Examination of witnesses (Questions 660
WEDNESDAY 28 FEBRUARY 2001
GRUER and DR
660. You accept that in Britain we have the
highest level of taxation and that poses a serious threat to industry
and to trading when smuggled goods come in to the country. What
do you suggest? If we increase the duty again then there are more
chances of smuggled goods coming into this country.
(Dr Gruer) That is right, we are in a dilemma. If
we were to increase the tax on drink then that would probably
be balanced by further advantage being taken of the price difference
on the continent and more stuff would come in. It does not seem
to me realistically that there is much scope in terms of having
a real effect on alcohol consumption by increasing taxation.
661. What about this, "The recent document
produced, by the Greater Glasgow Health Board suggested that some
proportion of excise duty could be hypothecated to combat alcohol
abuse". What is your final view on that?
(Dr Gruer) I think if you look at the level of alcohol
problems that are generated among people who drink too much alcohol
in a damaging way there has been very little money directed towards
helping such people from the Government, as any earmarked funding
for the Health Service or for Social Services. Yet we know that
there are a lot of very effective ways of helping and treating
people with alcohol problems if they are properly resourced and
you have the right staff and centres to do it. It does seem at
least in terms of principle a realistic idea that if you are generating
substantial revenues from the sale of a particular product which
is benefiting a lot of people in many ways, both through industry,
employment and the pleasure they get out of the product, but it
is having a bad effect on some others, there is a case perhaps
for directing some money towards developing services to help those
people. That has not happened in the last 20 years, whereas we
have seen huge investment by comparison in illegal drugs and I
think that is not appropriate.
662. What proportion of duty do you think would
be appropriate given the apparently high cost of alcohol abuse?
(Dr Gruer) I could not give a figure on that in that
I am not aware of exactly how much money in Scotland is generated
from alcohol duty. I think we can certainly multiply several fold
the amount of money currently being spent on alcohol-related services
in Scotland. We would see substantial benefits for many of the
people who are suffering most. Let us not forget it is not just
the individuals with the drinking problem, it is their families,
their communities in which they live, who are also affected.
Sir Robert Smith
663. You mentioned that the higher price reduces
the consumption and this seemed to be accepted, but what does
the research say about whose consumption is being reduced? Is
it the one with the ability to control their drinking or is it
the others who are already controlling their drinking deciding
"I will spend my money elsewhere"?
(Dr Gruer) My understanding, and maybe Martin might
say otherwise, is that it tends to be across the board. It does
tend to reduce everyone's drinking to some extent. Obviously there
are going to be some exceptions, there are going to be some people
who will keep on drinking regardless of the price, but everyone
has their limits as to what they can actually either afford or
can generate through whatever means to keep on drinking. I think
overall it shifts average consumption down a way whether you are
a light drinker or a very heavy drinker.
(Dr Plant) One suggestion that has been made is that
from a public health point of view it would make more sense if
alcohol tax bore a more obvious relation to the alcohol content
of beverages but for historical reasons that does not happen.
In the UK we have also got the interesting situation that although
alcohol consumption has not changed very much over the last few
years, underneath the surface of the water there has been a change
in that younger women are drinking more, teenagers are drinking
more, and certainly a lot of people are spending more but on better
quality alcohol. In a sense a lot of people, professional workers,
are not in general drinking a lot more than they were a few years
ago but they are tending to spend £4 a bottle on wine instead
of £2 a bottle on wine. Some kinds of alcohol are much more
severely taxed than others and there is actually not a public
health case for that. Beer is pretty much the same as wine or
spirits from the point of view of what it does to you when you
664. Why do you think that the UK's high tax
rates have apparently had only a limited effect on alcohol consumption?
(Dr Plant) I think because we are used to them. It
is a question of balance, as Dr Gruer has said. My wife and I
were recently in a restaurant in Stockholm where the wine ranged
from £40 a bottle to £500 and we then stepped out into
a bunch of skid row people who were very drunk on something. I
think in Scandinavia they have a system where they have a combination
of very rigid controls, very high prices, but a lot of very conspicuous
alcohol problems, a lot of which reflects the popularity of illegal
home brewed stuff. In Norway, for example, 40 per cent of the
alcohol that is consumed is home made and some of that is not
very healthy. In Hungary and some of the former Soviet bloc countries
alcohol consumption is completely out of control and to a large
extent it is toxic stuff that is made unofficially. I think if
you over-control you can run into problems. In the UK, although
we have quite a high price structure, the thing to remember is
that the real price of alcohol has actually gone down as people's
ability to buy it has gone up.
665. There are countries with lower taxes than
the UK, how do alcohol-related problems in lower tax countries
compare with the UK?
(Dr Plant) The lower tax countries are still above
us. Look at France and Italy, they are still above us for things
like liver cirrhosis, they still have higher consumption than
us, but the Italians have just halved their alcohol consumption
and the French have brought it down by a third and we are still
pretty much on a plateau.
666. Is that involving tax changes?
(Dr Plant) No. None of my Italian colleagues can give
me a sensible answer as to why that has happened.
667. Obviously it is a UK or Scottish cultural
problem and you have mentioned deprivation is a factor but is
there a cultural problem to tackle there?
(Dr Gruer) I think the point that Martin made earlier
about the Friday and Saturday night binge drinking, which is fairly
typical in Britain and is a Northern European type thing.
668. So rather than duty, should we not be tackling
(Dr Gruer) We do find that people in less affluent
circumstances for various reasons are using alcohol in a more
damaging way. It is not just the way they drink alcohol but because
it may be related to other factors, such as poor diet, such as
much heavier smoking, you are actually poisoning your body with
a whole load of things, and in that situation alcohol does a lot
more damage. Another thing that we have not mentioned but which
I think is quite important is that people who develop alcohol
problems over the years tend to slip down the social scale, it
is called downward social drift. One of the reasons why you may
tend to find more people with serious alcohol problems in most
deprived areas is because they have lost the capacity to earn
a higher income, they have become homeless. Most of our hostels
in Glasgow are in the more deprived areas. There is that extent
of people gathering because of the problems that have brought
them together in the first place, but that is only part of the
669. Just before we move on, you spoke about
young women being a group who are increasing their alcohol consumption,
particularly the consumption of wine, so if we were to increase
the duty on wine to the same as indigenous spirits, could that
make a difference to alcoholism?
(Dr Plant) I think people are largely limited in what
they drink by what they want to drink and what they can afford
to drink. People who are alcohol dependent will spend their money
to get as much alcohol as they can for that price. For example,
when there was a lot of interest in alcopops a few years ago,
what seemed to be the case was that both young men and young women,
teenagers and people in their 20s, were spending their money on
cheaper forms of alcohol rather than buying expensive alcopops.
I think with women what is striking, and we are producing some
results quite soon on this, is the heaviest group of adults in
Britain from the point of view of gender, first of all amongst
women are 18-25 year olds, whilst amongst men the heaviest drinkers
are 35-55. What we are now seeing, which is quite new, is the
development of alcohol dependence and liver disease amongst women
in their late teens and early 30s and that is completely unprecedented.
670. The last point I want to make is I am not
sure that increasing the price of alcohol will reduce the consumption
of alcohol because evidence suggests that in Glasgow there are
more social problems and 80 per cent of people in Glasgow are
from deprived and poor areas. If this is the case then there should
be a reduction in consumption in deprived areas and people should
be drinking more in prosperous areas because they are the people
who can afford it. It might be the case that if the price is increased
then the people who want to go for a pint will go for a pint and
will reduce their budgets for other basic needs such as bread
and fruit for themselves and for their families and it can have
a counterproductive effect.
(Dr Gruer) The situation is certainly complicated.
We cannot say that there is an absolutely direct relationship
that if you put the price up then alcohol consumption comes down
in exactly the same way. Also, what is very important now is the
smuggled alcohol, that people can compensate for higher prices
in the shops by getting stuff at the car boot sale or the bottom
of the street or from a friend they know. People have ways around
the problem of price now and there has been something of a fiscal
breakdown in the control of alcohol in recent years.
Mrs Adams: You will be glad to know that we
are now on our last question which is on industry initiatives
from Russell Brown.
671. Can I say, Mrs Adam is an office bearer
with the All-Party Scotch Whisky Group here and I am a member
of the All-Party Group on Alcohol Misuse. It was strange to hear
you mention what happens in Scandinavian countries, because I
attended a meeting of the Group last night and I was totally surprised
to discover that a very large Italian community here in the South
of England bring in their own grapes and make their own wine here
in this country, they ship the grapes in. That is a side issue.
The alcohol industry itself is obviously involved in a number
of initiatives designed to promote a whole aspect of sensible
drinking, that is included in the provision of educational material,
as you know, support for local alcohol agencies and its involvement
in drink driving campaigns, and one of those is obviously the
Portman Group. What is your actual opinion of the industry's response
to the level of alcohol related health problems in Scotland? Can
you identify any other steps that these groups could actually
take in assisting the problem that we have?
(Dr Gruer) I have not seen a huge amount of evidence,
from our standpoint, of the industry showing a great deal of concern
in relation to alcohol related problems. I have seen it more at
the level of things like trying to discourage underage drinking
and the identity card scheme. I have seen it more in relation
to things like encouraging transport for people to get home so
that they do not have to drive. It is more at the level, as it
were, of responsible consumption. It would be fair to say that
the unattractive, underbelly of drinking and alcohol dependence
is not one that the drinks industry associates itself with very
(Dr Plant) I think the industry has done a lot of
useful things. I think it is good, it is admirable they do take
a constructive role in this, however they are a number of things
they could do that could lead to a huge advance, like monitoring
the behaviour of their members as far as the enforcement of licensing
legislation is concerned. You can walk into any other pub in Scotland
on any night and find intoxicated people being served. You can
walk into a lot of bars and find people conspicuously under 18
years of age buying alcohol. There is a huge amount of interest
in other countries, particularly the USA, Australia and Canada
about responsible beverage services, which is really running a
safe and tidy house, training your staff to prevent incidents,
training your staff to handle incidents, things like that. There
is nobody better to do that than the industry. I think their role
could be vastly bigger in this respect than it appears to be at
the moment. I do not know everything they are doing, there may
be things I am not aware of.
672. Can I pick up on a point that you made
there, I wholeheartedly agree with you, I think it is despicable
that if you go into a licensed premises and there is somebody
there who is, quite frankly, smashed out of their mind they are
still continuing to supply them with alcohol. Do you think there
is need for even tighter legislation and, you know, more severe
punishment for people who act irresponsibly like that?
(Dr Plant) I think if they persist. I forget what
the figures are, there are very few instances in the whole of
the United Kingdom in any one year when people are brought to
court for serving underage drinkers or serving people who are
intoxicated, it happens but it is pretty unusual. When my daughter
was in school in Edinburgh she would actually point out the bars
where her 14 year old school friends went to drink. If my daughter
knew about it, I do not think you need to be Sherlock Holmes to
know what is going on in these places. If you talk to the police
they say, quite justifiably, they have other priorities, people
would rather they caught the murderers and rapists, this is not
a high priority.
673. Can I put that another way, it would be
much better offering the carrot rather than the stick. Is it not
the case, as with drugs, many university students dabble in drugs
and dabble in heavy drinking but not so many of them go on to
be addicted to drugs or addicted to alcohol, is that because something
that people in deprived areas do not have is hope, hope of a better
life. Would we be better concentrating our efforts and turning
that around rather than trying to deal with the consequences of
what happens as a result of that deprivation?
(Dr Plant) We can do both. There is nothing more important,
I think, than dealing with deprivation in a divided society. Internationally
we do not compare well in relation to many health indicators.
A lot of our young men and woman who are getting deeply involved
with illegal drugs, smoking or heavy drinking come from poor families,
they come from families where a single parent is struggling to
keep things together. I think the trouble is that drug use and
drinking have crossed all social barriers and so have the problems,
it is not only deprivation and poverty, however that is a big
chunk of it, but it is not all of it. If we can make the streets
and the bars safer, in the way they tried in a few places pretty
successfully in Scotland, but in general it has been little local
experiments by the police or concerned people, we would all gain
from that. It does not undermine the battle against social inequality,
it saves money, it does not cost money.
(Dr Gruer) Alcohol in our society is the main drug
for both celebration and solace, and clearly a lot of people take
to alcohol to blot out the despair and hopelessness they feel.
Then it has the sting in the tail, it can perpetuate that despair
and make things even worse. Anything that we as a society can
do to enable people to live happier, healthier and more secure
lives will be likely to reduce the amount of problems that alcohol
itself creates. We are not going to get rid of alcohol, it is
here to say, it has been here for centuries and there is no sign
of it going away. We need to work in whatever way we can so that
society can use it responsibly and derive as much benefit from
it as they can and reduce, as far as possible, the evident harm
it is still causing.
Mrs Adams: Thank you very much, gentlemen. We
have exhausted all of our questions to you. If there is anything
you would like to add at this stage please feel free to do so.
Can I thank you very much for attending today and giving us all
of the information you have, it will be useful to us when we come
to prepare this report.