Absinthe--Is Its History Relevant for Current Public Health?

Martijn Huisman; Johannes Brug; Johan Mackenbach

Disclosures

Int J Epidemiol. 2007;36(4):738-744. 

In This Article

The Diffusion of Absinthe and of Tobacco

With the transition from manual to industrial production of absinthe, in 1798 by the Pernod-fils distillery, it was introduced to a wider population. However, this initially primarily included the elite of France, including the idle rich. In retrospect, an editorial in the Lancet of 1868 stated it eloquently: '[...] absinthe was beginning to make a noise in Paris, by reason of its having become the drink of fashionable idlers, instead of being the vulgar luxury of peasants and labourers [...]'.[9] Only later did absinthe begin to change its social character, and more and more became the drink of choice of the lower social classes, and the penniless artists through whose work we can nowadays still sample its role in French society at that time (Absinthe figured in the paintings of among others Van Gogh, Manet and Degas. Poets like Rimbaud, Verlaine and Ernest Dowson drank absinthe and rhymed to its glory. Oscar Wilde said of absinthe: 'A glass of absinthe is as poetical as anything in the world. What difference is there between a glass of absinthe and a sunset?' Yet, in the words of the novelist Huysmans: 'Even when made less offensive by a trickle of sugar, absinthe still reeks of copper, and leaves on the palate the taste of a metal button slowly sucked.'). One of the causes of this change in the social pattern of absinthe use was a drop in the price of absinthe. Absinthe was relatively expensive until the grape alcohol that was traditionally used in the manufacturing process was replaced by alcohol from beets and grain, which made it much cheaper. Absinthe manufacturers turned to this other type of alcohol because phylloxera had plagued the French vineyards.[4] Not only did absinthe get cheaper because of this; wine on the other hand got more expensive. A glass of absinthe could be bought for 15 centimes, which was about a third of the price of a loaf of bread.[10] This happened in the early 1880s, and from then on the lower classes could afford their share of absinthe. By the end of the century, lower social classes were fully submerged in the habit of drinking absinthe. A paper in The Economic Journal singled out this habit as a major threat to wine consumption in France. 'Wine is no longer the one and only national French beverage, as for centuries it was wont to be. It has many rivals. The English have taught the Frenchman to drink tea; the Germans have taught him to drink beer. [...] For the present, indeed, these new habits are peculiar to the well-to-do classes, and have not yet penetrated to the tables of the million. But there wine is confronted by another and far more formidable rival, that is, alcohol in the shape of absinthe [...]'.[11]

The differential diffusion of absinthe across social classes in France corresponds with what has been observed for smoking almost a century later, as well as for other health-related behaviours (such as illegal drug use). Cigarette consumption in the Western world increased after the 1880s, with the invention of the Bonsack cigarette-rolling machine, together with mass marketing and the invention of safety matches.[7] Worldwide the burden of tobacco-related disease is still rising.[12,13] But in western countries, the distribution of smoking is increasingly becoming more concentrated among the lower socioeconomic groups.[14,15,16,17,18,19] The social shift in smoking started around the time that the Surgeon General's Advisory Committee published their report on smoking and health in 1964. The relevance of this diffusion pattern for public health should be obvious: the differences in the diffusion of tobacco between socioeconomic groups play an important role in the causation of socioeconomic inequalities in health.[20,21]

The diffusion of absinthe in France and the diffusion of tobacco in many developed countries are both grim examples of the relevancy of Rogers' diffusion of innovations theory for understanding the dynamics of socioeconomic inequalities in health.[22] This theory describes the processes in which an innovation is disseminated over time among members of a social system. It recognizes that the spread of an innovation (from cars, to Internet, to tobacco, to absinthe ...) is often socially stratified. The so-called 'early adopters' of an innovation are mostly found in the higher socioeconomic groups. In the case of absinthe, it were the 'fashionable idlers' who picked it up. In the case of smoking, it were doctors who ranked high among the early adopters. Widespread adoption in lower socioeconomic groups often occurs much later. In the case of tobacco use in many developed countries, such as in Western Europe, the prevalence in lower socioeconomic groups was rising by the time a decline was observed among higher socioeconomic groups.[18]

It is true that there may be multiple forces driving the distribution during different 'epidemics'. With regard to absinthe, the change in price that made absinthe more accessible to the lower classes was probably of utmost importance in its social distribution. Cigarettes on the other hand have rarely been so expensive that poor people in western societies could not afford them. Other candidate forces behind the social distribution of tobacco may be mass marketing and specific targeting of vulnerable groups by the tobacco industry.[23,24] Nevertheless, as long as specific substances can be used to buffer the effects of (poverty-related) stress and become available to everyone, we believe that they should always be expected to lead to a disproportionate burden in the lower social classes. It is important to realize that we cannot understand the prevalence of health-related behaviour and their social distributions without seeing them as a consequence of social conditions. Warner (2001) wrote about the reaction of British physicians and parliament in the 18th century to the 'gin-craze': '[...] while gin was doubtless bad for a good many people, its effects were inevitably compounded by social conditions that neither the physicians nor their allies in parliament had any intention of tackling, were they malnutrition, overcrowding, poor sanitation, disease or simply poverty in general'.[25] The same can be said of the polemic against absinthe drinking by the lower classes in France and currently for some reactions to smoking (for instance when price policies are not backed up by increased efforts to help people from lower social groups, who on average experience more difficulty with quitting, to tackle their addiction).

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