Examination of witnesses (Questions 640
- 659)
WEDNESDAY 28 FEBRUARY 2001
DR LAURENCE
GRUER and DR
MARTIN PLANT
Miss Begg
640. I know that with youngsters it is very
often binge drinking that they are involved in, do they grow out
of that?
(Dr Plant) Yes, some do and some do not. We followed
up a group of 1,000 teenagers in Lothian at 15/16, then at 25/26
and we found almost no connection between heavy drinking at that
early stage and heavy drinking later. If they were smoking at
15 they were smoking ten years later.
641. My other question is to do with youth culture,
there is a fairly sizeable subculture that take ecstasy and they
do not drink, they take water. Does that mean that there is likely
to be less alcohol related problems as that generation of young
people grow up?
(Dr Gruer) I would not be confident about that. It
seems to me that this apparent divide between ecstasy users and
drinkers has been breaking down in the last few years. There is
much more a trend towards people mixing the licit drugs and illicit
drugs and experimenting in different ways and there has been less
of a distinct culture of one sort or other. It is hard to predict
how things are going. One of the lessons of the last 20 years
is it is very hard to know what the next development will be in
the way in which people are using psychoactive, mind-altering
substances. We are always surprised by what happens next.
(Dr Plant) We surveyed 15 and 16 year olds in 1995
across the United Kingdom and we have just done it again and we
have had quite a big drop in ecstasy use. What we also found,
and everybody else has found this, is that people who use a lot
of illicit drugs are also heavy drinkers and they smoke a lot,
even though when you talk to them they do not present themselves
in that way.
642. They claim they have a different drug of
choice from the others.
(Dr Plant) They tend to be wide-ranging.
643. They are just taking lots of drugs, legal
and illegal. One other thing, I remember, I was fairly young at
the time, when the licensing hours were changed and the argument
for increasing the hours of licensed premises was to end the binge
drinking. It was not just young people, older people were involved
in that. From what you are saying today that really did not work,
it has not helped to reeducate the Scottish public on sensible
alcohol?
(Dr Plant) It led to quite an interesting change.
I reviewed this years ago with a colleague for the British Medical
Journal, because people were making statements that they did not
have alcohol problems any more or it had opened up the floodgates.
It seemed to have a neutral effect on public health, it did not
change any trends or direction. There was some evidence that certainly
the one thing that disappeared visibly was the carry out, that
just vanished overnight.
(Dr Gruer) One other thing is there has been an underlying
trend in Scottish drinking habits, particularly among more middle-class
type people towards what you might call a "Europeanisation"
of our drinking habits. We are drinking a lot more alcohol with
food, particularly wine, than we used to. Wine consumption has
been rocketing over the last 20 years. This is beginning to show
signs in the slow rise in the liver disease, cirrhosis. Britain
and Scotland is included within that, it is one of the few countries
in Europe where cirrhosis trends are going in the wrong direction,
they are going upwards, and in Spain, Italy and France cirrhosis
levels are coming down. If you look at the graphs we are gradually
moving towards France and Spain, we might meet them in terms of
our cirrhosis levels in the next 15 or 20 years. That is a reflection,
a change in the way that a proportion of the country are using
alcohol. There are still quite a lot of people in the lower income
bracket who are still drinking in typical traditional Scottish
fashion on a Friday and Saturday night.
Mrs Adams
644. In terms of the 1,000 teenagers you surveyed,
were the people who tended to go on to be heavy drinkers from
a particular socioeconomic group, and did that have more bearing?
(Dr Plant) I do not know. The problem was, we started
this with 15 and 16 year olds and when you do surveys in schools
there are certain questions they will not let you ask, one is
parental occupation and parental income, and whether their parents
drink like fish, so we do not know.
Mr Brown
645. I just want to pick up, Dr Gruer, on a
point you made about stress. You were painting a picture there,
and I can envisage somebody under a bit of stress who thought
the answer lay in the bottle, did that go on to be a repeated
trend, stress and the bottle were perhaps the answer? The fact
that we are living in a society where there is so much pressure
on people, we see it in stress related illnesses, court cases
about people being stressed out, has that brought with it an increase
in the number of people with alcohol related problems?
(Dr Gruer) It would be hard for me to say very definitely
that were the case, but I think that the co-existence of a more
stressful society, which most people tend to go along with, and
the rise in alcohol problems may not be a coincidence. Doctors
certainly see a large proportion of their patients who have alcohol
problems who have emotional problems, relationship problems and
difficulty with work, money and so on. They are all mixed together.
Sir Robert Smith
646. On closing time, in terms of, obviously,
the direct health and drinking thing it may be neutral, but in
terms of the social consequences and certainly from anecdotal
experience of the Student Union in Aberdeen, on a Friday night
it had a 1 o'clock licence and it drifted to a gentle close and
everyone went home, on a Saturday night it had a 12 o'clock licence
and it was a much more difficult closing time and a much more
anti-social problem, did your research show any benefit in that?
(Dr Plant) No is the straight answer. In some instances
there have been clear examples of nuisance being caused by whatever
the closing arrangements are in some places and a lot of senior
police in Scotland and England do not like the idea of every bar
in the town closing at the same time, because everyone spills
out on to the streets and there is often trouble when they go
from pubs to wherever else it is they are going.
Mr Clarke
647. I think it was drugs the last time we met
and now it is booze, so welcome. Advertising expenditure is what
we are going to talk about. Professor Cockburn, the Chairman of
Yorkhill Hospital Trust has contrasted the amount spent advertising
alcohol with that spent on campaigns to reduce drinking. For example,
the press reports suggest Diageo has plans to spend about £200
million alone in advertising Johnnie Walker, and Allied Distillers
have informed the Committee they will spend £277 million
on advertising and promotions in 1999-2000, how important is advertising
in promoting alcohol consumption?
(Dr Plant) First of all, there has been quite a lot
of effort put into looking at these very important issues over
the last 20 years. The results of this evidence are very disappointing,
the first thing relating to the impact of advertising is it is
clear that beverage alcohol advertising can persuade people to
switch their brand preference, to switch from one kind of alcohol
to another. There is no clear evidence, either way, on whether
this has an impact on overall consumption. The other thing I think
is really depressing is there are now hundreds of studies worldwide
into the effects of campaigns on alcohol and drugs from the point
of view of health promotion. These do not discourage people from
drinking heavily, they do not discourage young people from experimenting
with alcohol, and most researchers, including me, feel that is
a waste of public money, it does not work.
648. The other thing I want personally to ask
you is in relation to the trend of television. The first thing
that some people do when they come home is get the decanter out
and get themselves a drink. When I think back to my childhood
there were no decanters and there was no drink at all in my house,
it was taboo. The situation is that it is the in-thing to do,
to have wine with a meal. That is all being promoted as a natural
thing to do. Do you think that has an effect on people who drink
or does it encourage people to drink?
(Dr Gruer) I would say that certainly alcohol enjoys
a very privileged position among drugs. You said you had seen
me last time in relation to drugs, alcohol is a drug, let us not
beat about the bush. It is the only drug that gets good publicity
in the sense that it is widely advertised, it is part of the sponsorship
for so many things, it is seen in all sorts of circumstances as
very much part of soap opera culture, whereas tobacco has now
been largely vilified and they are struggling to keep their end
up, and obviously illegal drugs are vilified at every turn. Alcohol
has a particular situation where it is given a pretty good press
and there is a lot of good mood music around alcohol which I think
does influence how it is seen. It is seen as generally a good
thing, for most people it is associated with pleasure and socialisation
and so on. That aspect of it tends to be very much to the fore.
The more damaging aspects of alcohol do not get much of a look-in
in terms of any counter advertising. As Martin says, there is
very little evidence, unfortunately, that education in school
on alcohol makes much of a difference. Also there is not much
publicity about the damaging effects of alcohol with the clear
exception of drinking and driving, where there has been a lot
of emphasis and a lot of success in changing attitudes. There
is much more talk about lung cancer and heart disease from tobacco
and all the problems about Ecstasy and heroin and so on, very
little about what alcohol is doing to you.
(Dr Plant) I think one quite important difference
between alcohol and tobacco is with tobacco the evidence is pretty
clear, "don't do it, it is bad for you", but with alcohol
we know that low level consumption is either harmless or it is
actually beneficial in terms of heart disease and stroke. I think
this means that the message is a bit more complicated and a bit
more confusing and everybody naturally defines "harm"
as one unit more than they themselves drink. There has been a
change in drinking habits in our lifetimes. My parents hardly
ever drank, alcohol was not available at home when I was a child.
We have seen a huge sea change since the Second World War, people
do drink more now than they did in the recent historical past,
but not as much as they did in the previous century, for example.
Mr Sarwar
649. You have partly answered my question. I
am very interested to know a bit more from Dr Gruer because he
made two very interesting points. One was that campaigning for
alcohol does not increase the consumption and, in effect, what
you were saying was that if somebody is campaigning for vodka
or whisky people do not switch over to another brand, but how
do you compare that with the argument from the tobacco industry
campaigning for tobacco to switch over from one brand to another
brand? The other point you made was that excessive alcohol advertising
does not make any difference. What statistics do you have at your
disposal on which you can say so heavily that it does not make
any difference whatsoever? Unless the dangers of excessive drinking
are told to people there might be a consumption increase.
(Dr Plant) First of all, companies sometimes advertise
quite a lot and spend quite a lot on advertising when they are
in trouble or when they are starting a new brand. I can use the
dramatic example of a brand coming from nowhere and becoming popular
years ago: the Smirnoff campaign. What clearly seems to happen
is they take a bigger share of the market if they do this. Sometimes
if companies feel that their market share is dwindling they can
try to boost it by spending a lot. I think a Scottish jury would
find not proven on this because there have been a number of econometric
studies into advertising and alcohol consumption and they have
all been pretty much inconclusive. As far as health promotion
and health education is concerned, some of the biggest and most
elaborate campaigns have been in America and in Australia aimed
largely at young people in school. You can increase people's knowledge
and change their attitudes for a bit but changing their behaviour
is quite hard. In the Australian Life Skills Campaign, teenagers
who were exposed to this finished up drinking, smoking and using
drugs more than those who did not, which was a very unfortunate
and embarrassing outcome, but sadly not a unique one. I think
in a sense the jury is out on the effects of advertising but at
the moment it is rather inconclusive.
(Dr Gruer) On the specific effects of alcohol I would
amplify Martin's comment that alcohol consumption in the 19th
Century in Scotland was vastly higher than it is now and I think
it would be fair to say there was very little advertising of the
type we have now at that time. Much more important is the availability
of the stuff, the culture that you live in and the price and the
extent to which it is regulated, and in those days it was virtually
unregulated and very cheap.
650. It might have been cheaper at that time.
(Dr Gruer) At one stage it was very, very cheap.
(Dr Plant) Alcohol has cheapened in price since the
Second World War, it has roughly halved. The thing that has had
the biggest effect on tobacco consumption is the periodic price
hikes.
Mr Clarke
651. How does the amount spent on advertising
compare to health boards' own promotional budgets? Can you tell
us how much budget the Glasgow Health Board has, for instance,
for anti-drinking?
(Dr Gruer) It is minuscule. By comparison it bears
absolutely no relation whatsoever. In terms of health promotion
against alcohol you are talking about less than £100,000
per year in Greater Glasgow, very small sums indeed. The health
board gets virtually nothing really in terms of specific money
allocated for anti-alcohol advertising. There is a Drinks Wise
Campaign which comes up with several tens of thousands a year
but that is about it.
(Dr Plant) Nationally the Health Education Board for
Scotland has very few people working on alcohol.
Miss Begg
652. You said, Dr Plant, that there was no point
in spending public money on advertising to change people's behaviour
on alcohol. How should we spend it then? Assuming that we want
to spend public money on alcohol and we want to reduce the consumption
of alcohol and alcohol-related disease, what is your advice?
(Dr Plant) I think first of all health promotion is
very important and it is a moral thing we have to do to teach
young people about the potential dangers of a number of things
they might do, including their drinking. There are effective ways
that have been demonstrated to bring down rates of alcohol problems,
and these all come under the heading of harm minimisation. The
kinds of things that we know have worked because they have actually
produced dramatic results in the past range from enforcing existing
licensing laws, laws related to selling to people when they are
intoxicated, which should not happen but it does, laws related
to the supply of alcohol to people under age on licensed premises,
and in a number of cases in England and Scotland local byelaws
have actually brought about a big, big drop in rates of certain
kinds of alcohol-related nuisance. The problem is that these tend
not to be widely discussed. In Torquay years ago they brought
down not just alcohol-related crime but all crime by 20 per cent
with a successful one year experiment that was so successful that
it was immediately abandoned. I think there are a number of things
that people can do. We have seen an enormous fall across the whole
industrial world in alcohol involvement in driving but we do not
really know why because it has happened in different places with
different systems. The down-side of this is that this success
has almost been balanced out by an increase in road accidents
amongst pedestrians. I would rather drunks walked home than drove
home. There are examples of ways in which we can get a handle
on this.
653. You are saying that the regulation is there
but it is not applied?
(Dr Plant) Yes, it is often not a high priority.
Mr Tynan
654. I really think we have covered the question,
does advertising cause particular problems among young drinkers?
The perception is that advertising is not all that important,
is that your view?
(Dr Plant) That is what comes out of available evidence.
We organised a conference with the Scotch Whisky Association and
brought together many of those who had done research into this
and that was the view then. I do not think the evidence base has
changed very much since then. I am sure that the fact that alcohol
is so much part of our wallpaper, it is part of our social life,
young people form very strong impressions about drinking very
early on and this has a tremendously big, profound, long-lasting
effect on people.
655. As regarding advertising you do not think
it would make much difference?
(Dr Plant) I cannot be sure. One classic example that
is always given is that under the Soviet system they did not have
much resembling alcohol advertising in the USSR, but they certainly
did have a big alcohol problem. There the reason was that alcohol
was the only thing you could buy in the shops.
656. On the question of alcohol education, do
you think it is a waste of money?
(Dr Plant) No. I would distinguish between alcohol
education, which is the guidance teachers do in schools, and big
mass media campaigns about alcohol. The latter do not seem to
achieve anything, even though I can understand they might be quite
attractive because they are a visible sign that people are committed.
I think alcohol education is tremendously important, as with any
other kind of health promotion education, it is one thing to tell
people about the potential dangers. Young people, in particular,
feel it is not going to happen to me, I am invulnerable. It is
very, very difficult to make any connection between that and having
a long-term influence on the way somebody handles alcohol at a
later stage in their life, particularly when you are talking to
young people because the potential dangers seem so remote. When
you are 12 or 13, you cannot imagine being a drunk driver or getting
liver cirrhosis or being alcohol dependent, it is something which
seems quite alien.
657. Are there any lessons to be learned as
regards the French attitude towards alcohol? They have children
drinking at a younger age than in this country. Is there a case
there for lowering the age at which people are allowed to drink
alcohol?
(Dr Plant) You can drink alcohol in the United Kingdom
when you are five. I have always been very strongly in favour
of us doing what they have been doing pretty successfully in Southern
Europe for centuries, which is teaching your children to drink
in moderation and at home. The problem is that some people, because
of their religious backgrounds, do not want to do that. We did
a study of the western isles a few years ago and a fifth of teenagers
come from backgrounds where alcohol is not used at all and a third
drank very considerable amounts. In France and Italy they have
always had a family-centred, home-centred approach to drinking.
One thing we found out from the new International Teenagers Study
is that French teenagers say their parents know where they spend
their spare time, British teenagers often say they do not. What
goes on in the family is tremendously important.
(Dr Gruer) It is important if parents are going to
teach their children not to abuse alcohol they teach them the
right way. You have to have adults behaving sensibly with alcohol
first to pass on the right message, rather than adults boozing
on a Friday or Saturday night with their kids alongside them,
and they are learning how to do it when they are only ten. We
have still a long way to go in many parts of Scottish society
before we would recommend parents to teach their kids to do as
they do.
658. It is the question of the chicken and egg,
if the children have learned from seeing their parents introduce
alcohol on a regular basis to excess, compared to sensible drinking,
it is how you do that balance.
(Dr Gruer) That is right. We are an evolving society.
We are, as I said earlier, Europeanising slowly the way we drink,
that may be more hopeful for the future.
Mrs Adams: We are going to move on now to duty.
Mr Sarwar
659. The Greater Glasgow Health Board memorandum
argued that taxation of alcohol is a public health measure of
wide potential effectiveness. United Kingdom alcohol taxes are
among the highest in Europe. The recent document produced by the
Greater Glasgow Health Board suggested that some proportion of
excise duty could be hypothecated to combat alcohol abuse. This
might help to put the health boards on more of a level playing
field than the alcohol industry. What level of tax should be set
on alcohol?
(Dr Gruer) I am not a tax expert, I think that virtually
all of the studies that have been done throughout the world have
demonstrated that there is relationship between alcohol consumption
and price. The higher the price related to income, the less alcohol
is bought and consumed. In a general way, if you want to reduce
alcohol consumption you make it more expensive. The situation,
however, is much more complex than that in the world in which
we live, because of the problems of leakage. I think what we have
been seeing in Britain in the last 10 to 15 years, as the European
Union has developed and the common market has extended, we have
more expensive alcohol than our neighbours, so people are doing
all they can to get round our high price by bringing in alcohol,
not just for their own personal consumption but for sale illegally
by avoiding revenue. It does seem now that in many area of Scotland,
and this was brought home to us in our Drug Action Team by Customs
& Excise, that as much as a quarter or a third of alcohol
consumed is being smuggled in and tax has not been paid on it.
There is this difficulty about, if you set too high a level then
you get the smuggled stuff and you lose control. I think it is
a problem that we are having to face in Britain as part of the
European Union. I would expect that if we are going to have more
harmonisation and have lower taxes on alcohol we will have to
anticipate a higher general level of alcohol consumption as being
almost an inevitable corollary of that. It is not an easy question
to answer. If we could have strict control over alcohol pricing
and we could sustain that through controls at our borders then
we could anticipate reducing consumption by hiking the price.
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