Cancer Labels on Alcohol? Ireland, Where Pubs Still Rule, Will Have Them by Next Year

St. Patrick’s Day falls on a Monday this year, meaning the holiday honoring the fifth century missionary concludes a weekend of parades, parties, and—of course—drinking.

St. Patrick's Day, and its alcohol promotions, have gone global. | Image: Blog Red

Alcohol’s hold on a day that recalls the arrival of Christianity in Ireland has always created some irony. In today’s Ireland, defined for generations by pub culture, that irony is amplified by the country’s effort to rein in excess alcohol consumption, now aided by a landmark 2018 law.¹

As alcohol’s toll soars worldwide, the story of the law’s passage—and pushback by the alcohol industry at the European Commission (EC)—offer a cautionary tale for any nation that seeks to do the same.

In the US and globally, the costs of excess alcohol consumption on health are rising. Prepandemic estimates put the annual cost of alcohol use disorder at $249 billion, with $27 billion from health care.² US health costs for alcohol-related liver disease alone are projected to rise from $31 billion in 2022 to $66 billion in 2040.³ The World Health Organization (WHO) argues that alcohol use is “draining” European economies in health care costs and lost productivity; a recent editorial stated that 1 in 11 European deaths could be tied to alcohol.⁴ In the US and worldwide, much of the increased health spending related to alcohol stems from more women drinking to excess. A new article from International Journal of Drug Policy asserts that strategies are needed to maintain stretches of lower use of alcohol if global sustainable development goals are to be achieved.⁵

What could slow these trends?

Ireland's alcohol warning label. | Image: AAI

Starting in May 2026, all alcohol sold in Ireland will carry the world’s most comprehensive warning label, telling consumers about health risks in pregnancy and links to cancer and liver disease; it contains the language: “There is a direct link between alcohol and fatal cancers.”⁶ The labels took more than a decade to achieve, with hospitalizations and cancer cases climbing as they were debated, first within Ireland and later within the EC.

The Public Health (Alcohol) Act

For health leaders in Ireland, gaining a warning label has been no small feat among people who not only enjoy alcohol but have been making whiskey for nearly a millennium. The keys, said Sheila Gilheany, PhD, CEO of Alcohol Action Ireland (AAI), have been persistence and partnerships.

Sheila Gilheany, PhD | Image: LinkedIn

AAI was founded more than 20 years ago by Ireland’s national health care agency to advocate on alcohol policy fully independent from the industry. Then in 2012, following a report from a government-appointed steering committee on a national substance misuse strategy,⁷ efforts took shape to pass what became the Public Health (Alcohol) Act (PHAA) of 2018.¹

The PHAA sought to curtail alcohol’s effects on health and multigenerational harms on children.¹ Health leaders cited a survey that found 75% of adults consumed alcohol, and 52% who did were in the “hazardous” category.⁸ They also cited high rates of cancer and liver disease and hospitalizations tied to alcohol use.^9,10 Later, when the fight for the warning labels reached the EC, the Irish cited data from Ireland’s Health Research Board that the number of people hospitalized due to alcohol and the number of days they stayed nearly doubled from 1995 to 2018.¹¹

The law has 3 central areas of focus, with a goal of reducing consumption by 20% over 7 years, to 9.1 L per capita¹:

• Minimum pricing standards for alcohol
• Regulations for alcohol marketing, with a goal of avoiding messages to children
• Warning labels for alcohol sold in Ireland

Compelling evidence of links to cancer, coupled with the fact that only 21% know they exist, built support for the labels.¹²

“The Irish Cancer Society are actually the people that put forward the idea in the first place of having cancer warnings,” Gilheany said. “Being able to work with many different groups…the cancer groups, but also consumer groups as well, is very important.”

She echoed what former US Surgeon General Vivek Murthy, MD, said in January 2025 when he called for alcohol labels that warn of cancer risk: too many die of preventable cancers due to drinking, yet so few understand the connection.

“It really comes down to fair play,” Gilheany said. “The consumer has a right to know the risk.”

The Alcohol-Cancer Connection

Several international groups have documented the links between excessive alcohol intake and certain cancers: oral cavity, pharynx, larynx, esophagus, colorectum, liver, and breast.¹³ Ireland’s campaign also emphasized rising rates of alcohol-linked cancers and liver disease among women, especially that 1 in 8 breast cancers was tied to alcohol use.¹⁴

Although alcohol consumption in Ireland has slowly declined over 30 years, pubs per capita and binge drinking rates remain high relative to other countries—and these bouts of heavy drinking are known to exacerbate cancer risk and liver disease.¹⁵

“Alcohol causes liver disease, and we have had absolutely soaring rates of liver disease over the last number of decades, particularly with women,” Gilheany said. “You have increasing numbers of young women presenting with serious liver disease, and these are not necessarily people who are addicted to alcohol. They are just drinking at high levels in a way that is actually reflective of our broader society.”

Gilheany believes the rise in drinking among women is no accident. Historically, men drank two-thirds of all the alcohol consumed in Ireland, while women drank a third. “The alcohol industry kind of looked at that and went, ‘Oh my goodness, there's a wide open market here.’”

She sees more marketing of wine and sweeter drinks being aimed at women, and in a press statement last year took issue with the €115 million (US$125.607 million) spent annual on alcohol marketing in the small country.

“This state has modest laws that aim to protect children from being exposed to alcohol advertising,” she said in the statement, “but what about women, who are being relentlessly pursued by an industry only interested in profit?”

Taking Aim at Marketing

Ireland’s cultural connection with drinking, particularly on St. Patrick’s Day, is rooted in rituals surrounding the Catholic Church, its ties to the British, and some traditions the diaspora created when they emigrated to North America. The feast that honors Patrick falls during Lent, when Catholics are required to fast and give up alcohol for the 40 days ahead of Easter. In Ireland and in areas where Irish Catholics settled in large numbers, local bishops would offer a dispensation, or “day off” from fasting and abstaining from alcohol on St. Patrick’s Day.

Restaurants typically promote themed drinks to mark St. Patrick's Day.| Image: Applebees

Irish immigrants in the US and Canada organized parades even before such celebrations began in Ireland. New York City’s famous parade is believed to have started in 1762, when a group of Irishmen forced to serve in the British Army marched to combat homesickness on the feast day. On Sunday, new Canadian Prime Minister Mark Carney, whose ancestors were Irish, marched in Montreal’s 200th St. Patrick’s Day parade. From their nationalist and religious beginnings, today’s St. Patrick’s Day’s parades offer global marketing opportunities for the alcohol industry. Alcohol-themed celebrations start well ahead of the holiday, among Irish and non-Irish alike. In the US, the restaurant chain Applebee’s created holiday-themed drinks featuring Ireland’s Jameson whiskey. A Trenton, New Jersey, Irish pub, Tír Na nÓg, was founded by an advocate for Irish reunification; in 2025, it launched the St. Patrick’s “season” by inviting customers to have their names engraved on a custom Guinness pint glass.

Revelers from Charleville, County Cork, Ireland, don giant Guinness hats for the community's parade. Despite limitations on advertising designed to protect children, some industry promotions fall outside the rules. | Image: Charleville Coves

In Ireland, alcohol marketing has been no less ubiquitous, especially at sporting events. Gilheany said AAI has had to be vigilant to force the industry and other stakeholders to stay within the limits of the law. Some measures took effect in 2019; on January 10, 2025, after years of delay, a “watershed” limit banned alcohol ads on TV before 9 p.m. But Gilheany said the industry has found loopholes to get around this. Diageo, which owns Guinness, paid £15 million (US$19.5 million) to sponsor both the men’s and women’s rugby teams in the recent “Six Nations” tournament, then avoided a “field of play” advertising ban by pairing its familiar Guinness brand and harp with the blue “0.0” for its alcohol-free offering.

“One of the ways the legislation seeks to protect children is by banning alcohol advertising in certain places including on the field of play during sports events, because 7 out of 10 of the top programmes watched by children are sporting events,” Gilheany wrote in a statement. “However, just as restrictions under the PHAA came into force, big alcohol brands began circumventing the law by advertising zero-alcohol products using the same master branding, a move that former Minister for Health Stephen Donnelly labelled ‘cynical’.”

Pushback on the Warning Label

In 2023, The Lancet introduced the concept of “commercial determinants of health,” arguing that just 4 transnational commercial sectors—fossil fuels, ultraprocessed foods, tobacco, and alcohol—accounted for more than a third of global deaths, and the inability of society and government to counter their pressure leads to “policy inertia.”¹⁶

In other words, policies that the public supports are not implemented due to the influences of these industries. In 2023, 5 years after enactment of the PHAA, the warning labels had not been implemented and some advertising limits were not in effect, although a European journal survey of Irish households found 85% support for the advertising limits and 82% support for warning labels.⁸

As Gilheany explained, this inertia long explained the difficulty enacting alcohol reforms despite the public’s frustration with hospitalizations and high accident rates due to alcohol. For years, the industry perpetuated the belief that alcohol was either not a big problem or that it was limited to a small group of high-risk drinkers. As those arguments failed, she said, the myth spread that scientists didn’t really understand how alcohol worked in the body.

“They will say things like, ‘Oh it's all a bit complicated. And you know, you can't really say that it's just alcohol that causes cancer.’ But in fact, actually, the evidence is very clear. There are very direct pathways by which alcohol does cause cancer,” Gilheany said.

Noelle LoConte, MD, a hematologist and medical oncologist at the University of Wisconsin–Madison, said in an interview earlier this year that the link between certain cancers and alcohol has been well known among researchers for a long time. The connection with breast cancer is straightforward: “Alcohol raises estrogen, which in turn raises the risk of breast cancer,” she said.

In Ireland, it took years of public education to build the case that reducing excess alcohol consumption would require a population-level solution. Health officials have not yet met their goal of reducing alcohol consumption by 20%. The pandemic stalled progress, but Gilheany and others have also criticized the industry for relentless roadblocks, notably efforts to block warning labels with the EC, which had jurisdiction because the labels affected trade. Ireland is a member of the European Union, as are several wine-making countries. In January 2023, an investigative report in Europe uncovered industry political contributions to members of key EC committees weighing Ireland’s proposal; it finally cleared hurdles there and with the World Trade Organization before Donnelly signed off in May 2023.^17-18

In response, the national industry trade association Drinks Ireland called on the Irish government to “align with the EU-wide harmonised labelling plans.” At one point, a dozen countries were objecting to Ireland’s warning labels through their trade representatives, but Gilheany said the number is now less than 6. Alcohol interests predict some wine producers will refuse to sell in Ireland because they will not produce a separate label for country.

“The industry argued, ‘Ireland shouldn't be going its own way. We should wait for Europe to bring about its own label.’ But, you know, this is just laughable,” Gilheany said. But given the health stakes, “There's absolutely no way that we could wait for Europe for a label. What we should do is go ahead ourselves and let Europe catch up with us.”

In 2020, an editorial in the Journal of Studies on Alcohol and Drugs lambasted industry efforts to undermine Ireland’s legislation and called out the industry for interfering with a Canadian study on warning labels, stating, “In addition to the interference observed in Canada, South Korea, and Ireland, alcohol industry tactics are raising eyebrows in other parts of the world as well. These tactics are notable because of their inconsistency with the industry’s public pronouncements that they are committed to encourage ‘responsible drinking’ through guidance labels and other measures to prevent alcohol-impaired driving and youth drinking.”¹⁹

Ireland’s effort to fully implement the PHAA has drawn the attention of researchers who marvel at the ability of public health advocates to push back against a well-funded industry lobbying effort.²⁰ AAI also keeps tabs on what other countries are doing in alcohol policy, so the group cheered Murthy’s report in the final days of the Biden administration linking alcohol to cancer, as well as his call for warning labels in the US. Even if this proposal does not move forward, it supports Ireland, Gilheany explained.

“There are a number of countries which are moving in this direction,” Gilheany said. “We're very heartened by Norway, for example, [which] is also moving towards cancer labeling.” Public opinion in Canada has moved in support of labeling after studies on warning labels conducted in the Yukon showed they raised awareness of health effects and curbed drinking.²¹

“All of this is kind of building toward more and more countries recognizing and saying, ‘We need to do this’,” Gilheany said. “The WHO and their recent reports have been tremendously helpful, because they're pulling together all the evidence of what needs to be to be done.”

Most of all, she said, “We are very heartened by Ireland’s commitment.”

References

1. Public Health (Alcohol) Act of 2018. Health Service Executive of Ireland. Updated November 2024. Accessed March 17, 2025. https://www.hse.ie/eng/services/list/1/environ/alcohol-legislation.html
2. Choi HY, Balter DR, Haque LY. Epidemiology and health care burden of alcohol use disorder. Clin Liver Dis. 2024;28(4):577-588. doi:10.1016/j.cld.2024.06.006
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