In this month’s alert
Health Select Committee calls for tougher controls on alcohol advertising
The House of Commons Health Select Committee has issued a report generally supportive of the Coalition Government’s new Alcohol Strategy for England, but calling for tougher controls on alcohol advertising. The report followed an inquiry which gathered evidence from both public health and industry sources.
The Committee proposes the introduction of a UK version of the French Loi Evin, which effectively bans alcohol advertising on TV along with alcohol sponsorship of sports and cultural events. The Committee also calls for the Alcohol Strategy to have a wider focus and for the introduction of specific quantifiable targets and performance indicators in regard to alcohol-related mortality, hospital admissions and crime and disorder.
Launching the report, Committee Chairman, Stephen Dorrell, said:
“The main focus of the Strategy is binge drinking and its consequences for antisocial behaviour and public disorder. Those are important issues, but the health impact of chronic alcohol misuse is, in our view, also significant and greater emphasis needs to be placed on addressing that impact.
“The Strategy contains a series of outcomes the Government wishes to bring about but does not define success. We believe that, in order to be effective, the Strategy needs some clearer objectives to provide a framework for both policy judgements and accountability.
“We recommend that Public Health England should have a central role in developing these objectives, and linking them to local strategies in every area across the country.”
In relation to control measures, the Committee supports the minimum unit pricing of alcohol, which the Home Office now envisages being implemented by October 2014. However, the Committee decides against a ban on multibuys, arguing that minimum pricing would provide a floor price for the sale of all alcohol, including discounted sales, so rendering a ban unnecessary. The Committee also calls for a ‘sunset clause’ on the implementation of a minimum price, so that it only remains in place if it is shown to be effective in reducing harmful drinking.
Alcohol Industry on the Defensive
The Select Committee report emphasises the limitations of the Responsibility Deal on alcohol, and warns that the industry risks being seen as only paying lip service to the need to reduce health harm related to alcohol. This prompted much of the media coverage of the report to be in terms of the alcohol industry being placed in the “last chance saloon” and facing heavier regulation if it did not take more action to discourage dangerous drinking.
In regard to the Responsibility Deal the Committee came to two main conclusions: first, that participation in the Deal by the alcohol industry should not be regarded as optional, and, secondly, that the Responsibility Deal is not, and should not be, a substitute for Government policy. The Committee states that “It is for the Government, on behalf of society as a whole, to determine public policy and ensure that a proper independent evaluation of the performance of the industry against the requirements of the Responsibility Deal is undertaken.” The Committee calls for Public Health England to commission such an evaluation, adding:
“We will be particularly interested to see the assessment of the effect of reducing the alcohol level in certain drinks. We do not believe that reducing the alcohol in some lagers from 5% to 4.8% will have any significant impact. If the industry does not bring forward more substantial proposals than this it risks being seen as paying only lip service to the need to reduce the health harms caused by alcohol.”
However, while this comment is self-evidently a warning shot at the alcohol industry, it is less clear that the Committee has any serious disagreement with the Government over the Responsibility Deal. In stating that the RD is not a substitute for Government policy, the Committee is simply reiterating what Public Health Minister Anne Milton told them: “It (the RD) is an opportunity to add something. It is not a substitute for, and it is not a forum for developing, (alcohol) policy.” The Minister also raised the possibility of an independent evaluation of the RD.
There is a clearer disagreement between the Committee and the Government in relation to alcohol advertising, for, unlike the Select Committee, the Government has shown no signs of wanting to adopt in the UK the principles of the French Loi Evin. In relation to advertising, the Committee commented that it was concerned that those speaking on behalf of the alcohol industry “often appear to argue that advertising messages have no effect on public attitudes to alcohol or on consumption. We believe this argument is implausible. If the industry wishes to be regarded as a serious and committed partner in the Responsibility Deal it must acknowledge the power of advertising messages and accept responsibility for their consequences.”
The Committee also comments on the alcohol industry’s Drinkaware organisation, and on the health service response to alcohol health issues. On Drinkaware, the Committee welcomes the education and awareness campaigns it runs, but complains of a perceived lack of independence from the industry, which limits the value of its contribution.
On the health service, the Committee praises the work the Department of Health is undertaking to provide an evidence-base of the most effective models of treatment provision. The Committee concludes, on the basis of the evidence presented to it, that the establishment of Alcohol Specialist Nurse services throughout the country would be a major step forward.
The public health and alcohol control organisations welcomed the Committee’s report. Sir Ian Gilmore, special adviser on alcohol for the Royal College of Physicians, Chair of the Alcohol Health Alliance and President of the British Society of Gastroenterology, said that he particularly welcomed “the Committee’s recognition of the insidious and pervasive health damage from chronic use – they have clearly listened to the voice of medical bodies to conclude that it’s not just about young people binge drinking but the chronic health harms that affect many people in the UK.”
Sir Ian continued:
“I am pleased to see the Committee’s support for setting a minimum unit price for alcohol and agree that the price should be set at a level that is shown to be effective, and that a clear process is needed for monitoring and adjusting the price over time. We will continue to seek a minimum unit price of at least 50p per unit of alcohol.
“We also welcome the Committee’s emphasis on the cost-effectiveness of interventions, the important role of alcohol specialist nurses, and the call for tougher measures on advertising. We support looking at whether some form of the measures used in France, such as a ban on sports events advertising, could be applicable in England. But we are disappointed they didn’t call for a review of the overall regulatory structures and I’d also like to see more done to tackle the growing problem of marketing through digital, online and social media – to reduce children and young people’s exposure.
“As the Committee says, it’s time that the alcohol industry acknowledges the power of its advertising messages and accepts responsibility for their consequences. We need a clear Government commitment to an independent evaluation of the Responsibility Deal and a timetable for reviewing progress and detail of the action that will be taken if outcomes are not achieved.”
For the IAS, Katherine Brown said:
“We welcome the Committee’s calls for measures to strengthen the Government’s Alcohol Strategy. The Government has set out some commendable ambitions in the Strategy; however, we agree that a framework of quantifiable targets and indicators is essential in order to measure what success looks like.
“It is encouraging to see that the Committee supports the introduction of minimum pricing, a policy which has the potential to make a real impact on levels of health and social harm caused by alcohol. Given the question over how the market will respond to this policy, it is both sensible and helpful to recommend a sunset clause, which will stimulate a robust monitoring and evaluation process. Many other countries are waiting with bated breath to see how minimum pricing works, so evaluation is crucial to building an evidence base for an innovative policy that could be applied internationally.
“Britain has the opportunity to be a vanguard in public health policy, so support for minimum pricing is crucial.”
A copy of the full report can be downloaded here: http://www.publications.parliament.uk/pa/cm201213/cmselect/ cmhealth/132/132.pdf
Minimum pricing remains in the spotlight
Minimum unit pricing of alcohol remained centre-stage after the Scottish Parliament approved the Alcohol Minimum Pricing Bill and the Scottish Government announced that its preferred price for a unit is 50 pence. The Bill looks to set a minimum price for a unit of alcohol as a condition of a licence. It also sets the formula for calculating the minimum price (based on the strength of the alcohol, the volume of the alcohol and a price per unit of alcohol). The measure is expected to come into effect in April 2013.
Health Minister, Nicola Sturgeon, announced the preferred price during a visit to a gastroenterology ward at Glasgow Royal Infirmary, where 80% of patients are reported to be there because of alcohol misuse. Ms Sturgeon said:
“Cheap alcohol comes at a price and now is the time to tackle the toll that Scotland’s unhealthy relationship with alcohol is taking on our society. Too many Scots are drinking themselves to death. The problem affects people of all walks of life.
“It’s no coincidence that as affordability has increased, alcohol-related hospital admissions have quadrupled, and it is shocking that half of our prisoners now say they were drunk when they committed the offence. It’s time for this to stop.
“Introducing a minimum price per unit will enable us to tackle these problems, given the clear link between affordability and consumption. There is now a groundswell of support for the policy across the medical profession, police forces, alcohol charities and from significant parts of the drinks and licensed trade industry who recognise the benefits minimum pricing can bring – saving lives and reducing crime.
“Since 45p was first proposed as the minimum price 18 months ago, we have seen inflation of around 5%. A minimum price of 50p takes this into account and will achieve a similar level of public health benefits to what 45p would have achieved in 2010.”
However, despite the fact that the Westminster Coalition Government has also now come out in favour of minimum pricing as a central plank of its new alcohol strategy for England, Minimum pricing remains in the spotlight debate continues as to whether the policy is either desirable or legal. Opinion on the issue appears to divide the alcohol industry, for while the major producers appear to be opposed to MUP (see here), some individual companies and the pub sector are supportive of the proposal. A national poll of publicans carried out by the British Institute of Innkeeping revealed that almost four in five (77%) agreed with the concept of a national minimum price. Of those who were in favour, 81% said the actual price level should come in at 50p per unit of alcohol.
Opinion is also divided within Government and the public services.
In its evidence to the House of Commons Health Select Committee inquiry into the alcohol strategy, the Office of Fair Trading (OFT) came out against MUP, basically because of fears about possible adverse unintended consequences.
While emphasizing that it fully supports the Government’s aim of reducing alcohol harm, and also accepting that increasing the price of alcohol would be likely to lead to some reduction in consumption, the OFT goes on to say that the price increase is also likely to generate windfall gains for retailers, as predicted by recent independent modelling carried out by researchers at the University of Sheffield, and, unlike an increase in tax, additional consumer spending on alcohol would go to private firms rather than to the Government.
The OFT evidence continues: “
The OFT is concerned that the unintended consequence of this increase in profit may be to give retailers an incentive to sell more, rather than less, low cost alcohol. Retailers would gain additional profit for every unit of low cost alcohol that they sold. At worst, such an incentive could dull the effectiveness of the minimum price in reducing alcohol sales.
“More generally, the OFT is concerned about the long-term impact of minimum pricing restrictions on consumers and on productivity in the retail sector. International studies, including by the OECD, suggest that restrictions on retail prices, such as banning below cost selling, ultimately lead to lower productivity and worse outcomes for consumers. For example in France, between 1997 and 2002, food prices increased faster than general inflation -11.8% compared to 6% – in part because of retail price restrictions. In Ireland, it has been estimated that Irish families were paying €500 more per year for retail items in 2005 because of rules preventing below cost selling. Taken in isolation, a minimum price for alcohol may not have a significant negative effect on productivity. However, the OFT is concerned that, by legitimising intervention to control prices in a competitive market, it will be harder for the Government to resist calls for similar measures in other parts of the retail sector in future. This could have significant long-term costs. For these reasons, the OFT considers that a change in taxation would be preferable to imposing a minimum price, with less risk of creating unintended consequences.”
Local Government Association opposes MUP
Perhaps more unexpectedly, the Local Government Association (LGA) also issued a statement attacking minimum pricing, dismissing it as a ‘gesture’, and claiming that its introduction, and the planned ban on discounted multi-buy deals, “could see a surge in potentially dangerous black market booze”. The LGA said that the Government’s focus on making alcohol less affordable could risk pushing cash-strapped adults to buy cheap counterfeit wines and spirits which could make them blind or even kill them.
In a statement issued following the LGA’s Alcohol Strategy Conference in April 2012, the Association said that attempts to increase alcohol prices would also fail to curb binge drinking or tackle the associated antisocial behaviour and health problems it creates.
Cllr David Rogers, Chair of the LGA’s Community Wellbeing Board, said:
“We are concerned that targeting cheap alcohol could push people to the black market and cheaper drinks. When drinking counterfeit brands, you can never be sure what you are putting into your body. People who think they are getting a bargain could end up making themselves blind or even drinking themselves to death.
“We know there is no simple solution to alcohol abuse but tackling cheap drinks is only one part of the problem. Focusing solely on making alcohol less affordable will fail to address the root causes of binge drinking as well as the nuisance, vandalism and risks to health it causes.
“National gestures like minimum pricing and banning multi-buy discounts will only go so far in deterring binge drinking and don’t take into account the varying issues in town and city centres across the country. We need to see councils given the powers and flexibility to tackle problems locally.
“We now need a system that allows local authorities to act on the concerns of the people in their area by saying ‘no’ to a new late night club on a street that is already saturated with them. We also want to see health experts given a say on whether the opening of a corner shop selling cheap booze could contribute to alcohol dependency in a particular area.”
The LGA statement added that tests on bottles of fake vodka seized by council trading standards officers around the country have revealed alarming levels of methanol, a key ingredient used to make anti-freeze, which could potentially lead to blindness or death. Other industrial chemicals like isopropanol, used in cleaning fluids, and chloroform, used in pesticides, have also been found in bogus brands.
In April 2012, Southampton City Council’s Trading Standards team seized 124 bottles of fake vodka and wine from a local newsagent. The haul included 35 Jacobs Creek wine bottles with incorrect spellings of Australia and 45 bottles of Arctic Ice vodka, a brand that was found to be made-up. Recently a shopkeeper was fined £16,000 after Surrey County Council Trading Standards seized fake Glen’s vodka which, when tested, contained 235 times more methanol than the legal limit. Just five teaspoons of methanol can be fatal. While in Staffordshire, trading standards officers acted after people reported suffering from burning throats after drinking vodka that was later found to contain methanol. A recent crackdown has found suspected counterfeit alcohol in more than one in six (18%) of off-licenses in the county.
The LGA is now calling for the introduction of a broad package of measures which would give local areas the flexibility to address problems that are particular to them through licensing powers and the new public health role for councils. This includes ensuring the bureaucracy in the licensing system is reduced to allow local authorities to act more quickly on the concerns of people in their local area. This would include being able to refuse permission for a new nightclub or bar on a street that already has a proliferation of them. In addition, health experts should be given a say on whether the opening of a corner shop selling cheap booze could contribute to alcohol dependency in a particular area.
The LGA has also called for late-night pubs and nightclubs to contribute towards the cost of cleaning up the mess caused by rowdy alcohol-fuelled nights out through a late-night levy, with the police and councils able to decide locally how to spend and share the money.
Responsibility for alcohol services moves from the NHS to local Government from April 2013. The LGA wants to see reduced bureaucracy of the current licensing system to allow councils to act more quickly on residents’ concerns, local authorities given the power to decide locally how to spend a late night levy on nightclubs and bars, and local health experts given a say on the opening of new off-licenses selling cheap alcohol.
Illegal alcohol ‘not an issue’
However, speaking to Alcohol Alert, Dr Evelyn Gillan, Chief Executive of Alcohol Focus Scotland, rejected the LGA claims. “The Scottish Government has stated that illegal sales of alcohol are not a significant problem. In order to make an assessment of the level of unpaid duty, HMRC makes an estimate, annually, of the size of the illicit market. Currently the methodology only allows consideration of spirits and beer. For the UK, in 2008-09, this estimate was around 2% of total consumption; a figure which has been falling since 2006-07.”
Moreover, Dr Gillan continued,
“In evidence to the (Scottish) Health and Sport Committee in 2010, senior police officers indicated that across all eight forces in Scotland there was no evidence that illegal sales of alcohol were an issue nor did they consider that it was likely to become one.” Dr Gillan added: “Last year, the number of Scots dying as a result of alcohol was twice as high as in the early 1980s and alcohol-related hospital admissions were four times higher. We have reached the point where Government action is necessary to protect the public and begin to change our relationship with alcohol.
“The minimum price has been set at a level which will deliver significant health and social benefits for the people of Scotland by putting an end to supermarkets’ irresponsible practices where a unit of alcohol can be sold for less than 15p. Introducing minimum pricing sends out a clear signal that alcohol is not an ordinary commodity like bread or milk and shouldn’t be sold or marketed as such. The benefits of minimum pricing are clear. Estimates from Sheffield University suggest that in the first year of minimum pricing in Scotland there could be 60 fewer deaths; 1600 fewer alcohol-related hospital admissions and around 3500 fewer crimes.”
For the Institute of Alcohol Studies, Katherine Brown said:
“It is essential that the issue of illegal alcohol does not become a barrier to implementing effective pricing policies that will benefit public health and well being. By its own admission, the Government has failed to work with the drinks industry to secure supply chains in order to reduce the volume of alcohol that is illegally diverted back from the Continent for illicit sale in the UK. Better enforcement is needed so that large scale tax avoidance operations do not deprive the public purse of funds and do not undermine health policy.”
But is MUP legal?
However, the legality of minimum pricing under European Union competition law remains uncertain. The Daily Telegraph reports that three days after the launch of the Government’s alcohol strategy, the issue of minimum unit pricing was discussed at a prearranged meeting at the Treasury with senior alcohol industry figures. Afterwards, the industry representatives claimed that Treasury officials told them that there were questions about the legality of minimum pricing. The Treasury disputed this interpretation, but the Telegraph reported a Treasury spokesman as saying:
“The Government is taking a range of action to tackle the availability of cheap alcohol. We will introduce a minimum unit price for alcohol, ensuring for the first time that alcohol can only be sold at a sensible and appropriate price. The Government continues to take legal advice on this subject and will consider any potential legal implications as part of its forthcoming consultation.”
The legality of minimum pricing may be tested fairly soon, as a response to the Scottish Government’s notifying the European Commission of its intended unit price. Opponents of minimum pricing hope the notification will trigger an inquiry and potentially a legal challenge by other European Union member states. Bodies such as the Scotch Whisky Association and the Wine and Spirit Trade Association, and drinks companies such as Diageo, hope it will fail to comply with European law as it acts as a domestic barrier to free trade.
However, the desire for a legal challenge is not restricted to opponents of minimum pricing. The Scottish Conservatives are also urging other EU member states to challenge the policy to ensure a quick decision on whether it meets free trade rules.
Conservative health spokesman, Jackson Carlaw, said:
“This is not an attempt to thwart the Bill but rather to ensure that every effort is made to determine whether the measure is legal.”
His party agreed to back the policy after securing a voluntary commitment by the Scottish Government to notify the European Commission (EC) of its plan.
The EC might not give a ruling unless there is a challenge from one of the 27 EU member states, said Mr Carlaw.
He said: “It is vital that minimum pricing is given a robust MOT to ensure it does not break EU free trade rules. So, to ensure that the EC expresses a view, Scottish Conservatives intend to meet and encourage concerned member states to mount a challenge so we can have clarification from Europe on the legality of a 50p unit price for alcohol.
If other European member states do contest plans put forward by the Scottish Government, it would be the Westminster Government that would have to argue the case, as Scotland is not a member of the EU in its own right.
Labour plan to entice Scots booze cruisers
One of the potential problems caused by political devolution is that the policies of minimum unit pricing of alcohol are not fully aligned north and south of the border, with the result that, at least for a time, alcohol will be significantly cheaper in England than in Scotland.
An early indication of the complications to which this could give rise were given when members of the Labour group on Northumberland County Council suggested the authority should grasp the opportunity provided by MUP in Scotland from April 2013 to attract Scots drinkers to alcohol retailers in Northumberland. The Labour group said they wanted to see an advertising campaign prepared to entice Scottish drinkers. As reported in the Daily Telegraph, Northumberland County Council’s Labour group economic spokeswoman Susan Davey said: “By not setting aside an adequate advertising budget to promote travel and shopping in Northumberland to the Scots, the county may miss out on this golden opportunity. Shops in Berwick, Alnwick and Morpeth with easy access to the A1 should be preparing to accept a huge increase in trade but I expect, without an advertising campaign, Carlisle with its easy motorway access will win this race.”
However, Labour’s plan was condemned as irresponsible by Alnwick’s Conservative county councillor Gordon Castle. “We want to promote Alnwick, we want Scottish tourists, but we don’t want booze tourists,” he said. “As responsible councillors, we are supposed to be promoting the town for its visitor attractions.”
Mr Castle thought any crossborder increase in alcohol sales would benefit national supermarkets, not local independent stores.
“Frankly, the supermarkets are doing very nicely anyway,” he said. “This is not going to help our high street.”
Scotch whisky industry challenges minimum pricing of alcohol
– and is accused of putting profit before health.
The Scotch Whisky Association (SWA) is taking action in Europe and the UK against the Scottish Government’s minimum unit pricing (MUP) legislation, including a complaint to the European Commission and legal action through the Scottish courts. It is being joined in its opposition by other UK and European Union wine, beer and spirits organisations and companies. It is understood that the SWA and its allies will claim that MUP would be an illegal barrier to trade and would damage the Scotch Whisky industry. They will also argue that MUP will be ineffective in reducing alcohol harm, but will penalise responsible drinkers and put more pressure on household budgets.
In its statement, the SWA claims that “the Scottish Government’s own modelling illustrates that MUP will not reduce the number of hazardous drinkers and will instead force responsible drinkers to pay much more.”
The statement continues:
“Scottish Government figures show 73% of alcohol sold in the “off trade” will have to go up in price. Recent statistics reveal that alcohol consumption and alcoholrelated harm have been falling, calling into question the need for MUP. But the Scottish Government has decided to press ahead with its plans.
During the Parliamentary process, the Cabinet Secretary for Health, Nicola Sturgeon, said she expected the policy to be subject to legal challenge. The Scottish Conservatives have called for legal clarity and Scottish Labour has raised doubts over the legality of MUP.
“The SWA has been left with no option but to maintain its opposition to the legislation by lodging a complaint to the European Commission (EC) and filing a Petition for Judicial Review with the Scottish Court of Session in Edinburgh.
Now the Scottish Government has notified its plans for an MUP of 50 pence to the EC, other alcohol drinks industry organisations in the UK and across Europe are raising objections to the policy with the Commission.
“The SWA’s complaint to the EC states that MUP breaches EU trade rules. It says that minimum pricing of alcohol would artificially distort trade in the alcoholic drinks market, contrary to EU law.
“The SWA is also concerned that other countries are likely to adopt measures similar to MUP and use a ‘protection of health’ justification to target imported products. Such ‘copycat’ measures could cost the Scotch Whisky industry £500 million in exports. This would damage the Scottish Government’s own ambitions for an exportled economic recovery. Scotch Whisky is vital to the economy, accounting for just under 80% of Scotland’s food and drink exports.
The SWA is also taking action through the Scottish Court of Session by applying for Judicial Review of the legislation on the grounds that the law on minimum pricing is in breach of the UK’s EU Treaty obligations and contrary to the terms of the Scotland Act 1998. The European Spirits Organisation (CEPS) and Comité Vins (CEEV), the European wine body, have joined the SWA in the legal action in the Court of Session.”
Alcohol industry goes down tobacco road
Responding to the SWA statement, Dr Evelyn Gillan, Chief Executive of Alcohol Focus Scotland, accused the SWA of following the same path as the tobacco industry “in seeking to delay vital legislation that will save lives.”
Dr Gillan said:
Big alcohol’s claims that they are committed to working in partnership with Government and others to reduce alcohol-related harm must be seriously questioned by this move. This shows that, when effective policies that will reduce harm and save lives are introduced, the big producers simply close ranks and pool resources to prevent their implementation.
Minimum pricing will bring significant health benefits so to contest this makes it clear that some sections of the alcohol industry are motivated by profit not public interest. Quite simply, this is big business putting profit before the health and well-being of the people of Scotland.
New study suggests medical staff overlook alcohol problems if patients are not drunk
Medical staff struggle to spot problem drinking in their patients unless they are already intoxicated, according to research led by Dr Alex J Mitchell, Consultant at Leicestershire Partnership NHS Trust and Honorary Senior Lecturer at the University. In a new study published in the British Journal of Psychiatry, involving 20,000 patients assessed for alcohol problems by medical staff, all clinicians struggled to detect alcohol problems whether or not patients volunteered information regarding their drinking.
1 in 4 of the adult population in England (33% of men and 16% of women) consumes alcohol in a way that is potentially harmful to their health and 6% of men are alcohol dependent. 1 in 6 primary care patients have an alcohol use disorder or are alcohol dependent. General practitioners (GPs) identified 40% of problem drinkers, hospital doctors identified 50% of problem drinkers and mental health specialists recognised 55% of problem drinkers. Clinicians correctly recorded a diagnosis in the case-notes for only 1 in 3 people who had an alcohol problem. Only alcohol intoxication was accurately identified. A & E clinicians were able correctly to detect patients with alcohol intoxication in 9 out of 10 patients. In research studies where patients admitted to a drinking problem by self report, the same rates of under detection occurred.
Assessing for alcohol problems in patients using a short questionnaire is recommended by the UK Primary Care Service Framework and NICE but not widely implemented by clinicians.
Dr Alex Mitchell said: “This study highlights that clinical identification of alcohol problems is challenging in busy clinical environments. When clinicians try and spot alcohol problems they often miss patients who have serious alcohol problems but who are not currently intoxicated. Further they can misidentify about 5% of ‘normal drinkers’ as problem drinkers.
“Clinicians are not always sure what questions to ask or what screening tests to apply. We did not find that patients refused to admit alcohol problems, in fact it was more common for patients to disclose problem drinking when asked to self-report than the number found by clinicians’ judgement alone.
“There needs to be a greater awareness of the importance of carefully assessing alcohol problems for non-intoxicated patients. Patient responses to questioning about drinking habits should not be assumed to be misleading but questioning must be handled sensitively.”
New powers to tackle problems of late night drinking
New powers have been granted to local authorities in England and Wales to use early morning alcohol restriction orders (EMROs) to restrict the sale of alcohol in all or part of their areas between midnight and 6 am, and to charge a levy for late-night licences to contribute to the cost of extra policing and other costs linked to late-night drinking, like street cleaning.
The new powers have been introduced following a consultation carried out by the Coalition Government into the workings of the Licensing Act.
Announcing the new powers, Minister for crime prevention and antisocial behaviour reduction, Lord Henley said:
“The Government is radically reshaping its approach to crime and policing by giving back powers to local communities so they can reclaim their high streets.
“We have already overhauled the ineffective licensing regime and introduced new measures that will put local people back at the heart of licensing decisions, allowing them to take action against problem premises and alcohol-related offending.
“We are building on this through the Government’s new alcohol strategy which sets out plans to crack down on the ‘binge drinking’ culture, end the availability of cheap alcohol and irresponsible drinks promotions, and slash the number of people drinking excessively.”
The consultation ran for 12 weeks and asked the public for views on the types of premises which could be exempted from an EMRO, or eligible for a reduction in levy charges if they were viewed as having a minimal effect on alcohol-related crime and disorder. The Government also consulted on the process that areas would need to follow when adopting these new measures, as well as on the type of services local authorities may fund from their portion of the levy and whether to allow exemptions for New Year’s Eve.
The levy and EMRO measures are contained in the Police Reform and Social Responsibility Act 2011. Other measures in the Act that came into effect in April include:
- making it easier for communities to have their say by scrapping the ‘vicinity test’ which allows everyone the option to comment on licensing applications — not just those living close to premises
- giving health bodies a greater say by making them ‘responsible authorities’ so they are automatically notified about and can make representations on new premises applications
- taking tough action against premises that persistently sell alcohol to children by doubling the fi ne to £20,000 and extending orders that see premises closed on a voluntary basis as an alternative to a fine from 48 to 336 hours – which can lead to licences being revoked
- reforming the system of temporary event notices, including allowing, for the first time, objections from environmental health to be made on the grounds of noise, and the police and environmental health to be able to make objections on all licensing objectives – not just prevention of crime and disorder
- reducing burdens and bureaucracy by allowing councils to suspend licences due to nonpayment of fees, saving them the time and cost of pursuing non-payment through the courts.
These measures are at the heart of radical plans to turn the tide against irresponsible drinking as set out in the Government’s alcohol strategy, published earlier this year. This includes plans to introduce a minimum unit price for alcohol, consult on a ban on multi-buy price promotions in shops and give stronger powers to local areas to control the number of licensed premises. A number of key proposals within the strategy will be subject to consultation in the autumn.
New ‘traffic light’ test could save lives with earlier diagnosis of liver disease
A new ‘traffic light’ test, devised by Dr Nick Sheron and colleagues at the University of Southampton and Southampton General Hospital, could be used in primary care to diagnose liver fibrosis and cirrhosis in high risk populations more easily than at present.
Liver disease develops silently without symptoms, and many people have no idea they have liver failure until it is too late – one third of people admitted to hospital with endstage liver disease die within the first few months. A simple test available in primary care could diagnose disease much earlier, enabling those at risk to change their behaviour and save lives.
The Southampton Traffic Light (STL) test, details of which are published in the September 2012 issue of the British Journal of General Practice (BJGP), combines several different tests and clinical markers which are given a score that indicates the patient’s likelihood of developing liver fibrosis and liver cirrhosis.
The result comes in three colours: red means that the patient has liver scarring (fibrosis) and may even have cirrhosis, green means that there is no cirrhosis and the patient is highly unlikely to die from liver disease over the next five years. Amber means there is at least a 50:50 chance of scarring with a significant possibility of death within five years, and patients are advised to stop drinking to avoid further disease and death.
The test was given to over 1,000 patients, and their progress was carefully followed and monitored afterwards, in some cases over several years, to assess the accuracy of the test in predicting whether they developed liver fibrosis or cirrhosis.
The test proved to be accurate in severe liver disease, and while not a substitute for clinical judgement or other liver function tests, can provide GPs with an objective means to assess accurately the potential severity of liver fibrosis in high-risk patients – for example, heavy drinkers, those with type II diabetes, or obese people.
Dr Nick Sheron, lead author and Head of Clinical Hepatology at the University of Southampton, and consultant hepatologist at Southampton General Hospital, said: “We are reliant on general practitioners detecting liver disease in the community so they can intervene to prevent serious liver problems developing, but so far we haven’t been able to give them the tools they need to do this. We hope that this type of test for liver scarring may start to change this because the earlier we can detect liver disease, the more liver deaths we should be able to prevent.”
Study co-author and GP Dr Michael Moore said: “In primary care, minor abnormalities of existing liver tests are quite common but we struggle to know how best to investigate these further and who warrants specialist intervention. The traffic light test has the advantage of highlighting those at highest risk who should be investigated further and those in whom the risk is much lower where a watchful approach is more appropriate. This is not a universal screening test but, if targeted at those in whom there is a suspicion of liver disease, should result in a more rational approach to further investigation.”
Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance, added: “One of the challenges of liver disease, which is rising dramatically in this country, is the silent nature of the condition until it is often too late to reverse the damage. However, minor changes in standard liver blood tests are so common that it is difficult for GPs to know when to refer for specialist advice. This large study from Dr Sheron and colleagues in Southampton may prove really useful for guiding the right patients towards specialist care in a timely way.”
“Health warnings needed on alcohol”
Health warnings on alcohol would help inform people about the risks of drinking, according to the Faculty of Public Health. The FPH says they would also make it easier for people to understand the need for minimum unit pricing of alcohol.
The FPH says there is evidence that health warnings would increase people’s knowledge about the potential harm alcohol can cause. Professor Mark Bellis, FPH’s spokesman on alcohol, said: “At the moment, when people think about the dangers associated with alcohol, they are more likely to think of the problems caused by binge drinking rather than breast cancer. These health warnings would help educate the public and give them key information before they decide to buy a can or bottle of alcohol. The evidence linking alcohol to over 60 medical conditions is unarguable, so we need factual, not sensational, warnings to help the public understand the risks. People don’t realise that drink is associated with a whole range of health harms and has potential long-term implications.”
The type of warnings that alcohol labelling could include are:
- Alcohol is a drug that causes dependence
- Alcohol is a drug that causes addiction
- Alcohol increases risks of violence and abuse
- Alcohol reduces fertility in men and women
- Alcohol causes over 15,000 deaths a year in the UK
- Alcohol increases risks of mouth, throat and other cancers
Professor Bellis continued: “The health messages that are most important for people to see are the ones that drinks manufacturers are least likely to want to put on their products. Ministers would need to stipulate the size of the warnings on the label of all cans and bottles.”
Cutting daily alcohol intake to half a unit (5g) “could save 4600 lives a year”
– Current guidance unlikely to curb chronic ill health linked to alcohol, experts warn
Cutting daily alcohol intake to just over half a unit (5 g), could save 4,600 lives a year in England, say experts in the online journal BMJ Open.
Current Government recommendations of between 24-32 g (3 to 4 units) a day for men, and 16-24 g (2-3 units) for women may “not be compatible with optimum protection of public health,” suggest the authors.
They calculated what impact changing average alcohol consumption among regular drinkers and increasing the percentage of nondrinkers would have on the health of England’s population as a whole.
They used a mathematical model called the Preventable Risk Integrated Model for Alcohol (PRIME-Alcohol) to assess the impact on the death toll from 11 conditions known to be at least partially linked to long-term alcohol consumption.
These included coronary heart disease, stroke, high blood pressure, diabetes, cirrhosis of the liver, epilepsy, and five cancers.
As part of their calculations, the authors gathered the results of analyses of published research (meta-analyses), which quantified chronic disease risk for differing levels of alcohol consumption. They also used information from the 2006 General Household Survey, to ascertain weekly levels of alcohol consumption in grams among 15,000 adults in England.
In 2006, just under a third (29%) of adults in England were classified as non-drinkers (less than 1 g a day), and 170,558 people died from the 11 conditions at least partially associated with alcohol.
The results of the authors’ calculations showed that just over half a unit of alcohol a day (5 g) was the optimal level of consumption among current drinkers.
This would delay or prevent around 4,579 premature deaths, equivalent to 3% of all deaths from the 11 conditions. At this level of consumption, there would be 843 additional cardiovascular disease deaths, but this would be more than offset by 2,600+ fewer cancer deaths (8% decrease), and almost 3,000 fewer liver cirrhosis deaths (49% decrease), the figures indicated.
A belief that alcohol protects against cardiovascular disease is widespread, say the authors.
“However, our modelling shows that when multiple conditions are considered simultaneously, the levels of alcohol that would actually be likely to be associated with reduced risk of chronic disease are much lower than is generally accepted or recommended by Government,” they write.
The authors also suggest there is no reason for non-drinkers to start drinking for any health benefits, as there are safer ways of reducing cardiovascular disease risk. And encouraging abstainers to start drinking while encouraging drinkers to cut down “is a mixed message that may be difficult to communicate,” they say.
They conclude: “It is likely that Government recommendations would need to be set at a much lower level than the current ‘low risk’ drinking guidelines in order to achieve [the best possible outcomes for public health].”
What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels – Nichols, M; Scarborough, T; Allender, S; Rayner, M; 2012 – doi:10.1136/ bmjopen-2012-000957
John Bercow: More MPs seeking help for alcoholism
The Speaker of the House of Commons, John Bercow, has said that more MPs are seeking help for alcohol problems. His comment was made as Parliament attempts to crack down on Westminster’s drinking culture following highly publicized incidents involving MPs under the influence of alcohol.
In one incident, drunken Labour MP Eric Joyce attacked four Conservative politicians in a House of Commons bar before telling police: “You can’t touch me, I’m an MP”. In this, Mr Joyce was mistaken. He was prosecuted and he admitted four counts of assault at Westminster Magistrates’ Court. Magistrates imposed a 12-month community order and fined him £3,000. Mr Joyce said he was “ashamed and embarrassed”.
In an interview for Sky News’ Murnaghan programme, Mr Bercow suggested that there may be politicians with ‘other addiction issues’ as the House ‘reflects wider society’. It has emerged that House of Commons staff are to be told to top up MPs’ glasses fewer times at Parliamentary receptions, to discourage excessive drinking. Mr Bercow said there is no longer a heavy subsidy on alcohol served in Parliament’s bars, and he said John Bercow: more MPs seeking help for alcoholism
“I think it is important that the medical service in the House is as aware as it can be of members with problems. There is some evidence now that more members and staff who have got drink-related issues are seeking help and that’s a positive.
“I think we are a reflection of society and just as there are people in every walk of life who have got issues to do with alcohol, and possibly other addiction issues, there can be problems in this place.”
However, at least one MP is adamant that more needs to be done. George Galloway, the new ‘Respect’ MP for Bradford West, who is reported to be teetotal, demanded that every House of Commons bar be closed to stop MPs passing laws while they are under the influence. “No one else is allowed to drink alcohol while they work”, Mr Galloway said, “Why are we?”
Alcohol consumption and harm in England 2012
A paradoxical picture of declining alcohol consumption but increasing alcohol-related hospital admissions is provided by the latest compendium of alcohol statistics from the NHS Information Centre.
However, the NHS statistics on alcohol-related hospital admissions have been criticized as unreliable and unfi t for purpose, and there is currently a consultation underway on the best way of recording them. This follows criticism made by the Institute of Alcohol Studies of the official statistics on the affordability of alcohol. As a result of IAS representations, the method of calculating alcohol affordability has been changed. (See here)
The new figures
The alcohol consumption figures presented show a small decline in total consumption in 2010 compared with 2009. They also show a continuing trend of proportionately more alcohol being consumed within the home than outside it in licensed premises. In 2010, 65% of the alcohol consumed was home consumption.
There has been a long term downward trend in the proportion of adults who reported drinking in the week prior to interview. In 1998, 75% of men and 59% of women drank in the week prior to interview, compared to 68% of men and 54% of women in 2010.
Changes in attitudes and behaviour are also evident in children of secondary school age. 13% of secondary school pupils aged 11 to 15 reported drinking alcohol in the week prior to interview in 2010, down from 18% of pupils in 2009 and 26% in 2001. In 2010, 32% of pupils thought it was okay for someone of their age to drink once a week, compared to 46% in 2003. Similarly, only 11% of pupils thought that it was OK for someone of their age to get drunk once a week, compared to 20% who thought that in 2003.
In 2010/11 there were 198,900 hospital admissions where the primary diagnosis was attributable to the consumption of alcohol. This is a 2.1% increase since 2009/10 when there were 194,800 admissions of this type and a 40% increase since 2002/03 when there were around 142,000 such admissions.
The figures on alcohol mortality are mixed, showing a small increase in male alcohol-related deaths in 2010 compared with the previous year, but a small decrease in female deaths.
In 2011, there were 167,764 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings or NHS hospitals and dispensed in the community. This is an increase of 4.7% on the 2010 figure (160,181) and an increase of 63% on the 2003 figure (102,741). The Net Ingredient Cost (NIC) of these prescription items was £2.49 million in 2011. This is an increase of 3.3% on the 2010 figure (£2.41 million) and an increase of 45% on the 2003 figure (£1.72 million). It is estimated that the total cost of alcohol harm to the NHS in England is £2.7 billion in 2006/7 prices.
As reported previously in Alert (See Issue 1 2012 ‘NHS Alcohol Statistics – the war of numbers’) the statistics of alcohol-related hospital admissions have been condemned as invalid because of failing to take into account changes in hospital coding practices, which resulted in the admissions figures being artificially inflated. The issue hinges around the distinction between cases in which alcohol enters into the primary diagnoses and which, therefore, constitutes the main reason for admission to hospital, and secondary diagnoses, cases in which alcohol is an associated or underlying factor.
As stated above, the figures for alcohol-related primary diagnoses show a 2.1% increase in admissions for 2010 compared with the previous year. However, the issues concerning how alcohol-related admissions are coded result in the latest NHS Information Centre showing two sets of figures in relation to total admissions (both primary and secondary), one set being based on the old method of calculation and the other being adjusted to allow for changes in coding practices.
The problem, as commentator Nigel Hawkes was quick to point out, is that, in one set, total alcohol-related admissions rose between 2009-10 and 2010-11 from 1,056,900 to 1,168,300, but according to the other set they fell over the same period from 1,208,100 to 1,168,300.
Statistics on Alcohol: England, 2012.
The Information Centre for Health and Social Care.
New Alcohol Profiles for England provide national map of alcohol-related harms
– Confirmed – alcohol link with social deprivation
The Local Alcohol Profiles for England (LAPE 2010) have been released by the North West Public Health Observatory, based in the Centre for Public Health at Liverpool John Moores University.
The profiles contain 23 alcohol-related indicators for every local authority and 24 for every primary care trust in England. This time, key indicators in healthcare, criminal justice, benefits claimants, drinking patterns and life lost due to alcohol have been used in combination to identify and map those areas experiencing different overall levels of alcohol-related harms. The profiles confirm that poorer communities have substantially higher levels of alcohol-related ill health, anti-social behaviour and premature deaths than their wealthier neighbours, Although the data show that there are drink related problems across all communities, people living in England’s most deprived local authorities are more likely to suffer than those living in the more affluent ones.
Other key findings from the profiles:
Over the five years to 2008/09 there has been around a 65% increase in the number of people being admitted to hospital due to alcohol to 606,799 individuals – an increase of over 240,000 people.
There were 945,469 admissions to hospital for alcohol-related harm in England in 2008/09. This is 825 alcohol-related admissions a day more than five years ago.
However, these figures are based on the method of recording alcohol-related hospital admissions that is currently being reviewed because of the problem of failing to take account of changes in coding practices (see page 13 and Alcohol Alert Issue 1 2012)
Two thirds (65%) of all the local authorities suffering the highest levels of overall harms are in the North West and North East regions of England. The ten local authority areas with the highest levels of combined alcohol-related harm are, in descending order, Manchester, Salford, Liverpool, Rochdale, Tameside, Islington, Middlesbrough, Halton, Oldham and Blackpool.
By comparison, East of England and South East regions contain two thirds (65%) of all the local authorities with the lowest overall harm. The ten local authorities with the lowest levels of alcohol-related harm are, in ascending order, Broadland, East Dorset, South Northamptonshire, Babergh, Three Rivers, South Norfolk, Hart, Sevenoaks, Wokingham and North Kesteven.
Between 2006 and 2008 there were 11,247 deaths from chronic liver disease in men. The number of male deaths from chronic liver disease continues to rise steadily and increased by 12% for the five years up to 2008.
Across England, there were 415,059 recorded crimes attributable to alcohol in 2009/10; equivalent to 8.1 crimes per 1,000 population. The highest rates of alcohol-attributable crime occur in the London region where there were 12.2 crimes per 1,000 residents, although this has decreased by 2.1% from the previous year. The lowest rate is in the North East region at 6.2 crimes per 1,000 which also showed the largest decrease (13.5%) from the previous year.
Trends in alcohol-related harms vary between local authority areas. For instance, 64% saw an increase of over 5% in hospital admissions for alcohol-related harm in 2008/09, whilst only 7% showed a decrease of over 5%.
The 2010 Local Alcohol Profiles for each local authority and primary care trust in England are available from: http://www.lape.org.uk.
New report: Poorest “left behind in fight against unhealthy lifestyles”
The proportion of people engaging in multiple unhealthy lifestyle behaviours has fallen significantly according to a new report on the clustering of unhealthy behaviours over time from The King’s Fund. However, almost all the improvement has been among higher socio-economic and better educated groups, exacerbating health inequalities.
The study is the first to examine how patterns of multiple lifestyle behaviours have changed over time in England. It uses data from the Health Survey for England to analyse changes in the clustering of four key lifestyle behaviours – smoking, excessive drinking, poor diet and lack of exercise – between 2003 and 2008.
The report found that the proportion of the population engaging in three or four of these behaviours fell by 8% over the period (from 33% to 25%). This suggests that public health initiatives have been important in improving health among the population as a whole. However, the report shows that these initiatives failed to have an impact among lower socio-economic groups during this period. The proportion of manual workers and people with no qualifications engaging in all four behaviours remained unchanged. As a result, the gap between higher and lower socioeconomic groups has widened – those with no qualifications were five times more likely to engage in all four behaviours than better educated groups, compared to only three times as likely in 2003.
While noting the successes of public health initiatives, the report suggests that they have focused too much on tackling individual behaviours. It recommends public health policy should focus more on tackling multiple behaviours and targeting those in lower socio-economic and educational groups.
David Buck, Senior Fellow at The King’s Fund and the lead author of the report said:
“Our research highlights an unsung public health success – a reduction in multiple unhealthy lifestyle behaviours among the general population. However, the lack of progress among lower socio-economic and educational groups is worrying and has exacerbated health inequalities.
“If the Government is serious about improving the health of the poorest fastest, it must focus on reducing multiple unhealthy risky behaviours among the poorest groups, rather than only relying on approaches focused on single behaviours.”
Buck, D; Frosini, F; 2012: Clustering of unhealthy behaviours over time – implications for policy and practice available for download at: http://www.kingsfund.org.uk/publications/unhealthy_behaviours.html
Alcohol Awareness Week 19 – 25 November 2012
Alcohol Awareness Week 2012 is centred around the theme of encouraging a healthy national conversation about alcohol. It also invites people to give alcohol up for a month. Alcohol Concern, the promoter of Alcohol Awareness Week, says that one of the nation’s defining features is that people love to talk about drinking – but Alcohol Concern poses the question of whether we are having the right kind of conversation. It says that the Week will provide great flexibility to have all kinds of conversations about the health risks, social problems, stigmas and taboos associated with talking about the dangers of alcohol. It also allows local groups to focus on different areas.
To help the process, Alcohol Concern has produced a set of conversation starter cards, which can be downloaded from their website. Alcohol Concern’s pre-launch publicity continues:
“One of the main ways we’re going to start the conversation is by challenging people to give up alcohol for a month in January 2013. From AAW people will be able to sign up either as an individual or a team to give up drinking for a month. We’re going to ask people to pledge money or get sponsored to motivate them to stick at the challenge. We’ll also be providing people with tips and information on cutting down and how this will help their health, sleeping patterns and general wellbeing.”
Alcohol consumption and affordability
The IAS’s Dr Rachel Seabrook raised the question of the validity of the method of calculating the official alcohol affordability index in 2010. In a paper published in the scientific journal Alcohol and Alcoholism, Dr Seabrook identified five problems with the index as then constructed:
- The use of indices and adjustment for inflation made the measure unnecessarily complex and opaque
- The alcohol price index used in the calculation of affordability related to alcoholic drinks, not to alcohol itself and, therefore, did not take account of changing strengths of alcoholic drinks
- The income measure used in the calculation was a measure of the income for the whole population of the UK, not income per capita
- The income measure included ‘imaginary’ items, namely imputed rentals and attributed income from insurance policies
- The income measure was inconsistent in its treatment of housing costs
Following a Government consultation on the subject, the index has now been amended to accommodate one of Dr Seabrook’s main concerns; namely, that the income measure employed was based on changes in the total disposable income of all households, and not on per capita income. This had the effect that apparent changes in the affordability of alcohol were actually partly due to changes in the size of the population, and not to changes in the real disposable income of individual consumers. As can be seen in the graph, this, in turn, had the effect of exaggerating the extent to which alcohol had become more affordable.
Irish Republic and Northern Ireland come together to hold first all-island conference on alcohol
Irish Republic Minister of State Róisín Shortall and Dr James Reilly, Ireland Minister for Health, attended the first all-island conference on the issue of alcohol abuse held in Armagh early in 2012.
The conference was jointly opened by both Ministers for Health, Dr James Reilly and Mr Edwin Poots and brought together policy makers and representatives from a range of agencies from north and south of the border to explore common issues and challenges in relation to alcohol culture and alcohol harm. The conference focused, in particular, on the challenges relating to alcohol and young adults.
Establishing a cross-border minimum unit price for alcohol was one of the ideas being discussed. Given that Northern Ireland remains part of the UK, these moves, combined with those already taking place in other parts of the UK, clearly create the possibility of a move towards a common minimum unit pricing policy across the whole of the UK and the Republic of Ireland.
Speaking at the conference, Minster Reilly said “This conference Alcohol sports sponsorship to end in Republic of Ireland Subsequently, Minister of State for Health, Róisín Shortall, pledged to put an end to alcohol sponsorship of sports events. “I am committed to phasing that out over a reasonable period of time,” she said in the Dáil. There is “no room for ambivalence in our approach”. Ms Shortall was responding to Fianna Fáil spokesman on children Charlie McConalogue, who asked if the Government was committed to banning “the advertising of alcohol in conjunction with sports events”. has set the scene for a longer term, all-island collaborative approach for tackling issues relating to alcohol abuse. It makes sense to work together on an all-island basis to reduce levels of alcohol consumption in order to save lives and reduce the burden of alcohol abuse to society. The areas we would like progress on a North South basis are measures to reduce the availability of cheap alcohol, treatment and rehabilitation of those affected by alcohol misuse.”
Minister Edwin Poots said: “There is no doubt; alcohol misuse is one of the main threats to public health in Northern Ireland. Research has shown that it costs Northern Ireland up to £900 million every year, and almost £250 million of these costs are borne by the Health and Social Care Sector. If we do not take significant and robust action, the costs to Northern Ireland, and the health and social care system in particular, will continue to grow.
“I believe that alcohol is a cultural and societal issue – one that has a significant impact on both sides of the border and indeed across the UK. It makes sense that we share common goals and ambitions and, where appropriate, work across the UK and Ireland to develop a consistent and long-term approach. Today’s conference is the perfect opportunity for us to build a consensus of common goals and to look at how we can work together most effectively to reinforce the actions already underway in each jurisdiction.”
- The key objectives of the conference included:
- To broaden understanding of the impact of alcohol abuse across the island of Ireland
- To consider particular challenges relating to alcohol and young adults and our drinking culture
- To consider possible broad strategic responses
- To consider ways in which responses across the island of Ireland could be better coordinated
Minister of State with responsibility for Primary Care and Drugs Strategy Róisín Shortall stated: “Alcohol use and misuse is an area where both jurisdictions can achieve a lot together – especially in dealing with the challenges that alcohol presents for young adults. I am particularly concerned with the relationship Ireland has with alcohol. My Department has a report on alcohol from the National Substance Misuse Strategy Steering Group which shall shortly be brought to Government.”
At the conference, expert contributions came from Sir Ian Gilmore, who Chairs the UK Alcohol Health Alliance and also the European Alcohol and Health Forum Science Group, Dr Peter Anderson, an international public health consultant and expert on alcohol policy and Dr Fiona Measham, a renowned researcher in the fields of drug and alcohol use, gender, licensed leisure and the relationship between crime and culture.
The conference was jointly organised by both Departments of Health, the Institute of Public Health in Ireland, the Public Health Agency in Northern Ireland and Cooperation and Working Together, the cross border health partnership.
Ireland: new doctors’ policy group on alcohol to recommend minimum pricing and restricted availability to reduce deaths
The Royal College of Physicians of Ireland has established a national policy group to address the health and social burden of alcohol in Ireland. The policy group brings together experts from a wide range of organisations, including the Irish College of General Practitioners, the National Cancer Control Programme, the College of Psychiatry of Ireland, the Institute of Trauma and Orthopaedic Surgery, the Irish Society of Gastroenterology, and the Irish Association for Emergency Medicine.
This multi-disciplinary group will address the unacceptably high levels of alcohol health harm in Ireland by proposing practical solutions backed up by a robust, international evidence base. The group’s recommendations will be focused on reducing the harm caused by alcohol to health and society.
Professor Frank Murray, Registrar of RCPI and Consultant Gastroenterologist at Beaumont Hospital in Dublin, is Chair of the policy group. He said, “The damaging effects of Ireland’s dysfunctional relationship with alcohol simply can’t be ignored. Alcohol is the third major cause of premature death and disability, after cigarettes and hypertension, and the major cause of death in men aged 35-50.
“As a society, we need to openly discuss and address the consequences of alcohol-related problems and make well-informed decisions for the sake of our society and future generations.
“In Ireland, we have the twin problems of increased affordability and dramatically increased availability of alcohol. Restrictions on availability, pricing, advertisements and sponsorship are the main issues that we hope to address through the policy group. Minimum unit pricing for alcohol will reduce the widespread availability of cheap alcohol, which has been proven to have an immediate impact on alcohol related mortality internationally. Reducing the availability of alcohol by limiting the numbers of outlets that can sell alcohol and reducing their opening hours are also of proven benefit.
“The alcohol-benefitting industries will protest loudly but they should not be allowed to formulate health-related policy. Self-regulation of the alcohol industry has proven not to work.”
Alcohol problems account for a quarter of Scottish intensive care unit admissions
A quarter of patients admitted to Scottish intensive care units have alcohol problems and the majority of those have chronic alcohol disease, with particular problems among men and younger people. Those are key findings of a survey of all 24 Scottish intensive care units, carried out by the Scottish Intensive Care Audit Group and published online early by Anaesthesia, ahead of inclusion in an issue.
“Alcohol disease adversely affects the outcome of critically ill patients and the burden of this in Scotland is higher than elsewhere in the UK” says co-author, Dr Timothy Geary, Anaesthetic Registrar at the Victoria Infirmary in Glasgow.
“Our study of 771 patients admitted to intensive care units in Scotland showed that a quarter of admissions were alcohol-related and that nearly three quarters of those affected were male.
“Patients with alcohol problems tended to be significantly younger and admissions from deprived areas of the country were also more likely to be alcohol related. Patients with alcohol problems also needed to be mechanically ventilated for longer. We estimate that, overall, alcohol-related admissions cost intensive care units across Scotland £9 million a year.”
The World Health Organization suggests that alcohol consumption now accounts for 3.2% of global death rates and 4% of the global ill health. Annual alcohol consumption has grown steadily in the UK, from five litres of pure alcohol per head of population in 1963 to ten litres in 2006. This rise has been associated with increasing deaths and ill health. Between 1992 and 2008, deaths directly caused by alcohol almost doubled in the UK, from 6.9 to 12.8 per 100,000 people. Death rates in Scotland were particularly high for men during this period, with an average of 63.1 per 100,000 and up to 105 per 100,000 in some parts of the country.
A recent review re-examined the 2003 mortality fi gures in Scotland and suggested that the values underestimated the number of deaths related to alcohol by half. In 2003 the estimated direct cost to the Scottish National Health Service of alcohol misuse was £96 million. By 2007 this had risen to between £143.6 million and £392.8 million.
Key findings of the study include:
Of the 771 admissions, 83% were unplanned, 25% were alcohol-related and 22% of the patients had chronic alcohol disease. A third of the alcohol-related admissions were acutely intoxicated at the time of admission.
Patients admitted with alcohol related problems were significantly younger than those admitted without alcohol problems (51 years versus 63 years).
71% of the patients with alcohol-related issues were men, compared with just over 50% of the non alcohol-related patients.
Patients admitted with alcohol-related problems did not have signifi- cantly longer stay or death rates, but they did require a median level of two days’ ventilation, compared to one day for patients without alcohol issues.
When admissions were analysed by levels of multiple deprivation, it was clear that alcohol related admissions were much higher in the most deprived areas and fell steadily as areas became less deprived.
“The major strength of our study is that it was performed across an entire country’s healthcare system over one month, in contrast to previous single centre studies” says Dr Geary. “This has enabled us to estimate the annual cost of alcohol-related admissions, based on the daily cost of an intensive care unit bed, at just under £9 million.
“In Scotland the frequency and volume of alcohol consumed is significantly higher than in the rest of the UK, as is the proportion of people with hazardous drinking habits. This corresponds to higher death rates, particularly for Scottish men, but only indicates a fraction of the deaths attributed to alcohol.
“It is very clear that the increased costs identified by our intensive care unit study are part of a much wider problem caused by rising levels of alcohol abuse.”
But is the tide beginning to turn?
However, the latest analysis of Scottish alcohol sales data suggests that the level of national consumption may have peaked. The data indicate that in 2011, 11.2 litres of pure alcohol were sold per adult in Scotland. This is equivalent to 21.6 units per adult per week, above the recommended ‘sensible drinking’ limit, and around 20% higher than the equivalent figure for England and Wales.
While the 2011 figure represents a 10% increase compared with 1994, analysis of the most recent data suggests that per adult sales fell by 4% between 2010 and 2011, from 11.7L to 11.2L. Per adult sales in Scotland have therefore declined by a total of 5% over the last 2 years. This decline will presumably begin to be reflected, at some point, in reduced alcohol-related hospital admissions.
Reacting to the figures, Scottish Health Secretary, Nicola Sturgeon, welcomed the downward trend but said that sales were still at an unacceptably high level. She continued:
“These findings demonstrate the continuing extent of Scotland’s alcohol misuse problem, with enough alcohol being sold for every adult to exceed weekly recommended limits for men (21 units) each and every week since at least 2000.
“In particular, sales in the off-trade have increased significantly since the mid- 1990s, driven by very cheap alcohol prices, particularly in supermarkets.
“A minimum price per unit of alcohol will almost exclusively impact on the off-trade and will raise the price of this cheaper alcohol.”
Alcohol could account for nearly 2 million emergency care department visits in England and Wales each year
Alcohol may be involved in nearly 2 million visits to emergency care departments in England and Wales every year, suggests research published online in Emergency Medicine Journal.
The authors base their findings on the number of patients requiring treatment at one inner city emergency care department in the South West of England, and the extrapolation of those figures. Almost a thousand adults seeking emergency care at Bristol Royal Infirmary (BRI) over a period of four weeks in June 2009 were invited to take part in the anonymous study.
Each week was divided up into 14 periods of 12 hours, so that all relevant attendances were covered. Of those approached, 774 people were eligible and willing to take part.
An independent researcher asked each one if they had been drinking alcohol before their attendance in emergency care, and then asked about their average weekly alcohol consumption.
Treating clinicians were also asked their opinion as to whether a patient’s emergency department attendance was either directly or indirectly related to alcohol, or was unrelated.
In all, around one in five (149; 19%) patients said they had drunk anything between half a unit and 50 units of alcohol before coming to the emergency department. Some 14% (111) felt their attendance was related to alcohol, 87 (11%) of whom had sustained an injury.
Of these, just over half believed they had been injured by someone who had been drinking, while a similar proportion admitted to drinking more than the maximum recommended weekly units. Of the 111 patients who felt their attendance was related to alcohol, one in three was admitted to hospital.
Clinicians said that around one in five (21%) patient attendances was either directly (14%) or indirectly (7%) related to alcohol. And they felt that around one in ten (8%) of all attendances were attributable to alcohol-fuelled violence.
The authors caution that the BRI experience may not be applicable elsewhere. But they conclude: “If these figures are extrapolated, the number of patients presenting with alcohol-related injury [exceeds] 7,000 attendances to the [BRI] annually, or nearly 2 million patients every year in England and Wales.”
What is the burden of alcohol related injuries in an inner city emergency department? Hoskins, R; Benger, J; 2012 : Online First doi 10.1136/ emermed-2011-200510
Experts update addiction treatment guidelines
– Fresh guidelines on the best methods to treat substance abuse and addiction
The British Association for Psychopharmacology (BAP) has released fresh guidelines on the best methods to treat substance abuse and addiction, in the Journal of Psychopharmacology, published by SAGE. A panel of experts has carefully researched the new, comprehensive guidelines, offering practitioners a detailed review of the evidence to help them optimise their clinical decisions.
The new BAP guidelines target treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders, and primarily focus on pharmacological management. They represent a substantial revision of the fi rst BAP evidence based guidelines for “the pharmacological management of substance misuse, addiction and co-morbidity,” which were published in 2004. The new guidelines also take into account a number of recent documents from the UK National Institute for Health and Clinical Excellence (NICE), and other organisations.
The expert panel behind the updated guidelines searched for new evidence to offer practitioners recommendations based on the most respected and relevant research in the field. They considered pharmacological management of alcohol, nicotine, opioids, benzodiazepines, stimulants, and associated co-morbidity with mental health problems and substance use or abuse in pregnancy. The experts also reviewed the latest research into pharmacotherapy for younger and older people, those with personality disorder, and addressed ‘club drugs’, cannabis and polydrug users. As well as pharmacotherapies in common clinical use, the panel also covers those with limited but promising evidence, and highlights important areas of ‘key uncertainty’.
The new guidelines detail pharmacological interventions targeting the following areas:
- withdrawal syndromes
- relapse prevention and abstinence maintenance
- reducing harms associated with illicit drug use by prescribing a substitute drug or drugs (e.g. methadone maintenance treatment)
- preventing substance use complications (e.g. use of thiamine to prevent Wernicke’s encephalopathy and Korsakoff’s syndrome).
“Our aim is to provide helpful and pragmatic guidelines for clinicians such as psychiatrists and GPs involved in prescribing to people with substance abuse or harmful use alone and with psychiatric comorbidity,” says Anne Lingford-Hughes of Imperial College, London, lead author of these guidelines, who also co-authored the original 2004 BAP guidelines. “The update should also be of interest to other practitioners in the substance misuse field, nonspecialists, patients and their families,” she adds.
The British Association for Psychopharmacology:
Public Accounts Committee criticises HMRC over failure to tackle alcohol duty fraud
MPs have criticised Her Majesty’s Revenue and Customs (HMRC) for its failure effectively to combat evasion of alcohol duty on beer and spirits, which is estimated to cost the Treasury up to £1.2 billion each year. One of the MPs’ criticisms is that HMRC still do not know how much duty evasion there is on wine products. The House of Commons Public Accounts Committee Report on HM Revenue and Customs: Renewed alcohol strategy also critics HMRC for failing rigorously to prosecute alcohol fraudsters.
Richard Bacon MP, Member of the Committee of Public Accounts, said:
“HMRC’s drive to tackle alcohol duty evasion is being seriously hampered by a lack of information. Alcohol fraud is big business. The Department estimates that the gap between taxes due on alcohol and the amount actually collected might be as large as £1.2 billion. The Department does not, however, have enough reliable information on the returns from tackling different types of alcohol duty evasion. It cannot say, therefore, whether a more effective targeting of its resources might not secure a better return on its investment.
“It is unacceptable that the Department has still to produce an estimate of the tax gap for wine, despite a commitment to this Committee’s predecessors to do so. The absence of information on the scale and nature of wine duty fraud undermines the basis on which the Department directs its resources to tackling the problem.
“Since the criminal gangs who perpetrate major alcohol duty fraud operate across national boundaries, the Department needs to strengthen its intelligence by developing better links with the industry, the UK Border Force and other EU Member States.
The Department seems to be reluctant to prosecute offenders. Over a recent four year period, there were successful prosecutions in no more than six cases a year. This sends the wrong message to perpetrators and the wider public about the Department’s commitment to reducing alcohol duty evasion. It should give more weight to the deterrent impact of pursuing perpetrators through the courts.”
Online alcohol threat to Britain’s youth revealed
Online alcohol sales and purchasing by friends and family are creating a significant and emerging battleground in the fight against underage drinking, according to a new report by independent auditors of underage sales Serve Legal and Plymouth University.
The report – ‘Checked out: the role of ID checks in controlling underage drinking’ – indicates that high street retailers have become significantly better at checking the age of potential underage drinkers in recent years. In 2007, the ID of teenage mystery shoppers attempting to buy alcohol from retailers or pubs was checked just over half of the time (55%). By 2010, ID was checked in more than seven in ten cases (71%).
However, the report warns that while greater vigilance by retailers has helped reduce alcohol consumption among young people, it has also prompted a shift in the way underage drinkers are getting hold of alcohol. Online retailers are identified as a key potential source of alcohol for underage drinkers, presenting a window of opportunity for underage drinkers looking to circumvent the stricter alcohol policies now in place in many high street retailers.
Researchers working on the Checked Out report uncovered a number of websites that sold alcohol where there was either no discernible age-check policy or a simple disclaimer noting that the consumer needed to be over 18 to complete the purchase. Even major retailers, many of which have age-related policies in place regarding online alcohol purchases, mainly relied on an ID check at the point of delivery, placing delivery workers in potentially confrontational situations.
The report also identifies socalled ‘proxy-purchasing’ as a growing trend with 42% of underage drinkers claiming to have bought alcohol from friends, relatives or ‘someone else’. New Serve Legal data contained in the report found that while just 4% of underage consumers would try to buy alcohol at the till in a large supermarket, 74% would attempt to obtain alcohol from parents and 86% from older siblings or friends.
Ed Heaver, Director of Serve Legal, who commissioned the report, said: “Retailers have woken up to the fact that they have to get tough when it comes to making sure employees are checking IDs. While this is good news in reducing underage alcohol consumption, it is foolish to assume under-18s aren’t getting their hands on booze elsewhere.
“The battleground is changing in the fight against underage drinking – online retailers need to take heed of this warning and improve their age-checking procedures. Meanwhile, parents and friends also need to understand the harm their proxy purchasing is doing.”
Dr Adrian Barton, of Plymouth University said: “Most underage drinkers realise that it’s now not that easy to walk into a shop to buy alcohol. This factor, added to more relaxed attitudes toward alcohol consumption by parents and relatives, added to the growth of the internet, is creating a perfect storm in the battle against underage drinking. The report should give plenty of food for thought for anyone involved in reducing underage drinking.”
Baroness Newlove – Ten communities to tackle binge and underage drinking unveiled
The 10 communities that will lead work to tackle binge and underage drinking have been announced by Baroness Newlove, the Government Champion for Active Safer Communities. The successful bidders will share a £1 million fund that will put decision-making and resources right in the hands of local people to help them eradicate the effects of alcohol abuse that blight their lives.
Over the next two years these innovative grassroots projects, backed by local authorities, police and retailers, are expected to deliver real results to end the fallout of problem drinking. Other communities will hopefully be inspired to follow their lead. The projects will address separate issues that are the greatest challenges in their neighbourhoods, with measures of their success that will include:
- a reduction in the number of anti-social behaviour incidents related to alcohol consumption
- fewer A & E admissions to local hospitals or fewer ambulance call outs as a result of drinking
- the consumption of alcohol by young people reducing to safe levels; and
- a reduction in purchasing of alcohol made on behalf of under 18s (‘proxy purchasing’)
The 10 successful projects range from county-wide and whole city programmes, to projects targeting specific neighbourhoods. Each successful bid clearly identifi ed their local problems and outlined how innovative community-based approaches would deal with them. They also had to demonstrate how their projects would be sustainable beyond the two years of the programame.
The areas are:
Bury, Greater Manchester
Wakefield, West Yorkshire
Baroness Newlove will work closely with each of the 10 areas. She said:
“I am delighted that the Fund was 10-times oversubscribed, but not really surprised. I have always believed there is a seam of active citizens prepared and willing to work at creating safer, happier communities together with the agencies there to help them. This response proves it. We shall mine these wonderful examples of fresh ideas and local solutions to tackle alcohol misuse and the crime and blight that follows. In two years these areas will be transformed. I intend to support them all the way and ensure others follow their trail blazing progress.”
Among the projects that will receive funding are:
The City of Lincoln – Among their proposals is the development of social media to link up evening safety wardens, street pastors and local police to better address weekday problem drinking and antisocial behaviour in the city centre. They will tackle the repercussion of the rapid expansion of students and visitors to the city centre.
The local community in Moseley, Birmingham that wants to establish a lasting solution to the stubborn issue of street drinking and its associated problems of begging, littering and rough sleeping by giving local people a direct say in deciding how their project develops and how the budget is spent.
Newcastle that wants to work with young people and their families to address crime and antisocial behaviour in two inner suburbs: Elswick; and Benwell and Scotswood, where local surveys suggest that a third of people polled, consider drunk and rowdy behaviour to be a problem.
Shropshire, whose project will focus on five of the county’s public parks which experience seasonal summertime issues around underage drinking and antisocial behaviour. The Shropshire Safer Stronger Communities Board will work with local police, trading standards and retailers to confi scate alcohol from minors, tackle proxy buying and work with young people on developing positive park-based activities.
Proportion of schoolchildren drinking, smoking and taking drugs fell over the past decade, says new report
The proportion of 11- 15 year olds who drink alcohol has fallen markedly in the last ten years, as has the proportion of school children who report drinking frequently. There have also been significant declines in smoking and in drug use.
The findings come from a report published by the NHS Information Centre, Smoking, drinking and drug use among young people in England in 2011, which surveyed around 6,500 pupils between September and December 2011.
On alcohol, the survey found that 45% of pupils said they had drunk alcohol at least once – compared to 61% in 2001. The proportion of pupils drinking frequently also fell, with 7% of pupils saying they usually drank at least once a week, compared to 20% in 2001.
One in four (25%) 11 to 15-year-olds had smoked at least once – the lowest proportion since the survey began in 1982. One in twenty pupils (5%) were classed as regular smokers (smoking at least one cigarette a week) – half the percentage compared to 2001 when one in ten smoked regularly (10%).
Drug-taking among secondary school children fell by 12 percentage points in the past ten years. Around one in six (17%) 11 to 15-year-olds surveyed in 2011 said they had ever taken drugs. This compares to 2001, when 29% of pupils in the same age range reported that they had.
There were falls in the percentage of children who said they had taken drugs in the last year at every age surveyed. For example, among 15-year-olds, the fall was by 16 percentage points over the decade (39% in 2001 to 23% in 2011). 12% of pupils reported having taken drugs in the last year – compared to 20% in 2001.
Pupils were more likely to have taken cannabis than any other type of drug, but levels of cannabis use were still down on 2001 levels with 7.6 % reporting they had taken the drug in the last year compared to 13.4% a decade earlier.
HSCIC Chief Executive Tim Straughan said: “The report shows that pupils appear to be leading an increasingly clean-living lifestyle and are less likely to take drugs as well as cigarettes and alcohol. All this material will be of immense interest to those who work with young people and aim to steer them towards a healthier way of life.”
Smoking, drinking and drug use among young people in England 2011 Edited by Elizabeth Fuller
A survey carried out for the Health and Social Care Information Centre by NatCen Social Research and the National Foundation for Educational Research
ISBN 978-1-84636-726-7 Report available online at: http://www.ic.nhs.uk/
Youthful non-drinking – alive and well but socially invisible
Many young people in the UK drink little alcohol or do not drink at all, but public policy is based on the assumption that youth drinking is the norm, an assumption reinforced by stereotyped media portrayals of binge drinking. Now, a new study from the Joseph Rowntree Foundation casts light on a social phenomenon the existence of which is barely recognised, let alone understood. The study examines the lives of young people who drink little or no alcohol, and finds that:
- getting drunk is not an automatic rite of passage for young people
- young people who drink little or no alcohol tend to prefer activities where drinking alcohol rarely plays a role
- the immediate effects of drinking alcohol (e.g. hangovers) concern young people more than longer term health effects; and
- young people believe alcohol education is based on the assumption that young people drink. They want ‘not drinking’ to be presented as a legitimate option.
Download report at: http://www.jrf.org.uk/publications/positive-choice-young-people
Glass shape influences how quickly we drink alcohol
The speed at which we drink alcohol may be influenced by the shape of the glass we drink from, according to new research from the University of Bristol, published in PLoS ONE. This could be a target to help control the problematic levels of drunkenness that are becoming increasingly common in our society.
Dr Angela Attwood and colleagues from Bristol’s School of Experimental Psychology recruited 160 social drinkers aged 18-40 with no history of alcoholism to attend two experimental sessions. At one session they were asked to drink either lager or a nonalcoholic soft drink from either a straight-sided glass or a curved ‘beer flute’.
The participants were almost twice as slow when drinking alcohol from the straight-sided glass compared to the curved glass. There was no difference in drinking rates from the glasses when the drink was non-alcoholic.
The researchers suggest that the reason for this may be because it is more difficult to judge accurately the halfway point of shaped glasses. As a result, drinkers are less able to gauge how much they have consumed.
In order to test this, participants attended another session in which they completed a computer task that presented numerous pictures of the two glasses containing varying volumes of liquid. By asking participants to judge whether the glass was more or less than half full, the researchers were able to show that there was greater error in accurately judging the halfway point of the curved glass.
Importantly, the degree of this error seemed to be associated with the speed of drinking. That is, the participants who tended to show the greatest error in their halfway judgments tended to show the greatest changes in drinking rate.
The speed at which an alcoholic beverage is drunk will influence the level of intoxication experienced, and also the number of drinks consumed in a single drinking session. Therefore, slowing drinking rates is likely to have positive impact for the individual and also at a population level.
Dr Attwood said: “Due to the personal and societal harms associated with heavy bouts of drinking, there has been a lot of recent interest in alcohol control strategies. While many people drink alcohol responsibly, it is not difficult to have ‘one too many’ and become intoxicated. Because of the negative effects alcohol has on decision-making and control of behaviour, this opens us up to a number of risks.
“People often talk of ‘pacing themselves’ when drinking alcohol as a means of controlling levels of drunkenness, and I think the important point to take from our research is that the ability to pace effectively may be compromised when drinking from certain types of glasses.”
This work was funded by a small grant from the Alcohol Education and Research Council (now Alcohol Research UK).
Attwood AS, Scott- Samuel NE, Stothart G, Munafò MR (2012) Glass Shape Influences Consumption Rate for Alcoholic Beverages. PLoS ONE 7(8): e43007. doi:10.1371/journal. pone.0043007
Demon drink? – Temperance and the working class
Temperance provides the theme of the current exhibition at the People’s History Museum, Manchester.
The Temperance Movement, in which people took the pledge not to drink alcohol, effectively began in the North West of England and temperance played an important part in the lives of many people in the region. Despite this, it is a little remembered aspect of our history.
The exhibition, Demon Drink? has been supported by the Heritage Lottery Fund (HLF) as part of a research project led by Dr Annemarie McAllister from University of Central Lancashire’s School of Education and Social Science, who is working in partnership with the museum.
The exhibition focuses on the everyday experiences and concerns of working people and their families regarding drink and abstinence. It provides an opportunity to showcase some of the museum’s temperance collections and the University of Central Lancashire’s (UCLan) Livesey Collection, as well as drawing on local and national collections to uncover this history.
The project brings back to life a largely forgotten public movement which, the organizers say, still influences our lives today. The displays combine unique historical artefacts such as Joseph Livesey’s rattle, archive film footage of temperance processions and oral histories collected from local communities whose families were involved in the movement.
Thematic displays explore the perceived need for the Temperance Movement, how society viewed it, its key messages and how people were encouraged to join. The exhibition highlights the importance of children and social activities in promoting the movement’s message. It looks at alternatives to the public house such as temperance sporting events, parades, lessons, games, quizzes and children’s entertainments.
Visitors are able to take part in a whole host of activities, play on a human-scale temperance-related snakes and ladders game and tell their own families’ stories. A range of public events accompany the exhibition. These include illustrated talks, themed City Centre Trails, craft and family activities and a Magic Lantern Show.
The exhibition is also accompanied by a virtual exhibition that is available for the public to access via the internet at www.demondrink.co.uk.
The exhibition runs until 24 February 2013
Temperance and the working class
Prompted by the exhibition, Alcohol Alert invited Derek Rutherford, Chairman of the Institute of Alcohol Studies and a lifetime temperance advocate, to suggest what lessons the modern alcohol control field can learn from the temperance movement
It is difficult today to appreciate and understand the powerful sentiment that existed for temperance and the force it was in the latter part of the nineteenth and early part of the twentieth century. In 1849 Richard Cobden wrote, “The Temperance Cause really lies at the root of all social and political progression in this country… The moral force of the masses lies in the Temperance Movement, and I confess I have no faith in anything apart from that movement for the elevation of the working classes.” Leaders of working class organizations whole heartedly embraced temperance.
Thomas Burt, who founded the Northumberland Miners’ Association, was a keen advocate and worker for the temperance cause. In 1847 he became a member of parliament and in 1892 Gladstone appointed him Parliamentary Secretary to the Board of Trade. Before he retired from Parliament in 1918 he had become Father of the House of Commons. Speaking at the TUC Congress in 1905, Burt stated, “I regard the temperance question as one of the greatest social topics of the time. If democracy is to have a great future, one of the things it will have to do will be, individually and collectively to grapple with the drink problem.”
Keir Hardie, the founder of the Labour Party, had, at 17, joined IOGT – a leading international temperance organization. He became the leader of its local group and quadrupled its membership. It is of note that the IOGT movement established in Scotland in 1869 had, by 1900, recruited 1.2 million members. Keir Hardie, as leader of the Labour group in the House of Commons in 1906, had his members sign a pledge to abstain from alcohol whilst they were on business in the House. Hardie’s credo was: “Each socialist is by his creed under moral obligation to find his greatest pleasure in seeking the happiness and good of others. The man who can take a glass of beer or let it alone is under moral obligation for the sake of the weaker brother who cannot do so, to let it alone. To me, this matter is one of serious moment”.
By the 1930’s the endemic drink problem of the nineteenth and early twentieth centuries had drastically diminished and a period of sobriety had been established. The Hulton Readership Survey estimated that 40% of the population were abstainers and that young people aged 16 to 25 were most likely to abstain.
The Report of the Royal Commission on Licensing, England and Wales, 1929-31 noted that there had been a marked change in public attitude towards drunkenness and a distinct advance in sobriety, especially among young people. Factors contributing to this success were: the advocacy of temperance workers, the spread of education, counterattractions to drinking, reduction of licences, restriction of hours and the heavy increase in excise duties. Beer had more than doubled in price and the cost of spirits increased three and four times. The report states: “There can be no doubt that these large increases in price..…have imposed a strong check on the consumption of liquor and contributed substantially to the diminution of insobriety.”
Confirmation of the success of temperance advocacy may be seen in the Ministry of Health’s refusal to the request of Dr Max Glatt to attend a WHO conference on Alcoholism in Copenhagen in 1951. The Ministry considered that there was no alcoholism in England. This rather complacent attitude ignored the effect which would result from a lack of control over the marketing strategies of the drinks industry.
In 1933, Sir Edgar Saunders, Director of the Brewers Society, unveiled the brewers’ plans. His words were ominous: “Unless you can attract the younger generation to take the place of older men, there is no doubt that we shall have to face a steadily falling consumption of beer. That is a very serious matter for an industry of this sort…unless we can attract and secure the younger customers who will become the mainstay of the public house…. If we begin advertising in the press, we shall see that the continuation of our advertising is contingent upon the fact that we get editorial support as well in the same papers. In that way it is wonderful how you can educate public opinion, generally without making it too obvious that there is a publicity campaign behind it at all…We want to get the beer drinking habit instilled into thousands, almost millions, of young men who do not at present know the taste of beer,”
The results of the Drinks Industry marketing and sponsorship strategies are clearly seen. By the 1980s, young people had become the heaviest drinkers in the population. So, over the past 150 years, we have come full circle in the nation’s drinking habits.
What lessons can modern alcohol control advocates learn from their predecessors?
Beware of colluding with the Drinks Industry and their acolytes, believing you can make them more socially responsible. They will not promote effective alcohol policies but will actively work against them, hindering their implementation. The Scotch Whisky Association (SWA) states that their origins: “lie in the defence of the industry from what were seen as excessive and unfair taxes imposed by the temperance-friendly Chancellor, Lloyd George.”
At present they are heavily engaged in lobbying against the Scottish Government’s proposal to introduce minimum unit price. One hundred years later a leopard doesn’t change its spots. SWA do not accept a level playing field for health advocates, since they have challenged Alcohol Focus Scotland’s right to defend minimum price in the Court of Sessions, Edinburgh. The court has ruled that Alcohol Focus Scotland can give evidence in support of the Scottish Government’s legislation on minimum price.
When Alcohol Policy and the Public Good was produced to support the WHO Europe Alcohol Action Plan, the Portman Group attempted to offer £2000 each for alcohol researchers to rubbish the report with the promise to protect their anonymity.
The temperance movement was successful in creating a people’s movement, winning their hearts and minds. So far, modern advocates have not achieved this.
Encouraging a political will. There may be signs that this is on the way to being achieved. The recent excellent report on alcohol by the Select Committee on Health is certainly an encouragement and an increasing number of MPs are taking an interest in the issue. It may be that the transfer of responsibility for alcohol licensing from magistrates to local authorities will draw local councillors’ attention to problems faced by their electors with the social consequences of alcohol use, such as antisocial behaviour, thus recognising the need for policy action both at local and national level.
Temperance advocates emphasized the social problems and the impact on third parties. Modern advocates have tended to emphasise the health consequences and have not placed sufficient emphasis on the impact of alcohol on innocent victims. Recently, advocates have suddenly realized the need to place some emphasis on ‘passive drinking’, taking their cue from successful tobacco advocacy. Concern over the impact on the wellbeing of the family, interpersonal violence and the impact on children and poverty drove the commitment of temperance advocates.
The temperance movement created a network of groups active in almost all the major towns and counties. Trades Unions had their temperance sections.
The importance of coalition building with other civil society groups was seen. Examples of this today are the Alcohol and Health Alliance and the Open All Hours group established by the IAS to bring civil society groups together over the implementation of 24 hour drinking.
Suffolk Constabulary try to stop sales of super-strength drinks
A ban on sales of super-strength cider and lager in Ipswich is being sought by Suffolk Police and its partners. Off-licence owners are being asked to become Ipswich ‘superheroes’ by becoming ‘Super Strength Free’ and removing these products from their stores.
Suffolk Constabulary, NHS Suffolk, Ipswich Borough Council, Suffolk County Council, the East of England Co-operative Society, Tesco and Martin McColl are working together in an effort to end the sale of this kind of alcohol, which is said to have serious effects on consumers and communities.
‘Super-strength’ alcohol includes lager, beer and cider with an alcohol volume of 6.5% or over that is sold very cheaply. The campaign is targeting the sale of these items only, in off-licence premises.
Licensees in Ipswich have been asked to join the campaign by voluntarily removing the sale of these products from their stores. The East of England Cooperative Society, Tesco and Martin McColl have all agreed to remove super-strength alcohol from the shelves of their stores in Ipswich Borough and twenty independent stores in Ipswich are already ‘super-strength free’. In total there are 130 offlicences in Ipswich, 53 of which will be super strength free following the launch.
Super strength alcohol is sold very cheaply, and is often bought by young people, or those with alcohol dependency problems. Excessive consumption of these drinks can lead to health problems for the individual, can make them vulnerable to various types of crime and can lead to antisocial behaviour and community issues.
Campaign leaders hope that by highlighting the problems associated with the sale of this alcohol, the number of off-licence premises selling super strength alcohol in the town will be reduced, and members of the public will have a better understanding of the associated dangers.
Partners said, “We are positive that the ‘Reducing the Strength’ Campaign will have significant, long-lasting, positive effects for the people of Ipswich.
“The negative impacts associated with super strength alcohol are significant for the consumer and the wider community, but also for the public services who deal with the consequences. This campaign aims to take the problem away at the source.
“We hope that licensees will share our belief in the positives associated with becoming ‘superstrength free’ and that they will recognise the huge benefits that can result from removing these products from their shelves.
“We are the first county in the country to launch a campaign of this kind, and we hope that with support from our offlicences, we can roll this out across Suffolk, and eventually offer the campaign as a model for public services across the UK.”
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