which can be caused by drinking. The concerns must be with the sum of small problems as well as with large problems, with harm done to the family or bystander as well as the direct consequences for the drinker themselves, with acute mishaps as well as chronic illness, and with the problems which occur in the social as well as the medical domain. These matters cannot be tidied away by directing our responses solely at ‘ the alcoholic’.

Dr Harold Holder' s analysis brilliantly exemplifies this perspective. While not discounting the background importance of national alcohol policy responses, he offers an analysis at the level of local community.