Coalition's alcohol policy comes under attack

The Coalition Government’s alcohol policy has come under sustained attack by the Insitutue of Alcohol Studies and other health aligned organisations, which have decided to boycott the Government’s Responsibility Deal with the alcohol industry.

The Government’s policy to ban ‘below cost’ sales of alcohol has been dismissed as almost wholly ineffective in reducing alcohol harm by alcohol and health NGOs and even by sections of the alcohol industry.

And the Government has been condemned by the road safety community for refusing to heed the advice of its own experts and the police, and lower the drink drive limit.

Six alcohol and health organisations, led by the British Medical Association, that had been involved in a Coalition Government policy initiative, the Responsibility Deal for Alcohol (RDA), did their best to wreck its official launch by very publicly walking out of it. In briefings to the media they accused the Deal of being no more than diversion from the evidence-based alcohol policies likely to achieve a real reduction in alcohol harm, such as policies on pricing and availability of alcohol.

The other five organisations are the IAS, Alcohol Concern, the Royal College of Physicians, the British Liver Trust, and the British Association for the Study of the Liver. Later, Diabetes UK and the British Heart Foundation also withdrew their support from the Responsibility Deal, though their involvement had been with health issues other than alcohol.

At the time of writing, it appears that the remaining health groups in the Alcohol Network will continue to support the initiative despite some reservations. These are the Faculty of Public Health, Cancer Research UK and the National Heart Forum. The move coincided with a broader attack by the medical profession on the Coalition Government’s health policy, its plans for reform of the National Health Service in particular. On the day the RDA was officially launched, an emergency meeting of the British Medical Association urged ministers to withdraw the bill to reform the NHS so the plans could be looked at again. A motion of no confidence in Health Secretary Andrew Lansley was only narrowly defeated.

The Walk-out

The health organisations criticised the Coalition Government and the Responsibility Deal for being too close to the alcohol industry and for promoting policies lacking evidence of effectiveness. Don Shenker, Chief Executive of Alcohol Concern said it was “the worst possible deal for everyone who wants to see alcohol harm reduced. There are no firm targets or any sanctions if the drinks industry fails to fulfill its pledges. It’s all carrot and no stick for the drinks industry and supermarkets.”

However, Health Secretary Andrew Lansley rebutted the criticisms. He said that, in regard to tackling the alcohol issue, the Coalition was achieving more in months than the previous Labour Government had managed in years, and that it did the health organisations no credit to refuse to co-operate. He also defended the voluntary approach. He said: “We know that regulation is costly, can take years and is often only determined at an EU wide level anyway. That’s why we have to introduce new ways of achieving better results. The deals published today demonstrate the effectiveness of our radical partnership approach to deliver more and sooner.”

The Responsibility Deal

The RDA forms one part of a wider Responsibility Deal promoted by the Department of Health, which also takes in nutrition and obesity, physical fitness, health at work and behaviour change. The essential idea is to persuade the various industries relevant to these areas of health behaviour to sign up to the process of improving health by making pledges to undertake actions seen as helpful, for example in relation to improved labelling of food and drink products.

Launching the Deal, Mr Lansley said it showed how partnership and challenge can be the most effective way of tackling some public health objectives. Since September, five groups working on food, alcohol, behavioural change, physical activity and health at work had developed a series of pledges for action.

Key collective pledges agreed included:

• Calories on menus from September 2011

• Reducing salt in food so people eat 1g less per day by the end of 2012

• Removal of artificial transfats by the end of 2011

• Achieving clear unit labelling on more than 80 per cent of alcohol by 2013

• Increasing physical activity through the workplace; and

• Improving workplace health.

Supermarkets including ASDA, the Co-operative, Morrisons, Marks and Spencer, Sainsbury’s, Tesco and Waitrose are among more than 170 organisations which have signed up to the Deal. High street food outlets including McDonald’s, Pizza Hut and KFC have pledged to remove trans-fats and to put in place calorie labelling. Specifically in regard to alcohol, as part of the deal, Heineken is expected to announce it will reduce the alcohol strength of one of its leading brands, thought to be Strongbow, by 1% (currently 5.3%) by 2013. Asda has pledged to end front-of-store alcohol displays by the end of April and it will also give £1 million to community alcohol prevention projects.

The Responsibility Deal for Alcohol

The Responsibility Deal for Alcohol (RDA) is designed to provide a forum for discussing how agreed measures can be delivered across the whole of the alcohol industry, particularly at point of sale. It is co-chaired by Jeremy Beadles, Chief Executive, Wine and Spirit Trade Association and Professor Mark Bellis, Faculty of Public Health, and is supported by Paul Burstow MP, Minister of State for Care Services at the Department of Health.

The Coalition Government describes the alcohol pledges as showing how industry, along with health group partners and government, can help deliver the commitment to ‘foster a culture of responsible drinking to help drinkers stay within the NHS drinking guidelines’.

Drink producers and retailers, including Diageo, Carlsberg, Majestic Wine and Constellation, the producer of well-known brands including Hardys, Echo Falls and Stowells, have pledged to provide clear unit labelling, support awareness campaigns and develop a new sponsorship code on responsible drinking. The pledges open up the possibility of alcohol health messages appearing on alcohol products and in settings where alcohol is sold and consumed.

The main alcohol pledges are

We support tackling the misuse of alcohol in order to reduce the resulting harms to individuals’ health and to society, in particular through the implementation of the following pledges:

• A1. We will ensure that over 80% of products on shelf (by December 2013) will have labels with clear unit content, NHS guidelines and a warning about drinking when pregnant.

• A2. We will provide simple and consistent information in the on-trade (e.g. pubs and clubs), to raise awareness of the unit content of alcoholic drinks, and we will also explore together with health bodies how messages around drinking guidelines and the associated health harms might be communicated.

• A3. We will provide simple and consistent information as appropriate in the off-trade (supermarkets and off-licences) as well as other marketing channels (e.g. in-store magazines), to raise awareness of the units, calorie content of alcoholic drinks, NHS drinking guidelines, and the health harms associated with exceeding guidelines.

• A4. We commit to ensuring effective action is taken in all premises to reduce and prevent under-age sales of alcohol (primarily through rigorous application of Challenge 21 and Challenge 25).

• A5. We commit to maintaining the levels of financial support and in-kind funding for Drinkaware and the “Why let the Good times go bad?” campaign as set out in the Memoranda of Understanding between Industry, Government and Drinkaware.

• A6. We commit to further action on advertising and marketing, namely the development of a new sponsorship code requiring the promotion of responsible drinking, not putting alcohol adverts on outdoor poster sites within 100m of schools and adhering to the Drinkaware brand guidelines to ensure clear and consistent usage.

• A7. In local communities we will provide support for schemes appropriate for local areas that wish to use them to address issues around social and health harms, and will act together to improve joined up working between such schemes operating in local areas as:

• Best Bar None and Pubwatch, which set standards for on-trade premises

• Purple Flag which make awards to safe, consumer friendly areas

• Community Alcohol Partnerships, which currently support local partnership working to address issues such as under-age sales and alcohol related crime, are to be extended to work with health and education partners in local Government

• Business Improvement Districts, which can improve the local commercial environment.

A full list of the companies signed up to the alcohol pledges is available at: http://responsibilitydeal.dh.gov.uk

The attack on the Deal

In a statement, IAS and the other health organisations said that they were unable to support the RDA for a range of reasons:

• The overall RDA policy objective to ‘foster a culture of responsible drinking’ does not adequately address the need to reduce alcohol-related mortality and morbidity.

• The RDA drinks industry pledges are not specific or measurable and have no evidence of success.

• The RDA process has prioritised industry views and not considered alternative pledges put forward by the health community. These have included proposed pledges:

• not to advertise alcohol based on price,
• not to advertise in cinemas for under-18 films
• and to include health warnings on all drinks products.

• The scope of the RDA is extremely limited. It does not tackle issues of affordability, availability or promotion of alcohol, and focuses on voluntary interventions with no evidence of effectiveness. There is no evidence that we have seen to show that Government is working towards a comprehensive, cross-departmental strategy to reduce alcohol harm, based on evidence of what works, with rigorous evaluation metrics. There has been no commitment made on what alternative actions Government will take if the RDA pledges do not significantly reduce levels of alcohol-related harm.

The organisations called on Government to provide:

• A clear and firm commitment on how it intends – via evidence based policy – to tackle affordability, availability and promotion of alcohol as part of a cross-government strategy, with rigorous evaluation metrics

• A clear presentation of the steps that will be taken if the current RDA objectives are not met in 12 months time

• A firm commitment to consider change - including through regulation - if voluntary commitments from business are not met after an agreed time period.

Katherine Brown, Head of Research and Communications at IAS, said:

“We have serious reservations about the level of importance placed on the Responsibility Deal as providing a solution to the problem of alcohol in the UK. The RDA pledges are not based on evidence of what works, and were largely written by Government and industry officials before the health community was invited to join the proceedings. Furthermore, there are no hard outcomes attached to the pledges, which rely heavily on evaluation by the industry.

“We cannot endorse a process in which the alcohol industry is invited to co-create and self-regulate health policy. There is clearly a conflict of interest between industry economic objectives and public health goals of reducing alcohol consumption and associated harms. This has been highlighted by two Parliamentary Select Committees and the World Health Organisation. The most effective means of reducing alcohol related harm is through adjustments in affordability, availability and promotion. These policies are supported by a broad evidence base and have been recommended to Government by a recent cross party House of Commons Health Committee report. The Responsibility Deal fails to address any of these policy areas and we are yet to see any real proof that Government is looking into developing a cross departmental comprehensive alcohol strategy, based on evidence of what works.” As well as issuing the statement, the new Director of IAS, Dr Adrian Bonner, also wrote a letter to Health Secretary Andrew Lansley formally withdrawing from the initiative and elaborating on the reasons for doing so. Similar letters were sent from the other health organisations. Most of these letters stated that “policies outlined in the current RDA pledges – product labelling, workplace policies, unit information, education and voluntary marketing codes- have little if any impact on alcohol related harm.” The BMA letter also criticised the Coalition Government for appearing to ‘start from scratch’ in regard to alcohol policy, when in fact there had been two previous attempts by government to deal with the alcohol problem, and the evidence and experience required was readily available.

Government Response

In reply, Mr Lansley said that while the BMA and others were criticising the level of importance placed on the Responsibility Deal, the Government had made it clear from the start that it was just one strand of the Government’s public health policy.

He said that the Treasury had announced the results of their review of taxation, including the introduction of a new tax on super-strength beers. The Home Office had made their announcement on a ban on sales of alcohol below duty plus VAT, “an important first step in linking price to alcoholic strength”. And the Home Office had also introduced legislation to overhaul the Licensing Act to give stronger powers to local areas “and end the 24-hour drinking culture”. All this action, Mr Lansley said, had been taken within less than a year of office, as promised in the Coalition programme for Government just last May. Far from ‘starting from scratch’, the Government was making rapid progress where necessary, and amending poor legislation where required. On the commitments contained in the Responsibility Deal, Mr Lansley said: “you say there is little evidence that labelling and consumer education will deliver public health benefits on their own. Yet even the Health Select Committee on Alcohol from last year says people have a right to know the risks they are running. We recommend that information and education policies be improved by giving more emphasis to the number of units in drinks.”

Mr Lansley continued:

“…….The Responsibility Deal has achieved more in the last six months than the previous Government’s Coalition for Better Health did in a year and a half. What is more, this is only the first step. …..I would have liked the health partners to make more of their role within the Alcohol Network to challenge industry to be more ambitious. Instead, I understand valuable time was taken up repeatedly going over arguments around pricing, which we made clear at the outset would be addressed elsewhere. It does no credit to health partners to throw away a chance to play a constructive part in developing challenging targets with industry. I would also like to point out that we have also taken on board the concerns of health partners that they were not being given an equal voice in the network. Mark Bellis of the Faculty for Public Health has been appointed as a Co-Chair of the Alcohol Network Group. I hope you would continue to assist Mark with the necessary input and support from health partners to carry out this function effectively.”

In regard to the need for a cross-cutting, evidence based Government Alcohol Strategy, Mr Lansley pointed out that he had already announced his intention to publish such a strategy. He hoped the BMA and other health groups would co-operate in helping to determine its scope and content.

Origin of the Deal

When first announced, the Responsibility Deal was seen as controversial and it received considerable adverse publicity. Sections of the media, as well as opposition politicians, accused the Coalition of ‘selling out’ public health interests to big business. The Guardian newspaper ran a campaign against the Deal. It reported that ‘Public health interest experts are still trying to absorb the scale of Lansley’s pro-business shakeup’, and suggested that ‘Lansley’s public health reforms are seen as a test case for wider Conservative policies on replacing state intervention with private and corporate action’. The newspaper quoted Professor Sir Ian Gilmore, Chairman of the Alcohol Health Alliance, as saying “I am very concerned with the emphasis on voluntary partnerships with industry. We have to understand that their agenda is very different.” The Labour Shadow Public Health Minister, Dianne Abbott, who was reported to be shocked by the Deal, actually demanded an inquiry by the health select committee to review the Responsibility Deal “that gives industry a key role in deciding Government action on alcohol misuse and obesity.” Presumably, however, Ms Abbott’s Labour Party colleagues had failed to inform either her, or the Guardian, that the policy that so shocked her was actually their own, for the Responsibility Deal is, in reality, the Coalition’s version of Labour’s ‘Coalition for Better Health’. This brought together senior decision makers from across the health agenda, including major industry, public sector and NGO partners, and was designed to bring together “those organisations serious about playing a part in tackling the big health and wellbeing challenges facing us today”, with an initial focus on precisely the same policy areas featured in the Responsibility Deal: alcohol, work and health, obesity and physical activity.

The stated objectives were:

• Alcohol - How can we support the third of adults who drink too much, to change their behaviour?

• Obesity - How should we be reversing the rising tide of adult obesity?

• Health & work - How can we use workplaces significantly to improve the health of employees?

• Physical activity - How do we get 2 million people more active by 2012?

The Labour Government set up Leadership Groups on each of these areas, comprising leading figures from business, NGOs and professional organisations. These groups were intended to convene two to four times a year for half-day working sessions, with the first meetings taking place in autumn 2009. Coalition members would chair the groups and the Department of Health would provide venues, resources and secretariat support.

See also: Partnerships for better health

The bodies involved in the alcohol section of the Coalition for Better Health were largely the same as those who would later participate in the Responsibility Deal, such as the Portman Group and the BMA.

However, there was no media campaign against Labour’s Coalition for Better Health, and there were no walk-outs by any of the participating organisations. A record of one of the meetings by a representative of one of the health groups noted “Initial discussions revealed an acute awareness of conflicts within the group, but a willingness to seek common ground.” However, it may simply be that the coming general election put a stop to Labour’s initiative before it reached the point when the divisions between the different factions became too great.

Labour’s Alcohol Strategy

The Responsibility Deal on Alcohol is also the direct descendant of the specific partnership arrangements between Government and alcohol industry that were at the heart of the Labour Government’s National Alcohol Strategy. The Memorandum of Understanding in regard to the industry-funded Drinkaware Trust, referred to in the RDA agreement, was drawn up by the Labour Government and signed on 29 June 2006 by the head of the Portman Group and Government Ministers from the Department of Health, the Home Office, the Scottish Executive, the Welsh Assembly Government and the Northern Ireland Office.

There was an additional Memorandum of Understanding drawn up in 2007 by the Labour Government, in the person of the then Public Health Minister, Caroline Flint, and the alcohol industry in regard to the labeling of alcohol products with information on alcohol units and the sensible drinking message, including a warning in regard to the dangers of alcohol in pregnancy. The Memorandum stated that “The Government intends to work in partnership with and with the support of the alcohol industry and with Drinkaware to raise awareness of the sensible drinking message (SDM), and to progress relevant actions arising from the new English Alcohol Strategy expected to be published in June 2007.”

It is these very proposals for product labelling which have now been resuscitated by the Coalition Government through the RDA. Moreover, the Labour Government’s move towards unit labeling of alcohol products was a response to years of pressure from the alcohol and health lobby, both in the UK and at European level. For example, despite now appearing to dismiss unit alcohol labelling as having little or no effect on alcohol harm, on its web site the BMA itself is still calling for “Details of the unit content of the drink, along with safe maximum intake levels and a warning about the health risks of excessive drinking (to be) printed on standardised labels on all alcoholic products. Also in all printed and electronic advertisements and at the point of sale.”

The alcohol industry’s reaction to the prospect of improved labelling has been mixed. While some drinks companies and trade associations have sometimes come round to supporting the idea, and to undertake labelling voluntarily, somewhat ironically, in view of the current attitude of the health organisations, others have opposed it as an expensive waste of time, which could not be expected actually to reduce alcohol harm.

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Pubs can serve smaller measures

 

Some Health campaigners have welcomed a move announced by the Department for Business Innovation and Skills allowing some forms of alcohol to be sold in smaller measures. Campaigners have complained in the past that the trend towards larger servings of alcohol, as well as the increased strength of some drinks, has contributed to the problem of increased consumption in some groups.

Under the present regulations, wine cannot be sold in measures less than 125ml, while beer must be sold in thirds, halves or multiples of half-pints. Fortified wine must be sold in the same quantities as normal wine. Under the coalition government’s changes, premises will be able to sell wine in measures under 75ml, beers can be sold in ‘schooners’ which are two-thirds of a pint, while fortified wine will be sold in smaller sizes of 50ml and 70ml.

Welcoming the move, Chris Sorek, Chief Executive of the industry-funded alcohol awareness charity Drinkaware, said: “Smaller measures of alcohol alone won’t solve the UK’s binge drinking problem, but it’s certainly a great move in helping consumers keep within the recommended daily unit guidelines. Offering beer, cider, wine and fortified wine in smaller measures can help people drink less and avoid alcohol-related harm.”

However, some others have seen in the move a devious ploy to attract women consumers and so to increase alcohol consumption.

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Coalition overhauls alcohol licensing regime

People in England and Wales will have greater control over alcohol licensing decisions as the coalition government ‘moves to reclaim high streets for sensible law abiding drinkers’. 

This is the claim made by Theresa May, the Home Secretary, in relation to the Police Reform and Social Responsibility Bill which will give councils new powers to stop premises selling alcohol late at night and punish those that persistently sell alcohol to children, with fines of up to £20,000.

The new legislation will allow everyone to comment on individual licensing applications, in contrast to the original 2003 Licensing Act which restricted the right to object to those living ‘in the vicinity’ of a particular licensed premises. This was one of the most disliked features of the Labour Government’s Licensing Act, because people’s lives could be adversely affected by licensing decisions even if they did not live ‘in the vicinity’ - if, for example, they lived along the route in and out of the entertainment area of their town or city. The new legislation will also allow, for the first time, the impact of licensing on public health to be taken into account when granting licences, a reform for which the public health lobby has been campaigning since the implementation of the 2003 Act.

Drunkenness and violence

Announcing the reforms, Minister for Crime Prevention, James Brokenshire, said: “The introduction of 24 hour licensing promised a continental-style ‘café-culture’ which has not materialised - instead we see drunkenness, violence and anti-social behaviour and too many of our town and city centres are now considered ‘no go’ areas. We’re not saying every pub and club is a problem, we know it’s only a minority that drive crime and disorder. But it’s now time that local communities are put in charge and allowed to reclaim our high streets for sensible law-abiding drinkers. This package of measures will reverse the failed experiment that was the relaxation of the licensing act and ensure local people have the power to make their pub and local high street a place they want to visit.” 

The Bill also includes measures to allow councils to:

• charge for late-night licences to pay for extra policing 
• suspend licences if fees are not paid

The Home Secretary also outlined a package of measures to reduce alcohol related crime and disorder.

They include:

• scrapping bureaucratic and unused alcohol disorder zones
• a commitment to review the mandatory licensing code within 12 months of its introduction to assess its impact and any unnecessary burdens on business

In 2009 almost one million violent crimes were alcohol-related, and one-fifth of all violent incidents took place in or around a pub or club.

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Retailers will be banned from selling alcohol below the rate of duty plus VAT - but health lobby dismisses change as cosmetic

To tackle the issue of cheap alcohol, the government has announced it intends to introduce a new proposal which would prevent retailers from selling a 1 litre bottle of vodka (37.5% abv) for less than £10.71 and a 440ml can of lager (4.2 % abv) for less than £0.38.

The move was described as an important first step in delivering the Coalition Government’s commitment to ban the sale of alcohol below cost. However, the announcement from the Home Office was greeted with a distinct lack of enthusiasm by the health and alcohol control lobby, which said that the measure would have no significant impact on levels of alcohol consumption or harm as very little alcohol was sold below the proposed new legal minimum in any case. Coverage of the issue was muddled by some commentators and the media, confusing the Government’s proposal with minimum pricing of alcohol, for which the health lobby has been campaigning but which is actually a different concept from the one the Government has in mind.

Announcing the initiative, James Brokenshire Home Office Minister for Crime Prevention, said:

‘We know that pricing controls can help reduce alcohol-related violent crime and this is a crucial step in tackling the availability of cheap alcohol. In nearly half of all violent incidents the offender is believed to be under the influence of alcohol. That’s why we believe it is right to tackle the worst instances of deep discounting. By introducing this new measure we are sending a clear message that the government will not stand by and let drink be sold so cheaply that it leads to a greater risk of health harms or drunken violence.’

Reactions

If the Coalition expected to win praise for tackling the alcohol price issue it was rapidly disillusioned by the chorus of disapproval that greeted the Home Offi ce announcement. Indeed, the Coalition’s main achievement, an unlikely one, was to unite the health lobby with some important sections of the alcohol industry in attacking its proposals.

For Alcohol Concern, Don Shenker said that the Coalition’s plans would “hardly touch the sides in dealing with binge drinking and alcohol related harms”. He said that the price of the vast majority of drinks would not be affected and the threshold was not high enough to deter those who use cheap drinks to get drunk. There would need to be a minimum price of at least 40 pence per unit to see a drop in alcohol-related crime, health harms and deaths. “Once again,” Don Shenker added, “the supermarkets have won the day.”

Sir Ian Gilmore, Chair of the Alcohol Health Alliance and former President of the Royal College of Physicians, said that while he was pleased to see that the government accepts cheap drink is the main driver of the health harm we’re seeing, the proposed price floor would have a negligible impact. It equated to just 21p per unit of beer. Research conducted by the School of Health and Health Related Research found that if the minimum price was set higher, at 50p per unit, it would reduce hospital admissions by approximately 100,000 each year with total cost savings for England of £7.4 billion over ten years.

Sir Ian said:

“Whilst today’s announcement is a step in the right direction, it is a tiny one. It will impact on a small fraction of special offers and will have no meaningful impact on the health consequences of alcohol misuse.”

The strongest reaction, however, came from the Association of Licensed Multiple Retailers, the national trade body representing pubs and bars. The Association appeared to see no merit in the Coalition’s proposals at all, and it warned that “failure to tackle irresponsible retailing by supermarkets would result in further harm to the nation’s pubs and bars as people turn away from drinking in a social and responsible environment in favour of cheaper drinking at home.

Nick Bish, ALMR Chief Executive said:

“Today’s announcement is a fudged compromise – a ban based on duty plus VAT fails to deliver the very clear commitments the Government gave that they would ban below-cost selling. It will make no difference to pocket money prices on the high street nor the irresponsible retailing practices of Britain’s supermarkets. Actually, today’s announcement will make matters worse because it effectively legitimises the status quo and will see the price differential between pub and supermarket widen.”

The Association highlighted statements made by the Prime Minister, David Cameron, in interviews last summer where he pledged that his government would go after irresponsible promotions such as “20 Stella for £5” and “end deep discounting”. Today’s announcement will leave both untouched.

Nick Bish went on:

“If the Prime Minister is serious about tackling this social menace, then we need a package of measures to support the duty+VAT ban. All pubs and bars are prevented by law from offering the kind of discounts or special offers that have become almost routine in the off-trade. We simply want a level playing fi eld and the ban on irresponsible promotions extended to anyone who sells alcohol. That would make a material difference to pricing and commercial behaviour and the Prime Minister has a unique opportunity to deliver that through the Bill reforming the Licensing Act which is currently before Parliament. Ministers have ducked a ban on belowcost selling; for the sake of our pubs they must not duck this”.

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Budget alcohol tax increases - 'hammer blow' to trade

Move to discourage super-strength lagers

In a move which produced an angry reaction from the beer and pub industry, the Chancellor retained the alcohol duties ‘escalator’ introduced by the previous Labour government, and increased alcohol duties in his Budget by 2 per cent above the rate of inflation.

This adds four pence to the price of a pint of beer, 15 pence to the price of a bottle of wine, and 54 pence to the price of a bottle of spirits. As previously announced, changes will also be introduced to beer duty.

Chief Executive of the British Beer and Pub Association, Brigid Simmonds, condemned the “failed policy” of the escalator, which she said was a “hammer blow”, adding “The fight to end this damaging policy continues.”

Finance Bill 2011 will also introduce a new additional duty on beers over 7.5 per cent alcohol by volume (abv) in strength at a rate of 25 per cent of general beer duty. A reduced rate equivalent to 50 per cent of general beer duty will be introduced for beers exceeding 1.2 per cent abv and not exceeding 2.8 per cent abv in strength. These changes will be effective from 1 October 2011.

The Government says that the purpose of these measures is to tackle problem drinking by encouraging industry to produce, and drinkers to consume, lower strength beer. The new high strength beer duty is intended to reduce the availability and affordability of ‘super strength’ lagers associated with problem drinking. The reduced rate for lower strength beer will help to give responsible drinkers a wider choice of products.

The previous 2010 Budget announced that the Government would review alcohol taxation to tackle problem drinking “without unfairly penalising responsible drinkers, pubs or local industry.” The findings of this review were announced on 30 November 2010 as part of a Government-wide package of measures to help tackle problem drinking. 

The Government now seems fully to have accepted that alcohol taxes are relevant to public health. The Treasury Budget document says: ‘The Government is committed to fair excise duties on tobacco and alcohol which contribute to deficit reduction whilst supporting health objectives.’

However, the Government’s plan to tackle the problem of cheap alcohol from the supermarkets has been condemned as inadequate (see here).

 

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Alcohol pricing and harm - the research evidence

As part of the considerations of how to achieve the Coalition commitment to deliver a ban on below cost sales, the Home Office carried out a review of alcohol pricing. The Home Office had also commissioned a study of alcohol pricing and criminal harm from the School of Health and Related Research at the University of Sheffield.

The main conclusion drawn by the Home Office from these studies is that there is a link between a rise in the price of alcohol and a reduction in alcohol harms but that the relationships between price and harm are complex and not fully understood.

The conclusion of the Home Office review of alcohol pricing is that, on balance, the international evidence base suggests that policies designed to increase the price of alcohol may be effective in reducing the harms caused by alcohol. However, alcohol price is only one factor that may affect levels of alcohol consumption, with individual, cultural, situational and social factors also influential.

The review highlights that a number of potential impacts of increasing alcohol price are currently under-researched. There is limited UK-based research on alcohol pricing and criminal harm related to alcohol consumption, with UK evidence, in the main, limited to theoretical economic modelling studies. The evidence base for a link between alcohol pricing and crime is less comprehensive than that between alcohol price and consumption and alcohol price and health harms. Although evidence for a link between alcohol price and crime suggests that price increases tend to be associated with reductions in crime, this relationship is not linear and the evidence base is not able to support a direct causal link.

For individual crime types rather than overall crime, the evidence base for a link between alcohol price and violence is largest with the balance of evidence tending to support this link. Less is known about the potential distributional impacts on specific population groups, such as the impact on different income groups or how policies will impact on the majority of responsible drinkers, with the body of evidence tending to focus on impacts to heavier and younger drinkers.

Little is known about how the alcohol industry may be affected by alcohol pricing policies.

On the basis of the evidence reviewed, it is not possible to determine which alcohol pricing policies may be the most effective.

Public perceptions of alcohol and crime - Majority think drinking ‘out of control’ in England and Wales

The results of a study of public perceptions of the link between alcohol price and crime are also informing the policy-making process. The study was commissioned by the previous Labour Government but the findings are being used by the Coalition in regard to its review of alcohol taxation and pricing.

One finding to emerge was that the public’s views on alcohol questions are not always consistent.

The main findings of the survey were:

• In regard to perceptions of a link between alcohol and crime and disorder, a majority (65%) of those questioned agreed with the statement that ‘the amount people drink in this country is out of control’, although most (71%) also agreed that problem drinking is carried out by a minority

• 65% agreed that the Government needs to take action to stop people drinking too much, though

• 57% also thought that how much you drink is a personal choice and the Government should not interfere

• 68% of drinkers said they would support an increase in the price of alcohol in supermarkets, off-licences and convenience stores if a link could be proved between cheap alcohol and levels of crime and anti-social behavior

• 46% of drinkers said they would support an increase in the price of alcohol in these stores regardless of a link being proved

• 55% of the total sample felt that raising alcohol prices would not make any difference to the UK’s drinking levels - 38% thought it would have an impact

• Only 19% of drinkers said that they personally would drink less if the price of alcohol were raised

• 74% of drinkers thought that raising the price of alcohol would just be another way of increasing taxes

The likely impacts of increasing alcohol price:
a summary review of the evidence base. Home Office, January 2011

Public Perceptions of Alcohol Pricing:
Market Research Report. Bdrc continental. Prepared for Central Office of Information on behalf of the Home Office. November 2010.

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Mayor orders alcohol sobriety in London

The Mayor of London has put forward a proposal to Members of the Metropolitan Police Authority for an Alcohol Sobriety Scheme for London:

The compulsory Alcohol Sobriety Scheme is an enforcement approach providing specific powers for the court to order sobriety as an order for alcohol related violence offences. The compulsory alcohol requirement will involve twice daily breath testing for alcohol and failure of the test will result in immediate breach and sanctions, such as custody.

The idea of a compulsory Alcohol Sobriety Scheme for London has been inspired by a scheme that has been tried and tested in South Dakota and is currently being rolled out in other US states. In his proposal, the Mayor accepts that the crime types being envisaged are different from those in South Dakota and that the English legal system is based upon different principles. However, it is felt that the essential key principles upon which this model is based would be beneficial for London.

The Mayor states that he is committed to making London a safer and better place to live and, in doing so, has identified the need to tackle alcohol related violence in the capital, particularly in town centres. London experiences disproportionate levels of alcohol related crime in comparison to the rest of the country. This poses a huge threat, not only to the safety of Londoners, but also to the general well-being of Londoners, particularly those who live or work in boroughs with prominent town centres. It also has huge cost implications for the MPS and the NHS, as well as borough budgets, diverting increasingly scarce resources away from priorities.

It is based around some key principles:

• The judges opt to use compulsory sobriety as a sentencing option instead of choosing to incarcerate offenders

• The convicted individual is required to check into a designated venue twice daily to be breathalysed for alcohol consumption If the terms of the sentence are breached, the individual is arrested, put into a police cell overnight and presented to the judge the following day.

• The judge has the discretion to decide what happens to the offender, for example to incarcerate them, put them back on community sentence etc.

• Individuals pay for their testing

The Mayor has tabled an amendment to the Police Reform and Social Responsibility Bill for changes in the current law to enable the courts to make this order.

The possibility of an Alcohol Sobriety Scheme for London was floated in 2010 (See Alcohol Alert Winter 2010), and the Mayor has clearly decided to press ahead with the idea, despite the lukewarm or positively hostile response of some of the main alcohol control agencies and media commentators. Don Shenker, of Alcohol Concern, said the scheme would be unlikely to be a success, and the Guardian newspaper said the idea had to be a bad one because it was inspired by schemes in the United States. The newspaper described Kit Malthouse, London’s Deputy Mayor for Policing, as a ‘twerp’ for saying that an advantage of the scheme was that it would be self-funding as the offenders would have to pay for their own breath tests, and it also condemned the scheme as an infringement of civil liberties. The Guardian added that members of the Coalition government should be breath tested every time they make ‘an erratic suggestion.”

In reality, the Sobriety Scheme is probably best seen as a supplement to or variation of the Drink Banning Orders introduced by the last Labour Government. These are specific orders from a civil court imposed on an individual who has behaved in a disorderly manner or who has committed a criminal offence while under the influence of alcohol. They were introduced on 31 August 2009 and are covered by the Violent Crime Reduction Act 2006 and the Violent Crime Reduction Act 2006 (Drinking Banning Orders) (Approved Courses) Regulations 2009.

A drink banning order can be put in place to prevent an individual from entering premises that sell alcohol and entering pubs and clubs in a specifi ed area or vicinity. A drink banning order is a civil order, meaning that it does not carry criminal penalties and will be dealt with by a civil court so will not appear on an already existing criminal record or create a new criminal record. If, however, the terms are breached, then that person will have committed a criminal offence.

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Government rejects calls for random testing and a lower drink drive limit

Improved testing equipment to detect drink and drug drivers will be given the green light and key changes made to streamline enforcement of both offences. However, in an announcement that will cause dismay in the police, road safety and medical communities, the Government has turned its face against the two policies they have consistently advocated as the most effective measures against drink driving – random breath testing and lowering the current drink drive limit.

The Government’s policies were set out in its response to the North Report on Drink and Drug Driving. This was commissioned by the previous Labour Government but published in 2010 after the Coalition Government had come into office. The Coalition’s response extends also to the report of the Transport Select Committee, Drink and Drug Driving Law, which was published in December 2010 following an inquiry by the Committee into Sir Peter North’s main recommendations.

The Government rejects random testing as not being cost effective. On this it states:

“An EC recommendation that such procedures should aim to test all drivers once in three years would require more than ten million tests per year in this country – less than one million are conducted now. This would not be cost-effective, or a justified diversion of police resource. It would be better to develop smarter ways of using the existing power so that drink-drivers – rather than drivers in general – become at higher risk of testing and detection.”

However, this argument is unlikely to be regarded as convincing, especially as the police themselves have been part of the campaign for the introduction of random testing.

In a memo to the MP’s investigating the issue, the Association of Chief Police Officers stated:

“ACPO wholeheartedly supports the introduction of a power to randomly check any driver. Putting conditions on when a breath test can be required simply supports the view that you can drink, drive and avoid prosecution by playing within the ‘rules’, police have unrestricted powers to stop vehicles to check tyres, condition and the documents of a driver but are restricted when they can check for drink or drugs.

“A random power would support targeted checkpoint testing of drink drivers carried out now in some areas but requiring an element of consent.

“Random powers are supported, not necessarily because we believe that the existing powers are inadequate; rather, we believe that this simple measure, widely publicised, would increase the perception in the minds of drivers that if they do drink and drive they are likely to be caught and brought to justice at any time, anywhere.”

The same applies to the Coalition Government’s rejection of a lower alcohol limit for drivers, which has also been almost universally supported by the entire road safety community, as well as having the support of the large majority of the public.

On this, the Coalition’s response states:

‘Our strategy is to help the police to focus on the most dangerous people – those who feature most prominently in the drink-drive offence and casualty statistics; as well as the drug-drivers who at present escape detection. We do not believe that widening the scope of the drink-drive offence by lowering the limit is consistent with this approach. It has various operational and practical difficulties; and imposes social and economic costs which we do not consider, on the present evidence, to be matched by potential benefits.

‘For all these reasons, the priority on drink-driving must be to make the present regime work better. We do not propose to lower the prescribed alcohol limit for driving as well.’

Announcing the Government’s response, Transport Secretary Philip Hammond said:

“Drink and drug driving are serious offences and we are determined to ensure they are detected and punished effectively. It is just as dangerous to drive impaired by drugs as alcohol so we need to send a clear message that drug drivers are as likely to be caught as drink drivers and that drug driving is as socially unacceptable as drink driving has become. That is why we will approve drug-testing devices and change the law to speed up the testing process, ensuring the police can bring drug drivers to justice.

“The number of drink driving deaths has fallen by more than 75% since 1979. But drink driving still kills hundreds of people so we need to take tough action against the small minority of drivers who flagrantly ignore the limit. Their behaviour is entrenched and after careful consideration we have concluded that improving enforcement is likely to have more impact on these dangerous people than lowering the limit.

“We are, therefore, taking forward a package of measures which will streamline enforcement, helping the police to target these most dangerous offenders and protect law-abiding road users.”

On drink driving the Government will:

• revoke the right for people whose evidential breath test result is less than 40% over the limit to opt for a blood test (the ‘statutory option’). The breath testing equipment used in police stations is now very accurate and technically sophisticated so a blood sample is not needed to confirm the breath test. The need to organise a blood sample can mean that drivers who were over the limit when breath tested have fallen below the limit by the time their blood sample is taken – removing the statutory option will eliminate this loophole

• introduce a more robust drink drive rehabilitation scheme, so that we can require those drink drivers who are substantially in excess of the limit to take remedial training and a linked driving assessment before recovering their licence

• approve portable evidential breath testing equipment for the police – this will speed up the testing process and free up police time

• close a loophole used by high risk offenders to delay their medical examinations

• streamline the procedure for testing drink drivers in hospital.

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Slight fall in alcohol-related deaths

Alcohol-related deaths in the UK have declined slightly since 2008 although they remain at an historically high level, according to figures from the Office for National Statistics (ONS). The figures relate only to those deaths regarded as being most directly due to alcohol consumption and do not include deaths in which alcohol was an underlying cause, such as some forms of cancer.

The ONS figures show:

In 2009 there were 8,664 alcohol-related deaths in the UK, 367 fewer than the number recorded in 2008 (9,031)

Males accounted for approximately two-thirds of the total number of alcohol-related deaths in 2009.

The number of alcohol-related deaths in the UK has increased since the early 1990s, rising from the lowest figure of 4,023 (6.7 per 100,000 population) in 1992 to the highest of 9,031 (13.6 per 100,000) in 2008. In 2009 the number of deaths fell to 8,664 (12.8 per 100,000).

 

 

There are more alcohol-related deaths in males than in females. Male rates more than doubled over the period from 9.0 per 100,000 in 1992 to 18.7 per 100,000 in 2008, although the rate was lower in 2009 at 17.4 per 100,000. There were steadier increases in female rates, rising from 4.6 per 100,000 in 1992 to 8.7 per 100,000 in 2007 and 2008. The rate decreased slightly in 2009 to 8.4 per 100,000. In 2009 males accounted for approximately two-thirds of the number of alcohol-related deaths. There were 5,690 in males and 2,974 in females.

Trends differ according to age. The highest alcohol-related death rate across the period was in men aged 55–74. In 2009 the rate for this group was 41.8 per 100,000. The lowest male rate was in those aged 15–34; the rate for this group in 2009 was 2.6 per 100,000. The only rate to increase among men from 2008 to 2009 was in those aged 75 years and over, rising from 23.4 to 25.6 per 100,000. The rate for men aged 35–54 in 2009 was 29.1 per 100,000.

Female rates have been consistently lower than male rates, but the figures demonstrate a largely similar pattern between age groups. Like men, women aged 55–74 had the highest alcohol-related death rates over the period. In 2009 the rate for this group was 20.1 per 100,000. Rates were lowest in women aged 15–34. The rate for this age group in 2009 was 1.5 per 100,000. In 2009 the rates for women aged 35–54 and 75 and over were 13.8 and 13.3 per 100,000 respectively.

Across the 2000–09 period, rates were highest amongst those aged 55–74.

 

 

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Hospital admissions for alcohol 'due to rise to 1.5 million per year by 2015'

Rates of alcohol-related hospital admissions are due to rise to 1.5m per year by the end of this parliament if the Government does not invest in alcohol services, according to a new report from Alcohol Concern. The report, Making Alcohol a Health Priority, says that over a million hospital admissions per year are currently caused by excessive drinking, with the total cost to the NHS expected to rise to £3.7 billion, if no further action is taken to arrest this increase. Hospital admissions for alcohol misuse stood at half a million in 2002 and have doubled, now costing the NHS £2.7 billion every year. The report states that, If the 100% rate of increase continues, it will waste billions of pounds to the NHS.

The campaign group has called for Government to invest in alcohol health workers in every hospital, A&E unit and GP practice. This will save the NHS £3 for every £1 spent, according to the report, as well as reduce the current level of 15,000 alcohol-related deaths per year and 1.2m incidents of violent crime. Alcohol is now the second biggest risk factor for cancer after smoking and is the biggest cause of liver disease, which is the fifth most common cause of death in England. Campaigners have called for Government to make tackling alcohol misuse a public health priority, claiming that recent action to reduce smoking and illegal drugs has left tackling the nation’s alcohol problem far behind.

Alcohol Concern Chief Executive, Don Shenker said: “Whereas successful action has been taken to reduce rates of smoking and illegal drugs, successive Governments have failed to act decisively in treating the country’s drink problem. With the Prime Minister saying that the NHS is becoming ‘increasingly unaffordable’, we can show how billions can be saved simply by introducing alcohol health workers in hospitals to help patients reduce their drinking.

“Government must make tackling alcohol misuse a priority for public health, leading to huge savings for the whole country. We need to encourage those who drink too much to realise it and get the help they need. As problem drinking costs the country so dear, a modest investment in supporting problem drinkers will lead to a three-fold saving, surely a necessity in an economic downturn.”

Number of alcohol-related hospital admissions and projection based on current rate of increase (Department of Health, 2010)

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100 Scots per day treated for alcohol related injuries

Scotland’s accident and emergency rooms dealt with 36,000 alcohol-related admissions in 2009, according to the latest issue of Alcohol Statistics Scotland.

The figures show that, in total, there were 39,278 alcohol-related discharges from Scottish hospitals - nearly 100 every day - with 92% of these coming from A&E departments. This does, however, represent a small decrease compared with the previous year.

They also show that Scots continue to out-drink the English and the Welsh, consuming an average of 11.9 litres of alcohol each in 2009. Over a third of men and women were exceeding the recommended daily limits for alcohol units on their highest drinking day during the week, while over 50% said they drank most of their alcohol at home.

Alcohol was recorded as the underlying cause of 1,282 of the 53,856 deaths registered in Scotland in 2009, a small drop from the previous year. Deaths and disease from alcohol are disproportionately high in the most deprived areas of the country. People living in Scotland’s poorest areas are seven and a half times more likely to be treated in hospital suffering from alcohol problems.

In terms of age, an analysis of the figures for 2003 shows that deaths from alcohol in men and women are highest in the age group 35 - 54. (See graph showing alcohol attributable deaths below.)

 

 

However, although the highest numbers of deaths were seen in older age groups, younger age groups were more likely to be affected by their alcohol use as a proportion of overall deaths. For example, among 16 to 24 year old males, 17.5% of all deaths in this age group were estimated to be caused by attributable alcohol conditions. Over one in four (26.1%) of deaths in men and one in five of deaths (21.1%) in women aged 35 to 44 years old in 2003 were attributable to alcohol consumption. This compares to 2.0% and 1.1% in men and women aged 75 and over respectively.

Below the age of 35, alcohol attributable deaths were most likely to occur from the acute consequences of alcohol consumption, in particular, intentional self-harm and road traffic accidents.

Beyond the age of 35, chronic diseases, including mental and behavioural disorders due to alcohol use, alcoholic liver disease, cancer of the oesophagus and breast, colorectal cancer and hypertensive diseases were the more common causes of alcohol attributable deaths.

In relation to social harm, (see graph below) over 60% of both male and female violent offenders are under the influence of alcohol at the time of their offence, with high percentages of victims also being under the influence.

 

 

Dr Evelyn Gillan, Chief Executive of Alcohol Focus Scotland, said the figures showed that alcohol was still “ruining lives” in Scotland.

She added: “It’s worrying that the number of people dying from alcohol-related deaths has almost doubled since 2003. As a nation, Scotland needs to drink less and we need to push up the price of alcohol and also make it less available.

“These figures show we have a serious problem with alcohol and parties need to work together to bring in stronger policies to bring these figures down.” Responding to the figures, Scottish Government Health Secretary Nicola Sturgeon said: “Almost £100m has been invested in local services to prevent alcohol-related problems occurring and in providing treatment and support for those who already have problems. However, there is still a great deal of work to be done.

That is why our Alcohol Framework outlines a package of over 40 measures to reduce alcohol-related harm by helping prevent problems arising in the first place and by improving support and treatment for those who are already experiencing problems.”

Ms Sturgeon said the Alcohol (Scotland) Bill, passed by the Scottish Parliament last November, was a “significant step” in tackling alcohol problems; however, she re-stated the Scottish Government’s position on minimum pricing, which was not included in the act. She added: “We still consider minimum pricing to be the most effective and efficient way of reducing alcohol consumption and hence alcohol-related harms.”

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Alcohol a main cause of house fires in Scotland

Brian Sweeney, Chief Officer of Strathclyde Fire & Rescue, has urged people in Scotland to take more responsibility for their consumption of alcohol, which is linked to the key “three main reasons” for fire in the home.

In a hard-hitting message to journalists about the spate of domestic fires over the Festive Season which left five people dead and 68 people injured in Strathclyde, Mr Sweeney said: “The last 10 days have seen deaths and injuries in house fires in Scotland that have been worse than in the last 10 years.”

Mr Sweeney told a press conference on the recent ‘spike’ in house fires that the three key causes of domestic fires were smoking, cooking and heating. He continued: “There are also three key reasons (for house fires). Number 1: alcohol, Number 2: alcohol, and Number 3: alcohol.”

Mr Sweeney continued: “Scotland needs to redefine its relationship with alcohol. We believe the Scottish Government will introduce this year the Alcohol (Scotland) Bill. But the individual needs to take responsibility.

“People in Scotland and communities across Scotland are simply drinking too much and when we are drinking and under the influence of alcohol, our ability to simply go about our business in this seasonal period is diminished.”

Assistant Chief Officer Lewis Ramsay, SFR’s Director of Community Safety, said that close working with partner agencies including local authorities was resulting in ‘very specific’ identification of people particularly at risk of fire in the home.

Strathclyde Fire & Rescue was piloting case studies of every house fire and this policy would hopefully be rolled out across Scotland. The cause of each fire would be investigated and steps taken to avoid a repetition.

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Alcohol behind 'most violence'

Most violence in the west of Scotland is caused by alcohol, the head of Scotland’s largest police force said. Stephen House, Chief Constable of Strathclyde Police, said Scots need help to tackle their drinking problem, even though that may smack of the “nanny state”. He raised concerns about the amount people drink in the home where violence can flare because there is no “level of control” as there is in pubs.

Chief Constable House told Real Radio:

“Virtually all violence in the west of Scotland has got some link to drink. The main contributors are cheap vodka from the supermarkets and lager and cider.

“We’ve all seen it: someone goes into one of the big supermarket chains at six o’clock, seven o’clock at night and comes out with a slab of lager.

“Does that look like sensible drinking? If it’s for him and his 23 mates then maybe it is, but if it’s for him and two other people then it’s not sensible.

“We are spending our time managing unacceptable behaviour by the whole nation but certainly in the west of Scotland police are dealing day-in, day-out with people who have had far too much to drink.”

Mr House told the station that he doesn’t believe, as a nation, Scotland is able to self-regulate its drink.

He said: “We need to have it done for us. Now that might be a bit of a nanny state but I think it’s necessary in the first couple of stages for the state to step in and say no, sorry, the £3 billion a year we’re spending on drink-related problems in health and in violence and social care is just money we can’t afford to spend any more.

“We’ve got to do something about it. It’s got to be cut back. The police can do their bit but we cannot solve the problem.”

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Making alcohol policy - increasing consumption or reducing harm

Claire Harkins and David Poley disagree

In a recent issue of its magazine ‘People and Science’, the British Science Association invited two people of opposing views to debate in its columns the proper aims and objectives of alcohol policy. The two protagonists were Claire Harkins of the School of Applied and Social Sciences, University of Strathclyde, and David Poley, Chief Executive of the alcohol industry’s Portman Group. The debate took the form of open letters, which we here reproduce with the permission of the British Science Association.

Dear David
Alcohol is damaging the health of the British population. Respected medical organisations are now calling for evidence-based alcohol control policy to tackle this public health crisis.

Over recent decades alcohol has become increasingly affordable. Drinking exessively is more prevalent and socially acceptable, particularly for young women, than it was in the past.

The domination of large alcohol companies has created a market reliant on high volume sales. Heavy supermarket discounting, marketing and promotions have also contributed to the escalating rates of alcohol-related harm. Meanwhile, alcohol policy has, in the words of the 2009 Health Select Committee report, ranged from ‘the non-existent to the ineffectual’.

We require a strategy which will promote public health instead of cosseting the alcohol industry. The most robust evidence points to the need for restrictive measures on pricing, availability, advertising and marketing. All of these measures pose a serious threat to alcohol industry profits. The industry depends on harmful drinking: if people drank responsibly, alcohol sales would plummet by 40 per cent. It is the industry’s job to increase sales of alcohol. It is the government’s job to regulate and protect public health over trade - just as with other addictive drugs. Government should ignore special pleading by the alcohol industry and prioritise public health.
Yours, Claire

Dear Claire
There is a problem of alcohol misuse in the UK; the question is how it should be addressed.

The health lobby favours restricitve measures on pricing, availability, advertising and marketing, in the belief that this will reduce overall levels of consumption. Leaving aside some of the flaws in that assumption, is this really the fairest and most effective way of tackling the problem? Most of us who drink, do so moderately and responsibly; we don’t need to drink less. The people who need to cut back are the 7 per cent of drinkers whom, it is estimated, account for 33 per cent of all alcohol consumption in the UK. These are also the people who are least likely to change their drinking behaviour if their favourite tipple is made a little bit more expensive, or if they had to travel a little bit further to the nearest retail outlet.

Rather than impose these blunt, ineffective measures that impact on the moderate majority, the industry believes that one should instead educate consumers into drinking responsibly. It is only through education, coupled with targeted interventions against misusers, that we shall ultimately change the drinking culture and make a lasting difference to alcohol health harms.
Yours, David

Dear David
As a lobbyist, you argue that ‘we don’t need to drink less’ and that alcohol-related harm is essentially a problem for only 7 per cent of drinkers, presumably those who are addicted. The evidence, as opposed to alcohol industry propaganda, shows that the greatest costs associated with alcohol are linked to drunkenness rather than addiction, with the involvement of emergency, social and law enforcement services.

Education has been found to be an ineffective means of controlling alcohol consumption (price and availability are the most effective tools, as virtually all disinterested parties agree). A worrying precedent can be found in the anti-smoking campaigns funded with tobacco money which actually raised smoking rates. Research, on ‘responsible’ drinking campaigns found that such messages often encourage alcohol consumption by reinforcing social norms of drunkenness as part of a night out, rather than acting as a serious health warning.

The public need to be aware that most alcohol ‘education’ originates from the alcohol industry itself. It is a drive towards greater corporate social responsibility for economic ends rather than an altruistic source of objective public health information.
Yours, Claire

Dear Claire
I appreciate that drunkenness is as big a problem as chronic misuse. The 7 per cent of drinkers who consume a third of all alcohol (Department of Health estimate, not drinks industry propaganda) will include many of those who get drunk and cause trouble in town centres.

Education doesn’t work? Take a look at drink-driving. Deaths are 70 per cent lower than they were a generation ago. Educational campaigns have transformed attitudes and behaviour. We should now do the same to make public drunkenness socially unacceptable.

And yes, the industry is responsible for much of the alcohol education that takes place. Surely, this is to be applauded? In fact, the industry’s educational effort is now channelled through Drinkaware, an independent charity funded but not controlled by the Industry. You are right that the alcohol industry, like any industry, acts more out of self-interest than pure altruism. That doesn’t mean its actions can’t be worthwhile and of benefit to society.

No doubt , if the industry didn’t have a social responsibility programme, the health lobby would be even more apoplectic. It seems a case of ‘damned if you don’t and damned if you do’. The industry should and does, play its part in tackling alcohol misuse.
Yours, David

Dear David
The 7 per cent you refer to accounts for harmful drinkers whose consumption has already damaged their health or are addicted. Hazardous drinkers are those whose consumption risks their health but who have not yet developed health problems. This applies to 33 per cent of men and 16 per cent of wormen. Your use of the statistics to frame the debate in your favour is propaganda which replaces objective information.

Education alone did not change behaviour and attitudes towards drink driving; supporting sanctions such as fines, or even prison, did that. The effects of educational campaigns are counter balanced by widespread advertising of alcohol that does not portray the serious consequences of the drug.

The Portman Group is an effective lobby for specific private interests which profit from the harm that drink does. Industry-funded educational campaigns underplay the dangers and provide a sanitised view of alcohol-related harm - further offset by the illusions fostered by marketing, advertising and PR. The problem for those interested in the health of ordinary people is the power and influence that alcohol lobbyists have over public health policy. An industry that sells an addictive drug should not be responsible for education relating to its safe use. This is a clear conflict of interest and should be the responsibility of independent health organisations - not the alcohol lobby or its proxies.
Yours, Claire

Dear Claire
I’m sorry if I did not make this clear enough last time: Drinkaware is independent. Its board includes highly respected academics and health experts. Are you saying that the industry is wrong to fund it?

The industry voluntarily promotes Drinkaware’s educational website on over 3 billion drinks containers each year and in all advertising. This helps the website to attract over 130,000 visitors each month.

Alcohol marketing must be responsible and is regulated through strict Codes of Practice operated by the Advertising Standards Authority and the Portman Group. The Codes are independently enforced; the rare examples of irresponsible marketing are immediately withdrawn.

Finally, let’s return to your belief that the only way to reduce alcohol problems is to curb overall demand through restrictions on price and availability. Since 2005, (which, incidentally, was when licensing laws were relaxed), alcohol consumption has fallen by 11 per cent. Alcohol-related hospital admissions over the same period have risen by 52 per cent. The link between per capita consumption and alcohol-related harm unfortunately is not as simple as you portray. We need to persuade excessive drinkers to cut back through targeted, innovative actions. The industry should be seen not as part of the problem but as part of the solution. Yours, David

David Poley is Chief Executive of the Portman Group, the social responsibility organisation for UK drinks producers - dpoley@portmangroup.org.uk

Claire Harkins is at the School of Applied and Social Sciences, University of Strathclyde -
c.harkins@strath.ac.uk

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Manual workers smoke more but drink less than professionals

While smoking is nearly twice as common among adults in routine and manual occupations as it is in managerial and professional groups, a higher proportion of top earners drink more frequently, and they are more likely than manual workers to exceed the recommended limits for daily consumption. These findings are set out in two publications from the Office for National Statistics.*

Other facts revealed on drinking habits in 2009 were:

In managerial and professional households, 41% of men exceeded 4 units and 35% of women exceeded 3 units on at least one day in the week before interview, compared to 34% of men and 23% of women in routine and manual households

In managerial and professional households, 23% of men and 15% of women drank heavily (more than 8 units for men, more than 6 units for women) on at least one day in the previous week, compared to 19% of men and 11% of women in routine and manual households

Average weekly consumption was similar in all age groups from 16 to 64 years but was much lower in the 65 and over group

Older age groups tended to drink more often than younger age groups. The proportions drinking on 5 or more days in the week before interview were: 4% (16-24 years), 10% (25-44), 18% (45-64) and 20% (65 and over). The proportions drinking every day in the previous week were: 1% (16-24 years), 4% (25-44), 10% (45-64) and 14% (65 and over)

When they did drink, however, young people were more likely to drink heavily than older people. Of those that drank alcohol in the week before interview, the proportions who drank heavily on at least one day were: 46% (16-24 years), 35% (25-44), 25% (45-64), 6% (65 and over)

* Smoking and Drinking among Adults, 2009 published by the Office for National Statistics Health Survey for England 2009, published by the NHS Information Centre

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Drinking to belong

Why young people drink

A new report from the Joseph Rowntree Foundation examines the relationship of young people with alcohol and identifies the factors behind their drinking habits. It highlights the influence of the way they go drinking with friends and how pricing plays a significant role in how much young people drink. 

The research was carried out for the Joseph Rowntree Foundation by a team from Glasgow Centre for Population Health, who looked at the experiences of eighty 18-25 year-olds.

The research shows that:

For most young adults drinking to get drunk was seen as the default choice for socialising with peers. Few could imagine realistic alternatives to alcohol consumption for getting young people together.

The price of alcohol does play a role in the amount of alcohol young people consume and also the way in which it is consumed.

The research also highlights issues for policy makers to consider in order to have an impact on excessive alcohol consumption.

Moderate drinking in the family environment provides a potentially more balanced, alternative view of drinking behaviour, in contrast to the excessive consumption promoted commercially, and which specifically targets young adults.

The way alcohol is sold to young people needs to be looked at carefully, as young adults moderate their behaviour when subject to informal pressures of drinking among more mixed age groups, as opposed to drinking in bars aimed at young people.

Young people saw heavy drinking as a phase that would end when they reached adulthood. For young people who took longer to have adult responsibilities such as employment and parenting, the move away from excessive drinking was delayed.

Report author Peter Seaman said:

“With the increasing consumption of alcohol in the UK in recent decades, getting drunk together has become an established part of the experience of young adulthood. Alcohol has found a unique role in the way friendship groups are forged and maintained, partly because of the special nature of young adulthood; the absence of other group bonding opportunities; and the success of alcohol markets in filling that void. Working with young people to offer alternatives may help address this, rather than just imposing constraints.”

Joseph Rowntree Foundation Policy and Research Manager, Claire Turner, said:

“We know there is considerable interest in the drinking patterns of young people, and a desire to encourage safer use of alcohol. Having a good understanding of the drinking behaviour of today’s young adults is vital to reducing future levels of alcohol-related harm. This research can help policy makers understand the reasons why young people drink, and highlights issues needing consideration if they wish to make an impact on excessive alcohol consumption.”

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Offenders who misuse alcohol 'do not get enough support'

Offenders who drink harmfully are not offered as much support as those who use illegal drugs even though alcohol misuse is a bigger cause of crime and ill health. This is the main conclusion of a report, A Label for Exclusion, by Rob Fitzpatrick and Laura Thorne of the Centre for Mental Health.

The report explains that six out of ten male and four out of ten female sentenced prisoners in England are harmful or hazardous drinkers. Almost half of probation clients are recorded as having an alcohol problem. And alcohol is a factor in three-quarters of cases of domestic violence and more than half of assaults.

Yet A Label for Exclusion finds that there is inadequate support for offenders who misuse alcohol at all levels, from basic screening and advice to specialist counselling and treatment programmes.

The policy paper is based on research carried out in the South West of England to assess the support that is offered to offenders who misuse alcohol and to find examples of good practice that could be taken up more widely. A Label for Exclusion makes ten recommendations. It calls for commissioners of health and justice services to come together to pool their limited resources for offenders who misuse alcohol and involve service users in planning the support they offer. It says all front line workers, such as police officers and GPs, should have basic skills in recognising alcohol misuse and referring people on to specialist services if they need them. And it calls for good quality alcohol support to be available to people at any point in the criminal justice system, from first contact with the police, to courts, prisons and probation services.

Centre for Mental Health joint Chief Executive, Professor Sean Duggan, said: “Having a diagnosis of alcohol dependency or misuse is too often a label for exclusion from both health and drug treatment services. For people in the criminal justice system this exclusion can have a devastating impact.

“We have found in the South West a number of impressive examples of services who have responded creatively and sensitively to the challenge of offering better support to offenders who misuse alcohol despite the lack of policy support to do this. We hope that the Government will create a more conducive environment to improve responses at all levels and for all who need more help to manage their alcohol use and offending.”

Public Health South West policy lead, Dr Ruth Shakespeare, said:

“Alcohol misuse is a major public health issue across England, costing some £23 billion a year, more than half of it in the costs of crime.

“I am delighted that commissioners, providers and individual workers across the South West have taken the initiative to offer improved support to offenders who misuse alcohol. This not only improves the health of offenders but also reduces crime and makes communities safer - everyone benefits.”

The research for the paper was commissioned by the Department of Health South West.

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New Management Team at IAS

A new management team has been installed at IAS, and the Scientific Advisory Board has also been strengthened.

The new Director of IAS is Dr Adrian Bonner. Dr Bonner is an academic with many years experience in the addictions field. He remains a Reader in the Centre for Health Services Studies, University of Kent, where, as founder and Director of the Addictive Behaviours Group, he has facilitated the development of undergraduate and postgraduate teaching and research activities aimed at practitioners and managers working in social and health-related agencies. He has been a member of various UK government working groups, including Skills for Health. Adrian’s principal research has focused on mechanisms of brain damage and the role of alcohol and other nutritional factors in cognitive function. This research has become more integrated with psychological and social approaches, and underpins his current research into health inequalities and the role of alcohol in adversely affecting personal wellbeing. Adrian provides health-related support for The Salvation Army Social Services in the UK and internationally, including with the UNODC. He has produced over 100 books, reviews, and peer-reviewed papers.

Katherine Brown is the new IAS Head of Research and Communications. She joins IAS from the Central Office of Information where she worked on a variety of public health communications campaigns, including tobacco control, organ donation and the HPV vaccination programme. Katherine is a history graduate of the University of Exeter and was awarded MSc in Global Health and Public Policy by the University of Edinburgh, where she specialised in commercial sector involvement in global health governance, using the WHO Global Alcohol Strategy public consultation as a case study.

Derek Rutherford was appointed Chairman of IAS following the death of Professor Brian Prichard in 2010. His involvement in the alcohol field stretches over 60 years. He was the founder Director of the Teachers’ Advisory Council on Alcohol and Drug Education, and he also directed the National Council on Alcoholism, the precursor to Alcohol Concern. He is a former Director of IAS.

The IAS Scientific Advisory Board has been joined by two new members, Professor Petra Meier and Professor Gerard Hastings, both of whom are well known in the alcohol field.

Professor Meier is Professor of Public Health and Deputy Director of the Section of Public Health, University of Sheffield. Her research interests include alcohol policies and their effectiveness, especially pricing, marketing and availability.

Professor Gerard Hastings is the Director of the Institute for Social Marketing and the Cancer Research UK Centre for Tobacco Control Research, University of Stirling.

The other members of the IAS Scientific Advisory Panel are:

• Professor Rob Baggott, Director of the Health Policy Research Unit, Department of Public Policy, De Montfort University, Leicester

• Dr Marsha Morgan, Reader in Medicine, Royal Free Hampstead NHS Trust

• Professor Chris Cook, Professorial Research Fellow, Department of Theology & Religion, Durham University

• Professor Jonathan Chick Consultant Psychiatrist, Royal Edinburgh Hospital

• Miss M Le Feuvre, Former Head of Legal Services, Southampton & New Forest Magistrates Courts

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