Health Committee - The Government's Alcohol StrategyWritten evidence from 2020health.org (GAS 56)
Summary
Alcohol policy should be led by the Home Office.
Self-regulation is no regulation. We have the most lax alcohol regulation in Europe and the fastest rising rates of alcohol related liver disease.
The local pub has an important role to play in promoting responsible drinking and community health and cohesion.
Statutory regulation on advertising is far too lax and should be brought in line with other European countries, following WHO recommendations.
A universal alcohol assessment should be offered at age 30.
Public health should use the JSNA to commission alcohol services according to need.
Brief Interventions have been shown to reduce risky drinking and would lead to a saving to the NHS, with an average reduction of 5 units per week remaining one year after the intervention took place.
Public Health should take responsibility for education of the local population on alcohol, to ensure that all understand the harms of risky drinking.
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.
A minimum price of 40p per unit should be introduced for all alcohol sales.
Alcohol education should be an annual component of PHSE through secondary school education. This should include information on the long-term risks of drinking at different levels.
A national public health education campaign is needed.
Introduction
The lifestyle choices that we make will affect our health, our relationships, our work and our future. Alcohol consumption is one of the key areas where choices are being overly influenced by a powerful industry and the public is being exposed to coercion on a daily basis. Considering the costs to the public purse are estimated at up to £55 billion a year, we need a much more radical alcohol strategy to reverse the drain on the taxpayer and the prevent the huge number of damaged lives through alcohol misuse. We have to transform our thinking in society so that alcohol is not a prerequisite for enjoyment.
1. Government Leadership: The Alcohol Strategy should be a joint policy across Whitehall led by HO and including the DCMS, DH, DCLG and HM Treasury. The HO should lead because the largest costs of alcohol misuse come in the domain of the HO (crime, anti-social behaviour, domestic violence and family breakdown) and it is vital for people to understand that many determinants of health lie outside of healthcare.
2. Alcohol policy should be consistent between England and the devolved administrations to avoid public misunderstanding and cross-border problems and enable a consistent message for the public.
3. Regulation. The Portman group has been shown to be entirely ineffective. Self-regulation is no regulation. Whilst including the industry in discussions about legislation is fine, they cannot do anything effective to reduce the consumption of alcohol as this would be commercially unacceptable for their shareholders. “Responsibility Deal” agreements such as unit labelling on the back of bottles and cans in tiny font that cannot be read either by anyone over the age of 45 without glasses or in low lighting is hardly going to make an impression. Likewise, midwife training paid for by the alcohol industry could be a waste of time. Alcohol consumed before and during the first trimester of pregnancy before a midwife is seen has a huge impact on foetal health.
3.1
3.2
4. Minimum pricing would send an important signal to consumers about drinking in moderation. Despite increasing taxation, the affordability of alcohol in the UK has been steadily increasing and in 2010, alcohol was found to be 45% more affordable on average than in 1980.1 An association between taxation and alcohol consumption has been shown. Barber et al in 20032 identified that where the price of alcohol was raised the incidence of road deaths, violent crime associated with alcohol and incidence of cirrhosis fell. When Finland reduced taxation in 2004 to stem the flood of cheap imports, the country experienced a 17% rise in alcohol associated mortality.3 However in countries such as France and Italy there is less taxation and alcohol can be purchased cheaply. In France, the quality of the product has been given a higher focus and improving quality of wine and setting these products at a higher price has resulted in a reduction in the purchase of cheaper wines. Such a culture change would be difficult in England.
4.1
5. Advertising has a detrimental impact on children and adults. ELSA6 concluded that:
“Alcohol advertisements are related to positive attitudes and beliefs about alcohol amongst young people, and increase the likelihood of young people starting to drink, the amount they drink, and the amount they drink on any one occasion.” This view is strongly supported by the World Health Organisation.
5.1
5.2
Table 1
A COMPARISON OF EUROPEAN REGULATIONS ON ADVERTISING. DATA TAKEN FROM STAP (2007)7
COMPARISON OF EUROPEAN REGULATIONS ON ADVERTISING
Advertising |
Location/ |
Media |
Sanctions |
|
France |
S |
S |
S |
S |
Italy |
S |
S |
S |
S |
Norway |
S |
S |
S |
S |
Finland |
S |
S |
S |
S |
Germany |
S |
S |
S |
S |
Spain |
S |
S |
S |
S |
UK |
NS |
NS |
NS |
NS |
Key: |
6. Health Impact: The long-term health harm resulting from drinking is well known among the medical and scientific professions and alcohol has been implicated in over 60 types of disease and injury.8 The risks associated with high alcohol intake include increased risks of high blood pressure, stroke, coronary heart disease, liver disease and several forms of cancer as well as mental health disorders. Contrary to popular belief there is no safe level of alcohol consumption. The annual risk of death from alcohol consumption increases from only 10 grams alcohol/day (1.25 units), as can be seen from the graph below, which takes into account both the risks due to alcohol consumption and alcohol’s small protective effect against heart disease.
6.1
6.2
Figure 1: 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, 201110
Table 2: The increased risk associated with drinking three or six units of alcohol per day. Data taken from the Australian Guidelines to Reduce Health Risks from Drinking Alcohol11 and Corrao et al (2004)12
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 |
7 times |
Mouth cancer |
2.5 times |
5 times |
Throat cancer |
1.8 times |
3 times |
Breast cancer |
1.3 times |
2 times |
Hypertension (high blood pressure) |
1.7 times |
3 times |
Ischaemic stroke |
No change |
2 times |
Haemorrhagic stroke |
1.8 times |
3 times |
Pancreatitis |
1.3 times |
2 times |
6.3
6.4
6.5
7. Education: The government’s Alcohol Strategy mixed up binge drinking, dependency and excessive alcohol consumption. 2020health’s report “From one to many” clearly set out that a quarter of adults are drinking to excess but are NOT binge drinkers or alcoholics.13
7.1
7.2
8. Labelling: Progress on public information and awareness could be achieved by the clear display of units on bottles or cans of all alcoholic drinks being made compulsory. Units should be displayed on the front of the bottle and a minimum font size should be specified.
May 2012
1 The NHS Information Centre (2011): Statistics on Alcohol, England 2011. The NHS Information Centre. Leeds.
2 Barber et al (2003): WHO Alcohol and Policy Group report.
3 Koski A, Sirén R, Vuori E, Poikolainen K (2007): Alcohol tax cut and the increase in alcohol- positive sudden deaths: a time series analysis. Addiction. 2007 Mar;102(3):362-8.
4 NICE (2010): Alcohol-use disorders: preventing the development of hazardous and harmful drinking (PH24). NICE. London.
5 NICE (2010): Implementing NICE guidance: Costing Report, Alcohol-use disorders: preventing harmful drinking. NICE. London.
6 STAP (2007): Alcohol marketing in Europe: strengthening regulation to protect young people. Utrecht: National Foundation for Alcohol Prevention.
7 STAP (2007): Regulation of Alcohol Marketing in Europe Utrecht: National Foundation for Alcohol Prevention.
8 World Health Organisation (2004): WHO Global Status Report on Alcohol 2004. WHO. Geneva.
9 Purshouse R, Brennan A, Latimer N, Meng Y, Rafia R, Jackson R, Meier P (2009): Appendices from Modelling to assess the effectiveness and cost-effectiveness of public health related strategies and interventions to reduce alcohol attributable harm in England using the Sheffield Alcohol Policy Model version 2.0 Report to the NICE Public Health Programme Development Group. University of Sheffield. Sheffield.
10 Rehm J, Zatonksi W, Taylor B, Anderson P (2011): Epidemiology and alcohol policy in Europe. Addiction, 106 (Suppl. 1), 11–19
11 National Health and Medical Research Council (2009): Australian Guidelines to reduce health risks from Drinking Alcohol. NHMRC. Canberra.
12 Corrao G, Bagnardi V, Zambon A, La Vecchia C. (2004): A meta-analysis of alcohol consumption and the risk of 15 diseases. Prev Med. 38(5):613-9.
13 http://www.2020health.org/2020health/Publication/Wellbeing-and-Public-Health/From-one-to-many.html