Conclusions and recommendations
Defining the problem
1. 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 (Paragraph 6)
Why is it a matter of concern?
2. 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. (Paragraph
8)
3. 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, 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 (Paragraph 20)
4. 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. (Paragraph 21)
Objectives and targets
5. The
Committee believes it is important to ensure that the objectives
of policy on alcohol are clearly stated and calibrated. The great
majority of citizens enjoy alcohol without significant evidence
of harm to their health. The Committee accepts that it is not
possible to define a level of alcohol consumption which is, in
any absolute sense, safe for all citizens at all times. We do
not believe, however, that this conclusion should lead to disproportionate
or heavy handed controls which are justified neither by public
support nor evidence of proportionate health gain. (Paragraph
22)
6. The Committee also
believes that healthy societies expect all citizens, both corporate
and individual, to exercise their individual freedoms in ways
which respect the rights and interests of their fellow citizens
and observe shared standards of responsible behaviour. It is part
of the function of Government to stimulate, lead and if necessary
regulate, in order to encourage the development of this culture.
(Paragraph 23)
7. The Committee believes
that an Alcohol Strategy should be seen as part of a wider public
health strategy, and should contain some key quantified, alcohol-specific
objectives which will provide both a framework for policy judgements
and an accountability framework. (Paragraph 27)
8. We address in the
report the issue of all local areas having an alcohol strategy,
flowing from the national strategy but using local approaches
to deal with local problems. It seems logical that Public Health
England should oversee this process, given its overarching responsibility
for public health matters. It also seems logical that Public Health
England should devise the national measures against which the
strategy can be tested. (Paragraph 28)
What is 'safe'?
9. Although
we accept that it is a complicated issue, we regard a clearer,
evidence-based definition of the health effects of alcohol consumption
as fundamental to successful policy development in this area.
The work of the Chief Medical Officer needs to be carried forward
as a matter of urgency. Public Health England, acting independently
of Government, then needs to use the outcome of the review as
the basis for its promotion of public understanding of the issues,
setting out the level at which harms are likely to result alongside
sensible drinking guidelines. (Paragraph 36)
Binge drinking
10. Despite
some perceptions that binge drinking is largely a public order
issue, the evidence presented to us suggests that it does contribute
to some of the long-term health harms that have concerned us.
We conclude that these health problems need to be addressed no
less urgently than problems with public order and anti-social
behaviour. (Paragraph 40)
Minimum unit price
11. The
Committee welcomes the Government's decision to introduce a minimum
unit price for alcohol. Rather than relying on generalised
statements about the effect of price on consumption, the Committee
urges the Government to build its case for a minimum unit price
by establishing direct links: between specific alcohol products
and specific alcohol-related harms; between different levels of
minimum unit price and the resulting selling prices for the products
which are linked to alcohol-related harms; and the likely effect
of different levels of selling prices for those products on demand
for those products in the target range of households.
(Paragraph 54)
12. Given the Government's
decision to introduce a minimum unit price, the debate has been
about the level at which it should be set- whether it should be
40, 45 or 50 pence - but the setting of a minimum unit price will
not be a one-off event. Once a minimum price is introduced, if
it is judged to be successful, the level will need to be monitored
and adjusted over time. A mechanism will need to be put in place
in order to do this, but as yet there has been no indication from
the Government of what it intends to do other than to consult
on the price. One way of setting the level would be to establish
an advisory body (there are a number of these already, dealing
with a range of issues) to analyse evidence and make recommendations
to Government. Whatever mechanism is chosen should be used when
setting the initial level of the minimum unit price to ensure
that from the beginning the price is clearly evidence-based.
(Paragraph 55)
13. If the minimum
unit price in England were to be fixed at a different level to
that in Scotland, we would expect the evidence supporting that
decision to be set out clearly. This is another argument in favour
of establishing a transparent mechanism for setting the price.
(Paragraph 56)
14. We recommend that
there should be a "sunset clause" on any provisions
for setting a minimum unit price for alcohol, and that a decision
by Government to make a minimum price permanent should be taken
following advice from the advisory body or other mechanism used
to monitor and adjust the price during the initial period. (Paragraph
57)
15. We have emphasised
the need for the decision on minimum price to be evidence-based.
The debate so far is based almost entirely on the work of the
Sheffield Alcohol Research Group, though research from Canada
has become available more recently. It is not a criticism of the
integrity of that research to say that, if there is to be a minimum
unit price, a more substantial evidence base needs to be developed
in the future to help in the assessment of whether the minimum
unit price is achieving the anticipated benefits. (Paragraph 58)
Multibuys
16. The
evidence does not convince us that a ban on multibuys is either
desirable or workable. The proposed minimum unit price will provide
a floor price for the sale of alcohol, including discounted sales.
The Committee supports the principle of setting the minimum unit
price at a level which is effective at reducing identified alcohol-related
harm; it believes that an attempt to outlaw well-established and
convenient retailing techniques for alcohol products, regardless
of price level, would simply create opportunities for retailers
to find innovative and newsworthy work-arounds which would invite
ridicule and bring the wider policy objective into disrepute.
(Paragraph 64)
Challenging the industry to act responsibly
17. Messages
contained in alcohol advertisements play an important part in
forming social attitudes about alcohol consumption. The Committee
believes that those involved in advertising alcoholic products
should accept that their advertisements contain positive messages
about their products and that these messages are supported by
considerable economic power. If this were not the case it is not
clear why shareholders should be content for their companies'
resources to be spent in this way. Since it is true, however,
it is important that the alcohol industry ensures that its advertisements
comply in all respects with the principles of corporate social
responsibility. Closer definition of these principles as they
apply to alcohol advertising is a key objective of the Government's
Responsibility Deal. (Paragraph 66)
18. The Committee
does not believe that participation by the alcohol industry in
the Responsibility Deal should be regarded by anyone as optional
- we regard it as intrinsic to responsible corporate citizenship.
We welcome the willingness of the industry to address the harms
that alcohol can cause - for example by tackling issues with licensed
premises through the formation of a business improvement district
- but we believe that it should be clear that the Responsibility
Deal is not a substitute for Government policy. (Paragraph
76)
19. It is for the
Government, on behalf of society as a whole, to determine public
policy and ensure that a proper independent evaluation of the
performance of the industry against the requirements of the Responsibility
Deal is undertaken. We recommend that such an evaluation is commissioned
by Public Health England. We will be particularly interested to
see the assessment of the effect of reducing the alcohol level
in certain drinks. We do not believe that reducing the alcohol
in some lagers from 5% to 4.8%, for example, will have any significant
impact. If the industry does not bring forward more substantial
proposals than this it risks being seen as paying only lip service
to the need to reduce the health harms caused by alcohol. (Paragraph
77)
Expectations within the Responsibility Deal
20. The
Committee is concerned that those speaking on behalf of the alcohol
industry often appear to argue that advertising messages have
no effect on public attitudes to alcohol or on consumption. We
believe this argument is implausible. If the industry wishes to
be regarded as a serious and committed partner in the Responsibility
Deal it must acknowledge the power of its advertising messages
and accept responsibility for their consequences. (Paragraph
86)
21. The industry will
take a significant step down this road when it makes it clear
that alcoholic products should not be marketed in ways which address
audiences a significant proportion of whom are aged under 18,
and cannot therefore legally purchase the product. (Paragraph
87)
Existing precedents
22. Advertising
of alcoholic products on television is subject to rules which
are relatively targeted and sophisticated. The Committee believes
there is scope to apply these principles more widely - for example
in cinemas - and recommends that this principle be reviewed in
the context of the Responsibility Deal. Serious consideration
should be given to reducing to 10% the proportion of a film's
audience that can be under 18 and still allow alcohol to be advertised,
or to prohibiting alcohol advertising in cinemas altogether except
when a film has an 18 certificate. (Paragraph 91)
Drinkaware
23. The
Committee believes that it is right that the industry should support
education and awareness campaigns about the harms that alcohol
can cause, and doing so through a separate organisation such as
Drinkaware seems appropriate in principle, but the independence
of the organisation is vital. The value of this contribution is
likely to be very limited if the campaigns it promotes are considered
to be constrained by industry links. (Paragraph 96)
24. We acknowledge
that the Board of Drinkaware as presently constituted has a majority
of non-industry Members, and we welcome that fact. Nevertheless,
if Drinkaware is to make a significant contribution to education
and awareness over the coming years its perceived lack of independence
needs to be tackled, and as part of the review that is to be held
this year the Committee recommends that further steps are taken
to entrench that independence. (Paragraph 97)
Loi Evin
25. Although
the precise terms of the Loi Evin reflect the circumstances
of a different society at a different time, the Committee believes
that the approach adopted in the French legislation merits serious
examination in the English context. In particular the Committee
recommends that Public Health England should commission a study
of the public health effect which would be delivered in the UK
by adopting the principles of Loi Evin; such a piece of
work would provide a valuable reference point for the evaluation
of the effectiveness of the Responsibility Deal which the Committee
has recommended should also be undertaken by Public Health England.
(Paragraph 101)
Local responses
26. Birmingham
is one example of local action that has been drawn to our attention
during the inquiry, and it does demonstrate how local agencies
can put together an effective action programme without the need
for a substantial additional bureaucratic support structure. This
model of local action, linking in with national priorities, makes
sense as a pragmatic, practical way of addressing serious problems.
As we recommended earlier in this report, Public Health England
should use this model as the template for all local areas to address
the various problems that alcohol causes in their communities,
and to link local objectives to those at the national level. Central
Government cannot direct a local area to address alcohol problems
in a particular way, but the new public health structures, in
which local authorities have a key role, should provide the opportunity
to establish a national framework of local initiatives. (Paragraph
106)
Treatment Services
27. We
welcome the work which the Department is undertaking to provide
an evidence base to allow commissioners to make informed decisions
about which models of treatment provision are most effective in
addressing the health issues caused by alcohol abuse. In particular
commissioners need evidence about the most effective form of early
intervention in order to reduce the number of avoidable hospital
admissions which currently represent avoidable illness for patients
and avoidable costs for taxpayers. The evidence we received suggested
that the establishment of Alcohol Specialist Nurse services throughout
the country is one of those measures. The fact that over 70% of
the costs to the NHS of alcohol-related services was spent on
hospital treatment demonstrates the scale of the opportunity to
restructure services to achieve better outcomes. (Paragraph
117)
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