2 Defining the problem
4. The strategy is mainly focused on social order
and public binge drinking. The Prime Minister's introduction states:
Binge drinking isn't some fringe issue, it accounts
for half of all alcohol consumed in this country. The crime and
violence it causes drains resources in our hospitals, generates
mayhem on our streets and spreads fear in our communities.
My message is simple. We can't go on like this. We
have to tackle the scourge of violence caused by binge drinking.
And we have to do it now.[4]
5. We asked Anne Milton MP, Parliamentary Under
Secretary of State for Public Health if she felt that the Government's
strategy took sufficient account of the health impact of high
levels of alcohol consumption. She told us:
...the danger is that whenever you produce a strategy...somebody
is going to count up the number of lines that are dedicated to
issues A, B, C or D and say there has not been enough focus on
X, Y or Z... The antisocial behaviour and crime associations of
alcohol affect almost everybody's life in some way or another.
The health harms affect probably fewer people's lives but they
are still very relevant. There are huge financial costs, and we
have concentrated on the financial costs, but I say that we should
also concentrate on the human cost. I do not feel compromised.
I do not think there is any diminution of the other harms that
alcohol causes at all.[5]
6. The Committee shares concerns
about the social impact of binge drinking but we believe it is
also important to ensure that the Government's strategy recognises
and responds to the evidence of an increasing health impact of
excessive alcohol consumption.
WHY IS IT A MATTER OF CONCERN?
7. Alcohol-related disease reflects the lifestyle
choices and behaviours of individual citizens. This leads some
to conclude that these behaviours are matters of individual choice
which are of no concern to policy makers, and others to conclude
that alcohol-related disease should be accorded a lower priority
in public health policy than diseases and conditions which are
in all respects involuntary.
8. While it is sensitive to
the need to avoid a moralising tone the Committee does not accept
either of these positions. The establishment of Public Health
England provides an important opportunity to analyse the true
public health impact of alcohol consumption and adopt a package
of policy responses which is evidence-based, as well as being
carefully calibrated and targeted.
9. It is the evidence of the growing scale of
the health problems caused by alcohol consumption which makes
it a significant public health issue. The latest Government figures,
published at the end of May this year show that:
- There were 6,669 deaths directly
related to alcohol in 2010, 1.3% more than in 2009 (6,584) and
22% more than in 2001 (5,476)
- In 2010/11, there were 198,900 hospital admissions
where the primary diagnosis was attributable to alcohol, 2.1%
more than 2009-10 (194,800) and 40% more than in 2002-03 (142,000)
- In addition, overall there were 1,168,300 hospital
admissions which were to some degree attributable to alcohol,
11% more than 2009-10 (1,056,000) and more than twice as many
as in 2002-03 (510,700).[6]
10. In what it describes as an evidence paper
which it submitted with its memorandum to our inquiry, the Department
of Health tells us that the cost to the NHS of alcohol misuse
is £3.5 billion a year (2009-10 costs), and that lost productivity
due to alcohol across the UK is estimated at £7.3 billion
a year (2009-10 costs). It also says that:
Disability adjusted life years (DALY) are a measure
of combined ill health (adjusted for severity) and premature death.
Alcohol is 10% of the UK burden of disease and death, as measured
by DALYs lost - smoking is 15%. By this measure, alcohol is one
of the three biggest lifestyle risk factors for disease and death
in the UK, after smoking and obesity. This takes account of the
net benefit from a reduced risk of heart disease for moderate
consumption.
It is important to note that DALYs take account of
long term health damage and loss of life, short term accidents
and injuries, which account for a high proportion of early deaths,
and the burden of ill health linked to dependence. It is all of
these together that account for alcohol's importance as a risk
factor.[7]
11. The Royal College of Nursing made a similar
point:
Excessive alcohol consumption is a major source of
morbidity and premature death in the UK. The World Health Organisation
lists alcohol as the third leading risk factor for premature death
in developed countries, with only tobacco and blood pressure causing
more premature death and disability.[8]
The DH told us that "In England, the average
years of life lost for men and women dying from alcohol-attributable
conditions during 2003-2005 was 20 years and 15 years respectively."[9]
12. This chronic situation also links in to public
order and other social problems. The NSPCC pointed out general
harms alcohol causes to families:
It is estimated that between 780,000 and 1.3 million
children in England aged under 16 have parents whose drinking
is classified as harmful or dependent. Around 79,000 babies under
one year old in England have a parent who is a harmful drinker,
which is equivalent to 93,500 babies in the UK. And around 26,000
babies under one year old in England have a parent who is a dependent
drinker, which is equivalent to 31,000 across the UK. Furthermore,
parental alcohol misuse is present in a number of cases of child
abuse and neglect. Evidence shows that it was present in 22 per
cent of Serious Case Reviews in England from 2007-2009.[10]
13. Alcohol harm is also connected with health
inequalities. The Committee was told that people on lower incomes
"suffer a greater risk of harm per unit of alcohol than those
on higher incomes".[11]
There is no clear understanding of why this is. Dr John Holmes
of the Sheffield Alcohol Research Group said:
Partly it is to do with other confounding factors,
things to do with other aspects of their diet, other health behaviours,
the environments in which they drink, their access to medical
services and the quality of those services and, because of their
other health behaviours, their body's ability to deal with the
alcohol. There are lots of reasons which you could broadly consider
as social exclusion arguments which mean that people on lower
incomes are at greater risk of harm from alcohol than people on
higher incomes.[12]
14. The Committee explored with several witnesses
the paradox that these increases in alcohol-related harm have
coincided with decreases in the proportion of the adult population
who drink alcohol, and of the overall amount being drunk. Professor
Alan Brennan, of the Sheffield Alcohol Research Group, said that:
That is quite a complex thing to untie. There has
been a recent reduction in reported alcohol consumption, but from
quite a high level that has been going up over many years. Certainly
in relation to these chronic health harms, where people drink
substantially and over time that results in illnesses like cancers;
a shortterm downturn does not turn off that lagged effect
around health harm.[13]
15. His colleague, Dr Holmes, added that:
...alcohol consumption peaked in 2005. In 2005 we
were drinking more alcohol per person per year than we had been
at any other time in the last hundred years. So, yes, we have
seen a small fall from that peak, but in no way are we back down
at what might be considered low levels in an historical context.[14]
16. The Minister argued that part of the problem
was that "a small number of people are drinking more and
more alcohol. It should focus our attention on the fact that a
message is getting through to some people, but not everybody."[15]
Chris Heffer, Deputy Director, Alcohol and Drugs, at the Department
of Health said that:
consumption has risen over 30 years and quite dramatically
peaked...in about 2004 and is down about 10%. But one needs, I
think, to be cautious of overinterpreting yearonyear
falls in that. There are a number of measures of alcohol harm.
We can look at deaths, which fell the year before last but then
did not fall last year...You may come back to hospital admissions
as a measure...The primary coding has only grown about 2% or 3%
over the period, not quite in line with falling consumption but
certainly not growing rapidly while consumption falls. So I think
the timelag theory ...is very real. You might expect deaths
to respond faster, which may be why you saw that in one year.[16]
17. The Committee discussed with witnesses whether
the strategy correctly identified the main problems concerning
alcohol, and whether it provided appropriate solutions. Eric Appleby
of Alcohol Concern said:
It is a significant step forward from anything we
have had before...particularly because the strategy has looked
at tackling consumption through price and availability—perhaps
less so through marketing—which we know are some of the
key triggers there. I think it could have gone further in terms
of the issue of treatment... clearly the headlines are around
binge drinking. It is a problem and an unsightly problem. In health
terms, however, the bigger problem is not so much the binge drinking
but the longterm, more hidden perhaps, middleage and
middleclass sort of drinking. In health terms, the most
significant costs are hospital admissions, the vast majority of
those being the chronic longterm impact of drinking.[17]
18. Sir Ian Gilmore of the Royal College of Physicians
agreed with this last point, saying that
For example...Liverpool Primary Care Trust data show
that 90% of hospital admissions related to alcohol are for chronic
conditions. They are not for people falling over in Lime Street
when they are drunk, but for chronic conditions. In many areas
the strategy does measure up to making an impact on those areas...
it is stronger perhaps in areas that relate to crime and social
disorder—licensing—than it is perhaps in some of its
ambitions concerning health and, in particular, treatment...but
we would have preferred it to have been framed more in terms of
the health challenges and potential health benefits. None the
less, there is a lot there that gives us something to work on.[18]
19. Sir Ian also said that:
We have to accept...that "alcohol is not an
ordinary commodity". If it is left to personal choice as
an entirely libertarian issue, we will run into problems. It is
a drug. It is a drug of dependence. It is a psychoactive drug.
It happens to be legal. We do not want to make it illegal, but
it does require different handling from soap powder and other
things that may be dealt with otherwise by the free market.[19]
20. Alcohol misuse affects a
large number of people. The current annual death rate from alcohol-related
conditions is more than three times that for deaths in road accidents,[20]
and the cost to the NHS of treating such conditions is around
3% of its annual budget. The Government's strategy is a welcome
attempt to address some of these problems in a coherent way.
21. The main focus of the strategy
is the need to address public order issues. We agree that these
are important, but we believe that the health impact of the misuse
of alcohol is more insidious and pervasive; the remainder of this
report therefore focuses on ways in which those harms to health
can be addressed.
4 Alcohol Strategy, page 2. Back
5
Q 348 Back
6
Statistics on Alcohol: England, 2012, pages 11 and 12. NB, as
is stated on page 11 of this report, "Comparisons over time
in the broad measure are complicated by changes in recording practices
over the period. In order to estimate the trend once changes in
recording practices are accounted for, a method to adjust the
national figures has been devised which is presented in Appendix
G. Adjusted figures show a 49% increase from an estimated 783,300
in 2002/03 but a 3% decrease from 1,208,100 in 2009/10." Back
7
Ev 78-9 Back
8
Ev w70 Back
9
Ev 79 Back
10
Ev w39 Back
11
Q 26 Back
12
Q 27 Back
13
Q 4 Back
14
ibid Back
15
Q 307 Back
16
Q 310 Back
17
Q 2 Back
18
ibid Back
19
Q 6 Back
20
1,850 people were killed in road accidents in 2010: http://assets.dft.gov.uk/statistics/releases/transport-statistics-great-britain-2011/transport-accidents-summary.pdf
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