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I recognise the enormous amount of work that has gone into the Bill, which addresses an issue that needs urgent action. I assure the House that it is part of the process to which the Government are responding. We intend to respond in the very near future about how we tackle these issues because there is a clear obligation on us. However, as my noble friend will recognise, these are not straightforward or easy issues. Even within the framework of the Bill, there are issues that raise fundamental difficulties. The Government regard the Bill as a contribution to the debate and a pressure upon us to effect solutions, but we are not convinced that it provides the solution that the whole nation is looking forward to the Government providing.
Lord Brennan: My Lords, the Minister’s closing words were that we are dealing with an issue that needs urgent action, and I welcome them. I agree. It would be most unwise of the Government, the leaders of other political parties and civil servants to assume that the people can be ignored on this issue because it is too complicated. We do not expect that kind of longer term debate about something that needs an urgent solution.
I shall make four short points. First, I talked about compensation, but it would be infelicitous to treat that as synonymous with economic harm. I am talking about people who are killed, who have their arms shredded or who lose their eyes. They have to pay for their medical expenses, their rent and their families. That is what I mean by compensation, not
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Secondly, I am gratified that the issues that have been raised as creating difficulties were entirely predictable and, in my view, entirely soluble. The question is the intent, not the capacity to overcome detail.
Thirdly, there is the question of cost. I, and those working with me, sought to produce a cost. Those who oppose my cost can produce their own, and we can examine it. Nobody has yet done so.
I shall make two points about the insurance industry. If there are 10 million holidays to countries that do not have systems of compensation that we can call upon and we say that the average premium is £15 or £20, that is touching £100 million for the two-thirds of the 10 million who might take out a policy. Out of that £100 million, our Government takes 17.5 per cent insurance premium tax, which is £17.5 million. They are acutely aware of the value of the travel insurance market. There are six national insurance firms providing cover, and they must be doing so on the basis that it is economic, it covers the risk and there is a reasonable premium to be charged. So this is a case not of insoluble complexities but of a meeting—I am happy to propose one—between the insurers, the Government, the British Insurance Brokers Association and all interested parties in order to come up with a solution.
My last point is that if an American, an Australian, a Frenchman, an Italian, a Finn, a Swede or an Israeli was sitting in the Public Gallery, he would say to himself, “My Government provide me with this, either through insurance or through government schemes. Why doesn’t it happen in the United Kingdom?”. Are our complexities different from theirs? I think not. It is time for action. The Bill will pursue it, and I invite your Lordships to give it a Second Reading.
On Question, Bill read a second time, and committed to a Committee of the Whole House.
Alcohol Labelling Bill [HL]
12.16 pm
Lord Mitchell: My Lords, I beg to move that this Bill be now read a second time. It has a very simple objective: it seeks to compel manufacturers, distributors and retailers of alcoholic products to display a warning label on all bottles or cans that contain alcohol. The label will state the following:
“GOVERNMENT WARNING: drinking alcoholic beverages during pregnancy, even in small quantities, can have serious consequences for the health of the baby”.
In drafting the Bill, several points have been uppermost in my mind. The first is that the Bill should be tightly focused. We could have widened it much further, but we judged that for a privately introduced Bill of this nature, the wider it is, the less likely will be our chances of success.
We also thought long and hard about the inevitable objections that will be raised. The words “nanny state” have already been raised in some quarters, so
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Finally, we have thought about the cost of labelling. It is predictable that the alcohol industry will raise this matter, but its argument looks a little thin when it already meets identical costs in other countries where labelling is compulsory.
In a nutshell, the Bill is being introduced because drinking alcohol while pregnant is dangerous. Many women are unaware of the danger. We seek to make them, their partners and the world in general aware of the risks to the unborn baby.
It does not need me to stand here today to tell your Lordships about the alcohol pandemic that plagues our country; we see it in the media, and we see it in all its harsh and revolting reality on our streets. However, we are walking a tightrope; we do not want to come across as puritans preaching against fun. Drinking is a highly pleasurable experience, and most of us enjoy it. We are not against young people drinking, even occasionally to excess—after all, which of us never did that? However, what we do want to do is to increase the awareness of the dangers of drinking while pregnant.
Since time immemorial, drunken young people have engaged in sexual encounters that when sober they might have avoided, and there is nothing much we can do about that. However, put sex and alcohol together and there is indeed a cocktail, but of a very different kind. The physiology is simple. The developing foetus in its early stages in the womb has no liver. Its formative body is unable to deal with the same toxins as the fully fledged human being. Therefore, all the poisons its mother ingests will pass through the placenta into the baby’s bloodstream.
Alcohol is a lethal poison. It has the potential to cause great harm to a foetus. It can kill brain cells that can never be replaced; it can damage the nervous system and connections within the brain itself; and it can retard the growth of vital organs, particularly the heart and lungs.
Like tobacco and lung cancer, the correlation is not perfect. People who do not smoke still get lung cancer, just as people who smoke do not get lung cancer. Nevertheless, the relationship of one to the other is now beyond dispute. So it is with drinking when pregnant. Harm is not certain, but it is more likely. It is the risk of this harm that we are trying to address.
Through no fault of their own, future children are being sentenced to lifelong brain damage. Tragically, many of their mothers have not been educated or informed about the risks of alcohol in pregnancy. That is the objective of the Bill—to inform them of the harm that their unborn babies could be exposed to. That harm is called foetal alcohol spectrum disorder. As a spectrum it has many forms. In its most benign form it can cause many types of behavioural problems. It is claimed that, for example, some forms of attention deficit disorder are caused by FASD. It is also felt that many forms of juvenile unsocial behaviour can be similarly traced back to FASD.
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The cost to our society resulting from such conduct is vast. Any action taken to ameliorate this condition would be of benefit to society as a whole. It is believed that one live birth in 100 produces a baby with some form of foetal alcohol spectrum disorder. Put another way, this equals 7,500 babies per year.
At the other end of the spectrum is foetal alcohol syndrome. This takes the problem into a different and more acute dimension. It is judged that in this country between one and three children in 1,000 are born with the condition. That represents somewhere between 750 and 2,250 per year. That is more than the combined number of babies born with muscular dystrophy, spina bifida, HIV and Down’s syndrome. Foetal alcohol syndrome manifests itself in many ways. In some cases the child appears physically normal; in others the child has a series of facial deformities. Widely spaced eyes, a small head due to a smaller brain, thin lips and a flattened philtrum between the base of the nose and the upper lip are all indicators of the presence of the syndrome.
However, it is the hidden brain damage that causes maximum problems. Children with FAS are emotionally and mentally delayed. Typically, they have difficulty in telling time, they get lost, they cannot remember instructions and they are largely innumerate. Eighty per cent are not able to live independently and will always need to rely on the state or other carers.
Sadly, many children in this world are born with all sorts of physical or mental handicaps and sometimes with both. But the harsh reality of foetal alcohol syndrome is that these births are not inevitable. They are not a quirk of nature; they are the result of someone else's actions, and that someone is the child's mother. The fact is that foetal alcohol syndrome and the complete spectrum is preventable: it does not have to happen.
For many years I and others have been lobbying the Department of Health, the alcohol industry and anyone else we can get our hands on, to make them aware of this problem. In the beginning we received polite but cool brush-offs. They asked: where is the evidence? And when confronted with experiences elsewhere, particularly in the United States, we heard, “Just because other countries make it mandatory for alcoholic containers to have labels attached to them, doesn't mean that we have to follow suit”. That is an odd and somewhat parochial conclusion when you think about how rampant binge drinking and alcohol abuse is in this country.
Refusing to take no for an answer is now paying dividends. We hear that the Department of Health is close to reaching an agreement with the alcohol industry. It has been reported that the industry is willing to adopt a code that will encourage labelling. I gather that the label will warn the public in general to restrict alcohol consumption to a number of units per week. I have always had a problem with units as a measure; it is too imprecise and too easily fudged. What is a unit? Is it a glass of wine? How big is that glass of wine, and how strong is that wine? Is it 14 units per week spaced over the week, or is it 14 units consumed in one boozy evening? And, “If they say 14 units, they probably
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Standing around a bar with a bunch of friends is no place to consult the alcohol unit calculator. Nevertheless it is a start. What would be even better is if the label had a warning specifically directed at the dangers of drinking while pregnant. That would be the bold decision.
When it comes to pregnancy we are dealing with an imprecise measure. We do not know how much alcohol is safe. Neither do we know when it is safe. It is a game of Russian roulette—drink at one moment and the chances are you will be safe, but pick the wrong time, without realising it is the wrong time, and the consequences can be lethal.
I therefore ask the Department of Health to reconsider its current position, which is that for pregnant women a few units per week are acceptable. The only reliable message that they should be giving is that no alcohol is safe during pregnancy, and it is to be totally avoided.
Then the question is whether a code imposed by self-regulation is sufficient. I do not think it is, and that is why I believe that this Bill, making it mandatory to include a warning label, is a better solution. I simply do not believe that all suppliers of alcoholic beverages will abide by the code all of the time. The bottle of Bacardi Breezer may have the label attached, but will the bottle of Château Lafite 1982? Perhaps the Minister will let us know the department's thinking on that point.
Other countries have taken the lead on this issue. In the United States compulsory labelling has been in place since 1989. In France a law was passed last year. Others are following; for example, Finland, Chile and Poland. Of course this causes the alcohol industry a great dilemma. How can it possibly object to compulsory labelling in our country when it is forced to include it elsewhere? Where is the logic that requires one consignment of Scotch whisky going to New York to have an American label stuck on at the distillery, whereas a similar consignment bound for London from the same distillery will not? Is it really saying that British women are not entitled to have the same health message as American women? I sincerely hope not.
I should like to take a few moments to make a further comparison with the tobacco and cancer issue, because it is relevant and a pointer as to how matters could develop if not addressed now. The tobacco companies were well aware of the links between smoking and cancer from the early 1950s, yet they sat on the evidence and denied it in public. Labelling was eventually introduced on tobacco products, despite intensive lobbying by the very well resourced tobacco industry. Finally, the anti-smoking lobby won through. Warning labels are now printed on every pack of cigarettes, and with great success. Today, smoking in public places has become socially unacceptable. In many countries it has been banned outright, including our own with effect from 1 July of this year.
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At least that is true in the developed western world. Elsewhere the tobacco companies ply their wares with ever increasing resolve. All of this is a pretty strong indicator that multinational companies, whether tobacco or alcohol, will respond to imperatives only if legally compelled to do so. The alcohol companies would do well to study what happened to the tobacco industry and the potential for legal actions against them.
In a recent article in the Lancet, Dr Raja Mukherjee of St George's Hospital in London and Mr Nigel Eastman address some of the legal and ethical issues. Dr Mukherjee has been to the forefront in matters to do with foetal alcohol syndrome, and we should all thank him for his persistence and scholarship. He cites a case in the American state of Wisconsin where a mother was charged with attempted murder and reckless endangerment because she drank heavily during her pregnancy. It was held that she should be held accountable to her unborn child by her actions.
The Wisconsin appeals court concluded that because a foetus is not a human being the mother could not be held criminally liable. In our country, if a mother were to feed her newly born baby with neat alcohol, she could be prosecuted for doing so, but if she feeds her unborn child alcohol through her bloodstream, she has no responsibility. I find this somewhat bizarre.
Dr Mukherjee also shows in the same article that many healthcare professionals have shown difficulties in diagnosing FAS. In Canada, in a survey, 98 per cent of paediatricians and GPs had heard of FAS but fewer than half felt able to diagnose it. Dr Mukherjee states that diagnosis is key because after the birth of a single child with FAS, the risk of another child, similarly affected, being born to the same mother increases by 800 times. The ethical issues are enormous.
In getting to this point, I have been helped by many people whom I must thank. In particular, I have been ably assisted by Susan Fleisher, who heads NOFAS-UK, and Mr Ross Cranston, a former MP who helped me to draft this Bill. I owe both of them a huge debt. There are also many people who confront the consequences of foetal alcohol spectrum disorder every day of the year; that is, doctors, social workers and other carers, but most of all parents, particularly mothers. Imagine, if you can, the guilt and grief that thousands of mothers endure, realising only too well what the momentary pleasure of drinking went on to cause. It does not bear thinking about. Finally, the children themselves only want normality. There is somehow a haunting plea from all of them—“Mummy, why can’t I be normal?”.
In market research that we commissioned, 61 per cent of women admit to drinking when they are pregnant and 75 per cent are aware that it might have some effect on their unborn child. Sadly, it is still the young and less-educated women who are unaware of the dangers and it is particularly them we seek to inform. Ask a mother-to-be what she wants for her baby and, whoever she is and whatever her background, the answer will be the same: “I want my
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Moved, That the Bill be now read a second time.—(Lord Mitchell.)
12.32 pm
Baroness Finlay of Llandaff: My Lords, I support the Bill introduced by the noble Lord, Lord Mitchell. Drinking alcohol to excess in pregnancy is known to harm the unborn child. As the noble Lord has said, we do not know whether there is a safe level of alcohol intake during pregnancy. Although there is overwhelming evidence of harm, there is no evidence of harm from abstinence. The Government’s policy, which is based on a precautionary principle, is eminently sensible but it could go further. Therefore, the Bill misses a potential opportunity, but I understand why it does not target the many others who are at risk from alcohol abuse. Let me be clear that it is not alcohol but excessive binge drinking which leads to some of the problems that we see in society today. It seems that in pregnancy the drip-drip of alcohol is also harmful. Therefore, the problem of foetal alcohol spectrum disorder is being addressed in this Bill.
The Bill also raises a question, and an opportunity, as to whether other health benefits could come from labelling. In the sub-committee on allergy, which I have the privilege to chair, we have heard about the allergenic potential of the sulphites found in wines and the benefit that a statement of the sulphite content would have for those allergy sufferers who can tolerate low but not high levels of sulphites. In this Bill, labelling is confined to pregnancy, although there would be benefits in extending the warnings about the dangers of excessive drinking to everyone, not just to pregnant mothers. My support is built on the evidence that we need a commitment to a broad-reaching approach. I fear that this Bill, by itself, may not prevent mothers drinking while pregnant, but it is a very important move towards prevention.
We have seen from warning labels on tobacco products about harmful effects that labels are not enough to bring about culture change. Warning labels on alcohol may act as a deterrent where alcohol is sold in sealed containers to people who are sober, but they will not deter those buying excessive alcohol in licensed premises, such as pubs and clubs, where it is dispensed in glasses, which cannot, of course, be labelled. I would like to see an amendment to require such premises to display a warning similar to that proposed for labels.
Drinking in moderation produces health benefits in those who are not pregnant and is an enjoyable social interaction, but excessive drinking harms individuals and society. The social role of drinking
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The excellent report by the Academy of Medical Sciences, Calling Time: The Nation’s Drinking as a Major Health Issue, suggests that price and availability make a difference to alcohol consumption and, therefore, to alcohol-related health damage. In order to decrease excessive drinking, we need to consider measures affecting both those factors. Such measures will often be unpopular.
Alcohol has never been cheaper in real terms in living memory. The price is determined in large part by the duty on alcohol, but that is no longer linked to the strength of the drink. White cider, at up to 7.5 per cent alcohol by volume, is taxed at only half the excise duty on weaker beers. Sadly, there is a cohort of poor, stressed single mothers who find escape in alcohol. I am informed by Professor Gilmore, president of the Royal College of Physicians, that some mums with liver damage are drinking up to two litres of white cider a day because of the combination of high strength and low price, which allows them to escape from their problems. We also know that when these mums are under the influence of alcohol they are at a higher risk of unplanned pregnancy. Therefore, the unborn child is at high risk again and there is a cycle which perpetuates itself. The low price of alcohol also makes it more available to young people and puts it within the financial, if not always legal, reach of teenagers. Most pregnancies occur in young women, so it is important to ensure that they heed the warnings in order that the next generation is not damaged.
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