Alcohol - Health Committee Contents

1  Introduction

1. Over the last 60 years English drinking habits have been transformed. In 1943, a Mass Observation survey noted that young people represented the lowest proportion of pub goers, preferring to frequent milk bars and coffee shops.[2] In 1947 the nation consumed approximately three-and-a-half litres of pure alcohol per head; the current figure is nine-and-a-half litres.[3] According to the General Household Survey data from 2006, 31% of men are classified as drinking hazardously (more than 21 units per week) or harmfully (more than 50 units per week); of these 9% drink harmfully. 21% of women are drinking hazardously (more than 14 units per week) or harmfully (more than 35 units per week); of these 6% drinking harmfully. While the consumption of alcohol has increased, taxation has declined in real terms and even more so as a fraction of average earnings. The rate of duty on spirits per litre of pure alcohol in 1947 was more than the weekly average manual earnings of a woman and almost 60% of a man's. If the rate of duty on spirits had been increased in line with average manual male earnings since 1947, it would have stood at about £200 in 2002; it was £19.56.[4]

2. The rising levels of alcohol consumption and their consequences have been an increasing source of concern in recent years. Media headlines emphasise the consequences of binge drinking which are a cause of many serious accidents, disorder, violence and crime. However, long term heavy drinking causes more harm to health. The President of the Royal College of Physicians told us that alcohol was probably a significant factor in 30 to 40,000 deaths per year. The WHO has put alcohol as the third most frequent cause of death after hypertension and tobacco. UK deaths from liver cirrhosis increased more than five-fold between 1970 and 2006; in contrast, in France, Italy and Spain the number of deaths shrank between two- and four-fold. UK deaths from cirrhosis are now above the other three countries.

3. Since 2000 a number of key studies have examined in more detail the scale of the damage done to health and society and considered the effectiveness of measures to reduce the harm.[5] Among these was the Prime Minister's Strategy Unit's highly regarded study of the costs of alcohol to the NHS and society entitled Alcohol misuse: How much does it cost?', which was published in 2003.

4. Following these studies, in March 2004 the Government produced its long-awaited alcohol strategy: Alcohol Harm Reduction Strategy. However, many of those who had pressed for the strategy were disappointed by it. It was thought that there was too much reliance on the provision of information while the most effective policy, increasing the price, had been ignored. Indeed, the duty on spirits was frozen from 1997 to 2007.

5. After 2004 a series of reports, several commissioned by the Government, increased our understanding of the causes of alcohol consumption and the effectiveness of measures to counter them and threw further doubt on the Government's strategy.[6] The RAND Corporation's study, Early Adolescent Exposure to Alcohol Advertising and its Relationship to Underage Drinking (2007) found that children exposed to high levels of alcohol advertising were more likely both to drink and to intend to drink than those with low levels of exposure. KPMG undertook a Review of the Social Responsibility Standards for the production and sale of Alcoholic Drinks (commissioned by the Home Office from KPMG, April 2008), which found that the standards were widely breached and often inadequate. In 2008 work commissioned by the Department of Health from Sheffield University concluded that setting a minimum price of 50p for the sale of a unit of alcohol would prevent over 3,000 deaths a year and reduce the number of hospital admissions by 98,000.[7]

6. Given the scale of the problem and the widespread feeling that the Government's response has been inadequate we decided to undertake an inquiry.[8] We received memoranda from over 80 organisations and held seven evidence sessions. The witnesses included the authors of many of the recent important reports, clinicians, economists, historians, the drinks industry, supermarkets, advertisers, media agencies, PR firms, a range of quangos, including the Ofcom, the OFT and NICE, an official from HM Treasury, Ministers from the Home Office and the Department for Culture, Media and Sport, the Chief Medical Officer and the Minister of State for Public Health.

7. We asked a number of drinks companies, advertising agencies, PR firms and media organisations for internal documents relating to the marketing of a number of brands. These were examined for us by one of our advisers, Professor Hastings. We recognise the amount of work this involved and would like to thank all those who supplied us with information and Professor Hastings for analysing it. We would also like to thank a number of supermarkets for supplying us in confidence with information about their sales of alcohol.

8. As part of our inquiry we visited Scotland to examine the Scottish Government's very different approach to alcohol, which proposes the introduction of minimum pricing and a determination to address total alcohol consumption rather than concentrate on the minority of problem drinkers, which is the policy in England. We would particularly like to thank Dr Evelyn Gillan, Project Director, Scottish Health Action on Alcohol Problems,.for her help in organising a very useful series of meetings and Professor Sir Neil Douglas, the President of the RCPE, for hosting them. We also spent a day and a half in Paris discussing the restrictions on alcohol advertising and sponsorship. We were able to meet the Commission des Affaires Sociales of the Senate, policy specialists from the Health Ministry and the public health organisation INPES, an addiction psychiatrist and hospital director and a representative of the Ligaris advertising agency. We would like to thank them all for their help. During our visit to New Zealand earlier in the year in connection with several inquiries we found similar problems to those in England. A number of measures were being considered to improve the situation, including a comprehensive review of the legislative framework for the sale and supply of liquor which the New Zealand Law Commission was undertaking. We would like to thank the FCO, in particular Georgina Hill and Kate Jarrett in Paris and Jonathon Jones and Kendyl Oates in Wellington for organising the visits.

9. We would also like to express our gratitude to our advisers: Professor Christine Godfrey of York University, Department of Health Sciences, University of York, Professor Gerard Hastings of Stirling University, Institute for Social Marketing, Stirling and the Open University and Dr Nicholas Sheron, Head of Clinical Hepatology University of Southampton and Southampton University Hospitals Trust..[9]

10. During the inquiry it became clear that there is a great deal of evidence about the risks of drinking and the effectiveness of various policies to reduce the harm caused by alcohol. Because of the thorough research undertaken there is general agreement about the facts. However, their interpretation and the policy implications are disputed by health professionals, the alcohol industry and the Government. The main question we have had to address is whether Government policy is firmly based on the extensive evidence it has gathered.

11. In the report, chapter two looks at the history of alcohol consumption. The chief characteristics are the huge decline in consumption from the late 19th century to the mid-twentieth and its subsequent rise. Chapter three considers the impact of alcohol on health, the NHS and society as a whole, including the costs of crime and loss of work. Chapter four analyses the Government's alcohol strategy. Chapters five to nine consider respectively NHS policies on prevention and treatment; education and information policies, the marketing of alcohol, pubs and licensing; and off-licence sales, particularly in supermarkets. Chapter ten looks at the key issue of the price of alcohol, considering arguments for minimum pricing and rises in alcohol duty. Finally, in chapter eleven, we put forward a new alcohol strategy.

12. One of the historians who gave evidence to this Committee pointed out that there is a long history of select committees examining the problems associated with alcohol. A select committee, which reported in 1834, was described by contemporaries as the 'Drunken Committee'. Its recommendations were ignored at the time, but became part of Government policy much later in the century.[10] We trust it will not take so long for our own recommendations to be implemented.

2   Q 26 Back

3   Statistical handbook 2007 (British Beer and Pub Association, 2007) Back

4   We would like to thank the House of Commons Library and the Scrutiny Unit for providing these figures and undertaking the calculations.  Back

5   For example see the CMO's report in 2001; Alcohol: Can the NHS Afford It? (RCP 2001); Alcohol No Ordinary Commodity: Research and Public Policy (Thomas Babor et al, 2003); Calling Time (Academy of Medical Sciences, March 2004). Back

6   See below, chapter four. Back

7   Independent Review of the Effects of Alcohol Pricing and Promotion (independent review commissioned by the Department of Health from the School of Health and Related Research at the University of Sheffield, ScHARR, December 2008). Back

8   For the terms of reference, Back

9   Professor Christine Godfrey declared her remunerated interest as adviser to the Institute of Alcohol Studies. Professor Godfrey's research group at the University of York also receives funding from the Department of Health and the NHS National Institute for Health Research (NHS NIHR).

Dr Nick Sheron declared his interest as Head of Clinical Hepatology University of Southampton and Southampton University Hospitals Trust, various memberships and unremunerated advisory work for the EU, national and local governments and as an unremunerated trustee of the Drinkaware Trust. Research grants from MRC, Wellcome Trust, British, Liver Trust, Alcohol Education Research Council and various other funding bodies. He has undertaken paid consultancy work and received travelling expenses from pharmaceutical companies developing drugs for the treatment of inflammatory bowel disease and liver disease. He has been paid for medico-legal work in the area of Hepatitis C and alcohol related liver disease.

Professor Hastings declared his interest as member of the Alcohol Education and Research council and other interests associated with his role as Professor of Social Marketing at Stirling University; involved with the BMA in its Under the Influence report. Back

10   Q 72 Back

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