A new EU Alcohol Strategy? - European Union Committee Contents


CHAPTER 2: ALCOHOL ABUSE: THE FACTUAL BACKGROUND


11.  Any strategy which "addresses the adverse health effects related to harmful and hazardous alcohol consumption"[10] needs to consider first what the levels of alcohol consumption are in the Member States, what levels can be considered harmful or hazardous, and what are the adverse health effects. The 2006 Strategy did so only in a perfunctory way. It stated that it "recognises that there are different cultural habits related to alcohol consumption in the various Member States", but it treated the (then 25) Member States as a single area, and their half billion inhabitants as one group of consumers. In this chapter we attempt, while considering the figures for Europe as a whole, to expose the very wide disparities between areas, States, age groups and sexes, before doing the same for the United Kingdom and its constituent parts.

12.  It takes time to collect and analyse data, and most of the information on which the Strategy was based is now at least 10 years old. We aim to consider the position as it is now with the latest figures available to us. The 2012 WHO report, which is based on data collected in 2011,[11] is a valuable source of information. We also took oral evidence from two of the report's authors, Professor Peter Anderson and Dr Lars Møller, Programme Manager, Alcohol and Illicit Drugs, WHO Regional Office for Europe.

13.  WHO statistics sometimes refer to Europe—in which Russia is not included—and sometimes to the EU. The same is true of figures from DG SANCO. Within the United Kingdom, some statistics refer to the UK as a whole and some only to its constituent parts. Where we have cited figures, in addition to giving their source we have made clear precisely what they relate to.

Terminology

14.  There is no general agreement, either in the relevant literature or in the evidence we received, or indeed between different States or organisations, about descriptions of levels of consumption: what constitutes safe, responsible, harmful or hazardous drinking, binge drinking, or alcohol abuse. Some of the terms used by the WHO are generally recognised.[12]

15.  The EU Strategy defined hazardous consumption as "a level of consumption or pattern of drinking that is likely to result in harm should present drinking habits persist". It used the WHO definition of harmful use of alcohol: "a pattern of alcohol use that is causing damage to health, and the damage may be physical (as in cases of liver cirrhosis) or mental (as in cases of depressive episodes secondary to heavy consumption of alcohol)".

16.  In the United Kingdom the following measures of the strength of alcoholic drinks are generally accepted.

Box 1: UK measures of alcohol
One unit of alcohol is 10ml or 7.9 grams of pure alcohol. One litre of drink which is x% alcohol by volume (ABV) is therefore x units of alcohol. A 750ml bottle of wine of 12% ABV contains 9 units. A single measure of spirits is 1 unit. A pint (560ml) of normal strength beer or a medium (175ml) glass of wine is 2 units. A large (250ml) glass of wine is 3 units, and a pint of strong beer 4 units. The Government recommends that men should drink no more than 3-4 units a day, and women no more that 2-3 units a day.

17.  Even terms such as "responsible drinking" or "safe drinking" cannot easily be quantified. Consumption which would usually be classed as both would generally be regarded as neither safe nor responsible if indulged in by a driver. For our report we believe that the terms "moderate drinking", "harmful drinking" and "binge drinking" will be generally understood. We use "alcohol abuse" to embrace both harmful and binge drinking.

European alcohol consumption

18.  Europe is the region with the highest per capita alcohol consumption in the world. In Europe, alcohol abuse is the third leading risk factor for disease and mortality after tobacco and high blood pressure. The WHO estimated that in 2009, average adult (aged 15+ years) alcohol consumption in the EU was 12.5 litres of pure alcohol—27g of pure alcohol a day, more than double the world average.[13]

19.  The WHO divides the EU into four regions. The United Kingdom, together with Ireland, Austria, Belgium, France, Germany, Luxembourg and the Netherlands belong to the 'Central-Western and Western Europe group'. The region has a high GDP, about 10% above the EU average. Beer has been the preferred drink in all countries except France (which is sometimes grouped with Southern Europe).

20.  The 'Nordic countries' (which include Denmark, Finland and Sweden) used to experience heavy episodic drinking of spirits, but recently the overall consumption has been lower than the EU average, and spirits are no longer the dominant alcoholic beverage. The countries of 'Southern Europe' (Cyprus, Greece, Italy, Malta, Portugal, Spain and, in some classifications, France) have a Mediterranean drinking pattern. Wine has traditionally been produced and drunk, characterized by almost daily drinking of alcohol (often wine with meals), avoidance of irregular heavy drinking and no acceptance of public drunkenness. The overall volume of consumption has traditionally been high, but it has been falling over recent decades.

21.  Finally the countries of 'Central-Eastern and Eastern Europe' are the A8 which acceded to the EU in 2004, and Bulgaria and Romania—Croatia is not included in the WHO classification. In 2005 their GDP was on average half that of the rest of the EU, but alcohol consumption was on average higher, with a higher rate of unrecorded consumption.

22.  There are huge disparities in consumption among the Member States. The chart below shows changes in average per capita consumption of alcohol in one Member State from each European region between 2005 and 2012: the UK, Sweden, Lithuania (where in 2012 consumption was highest, at 16.9 litres[14]), and Italy (the lowest consumption of a Member State, at 5.7 litres).[15]

Figure 1: Litres of pure alcohol consumed per person aged 15+ per year (recorded and unrecorded), time series of 7 years

Source: European Commission, European Core Health Indicators (ECHI)

United Kingdom expenditure and revenue

23.  United Kingdom households spend some £15 billion a year on the consumption of alcoholic drinks, around 18% of their total expenditure on food and drink. The Government collected £10.5 billion in alcohol duties in 2013-14, around 2% of all tax revenue.[16] This accounts for 38.8% of all alcohol duty paid by EU consumers across Member States, more than France, Germany, Italy, Poland and Spain combined. UK consumers pay 68% of all tax on wine raised in the EU.[17] In all Member States alcohol duties are a significant revenue raiser, but in none more than the UK.

Differences in consumption levels and patterns

DIFFERENCES BETWEEN MEN, WOMEN AND CHILDREN

24.  Drinking patterns between men and women, and between adults and children, vary greatly across the Member States, but in every state men drink more than women, and suffer more harm from drinking.

25.  The Health and Social Care Information Centre (HSCIC) is an executive agency sponsored by the Department of Health and is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care. The data are for England alone. They show that:

·  between 2005 and 2012 the proportion of men who drank alcohol in the week before being interviewed fell from 72% to 64%, and the proportion of women fell from 57% to 52% in Great Britain;

·  among adults who had drunk alcohol in the last week, 55% of men and 53% of women drank more than the recommended daily amounts, including 31% of men and 24% of women who drank more than twice the recommended amounts in 2012;

·  in 2012, 43% of school pupils aged 11-15 said that they had drunk alcohol at least once. This continues the downward trend since 2003, when 61% of pupils had drunk alcohol.

26.  Daniel Greaves, the Head of the Home Office Drugs and Alcohol Unit, told us that in recent years there had been "a marked decline" in underage drinking: "Over the last decade the proportion of 11-15 year olds who have ever had an alcoholic drink reduced from 61% to 39%, and those who had drunk in the last week from 25% to 9% … If we contrast it with 10, 20, 25 years ago, it is much harder for a young person to access a drink than it would have been previously. The penalties are stiffer; there is much greater awareness about the harms associated with early exposure to drink and early drunkenness; and there is much greater focus on standards and policies within retail outlets and pubs, and much greater expectation."[18] While these trends in underage drinking are welcome, the UK still has some of the highest levels of childhood binge drinking in Europe, with 52% of UK children aged 11-15 reportedly binge drinking in the last 30 days in 2011, compared to the 39% average.[19]

27.  In the view of some of our witnesses the real problem is adult drinking. Prof Anderson, commenting on the current EU Youth and Binge Drinking Action Plan, told us: "This is not the problem that Europe faces. The problem that Europe faces is heavy drinking … including binge drinking among the adult population. If you look back 20 or 30 years, normally what would happen as people aged was that they would start to drink less, but that does not seem to be occurring. As the middle-aged get older, they take forward the heavy drinking pattern and this is going to cause a lot of problems for the European Union; as that group goes on into older age, we will get more and more problems."[20]

DIFFERENCES WITHIN THE UNITED KINGDOM

28.  Figures for the UK as a whole disguise large variations between regions. Dr Evelyn Gillan, Chief Executive of Alcohol Focus Scotland, told us: "We know that in Scotland death rates from alcohol-related mortality are seven times higher in areas that we describe as deprived than anywhere else … that is not because everybody on lower incomes is drinking more … people on lower incomes on average drink less than people on higher incomes, but those who do drink, drink much more harmfully." Professor Nick Sheron, the Head of Clinical Hepatology at the University of Southampton added: "There is a ten-fold difference in alcohol-related mortality between the highest and lowest social classes in Wales."[21]

29.  Health, and hence alcohol policy, is a devolved matter in Scotland, Wales and Northern Ireland. Scotland has its own Licensing Act. On 5 December 2014 Scotland reduced its drink driving alcohol level to 50mg of alcohol per 100ml of blood, leaving the rest of the UK, with Malta, as the only countries of the EU with an 80mg limit. In Chapter 6 we explain the variations within the UK on introducing minimum unit pricing (MUP).

Alcohol-related harm

HARM TO THE DRINKER

30.  The passage in the 2012 WHO report dealing with the impact of alcohol on health includes an introduction by Prof Anderson, which is summarised in Box 2.

Box 2: Impact of Alcohol on Health
Apart from being a drug of dependence, alcohol has been known for many years as a cause of some 60 different types of disease and condition, including injuries, mental and behavioural disorders, gastrointestinal conditions, cancers, cardiovascular diseases, immunological disorders, lung diseases, skeletal and muscular diseases, reproductive disorders and pre-natal harm, including an increased risk of prematurity and low birth weight. In recent years, overwhelming evidence has confirmed that both the volume of lifetime alcohol use and the combination of frequency of drinking and amount drunk per incident increase the risk of alcohol-related harm, largely in a dose-dependent manner, with the higher the alcohol consumption, the greater the risk.

31.  There are differing views as to the correlation of some of these conditions with alcohol consumption, and the degree of consumption which produces some of these diseases, but this general statement of the impact of alcohol consumption on health is not seriously contested.

32.  The WHO Report estimates that in the EU in 2004 94,451 men and 25,284 women aged between 15 and 64 years died of alcohol-attributable causes (total 119,735). This corresponds to 13.9% of all deaths in men and 7.7% of all deaths in women in this age category (11.8% of all deaths).[22] Again, these figures mask very large regional variations. Over a quarter of male deaths in that age group in the Baltic States in 2004 were attributable to alcohol-related causes, compared to 9.2% in Southern Europe.

33.  The UK figures are 8% of men, and 6% of women. Nevertheless the long-term trend in harm to the drinker's health in the UK, outlined in Box 3, is worrying.

Box 3: Alcohol attributable and alcohol-specific deaths in the UK, 2001-11

Alcohol-attributable deaths in England rose by 7%, from 14,000 in 2001 to 15,000 in 2010. In contrast, deaths from all causes in England fell by 7% over this period. Over the same period, alcohol-specific deaths rose by 30%. The rate of liver deaths in the UK has nearly quadrupled over 40 years, a very different trend from most other European countries. Approximately 60% of people with liver disease in England have alcoholic liver disease, which accounts for 84% of liver deaths. In addition, the rate of alcohol-related hospital admissions has also continued to rise by an average of 4% each year over the eight years 2002-03 to 2010-11. Alcohol is now one of the three biggest lifestyle risk factors for disease and death in the United Kingdom, after smoking and obesity.[23]

34.  The more recent figures are slightly more encouraging. ONS figures for alcohol-related deaths of all age groups in the United Kingdom in 2012 are summarised in Box 4.[24]

Box 4: Alcohol-related deaths in the UK, 2012

·  In 2012 there were (excluding road traffic and other accidents) 8,367 alcohol-related deaths in the UK, 381 fewer than in 2011 (8,748).

·  Males accounted for approximately 65% of all alcohol-related deaths in the UK in 2012.

·  Death rates were highest among men aged 60 to 64 years (42.6 deaths per 100,000 population) and women aged 55 to 59 years (22.2 deaths per 100,000).

·  Of the four UK constituent countries, death rates have been lowest in England, significantly higher in Wales and Northern Ireland, and much higher in Scotland.

·  In 2002 the death rate in Scotland was twice that in the rest of the UK (for males 40 deaths per 100,000 population compared to 15 in England; for females 16 compared to 7); by 2012 rates in England were substantially unchanged, but rates in Scotland were down to 25 for males and 10 for females.

35.  For England only, the HSCIC figures show that in 2012-13 there were an estimated 1,008,850 hospital admissions related to alcohol consumption where an alcohol-related disease, injury or condition was the primary reason or a secondary diagnosis, making 1,890 alcohol-related hospital admissions per 100,000 population. Of the overall admissions, 65% were male patients; however among under 16s, females accounted for 55% per cent of all admissions to hospital with alcohol related diseases, injuries and conditions.

36.  Within England, there are also wide variations. HSCIC figures show that in 2012-13 the rate of alcohol-related admissions to hospital varied from an estimated 2,500 per 100,000 population in North East Region to 1,500 admissions per 100,000 population in South East Region. Figures from the Office for National Statistics (ONS) show that in England, alcohol-related death rates were highest among regions in the North and lowest among those in the South throughout the period 2002-12.[25]

37.  The ONS figures show that in England and Wales, 63% of all alcohol-related deaths in 2012 were caused by alcoholic liver disease, with 16% of these deaths occurring among those aged 55 to 59 years. Prof Sheron, whose specialism is liver diseases, gave us graphic illustrations of the correlation between alcohol consumption and liver disease, giving as an example "countries such as France, Spain and Italy, which historically have had very, very high levels of per capita alcohol consumption, liver mortality and alcohol-related harm. Alcohol consumption has been in freefall in those countries, and liver mortality has followed it almost exactly."[26]

38.  Dr Gillan agreed, giving us the converse argument: "People often think that the UK has always had this heavy drinking culture, but in 1960 the UK had one of the lowest liver cirrhosis mortality rates in western Europe … We have moved from a position of having one of the lowest liver cirrhosis rates in western Europe to having one of the highest."[27]

HARM TO OTHERS

39.  We thought it important to hear from witnesses who have experience in England of the treatment of alcohol abuse, and its effect on their families and on the wider community. We took evidence from Adrian Brown, Alcohol Liaison Nurse at Northwick Park and Central Middlesex Hospitals, who told us that the change in the culture of people who were drinking had gone from "mostly male to more like 50-50 men to women in younger people". Among this group, the people seen in A&E were just as likely to be female as male.[28]

40.  We also heard from Vivienne Evans, the Chief Executive of Adfam, a charity supporting families affected by drug and alcohol use. She told us that ChildLine received on average 100 calls a week from children and young people about substance misuse by their parents, and the majority of these were about alcohol.[29]

41.  The harm caused to the unborn child by heavy drinking is also beyond dispute. Many of our witnesses discussed how labelling could minimise consumption during pregnancy. We consider this further in Chapter 7.

DRINK DRIVING

42.  Drink driving has the most obviously serious effect on third parties. In the EU in 2010 1.04 deaths per 100,000 people (0.56 deaths per 100,000 women and 1.55 deaths per 100,000 men) were caused by alcohol-attributable motor vehicle accidents and assaults. This burden of alcohol-attributable harm to others was greatest in the Central-Eastern and Eastern country group, with 2.23 deaths per 100,000 people (1.20 deaths per 100,000 women and 3.36 deaths per 100,000 men).[30]

43.  The European Transport Safety Council (ETSC) has reported that of the 31,000 deaths in road collisions in the EU in 2010, official statistics attribute 11.5% to drink driving. However, it is thought that massive under-reporting distorts the picture: the Commission estimates that 25% of all road deaths across the EU are alcohol-related. Using this figure, the ETSC estimates that 6,500 deaths would have been prevented in 2010 if all drivers had obeyed the law on drink driving.[31] Within the UK, in the last 10 years road casualties caused by drink driving have fallen dramatically, but in 2012 there were still 230 deaths in the UK due to drink driving, accounting for 13% of all road fatalities.[32]

DOMESTIC VIOLENCE

44.  Adrian Lee, the Chief Constable of Northamptonshire and National Police Lead for Alcohol Licensing and Harm Reduction, told us in written evidence that it was estimated that alcohol was a factor in a third of all domestic abuse incidents.[33] The third parties in these cases were not just the offender's partner or other direct victims, but extended to any children within the relationship. As a result of witnessing incidents, children might develop anxiety or behavioural issues, for example, becoming withdrawn, exhibiting violence themselves, suffering sleep disturbance and performing poorly at school.

OTHER CRIMINAL OFFENCES

45.  Mr Greaves told us that alcohol also played a large part in the amount and extent of public disorder:

    "We know from the Crime Survey for England and Wales that in about 49% of violent incidents the victim believed the perpetrator to be under the influence of alcohol. This is particularly the case where the violence is committed by a stranger. It rises to 70% in those cases … one-fifth of people perceive people being drunk and behaving antisocially as a very or fairly big problem in their area. We know that a quarter of penalty notices for disorder issued by the police are for drunk and disorderly in a public place. That equated to some 16,000 notices in the year ending June 2014."[34]

46.  Chief Constable Lee told us that in order to obtain a comprehensive snapshot of the demands that alcohol-related incidents place on local policing, he had commissioned a thorough review of all incidents that were reported to Northamptonshire Police during a 24-hour period on Saturday 21 September 2013. The results established that 27% of incidents were alcohol-related and ranged from violence and disorder to other categories such as burglary, criminal damage, drugs offences, missing people, welfare concerns, road traffic matters and suspicious circumstances.[35]

47.  Chief Constable Lee also pointed out that the time and associated costs required to deal with a drunk detainee were significantly greater than the equivalent for a sober suspect. Drunk prisoners could not be interviewed, or evidence taken from them, until they were sober, and this extended offenders' periods in custody and increased associated costs.

48.  Mr Greaves estimated that the cost to society of alcohol-related crime at 2010-11 prices was "some £11 billion … broken down into three components. The first is in the cost incurred in anticipation of crime, so security expenditure. The second is consequence of crime, such as property stolen, and emotional and physical impact. The third is in response to crime; that is, cost to the police and criminal justice system."[36]

The effect of alcohol consumption on the wider economy

49.  The negative effect of alcohol abuse on the wider European economy—death, injury, effects on health of the drinker, effects on others including unborn children, effects on productivity, and many other matters—is almost impossible to quantify. One estimate given to us by Mariann Skar, the Secretary General of Eurocare, was €156 billion. In the UK, the Institute of Alcohol Studies has estimated that absenteeism from the workplace and loss of productivity could alone cost £7.3 billion a year.[37]

50.  There is a positive economic effect which should not be overlooked. In their written evidence the British Beer & Pub Association (BBPA), the leading body representing Britain's brewers and pub companies, pointed out that their members owned around half of the nation's 49,500 pubs, and that in the UK overall pubs and brewing supported over 900,000 jobs and contributed around £22 billion to the UK economy annually.[38] The Scotch Whisky Association (SWA) told us that the industry supported around 40,000 jobs across the UK, and that the value of Scotch whisky exports in 2013 was £4.3 billion, accounting for nearly 25% of the UK's total food and drink exports.[39]

51.  In other Member States the alcohol industry plays an even more important part. Italy is the world's largest wine exporter by volume and, until last year when it was again overtaken by France, was the world's largest wine producer.[40] Its 200,000 producers employ 1.25 million people and have a combined turnover of €9.5 billion, half of which is raised from exports.[41] Though France exports less than Italy by volume, in 2013 its wine exports were worth €7.6 billion.[42]

Medical and social effects of moderate alcohol consumption

52.  Even the smallest quantities of tobacco are harmful, but it is thought by some that, for those in their 60s and 70s or older, alcohol has a preventative effect against cardiovascular mortality which may partly, or in later years even wholly, counteract mortality from other causes.[43] Prof Anderson conceded that a small amount of alcohol could reduce the risk of heart attacks and certain types of stroke, but he argued that "the evidence increasingly shows you need only a really very small amount to get this protective effect and that probably the protective effect is not nearly as big as the previous studies have shown."[44]

53.  And finally, in a report dealing almost exclusively with ways to combat the harm caused by alcohol abuse, we think it should not be forgotten that alcohol, drunk responsibly and in moderation is, rightly in our view, regarded by many people as a pleasure, a social lubricant, and an aid to relaxation and celebration.


10   The opening words of the EU Strategy. Back

11   WHO Regional Office for Europe, Alcohol in the European Union: Consumption, harm and policy approaches (2012): http://www.euro.who.int/__data/assets/pdf_file/0003/160680/e96457.pdf [accessed 24 February 2015] Back

12   WHO, Global status report on alcohol and health 2014 (2014): http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf?ua=1 [accessed 24 February 2015] Back

13   WHO Regional Office for Europe, Alcohol in the European Union: Consumption, harm and policy approaches (2012): http://www.euro.who.int/__data/assets/pdf_file/0003/160680/e96457.pdf [accessed 24 February 2015]. In that report (and hence in our report when quoting from it) 'Europe' is defined as the EU plus Norway and Switzerland. Back

14   This is the equivalent of some 180 bottles of wine 12.5% ABV. Back

15   These figures are from European Core Health Indicators (ECHI) for 2012 and are for total recorded and unrecorded consumption for 2012, see http://ec.europa.eu/health/alcohol/indicators/index_en.htm [accessed 24 February 2015]. Total alcohol consumption is defined as the total (recorded + unrecorded) amount of alcohol consumed per adult (15+ years) over a calendar year, in litres of pure alcohol or total Adult Per Capita (Total APC). Recorded alcohol consumption refers to official statistics (production, import, export, and sales or taxation data), while the unrecorded alcohol consumption refers to alcohol which is not taxed and is outside the usual system of governmental control. Back

16   HMRC, Estimation of Price Elasticities of Demand for Alcohol in the UK (16 December 2014): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/387513/HMRC_WorkingPaper_16_Alcohol_elasticities_final.pdf [accessed 24 February 2015] Back

17   European Commission, DG Taxation and Customs Union (DG TAXUD), excise duty tables ref 1.037, July 2013, quoted in: Wine and Spirit Trade Association (WSTA), Budget submission 2014: Supporting a Great British Industry (2014): http://www.wsta.co.uk/images/budget/Budget2014FINAL.pdf [accessed 24 February 2015]. Back

18    Q172 Back

19   European School Survey Project on Alcohol and Other Drugs (ESPAD survey), 'United Kingdom Key results 2011': http://www.espad.org/unitedkingdom# [accessed 24 February 2015] "Europe" here includes Russia, Ukraine, Moldova and Turkey. Back

20    Q5 Back

21    Q39 Back

22   This contrasts with a drug-induced mortality rate of 17 deaths per million in the same age range in Europe in 2012: European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), European Drugs Report 2014: trends and developments (2014): http://www.emcdda.europa.eu/attachements.cfm/ att_231875_EN_EDRTD2014-annotated.pdf [accessed 24 February 2015]. In other words, in Europe some 7,000 times as many men and women aged between 15 and 64 die of alcohol-attributable causes as die of drug overdoses. Back

23   Home Office, A Minimum Unit Price for Alcohol: Home Office Impact Assessment (1 November 2012): https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/157763/ia-minimum-unit-pricing.pdf [accessed 24 February 2015]. The terms "alcohol-attributable" and "alcohol-specific" are those used in that Impact Assessment. Back

24   Ibid. Back

25   ONS Statistical bulletin, Alcohol-related deaths in the United Kingdom registered in 2012 (19 February 2014): http://www.ons.gov.uk/ons/dcp171778_353201.pdf [accessed 24 February 2015] Back

26    Q34 Back

27    Q37 Back

28    Q219 Back

29    Q218 Back

30   WHO Status Report on alcohol and health in 35 European countries (2013): http://www.euro.who.int/ __data/assets/pdf_file/0017/190430/Status-Report-on-Alcohol-and-Health-in-35-European-Countries.pdf [accessed 24 February 2015] Back

31   ETSC, 4th Annual Road Safety Performance Index (PIN) Report (June 2010): http://etsc.eu/4th-annual-road-safety-performance-index-pin-report/ [accessed 24 February 2015] Back

32   These figures from the Department for Transport include drivers as well as third parties. Back

33   Faculty of Public Health of the Royal College of Physicians of the United Kingdom, Alcohol and Violence-Briefing Statement (2005) Back

34    Q172 Back

35   Written evidence from the Association of Chief Police Officers (EAS0021) Back

36    Q175 Back

37   Institute for Alcohol Studies, Economic Aspects of Alcohol Factsheet (May 2013) Back

38   Written evidence from BBPA (EAS0013) Back

39   Written evidence from SWA (EAS0020) Back

40   Italian Wine Central, 'Facts and Figures': http://italianwinecentral.com/resources/facts-figures/ [accessed 24 February 2015] Back

41   Coldiretti, 'Vino: Coldiretti, all'estero più della metà della vendemmia 2014': http://www.coldiretti.it/ News/Pagine/616--%E2%80%93-19-Settembre-2014.aspx [accessed 24 February 2015] Back

42   Vin et société, 'Key figures of the wine industry': http://www.vinetsociete.fr/chiffres-cles [accessed 24 February 2015] Back

43   Liverpool John Moores University, Updating England-specific alcohol-attributable fractions (2013)-a study commissioned by the Department of Health, Figures 3 and 4. This however is contested by others, including a recent report from the INGT-NTO, a Swedish temperance union, and the Swedish Society of Medicine, Alcohol and Society 2014, the effects of low-dose alcohol consumption (2014)Back

44    Q4 Back


 
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