Conclusions and recommendations
International comparisons
1. The
UK's alcohol guidelines are about average, compared with those
of other developed nations. However, national guidelines can reflect
social objectives and cultural differences as well as scientific
evidence, and therefore we do not consider that international
comparisons should be relied on as an indicator of how appropriate
the UK's alcohol guidelines are. (Paragraph 13)
The evidence base
2. There
is a lack of consensus amongst experts over the health benefits
of alcohol, but it is not clear from the current evidence base
how the benefits of drinking alcohol at low quantities compare
to those of lifelong abstention. In addition, it seems likely
that the same purported health benefits could be gained through
a healthy lifestyle. Therefore we are sceptical about using the
alleged health benefits of alcohol as a basis for daily alcohol
guidelines for the general adult population, particularly as these
benefits would apply only to men over 40 years and post-menopausal
women and the guidelines are aimed at all adults. (Paragraph 25)
3. As the Government
provides guidelines for specific population groups such as children
and pregnant women already, we consider that there could be merit
in producing guidelines for older people, balancing evidence of
beneficial effects of alcohol with evidence of increased risks.
(Paragraph 28)
4. We are content
that there is sufficient physiological and epidemiological evidence
on health risks to support the retention of lower drinking guidelines
for women in general. (Paragraph 31)
5. The UK's Chief
Medical Officers (CMOs) reviewed the guidelines for drinking during
pregnancy in 2006 and produced updated guidelines that encouraged
abstinence but also provided advice for women who chose to drink.
We are satisfied that the CMOs have recently reviewed the evidence
base and consider that the current guidance adequately balances
the scientific uncertainty with a precautionary approach. However,
we note that the Scottish CMO has adopted different advice. Consistency
of advice across the UK would be desirable. (Paragraph 33)
6. We have heard sufficient
concerns from experts to suggest that a thorough review of the
evidence on alcohol and health risks is due. The Department of
Health and the devolved health departments should establish a
nationwide working group to review the evidence base and use the
findings of the review to provide advice on whether the guidelines
should be changed. In the meantime, we consider that there does
not appear to be sufficient evidence to justify increasing the
current drinking guidelines. (Paragraph 37)
Public understanding and communication
7. Public
awareness of alcohol units appears to be high, but there are problems
with public understanding of how many units are in alcoholic beverages.
We see no reason why the established concept of alcohol units
should be changed. We consider that efforts should be focused
on helping people to translate the concept of alcohol units and
sensible drinking guidelines into practice. (Paragraph 44)
8. We are concerned
that the Government views the guidelines as a tool to influence
drinking behaviour when there is very little evidence that the
guidelines have been effective at this. The Government should
treat the guidelines as a source of information for the public.
(Paragraph 48)
9. It is unclear to
us how the term "regular", as applied to all adults
who drink, relates to the advice to take a 48 hour break after
heavy drinking episodes. We suggest that, if daily guidelines
are retained, the Government consider simplifying the guidelines
so that, as is the case in Scotland, all individuals are advised
to take at least two alcohol-free days a week. This would enforce
the message that drinking every day should be avoided, and would
helpfully quantify what "regular" drinking means to
the public. (Paragraph 52)
10. On balance, we
consider that introducing guidance for individual drinking episodes
could be helpful to inform the public and we invite the Department
of Health to consider the suggestion as part of a review of the
evidence base, taking into account social science evidence, including
evidence from other countries on the impact that similar guidelines
have had on drinking patterns. Guidance for individual drinking
episodes should only be introduced if guidance is provided in
a weekly context again, as having two daily drinking limits would
be confusing to the public. (Paragraph 53)
11. There is clearly
a risk that drinks companies could face a conflict of interest
as promoting a sensible drinking message could affect profits.
However we have heard no evidence to suggest that the alcohol
labelling pledges within the Public Health Responsibility Deal
could be achieved without the cooperation of drinks companies.
Nor have we heard sufficient evidence to suggest that, given the
Government exercises proper scrutiny and oversight, a conflict
of interest would jeopardise the progress of the alcohol pledges.
(Paragraph 61)
12. We are concerned
that there will not be an independent assessment of the programme
until the target date of December 2013. We recommend that the
Government immediately set an interim labelling target for December
2012. It should then conduct a preliminary assessment of the progress
of the alcohol pledges in the Public Health Responsibility Deal
in December 2012. If through the voluntary involvement of the
drinks industry, the intermediate target has not been met by December
2012, the Government should review the initiative, including the
possible need to mandate compliance with labelling requirements.
(Paragraph 62)
Conclusions
13. At
a time when the Government is putting efforts into encouraging
people to drink within guidelines, we consider that a review of
the evidence would increase public confidence in the guidelines.
(Paragraph 63)
14. The review of
the evidence base should be conducted by an expert group, including
amongst its members civil servants and external scientific and
medical experts from a wide range of disciplines, including representatives
from the devolved administrations. The group should review:
a) The evidence base for health effects of alcohol
including risks and benefits;
b) Behavioural and social science evidence on
the effectiveness of alcohol guidelines on (i) informing the public
and (ii) changing behaviour;
c) How useful it would be to introduce guidance
on individual drinking episodes;
d) What terminology works well in public communication
of risks and guidelines; and
e) Whether further research is needed, particularly
for the alcohol-related risks to specific demographic groups (for
example, older people).
The group should provide a recommendation to Government
on whether the current alcohol guidelines are evidence-based,
and if they are not, what the guidelines should be changed to.
(Paragraph 64)
15. We
consider that the Government, industry and charities should emphasise
in public communications:
a) The specific risks associated with drinking
patterns, that is, (i) the acute risks associated with individual
episodes of heavy drinking and (ii) the chronic risks associated
with regular drinking;
b) That there are situations where it is not
appropriate to drink at all, for example while operating machinery;
and
c) That people should have some drink free days
every week. (Paragraph 66)
16. Having
explored the complexity around the risks faced by different groups
of people, for example women, pregnant women, older people and
young people, we consider that while simplicity of advice is preferable
for public communication, complexity should not be avoided if
it improves public understanding and confidence in the guidelines.
For example, the guidelines for children and young people are
more complex than for adults but are also clear, concise and leave
no room for misinterpretation, and we consider that guidelines
for adults could be similarly expressed. (Paragraph 67)
17. We recommend that
there should be an online resource where individuals could obtain
more individualised advice where factors such as weight, age,
ethnicity and family history of alcohol problems could be taken
into consideration. This resource should include links to sources
of further information and support, and recommendations on whether
to seek further expert medical advice. We consider that this resource
could help dispel people's notions that generic alcohol guidance
does not apply to them. Charities such as Drinkaware and other
organisations should develop methods of increasing access to this
type of individualised advice for those who have limited or no
access to online resources. (Paragraph 68)
18. The cooperation
of the drinks industry is essential if the Government wants to
achieve the Public Health Responsibility Deal's alcohol pledges.
However, the Government should remain mindful that sensible drinking
messages may conflict with the business objectives of drinks companies,
and should therefore exercise scrutiny and oversight to ensure
that any conflicts of interest are mitigated and managed. (Paragraph
69)
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