Written evidence submitted by 2020health
1.1 At 2020health we have recently conducted
research into "risky drinking" to be published in our
forthcoming report "From One too many: The risks of frequent
excessive drinking". In this report we have drawn on
both our internal and external expertise. Our Consultant Director,
Gail Beer, was a renal nurse in her early work within the NHS,
before becoming an NHS Trust COO, and we conducted interviews
and conversations with experts in the field. The area of patient
education and information is a central theme at 2020health and
we have identified alcohol consumption as an area where there
is not enough knowledge in the general population for people to
be able to make informed choices about their lives.
1.2 In our report we identified the confusion
regarding recommended safe limits. DH guidelines state that men
should drink no more than 3-4 units per day and women 2-3. However
historically weekly guidelines have been given that men should
drink no more than 21 units per week and women 14 units, and these
weekly guidelines are often still used. These two figures are
clearly at odds with each other and cause some confusion. In addition
there is misunderstanding of the term unit. A unit is taken as
8g of alcohol but many drinks contain more than 8g and drinkers
are often unaware they are drinking more than 1 unit.
1.3 The current use of daily guidelines suggest
that it's acceptable to drink every day and that this causes no
harm; this may be the case if only 1 unit is consumed. Where the
guidelines fail is when consumers believe that the maximum recommended
limit is the amount they can safely consume every day. We believe
that education about the risks of drinking at different levels
would be more beneficial than the setting of limits.
2. What evidence are Government's guidelines
on alcohol intake based on, and how regularly is the evidence
2.1 The evidence base for the government's current
guidelines is unclear. Research has shown that for many alcohol-related
conditions there is a continuing increase in risk with the amount
of alcohol drunk and no clear cut-off between "safe"
consumption and "risky" consumption. Whilst much is
known about the risks of different levels of alcohol consumption
over a period of time, and the risks of binge drinking, there
is no clear reason for the current daily limit on alcohol consumption.
3. Could the evidence base and sources of
scientific advice to Government on alcohol be improved?
3.1 There is extensive medical evidence around
the relationship between alcohol consumption and the risk of many
different diseases, including liver disease, many types of cancer,
hypertension, stroke, pancreatitis and mental illness. Graphs
showing the relationship between level of alcohol consumption
and increasing risk of each condition show that there is no cut-off
limit beneath which alcohol consumption is "safe". Any
level of consumption will increase the risk of developing these
conditions. For this reason the government should not attempt
to define a "sensible limit" for drinking, but instead
should educate the population of the risks associated with different
levels of drinking. Drinking alcohol should be treated In a similar
manner to smoking, where the focus is on public education of the
risks associated with the behaviour.
ABSOLUTE ANNUAL RISK OF DEATH FROM DRINKING
DIFFERENT AVERAGE AMOUNTS OF ALCOHOL PER DAY, FROM 10 G (1.25
UNITS) ALCOHOL/DAY TO 100 G (12.5 UNITS)/DAY. TAKEN FROM REHM
ET AL. 2011
3.2 As we have described in our forthcoming report
"From one to many: The risks of frequent excessive drinking"
there are three main types of drinkers. These are:
The risks for these different groups are different.
Whereas binge drinkers are more likely to subject themselves to
acute damage, risky drinkers, who drink but do not get drunk,
increase their risk of chronic conditions such as cancer and liver
3.3 Separate guidelines should be issued by the
government to target risky drinkers and binge drinkers. These
types of drinking carry different risk. Education about the risk
of chronic conditions are needed for risky drinkers, whereas warning
about the risks of binge drinking is also needed. Targeting these
two populations should in turn help to avoid the development of
4. How well does the Government communicate
its guidelines and the risks of alcohol intake to the public?
4.1 The current guidelines on the risks of alcohol
intake are confusing and this has resulted in poor understanding
of the recommendations around alcohol consumption in the population.
Both daily limits of 3-4 units per day for men and 2-3 units per
day for women and weekly limits of 21 units per week for men and
14 units per week for women are used. These guidelines are not
compatible and result in confusion.
4.2 A YouGov poll conducted in January 2010 showed
that 55% of English adults believe that alcohol only damages your
health if you binge drink or get drunk. The poll showed that 83%
of those who regularly drink more than the recommended limits
don't think their drinking is putting their long-term health at
risk. In another survey from 2008, 46% of the population did not
know the sensible drinking guidelines.
There is a widespread ignorance of the harms associated with heavy
drinking. While 86% of drinkers surveyed knew that drinking alcohol
is related to liver disease, many were unaware of the links with
cancer, stroke or heart disease. One of the difficulties in making
sound behavioural choices is the time gap between the drinking
behaviour and the health consequences. Chronic diseases such as
liver disease and cancers may not manifest until the damaging
drinking behaviour has continued for many years. This makes education
about the risks and future consequences of this behaviour essential.
4.3 As explained above any guidelines issued
by the government need to target risky drinkers and binge drinkers
separately. Targeting these two populations should in turn help
to avoid the development of alcohol dependence.
4.4 Risky drinkers are those who drink
regularly, but do not binge drink or get drunk. They may be drinking
several drinks every day, and are increasing the risk of developing
long-term health conditions. Given the time lag between alcohol
consumption and the development of conditions such as liver disease
or cancer, the harm caused by drinking is often not seen for up
to 10 or 20 years. This makes the need for education about the
risks more pressing.
4.5 Rather than an arbitrary choice of limits
for alcohol consumption, education of the public is needed about
the different conditions related to alcohol consumption and the
relationship between level of consumption and risk. Guidance should
state that it is inadvisable to drink every day, and a public
education campaign is needed to convey the risks of drinking at
different levels. Information such as that shown in Table 1 should
be more widely known and understood.
|Condition||Increased risk associated with drinking:
|3 units of alcohol per day
(1.5 pints of beer, 250ml of wine)
|6 units of alcohol per day|
(3 pints of beer, 500ml of wine)
|Liver disease||3 times
|Mouth cancer||2.5 times
|Throat cancer||1.8 times
|Breast cancer||1.3 times
|Hypertension (high blood pressure)||1.7 times
|Ischaemic stroke||No change
|Haemorrhagic stroke||1.8 times
Table 1: The increased risk associated with drinking 3
or 6 units of alcohol per day. Data taken from the Australian
Guidelines to Reduce Health Risks from Drinking Alcohol
and Corrao et al. (2004).
4.6 Binge drinkers are those who drink eight or more
units in a single session for men and six or more for women. In
addition to the messages about risky drinking, it needs to be
understood that binge drinking is not recommended. The harms of
binge drinking are better understood than risky drinking as the
effects of alcohol are usually seen immediately. Binge drinking
can result in acute health problems, violence, crime, as well
as a cost to employers due to time off or decreased productivity
4.7 In order for the public to regulate their alcohol intake
efficiently, they need to be aware of not only the risks associated
with the consumption of a given number of units of alcohol, but
they also need to be aware of how many units are contained in
their drink. For this reason it is very important that beverages
are labelled with information giving the units of alcohol contained
both on the bottle/can itself and on drinks menus in restaurants/pubs.
5. How do the UK Government's guidelines compare to those
provided in other countries?
5.1 In most respects the UK Government guidelines are comparable
to those given in other European countries. However the UK guidelines
around drinking in pregnancy are less clear than in the rest of
Western Europe, North America and Australasia. Whilst the UK CMOs
advise that "pregnant women or women trying to conceive should
avoid drinking alcohol" this conflicts with NICE guidance
which only advises women to avoid alcohol in the first trimester
of pregnancy. CMO and DH guidance to drink no alcohol throughout
pregnancy should be made more explicit.
5.2 One area where there is a disparity between the UK and
other European countries is the marketing and advertising of alcohol.
Alcohol advertising encourages positive attitudes to alcohol and
increases levels of drinking. The UK operates a voluntary, self-regulatory
code with no legal limitations in force and compared to many European
countries is seen to be lax on alcohol advertising. Whilst the
UK has voluntary codes of practice detailing how, where and when
alcoholic drinks can be advertised, France has a legal ban on
advertising of all alcoholic drinks over 1.2% abv on TV and in
cinemas and also prohibits sponsorship of sport or cultural events
by alcohol companies. In Italy there is a ban on TV and radio
advertising of alcohol between 4pm and 9pm and alcohol advertisements
are prohibited within 15 minutes of the start or end of children's
programmes. Meanwhile, in Sweden there is a complete ban on advertising
of all drinks above 2.25%abv, except at the point of sale and
in trade journals.
5.3 The ELSA (Enforcement of National Laws and Self-regulation
in Advertising and Marketing of Alcohol) project which was funded
by the European Commission and concluded in 2007, made specific
recommendations for the protection of young people and vulnerable
groups which should be taken into account during further development
of UK alcohol policy. Statutory regulation on advertising in the
UK should be brought in line with other European countries and
6. 2020health Key Recommendations
6.1 The clear display of units on bottles or cans of all alcoholic
drinks should be made compulsory. Units should be displayed on
the front of the bottle and a minimum font size should be specified.
6.2 Statutory regulation on advertising should be brought
in line with other Northern European countries, following WHO
6.3 A national public health education campaign is needed
to ensure that the population is made aware of the harms related
to risky drinking. The campaign needs to advise people of the
risks of different conditions associated with drinking and the
harms of drinking every day. In particular the campaign should
highlight risks such as the risk of specific cancers, of which
many are not aware.
7. Further Information
7.1 For further information on the harm and cost of risky
drinking please see our forthcoming report, due to be published
mid-October "From one to many: The risks of frequent excessive
8. Declaration of Interests
8.1 2020health is an independent health and technology think
tank with no connection to the alcohol industry. Our forthcoming
report on alcohol "From one to many" has been sponsored
by an unrestricted educational grant from Lundbeck, a pharmaceutical
company with a specialist focus on psychiatry and neurology. This
submission draws on the research undertaken for this report, but
is an independent submission by 2020health.
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National Health and Medical Research Council (2009): Australian
Guidelines to reduce health risks from Drinking Alcohol. NHMRC.
Corrao G, Bagnardi V, Zambon A, La Vecchia C. (2004): A meta-analysis
of alcohol consumption and the risk of 15 diseases. Prev Med.
Institute of Alcohol Studies (2010): Alcohol & Advertising
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