Alcohol - Health Committee Contents

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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