PROFESSOR ROSS FITZGERALD

Peter Sainsbury response ” Tobacco, not alcohol causes most harm in Australia ” (Pearls & Irritations, April 15) makes some valid claims.

But as far as harms are concerned, it is important to understand that, unlike tobacco, consuming alcohol often causes extreme violence and dangerous social disturbance in many drinkers .

Professor Ross Fitzgerald, Redfern, NSW

April 16, 2025

Tobacco, not alcohol, causes most harm in Australia

April 15, 2025

Ross Fitzgerald correctly asserts that alcohol is a significant sources of illness, trauma, premature death and social distress for users and people close to them.

However, “in terms of its harm, alcohol is not by far Australia’s most dangerous drug”. While the proportion of the Australian population that smokes tobacco has fallen dramatically, tobacco is still the drug which causes the most illness and premature death.

In terms of disease burden in Australia (as measured with DALYs which combines premature death with years living with a disability), in 2024 tobacco was the top behavioural risk factor and alcohol was third. Illicit drug use was fourth. Of the total DALYs lost, tobacco was responsible for 7.6%, alcohol 4.1% and illicit drugs 2.9%.

Looking at only years of life lost due to premature death, tobacco caused 11.7%, alcohol 5.4% and illicit drugs 4.2%, together accounting for more than a fifth.

Alcohol is, however, a bigger problem than tobacco in both sexes before age 50, when tobacco leaps ahead.

Tobacco, alcohol and illicit drugs all cause significant health and social problems in Australia. To reduce that harm, more resources should be invested in evidence-based prevention and management of all three.

Peter Sainsbury, Sydney

Pearls and Irritations, April 15, 2025