11 Solutions: a new strategy
333. Is alcohol a problem in England? Is it just
a problem for a small minority as the drinks industry states and
as the Strategy Unit repeated in the 2004 Alcohol Strategy? During
this inquiry we heard strikingly contrasting views from Diageo
and the Royal College of Physicians
While we believe that alcohol misuse is a problem,
particularly for some specific groups (under-age drinkers, binge
drinkers and harmful, private drinkers), it is wrong to paint
Britain as a nation with an alcohol problem [302]
In the UK the health harms caused by alcohol misuse
are underestimated and continue to spiral:… 6.4 million people
consume alcohol at moderate to heavy levels (between 14 and 35
units per week for women and 21 and 50 units per week for men…
In the last 30 years of the 20th century deaths from liver cirrhosis
steadily increased, in people aged 35 to 44 years the death rate
went up 8-fold in men and almost 7-fold in women.
334. We believe that England has a drink problem.
Three times as much alcohol per head is drunk as in the mid 20th
century. It is not just a problem for a small minority, for the
obvious alcoholics and heavy binge drinkers, but for a much larger
section of the population. 10m people drink more than the recommended
limits, 2.6m more than twice the limit. We take all kinds of risks
and drinking a little more than the recommended alcohol limits
is similar to other risks we often take in life. However, most
medical opinion suggests that drinking twice the limits is unwise.
While liver disease rates have declined in the EU, in the UK they
have risen at an alarming rate. Other diseases caused by alcohol,
such as cancer, have risen too. The President of the Royal College
of Surgeons told us that 30-40,000 deaths per year could probably
be attributed to alcohol. In addition, binge-drinking causes serious
disorder, crime and injuries. 27% of young male and 15% of young
female deaths were caused by alcohol. Our teenagers have an appalling
drink problem; among Europeans only Bulgaria and the Isle of Man
are worse. In 2003 the Strategy Unit estimated the total cost
of alcohol to society to be £20 bn; another study in 2007
put the figure at £55 bn.
335. Faced by a mounting problem, the response of
successive Governments has ranged from the non-existent to the
ineffectual. In 2004 an Alcohol Strategy was published following
an excellent study of the costs of alcohol by the Strategy Unit.
Unfortunately, the Strategy failed to take account of the evidence
which had been gathered.
336. The evidence showed that a rise in the price
of alcohol was the most effective way of reducing consumption
just as its increasing affordability since the 1960s had been
the major cause of the rise in consumption. We note that minimum
pricing is supported by many prominent health experts, economists
and ACPO. We recommend that the Government introduce minimum pricing.
337. There is a myth widely propagated by parts of
the drinks industry and politicians that a rise in prices would
unfairly affect the majority of moderate drinkers. But precisely
because they are moderate drinkers a minimum price of for example
40p per unit would have little effect. It would cost a moderate
drinker who drinks 6 units per week 11p per week, as we have seen,
a woman drinking the recommended maximum of 15 units could buy
her weekly total of alcohol for £6.
338. Opponents also claim that heavier drinkers are
insensitive to price changes, but as a group their consumption
will be most affected by price rises since they drink so much
of the alcohol purchased in the country. Minimum pricing would
most affect those who drink cheap alcohol, in particular young
binge-drinkers and heavy low income drinkers who suffer most from
liver disease. It is estimated that a minimum price of 50p per
unit would save over 3,000 lives per year, of 40p, 1,100 lives.
339. Minimum pricing would have benefits. Unlike
rises in duty minimum pricing would benefit traditional pubs which
sell alcohol at more than 40p or 50p per unit; unsurprisingly
it is supported by CAMRA. Minimum pricing would also encourage
a switch to weaker wines and beers. With a minimum price of 40p
per unit, a 10% abv wine would cost a minimum of £2.80p,
a 13% abv. wine about £3.60p.
340. However, without an increase in duty minimum
pricing will lead to an increase in the profits of supermarkets
and the drinks industry Alcohol duty should continue to rise
year on year, but unlike in recent years duty increases should
predominantly be on stronger alcoholic drinks, notably on spirits.
The duty on spirits per litre of pure alcohol was 60% of male
average manual weekly earnings in 1947; in 1973 (when VAT was
imposed in addition to duty) duty was 16% of earnings; by 1983
it was 11% and by 2002 it had fallen to 5%. We recommend that
the duty on spirits be returned in stages to the same percentage
of average earnings as in the 1980s. The duty on industrial white
cider should also be increased. Beer under 2.8% can be taxed at
a different rate and we recommend that the duty on this category
of beer be reduced.
341. An increase in prices must be part of a wider
policy aimed at changing our attitude to alcohol. The policy must
be aimed at the millions who are damaging their heath by harmful
drinking, but it is also time to recognise that problem drinkers
reflect society's attitude to alcohol. There is a good deal of
evidence to show that the number of heavy drinkers in a society
is directly related to average consumption. Living in a culture
which encourages drinking leads more people to drink to excess.
Changing this culture will require a raft of policies.
342. Education, information campaigns and labelling
will not change behaviour, but they can change attitudes and make
more potent policies more acceptable. Moreover, people have a
right to know the risks they are running. Unfortunately, these
campaigns are poorly funded and ineffective at conveying key messages;
people need to know the health risks they are running, the number
of units in the drink they are buying and the recommended weekly
limits, including the desirability of having two days drink-free
each week. The information should be provided on the labels of
alcohol containers and we recommend that all alcohol drinks containers
should have labels containing this information. We doubt whether
a voluntary agreement, even if it is possible to come to one,
would be adequate. The Government should introduce a mandatory
labelling scheme.
343. Expenditure on marketing by the drinks industry
was estimated to be c. £600-800m in 2003. The current system
of controls on alcohol advertising and promotion is failing the
young people it is intended to protect. Both the procedures and
the scope need to be strengthened. The regulation of alcohol promotion
should be completely independent of the alcohol and advertising
industries; this would match best practice in other fields such
as financial services and professional conduct. In addition young
people should themselves be formally involved in the process of
regulation: the best people to judge what a particular communication
is saying are those in the target audience.
344. The current controls do not adequately cover
sponsorship or new media which are becoming increasingly important
in alcohol promotion. The codes must be extended to address better
sponsorship. The new media present particular regulatory challenges,
including the inadequacy of age controls and the problems presented
by user generated content. Expert guidance should be sought on
how to improve the protection offered to young people in this
area. Finally, there is a pressing need to restrict alcohol advertising
and promotion in places where children are likely to be affected
by it.
345. Alcohol-related crime and anti-social behaviour
have increased over the last 20 years, partly as a result of the
development of the night time economy with large concentrations
of vertical drinking pubs in town centres. The DCMS has shown
extraordinary naivety in believing the Licensing Act 2003 would
bring about 'civilised cafe culture' and has failed to enable
the local population to exercise adequate control of a licensing
and enforcement regime which has been too feeble to deal with
the problems it has faced. Some improvements have been made through
the Policing and Crime Act 2009, in particular the introduction
of mandatory conditions on the sale of alcohol. We urge the Government
to implement them as a matter of urgency, but problems remain.
It is of concern that section 141 of the Licensing Act 2003 is
not enforced and we call on the police to enforce s.141 of the
Licensing Act 2003.
346. The 2009 Act has made it easier to review licences,
giving local authorities the right to instigate a review. We support
this. However, we are concerned that local people will continue
to have too little control over the granting of licences and it
will remain too difficult to revoke the licences of premises associated
with heavy drinking. The Government should examine why the licences
of such premises are not more regularly revoked.
347. In Scotland legislation gives licensing authorities
the objective of promoting public health. Unfortunately, public
health has not been a priority for DCMS. We recommend that the
Government closely monitor the operation of the Scottish licensing
act with a view to amending the Licensing Act 2003 to include
a public health objective.
348. The most effective way to deal with alcohol
related ill-health will be to reduce overall consumption, but
existing patients deserve good treatment and a service as good
as that delivered to users of illegal drugs, with similar levels
of access and waiting times. As alcohol consumption and alcohol
related ill health have increased, the services needed to deal
which these problems have not increased; indeed, in many cases
they have decreased, partly as a result of the shift in resources
to dependency on illegal drugs.
349. Early detection and intervention is both effective
and cost effective, and could be easily be built into existing
healthcare screening initiatives and incentives for doing this
should be provided in the QOF. However the dire state of alcohol
treatment services is a significant disincentive for primary care
services to detect alcohol related issues at an early stage before
the serious and expensive health consequences of regular heavy
drinking have developed. These services must be improved.
350. The alcohol problem in this country reflects
a failure of will and competence on the part of government Departments
and quangos. Although the CMO has struggled to get Government
to introduce effective policies, the Strategy Unit produced an
excellent analysis of the problem in 2003 and the Department of
Health has commissioned important pieces of research, most Departments
have failed adequately to engage with the problem. DCMS has been
particularly close to the drinks industry. The interests of the
large pub chains and the promotion of the 'night-time' economy
have taken priority; Ofcom, the ASA and the Portman Group preside
over an advertising and marketing regime which is failing to adequately
protect young people. OFT shows a blinkered obsession with competition
heedless of concerns about public health. The Treasury for many
years pursued a policy of making spirits cheaper in real terms.
Collectively Government has failed to address the alcohol problem.
351. It is not inevitable that per capita alcohol
consumption should be almost three times higher than it was in
the middle of the twentieth century or that liver disease should
continue to rise. Nor is it inevitable that at night town centres
should be awash with drunks, vomit and disorder. These changes
have been fuelled by cheap booze, a liberal licensing regime and
massive marketing budgets. In the past Governments have had a
large influence on alcohol consumption, be it from the liberalisation
which encouraged the eighteenth century 'Gin Craze' and to the
restrictions on licensing in the First World War. Alcohol is no
ordinary commodity and its regulation is an ancient function of
Government.
352. It is time the Government listened more to the
Chief Medical Officer and the President of the Royal College of
Physicians and less to the drinks and retail industry. If everyone
drank responsibly the alcohol industry would lose 40% of its sales
and some estimates are higher. In formulating its alcohol strategy,
the Government must be more sceptical about the industry's claims
that it is in favour of responsible drinking.
302 (Diageo AL 18) Back
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