HANOVER, N.H.

In August 2008, 135 college and university presidents called for renewed debate over the 21 minimum legal drinking age, and some of them have appeared in various media since then arguing that the age should be lowered.

It is hard for me to understand why there is any debate about this issue in this day and age. The question pits the theory that lowering the drinking age will reduce drinking problems against the facts that lower minimum drinking ages are associated with more drinking, more death on the highways and higher rates of alcohol dependence.

Proponents of lowering the drinking age often argue that the drinking age of 21 isn’t working because alcohol problems persist among the young. By analogy, this seems like giving up on AIDS education because many people continue to become infected or give up on smoking control because many people continue to smoke. Nonetheless, there is benefit to airing the issues, the data and a bit of the history on the issue.

I was fortunate enough to have played a role in the history of the minimum drinking age issue. In the 1970s, liberalized views of drug use, the Vietnam War and other factors converged to produce an important experiment in public health. Until 1970 the legal age for purchase of alcoholic beverages was 21 in most states. In the 1970s, 29 states lowered the minimum age to 18, 19 or 20.

The core arguments for reducing the minimum age were the following:

1. If men were old enough to marry, be drafted and go to war shouldn’t they be able to buy a beer? (Of course, we are hearing this all over again in the context of our new wars.)

2. Anyone who was below 21 could get alcoholic beverages anyway so why make them travel to states with lower ages or commit illegal acts to obtain alcohol?

3. It was argued that there was no strong evidence that lowering the drinking age would lead to more alcohol related problems.

Sadly, and horrifically, the data quickly began rolling in, in the form of increasing traffic deaths and other problems related to alcohol use in young people. Although not intended as an experiment and although not a perfect epidemiological study, the trends in states that had lowered the drinking age compared to those that had not were strong and compelling.

By the time that I was appointed U.S. surgeon general, in 1981, we had extensive data, and on the basis of that, many of us in different sectors of the public-health community came to the strong conclusion that lowering the drinking age was associated with increased alcohol problems and fatalities, and that raising the minimum drinking age would be vital to the health of our nation. President Reagan backed this by restricting federal highway funds to states with minimum age of procurement lower than 21 years.

As states raised the drinking ages, the highway body count among youth began to decline. Of course, other factors were involved in reducing drinking and driving fatalities, but leading scientists remain convinced that raising the drinking age was an important factor.

At that time, the alcoholic-beverage industry, the beer industry in particular, was playing the same destructive game that it is playing now. On one hand, the industry pretended to care about underage drinking while on the other hand it was doing its best to promote drinking among the young. They were not exactly helpful in efforts to raise the minimum drinking age — they clearly put their profits ahead of the welfare of the young and the health of our nation. And they continue to do so.

Raising the drinking age back to 21 did not solve problems of alcohol abuse but it did help significantly. In real world public-health policy, the ideal is rarely achievable but efforts to discourage deadly behaviors and encourage healthy behaviors can make a difference. It is rare that a policy can do more than stand as one factor among many that must be brought to bear on a problem. But we should not fail to act where we can to make positive differences.

For example, providing drug-abuse treatment and condoms did not solve the HIV/AIDS problem, but these efforts helped reduce the spread. Wearing seatbelts and mandating airbags does not end traffic accidents, but they help reduce serious injury and death. Wearing helmets does not eliminate motorcycle fatalities, but it reduces them and devastating head injuries. Washing your hands does not end disease transmission, but it helps.

In all of these examples, one could argue that the problems continue so why bother with advocating these various strategies. My answer is to acknowledge that rarely will a single action solve complex problems. As H.L. Mencken observed, ”For every problem, there is a solution that is simple, neat and wrong.”

The problem of alcohol abuse is a very complex one. Like many other complex problems, be it smoking, teenage pregnancy, HIV/AIDS, the war in Iraq or the financial crisis, this problem needs a comprehensive approach. I would not argue that keeping the drinking age at 21 is the solution to alcohol abuse — just that it is one part of what should be a comprehensive strategy.

Fortunately, many aspects of such prevention strategies are understood. Unfortunately, many sit on the shelves. Some of these things have been known for decades. The Presidential Commission on Drunk Driving, to which I was appointed by President Reagan as surgeon general in 1988, concluded that the marketing of alcoholic beverages, especially to young people, was a serious problem. It was a problem then and it continues to grow. Witness the proliferation of alcohol beverages specifically targeted at young people, the branding of clothing and other merchandise with alcohol product logos, and industry sponsorship of sporting events on college campuses. We need the genuine support of industry to solve this problem: How can we garner such support when reducing drinking among the young shrinks an important market for their products?

We need stronger support of families to discourage inappropriate drug and alcohol use among their children. We need to make it as easy for kids and adults to get help for problem drinking as it is for them to get alcohol and other drugs. We need to make sure that our campuses and communities take actions to discourage excessive and inappropriate drinking.

Yes, there continue to be drunken youth and alcohol-related deaths on the highway and there are still alcohol-related problems on campus. But legitimizing the problem by lowering the drinking age will not reduce it, and those who argue it will should re-examine history and bring to the table data, not theory, to support their approaches or alternatives. Too many lives are at stake.

C. Everett Koop, M.D., was U.S. surgeon general in 1981-89. He is now a professor at the Dartmouth Medical School.