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.

3.1Drinkaware, like Gamcare, is a convenient way for industry to claim that they are being responsible. However the impact of such charities pales into insignificance compared with the amount of money spent by the industry on advertising and promotion.

3.2The local pub is in a different situation. The British Beer and Pub Association have promoted clear, large print information about drink units through beer mats and posters but the local pub can take an active role in helping to moderate consumption, offer non-alcohol and low alcohol alternatives and promote the European model of having a drink with a meal. There is also anecdotal evidence that the local pub has a role to play in mental and public health and can play a significant role in community cohesion and informal policing. Enabling pubs to diversify and extent their community involvement would make a positive contribution to society.

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.

4.1A minimum price per unit of alcohol and an end to “bogof” promotions could stop supermarkets selling alcohol as a loss leader. NICE public health guidance has suggested a minimum price of 40p per unit. The WHO reported that a price increase and minimum pricing per unit were more likely to reduce drinking in those who drank at harmful levels than those who consumed less and even a small shift in price can reduce consumption. Modelling suggests that a minimum price of 40p per unit would lead to a 2.4% reduction in consumption,4 and a saving of £80.3 million to the NHS together with savings of £6.8 million in crime and £13.2 million in employee absenteeism.5

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.

5.1While the UK has many regulations relating to the taxation and production of alcohol, it is one of only two countries in Europe where there is no statutory regulation with regard to the advertising and marketing of alcohol, a system of co-regulation and non-statutory guidance being in place, the other country with limited regulation being the Netherlands, which incidentally has also seen a rise in the incidence of cirrhosis.

5.2In general the UK is perceived as lax as with regard to advertising when compared to other European countries and has been criticised for ignoring other national media rules when transmitting abroad. England should be brought in line with other European countries, following WHO recommendations.

Table 1

A COMPARISON OF EUROPEAN REGULATIONS ON ADVERTISING. DATA TAKEN FROM STAP (2007)7

COMPARISON OF EUROPEAN REGULATIONS ON ADVERTISING

Advertising
to Children

Location/
Time

Media
Channel

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:
S: statutory
NS: non statutory

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.

6.1The death rate from liver disease has been rapidly increasing in recent years and has doubled in the past two decades. Eleven of every 100,000 deaths were due to chronic liver disease and cirrhosis in 2008. For alcoholic liver disease alone there were 14,700 admissions in 2009–10, with the cost per person-specific hospitalisation calculated at £4,626.9

6.2Alcohol, as a toxic substance, increases the risk of diseases in many different parts of the body. Whilst there will of course be individual variation in how alcohol affects different people, we have good data about the increased risk of different diseases due to increasing levels of alcohol consumption. For most conditions related to alcohol the message is simple; the more alcohol consumed, the greater the risk of harm. Table 2 shows the increased risk of different conditions associated with drinking 3 or 6 units of alcohol per day, compared to no alcohol consumption. These are just two snapshots of the gradual increase in risk which occurs as alcohol consumption increases.

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

6.3GPs do not routinely ask about alcohol as they do with smoking. This should be the case, and if there seems to be an issue, people should be offered a “Brief Intervention” which is a 15 minute discussion about alcohol consumption (see 6.3). A universal alcohol assessment should be offered at age 30. This could be cheaply and easily done as an online or email-based assessment. Screening of alcohol consumption should be included in all NHS Health Checks.

6.4Public health should use the Joint Strategic Needs Assessment to commission alcohol services according to need. This would include a service for the delivery of Brief Interventions, with measurable outcomes.

6.5Brief Interventions have been shown to reduce risky drinking, with an average reduction of 5 units per week remaining one year after the intervention took place. Brief interventions cost as little as £15 per patient, and the reduction in alcohol-associated health costs resulting from a policy of screening and brief interventions on GP registration would lead to a saving of £124 million across the NHS over 10 years.

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

7.1Public Health should take responsibility for education of the local population on alcohol, to ensure that all understand the harms of risky drinking. 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.

7.2The UK has through PHSE a formal mechanism for education in schools; however it is left to individual head teachers to determine time spent on the subject and the content. Ofsted’s assessment of the education in schools on the dangers of alcohol recognises this as a gap within the UK’s educational system. The danger is that there is a focus on binge drinking rather than an informed approach towards drinking generally. Given the UK’s propensity to drink there would appear to be the need for improved education, coupled with a more hard hitting national campaign to deliver the messages on the harmful effects of alcohol.

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

Prepared 21st July 2012