The evidence base for alcohol guidelines

Supplementary written evidence submitted by the

Department of Health (AG 00a)

Letter from Anne Milton MP, Parliamentary Under Secretary of State for Public Health, Department of Health to the Chair of the Committee, 3 November 2011

The evidence base for alcohol advice

I promised to send you further information to assist in your Inquiry into the evidence base for alcohol advice.

We discussed ways of increasing public awareness of the guidelines:

· In England, alcohol has been integrated into the wider Change4Life brand. The role for a Change4Life alcohol campaign is to communicate the health harms of excessive drinking, and to provide hints, tips and tools to encourage people to drink within the lower-risk guidelines.

· The NHS Choices website already includes information about units and health harms, along with tools such as a unit calculator, drinks diary and drink tracker iPhone app (

· The Department of Health also provides supporting materials to the NHS (especially primary care), to enable local health interventions to be delivered effectively. We know that over 60% of people expect to find information on lower-risk drinking at their GP surgery .

· There will be a n upgraded NHS ‘health harms toolkit’ for NGOs, charities, PCTs and local authorities to use as part of their localised activit y such as press adverts and posters.

I n 2011/12 , t he Government is spending £2 million on social marketing in relation to alcohol. This is an important area but w e are conscious of the economic climate and the Government’s commitment to spend public funds cautiously.

You asked about local spend on social marketing . As I suggested , the Department does not keep a record of this. Local areas are responsible for manag ing their own budgets in relation to local campaigns :

· The Department has published guidance designed to direct commissioners in areas where tackling alcohol harm is an identified priority to resources and good practice guidance, which will assist them in commissioning interventions to reduce the harm caused by alcohol in their local community ( ‘Signs of Improvement – commissioning interventions to reduce alcohol-related harm’ , ) This includes a number of High Impact Changes, shown to be the most effective actions for reducing alcohol-related harms, one of which is to amplify national social marketing priorities.

· The Alcohol Learning Centre contains materials for local areas to use when creating local campaigns and includes a section on social marketing ( )

· As an example of local activity on public awareness, you may want to see the work of Balance , the North East of England’s Alcohol Office . Funded by North East Primary Care Trusts, the Department of Health, the Home Office and local Police forces , Balance has carried out campaigns and public awareness work, examples of which are on its website ( )

The alcohol industry has a role to play too in improving information for consumers, it can reach environments , such as pubs , that no Government brand can.

The Public Health Responsibility Deal include s a pledge to foster "a culture of responsible drinking, which will help people to drink within guidelines". So far around 115 companies have signed up to one or more of the seven alcohol pledges , which cover areas from the improving of labelling and the availability of unit and health information to providing support for local Community Alcohol Partnerships designed to address local issues around alcohol-related social and health harms . As you asked, I am sending the details of these pledges (Annex A).

You also asked about monitoring and evaluation of the Responsibility Deal:

· Partners to the Responsibility Deal will be required to set out what they plan to do to meet the pledges they have signed up to and this information will be publicly available on-line.

· Following on from this, partners will have to report annually on their progress, using a set of defined quantitative measures. This information will also be publicly available on-line. Based on the published information, it will be transparent whether, or not, partners have delivered their pledges and the progress that they have made.

· Partners’ pledge delivery plans, and the full list of quantitative measures that they will report against, will be published on the Department of Health’s website shortly.

· Annual updates from the first year of the Responsibility Deal will be available on the Department’s website in the Spring.

· In parallel, the Department’s Policy Research Programme is assessing the feasibility of an overarching independent evaluation of the impact of some elements of the Responsibility Deal.

We discussed alcohol labelling. The labelling pledge will mean unit information appearing on 80% of products by December 2013, which will be a real achievement. By working with industry, rather than trying to regulate them through legislation, we can go further and faster and impact areas where it is simply not practical to regulate. Food and drink labelling legislation is an area of European Union competence and any attempts to regulate in this area would need to secure EU approval. Attempting this would take significant Government time and resources and would have no guarantee of success.

The Department and the Portman Group have jointly agreed the terms for transparent monitoring and reporting on compliance of the labelling pledge. This includes monitoring at interim stages, which will give us early warning of any risk of missing the target.

In agreement with the Department, the Portman Group will commission independent experts to monitor the implementation of the labelling agreement on behalf of the alcohol industry. The results of the monitoring exercise will be published and companies will also self-report on individual progress through the Responsibility Deal website.

I also mentioned the ‘ladder of intervention’ approach to policy, which is explained in Healthy Lives, Healthy People (page 29, We are committed to determining the least intrusive approach necessary to achieve the desired effect. However, if partnership approaches (like the Responsibility Deal) fail to work, we will consider the case for ‘moving up’ the intervention ladder where necessary.

I have seen the 26 October transcript and think it helpful to clarify a couple of points. I offered to set out some facts and figures on alcohol consumption and other areas, as the picture is confusing. These are given at Annex B . I would also like to amend a couple of the figures I mentioned – 57% of the public drink only once a week or less (not 58%, question 71) and 75% of people have heard of drinking limits (rather than drinking units, question 78 ) . In response to question 93, it would of course be a weekly rather than daily limit that would run the risk of people thinking this is an allowance they can save up for the weekend.

I look forward to the Committee’s report on the challenging and important issue of how best to provide people with guidance and an advice on alcohol.

Anne Milton MP

Parliamentary Under Secretary of State for Public Health

Department of Health

3 November 2011

Annex A

Responsibility Deal - Alcohol Network pledges

Core Commitment

We will foster a culture of responsible drinking, which will help people to drink within guidelines

Collective Pledges

We support tackling the misuse of alcohol in order to reduce the resulting harms to individuals’ health and to society, in particular through the implementation of following pledges:

A1. We will ensure that over 80% of products on shelf (by December 2013) will have labels with clear unit content, NHS guidelines and a warning about drinking when pregnant.

A2. We will provide simple and consistent information in the on-trade (e.g. pubs and clubs), to raise awareness of the unit content of alcoholic drinks, and we will also explore together with health bodies how messages around drinking guidelines and the associated health harms might be communicated.

A3. We will provide simple and consistent information as appropriate in the off-trade (supermarkets and off-licences) as well as other marketing channels (e.g. in-store magazines), to raise awareness of the units, calorie content of alcoholic drinks, NHS drinking guidelines, and the health harms associated with exceeding guidelines.

A4. We commit to ensuring effective action is taken in all premises to reduce and prevent under-age sales of alcohol (primarily through rigorous application of Challenge 21 and Challenge 25).

A5. We commit to maintaining the levels of financial support and in-kind funding for Drinkaware and the "Why let the Good times go bad?" campaign as set out in the Memoranda of Understanding between Industry, Government and Drinkaware.

A6. We commit to further action on advertising and marketing, namely the development of a new sponsorship code requiring the promotion of responsible drinking, not putting alcohol adverts on outdoor poster sites within 100m of schools and adhering to the Drinkaware brand guidelines to ensure clear and consistent usage.

A7. In local communities we will provide support for schemes appropriate for local areas that wish to use them to address issues around social and health harms, and will act together to improve joined up working between such schemes operating in local areas as:

· Best Bar None and Pubwatch, which set standards for on-trade premises

· Purple Flag which make awards to safe, consumer friendly areas

· Community Alcohol Partnerships, which currently support local partnership working to address issues such as under-age sales and alcohol related crime, are to be extended to work with health and education partners in local Government.

· Business Improvement Districts, which can improve the local commercial environment

Individual pledges agreed to date:

· By 30th April 2011 we (ASDA) will no longer display alcohol in the foyers of any our stores.

· We (ASDA) will provide an additional £1m to tackle alcohol misuse by young people.

· We (Heineken) will aim to remove 100 million units of alcohol from the UK market each year through lowering the strength of a major brand by 2013.

· We (Heineken) will distribute 11 million branded glasses into the UK on trade showing alcohol unit information by end of 2011.

· We (Bacardi Brown-Forman Brands, Diageo, Heineken and Molson Coors) commit to working with the BII (British Institute of Innkeeping) and The Home Office to support the continuation and further development of the Best Bar None scheme for at least the next three years to the value of at least £500,000. (commencing May 2011).

· We (the Wine and Spirits Trade Association) will expand the reach of Community Alcohol Partnerships (CAPs) in the UK through an investment of at least £800,000 by alcohol retailers and producers over the next three years [1] . This will allow us to significantly increase the number of CAP schemes in local communities and extend the remit of CAPs beyond tackling under-age sales to wider alcohol-related harm and in particular. We will seek to:

· Reduce young people’s demand for alcohol through prevention, information and diversionary activities.

· Improve the delivery, consistency and quality of alcohol education for all age groups - education [2] , promotion of knowledge and safer drinking concepts; and

· Promote key health initiatives - unit information and sensible drinking messages in store.

· Three year project to extend the NOFAS-UK "What Do You Tell A Pregnant Woman About Alcohol" programme across England & Wales to inform over 1 million pregnant women of what they need to know about alcohol in pregnancy. We (Diageo) commit that in addition to the existing NOFAS-UK booklets and materials, new resources and films will be produced, alongside face to face training sessions, a new online training package, and distance learning packages (online course also available in DVD format). These materials and courses will be CPD accredited by the Royal College of Midwives and offered free to at least 10,000 midwifes, who we expect to inform over 1 million pregnant women of the risks of drinking alcohol in pregnancy by the end of 2014.

Annex B

Alcohol facts and figures


· 22% of adults (9.1 million) self-report that they regularly drink above NHS guidelines, with 2.2m drinking over twice that level.

· These 22% drink about three quarters of all the alcohol consumed.

· Self-reports understate the true levels of consumption – based on HM Revenue & Customs data, that is 67% higher than ONS data.

· 21% of men and 15% of women are binge drinkers (defined as those who say they drank more than double the guidelines on their heaviest drinking day in the previous week) – about half of these are not part of the 9m who drink daily or regularly above NHS guidelines.

· 13% of 11-15 year olds reported drinking in the last week and the amount of alcohol consumed by 11-15 year olds has doubled since 1990 but is now declining.

· Rising UK alcohol consumption and health harm over the last 50 years contrasts with the position of most other major EU countries, such as France and Italy, where both have fallen consistently over many years.

· Total alcohol consumption has increased 60% since the 1970s, reaching highest point in 2004/5 and appears to have stabilised since. The off-trade sells some 65% of the alcohol consumed, and the largest few supermarkets dominate that market; in 1978, only 1 in 3 supermarkets sold alcohol.


· Alcohol penetrates every cell in the human body; this one reason why it causes such a range of different types of harm.

· 60 different medical conditions, both acute and long term; some, e.g. certain cancers, only discovered in the last 20 years.

· Individuals vary in how fast they metabolise alcohol by 3- to 4-fold and in the extent to which they are affected by a given amount of alcohol by 2- to 3-fold. This affects how people drink, the risk of developing alcohol dependence, and the long term risks for damage to the body.

· An average man drinking exactly on 50 units weekly for a long time (double the guidelines) would run about a 10% chance of dying in their lifetime from an alcohol-related cause. As with smokers, it will always be possible to find heavy drinkers who live long lives and die from extreme old age.

· 1.2m hospital admissions (of 14m total admissions) were alcohol related (cancer, liver disease, strokes, etc) in 2010-11, 8% higher than the previous year per head of population.

public awareness

· 90% of people say they have heard of measuring alcohol in units and 75% have heard of drinking limits.

· But many people are unaware that they are drinking above the lower-risk guidelines – over half of those drinking above the guidelines said they drink alcohol to relax and unwind without thinking about how much they drink.

· 87% of people agree that ignoring the lower-risk guidelines can lead to serious health problems. But 44% of those dinking above the guidelines felt that the health risks of regularly drinking more than the lower-risk guidelines were exaggerated.

· In surveys, only 15% of people who drink at higher risk levels say they wish to change their behaviour (for smoking and obesity the equivalent measure is around 80%).

[1] Financial Years July 2011 - June 2014

[2] Schools education projects will be delivered by recognised third parties, without direct industry involvement.


Prepared 9th November 2011