Editorial – July 2019

Welcome to the July 2019 edition of Alcohol Alert, the Institute of Alcohol Studies newsletter, covering the latest updates on UK alcohol policy matters.

This month, researchers from Kings College London find that one in ten hospital patients are alcohol dependent, an occurrence eight times more commonplace than in the general population. Other articles include: a joint IAS and Fraser of Allander Institute report finding that, contrary to received wisdom, higher taxes could indeed boost the economy, the new prevention green paper neglects to pledge anything new of note about alcohol, and half of young drinkers admit to being unaware of health messaging on alcohol packaging.

Please click on the article titles to read them. We hope you enjoy this edition.

COVER STORY – 10% of hospital patients found to be alcohol dependent

 Extent of hospital patient alcohol misuse ‘much bigger’ than assumed

04 July 2019 – A fifth (20%) of UK hospital patients have been diagnosed as using alcohol harmfully, and a tenth (10%) diagnosed as dependent on alcohol, according to a study published in the journal Addiction earlier this month. That suggests that harmful alcohol use is ten times more common among people in hospital than the general population, and alcohol dependency eight times more common.

The figures were even higher for accident and emergency (A&E) departments, as well as for psychiatric hospitals. 24% of patients in A&E were estimated to be using alcohol harmfully and 16% alcohol dependent. Over a third of people in psychiatric hospitals were found to be using alcohol harmfully.

These figures represent the first large-scale estimate of the prevalence of the conditions within NHS hospitals, drawing on data from over 1.6 million patients, whereas previous estimates had come from relatively small studies. A team of researchers led by Emmert Roberts of King’s College London and South London and the Maudsley NHS Foundation Trust systematically reviewed the existing evidence and combined data from 124 different studies to reach the figures. Roberts believes that doctors currently underestimate how common alcohol-related issues are among their patients, saying: ‘Our results suggest the problem is much bigger than anecdotally assumed’. He called for dedicated inpatient alcohol care teams as the most appropriate response.

Katherine Oldridge-Turner, head of policy and public affairs at the World Cancer Research Fund, argued that the findings reinforce the need for minimum unit pricing: ‘We need the government to empower people to drink less by making our daily environments healthier. Information alone won’t lead to large-scale change in behaviours.’

You can hear lead author Dr Emmert Roberts explain the report’s findings in our Alcohol Alert podcast.

Higher alcohol taxes would boost the economy

10% increase in alcohol duty would create 17,000 more jobs, study suggests

05 July 2019 – Raising alcohol taxes could benefit the UK economy, according to a new study from the University of Strathclyde’s Fraser of Allander Institute (FAI) and the Institute of Alcohol Studies (IAS). The research, published in the journal Drug and Alcohol Review, finds that higher alcohol taxes would lead to an increase in both national income and employment, provided the additional revenue is invested in public services.

Using a sector-by-sector model of the economy, the researchers estimated the effects of a 10% increase in alcohol tax, with the government using the proceeds to increase spending on public services, finding that:

  • The higher rate of duty would raise an extra £789 million for the Treasury
  • UK GDP would rise by £847 million
  • There would be over 17,000 more full-time equivalent jobs

Opponents of policies to reduce harmful drinking, such as raising alcohol taxes, often claim that reducing alcohol sales will lead to job losses and negatively affect the economy. Yet the new analysis shows that any adverse impact on the alcohol industry can be offset by higher spending on other goods and services, with more jobs created in sectors like health and education.

These results are likely to underestimate the full economic benefit of higher alcohol taxes, as the model did not account for any reduction in alcohol-related illness and injury, which in turn would increase productivity and reduce sickness-related absence from work.

Peter McGregor, director of the Fraser of Allander Institute, and one of the authors of the study, said:

‘For an increase in alcohol duties we find evidence of a net positive effect on both value-added and employment in addition to improved health outcomes, indicating that here there is no trade-off between the two: indeed, there is potential for a “double dividend” of a simultaneous improvement in health and a stimulus to the UK economy.’

Aveek Bhattacharya, policy analyst for the Institute of Alcohol Studies, and a co-author on the study, said:

‘This study clearly demolishes the argument that we cannot afford to tackle cheap alcohol. While the weight of evidence that reducing the affordability of alcohol would save lives and reduce crime and violence should be reason enough to take action, this research strengthens the economic case for raising its price.

‘Supermarket beer is 188% more affordable today than it was in 1987. The government should get back on track and ensure that alcohol taxes rise above inflation, as well as introducing a minimum unit price to address the cheapest products.’

You can watch a video summary of the study on the IAS Twitter feed.

Industry in call for coordination on Irish minimum unit pricing plans

Political deadlock at Stormont risks damaging all-Ireland unity on alcohol policy

13 July 2019 – Irish trade associations have expressed concern about the potential for increased cross-border alcohol sales if minimum unit pricing (MUP) is introduced in the Republic of Ireland, but not in Northern Ireland. The Irish Government had originally intended for the policy to come into force on both sides of the border at the same time. However, Northern Ireland has been without a regional government since 2017, and so the Irish Government has decided to press ahead alone, and is planning to introduce MUP in the Republic within the next 12 months.

MUP would make it illegal to sell alcohol for less than €1 per unit in the Republic, which would mean that prices of certain products would be substantially lower in the North. For example, a bottle of supermarket own brand vodka would be 71% higher in the Republic of Ireland (£18.80 vs £11) under MUP.

According to Thomas Burke of Retail Ireland: ‘There’s a general disquiet within the industry and concern about what is being proposed.

‘The concern stems from a fear that if we press ahead with MUP here in the Republic without a reciprocal move in Northern Ireland all we will do is distort the market and send consumers north of the border…There is a lot of concern within our sector a decision government may take over the next couple of weeks has the potential to distort trading patterns and put real pressure on border retailers particularly.’

Paddy Malone, chief executive of Dundalk Chambers of Commerce, suggested that the move risks ‘mayhem’, encouraging illegal organisations to smuggle cheap alcohol into the Republic.

The issue of cross-border trade is particularly sensitive given the ongoing negotiations around the status of the Irish border after the UK leaves the European Union. Burke added: ‘At a time when Government are trying to ensure regulatory alignment between Northern Ireland and the Republic — they are now intending to bring in a different approach on a particular product.’

Evelyn Jones of the National Off-Licence Association of Ireland reiterated her organisation’s support for MUP, describing it as a ‘responsible, targeted alcohol pricing policy.’

Meanwhile, north of the border, some argued that these issues reinforce the need for MUP in Northern Ireland. Colin Neill of Hospitality Ulster said that Northern Ireland must introduce minimum unit pricing to reflect the needs of the modern marketplace and tackle the misuse of alcohol. ‘We simply cannot continue with no decisions being made and the political paralysis stopping our industry from growing and developing… We are regressing through inertia and having to live with the consequences of the fact that the Assembly and Executive isn’t in operation.’

An editorial in the Belfast Telegraph agreed: ‘This is yet another example of the damage being caused to so many aspects of life here because our political representatives are still failing dismally to agree on a form of government… A minimum price policy could play a significant role in reducing alcohol abuse, and reduce the number of deaths in Northern Ireland caused by excessive drinking’.

£1bn tax giveaway costs NHS 40,000 nurses

Alcohol Health Alliance UK campaign pushes for duty increase

15 July 2019 – The Alcohol Health Alliance UK (AHA UK) has launched a campaign asking the UK Government to prioritise the funding of public health and prevention services by raising alcohol duty by 2% above inflation in the autumn Budget.

Alcohol continues to cause substantial harm to families and communities across the UK, and alcohol treatment can be fundamental to help people turn their lives around, say AHA UK.

However, the government has supported alcohol companies with tax giveaways, while budgets for public health services have been cut substantially.

Now, only one in five people who need alcohol treatment can access it, and as a result, vulnerable people are falling through the safety net of health and welfare service provision.

The trend of below-inflation duty changes, instigated by the most recent two chancellors, now costs HM Treasury more than £1 billion annually. This, AHA UK argue, is money which could, for example, fund the salaries of 40,000 nurses or 28,500 police officers.

Hence AHA UK are asking the government to increase alcohol duty by 2% above inflation in this year’s Budget, to invest in public health and prevention services. They also urge people to write to their MP, which you can do by clicking on the postcard link.

Scottish Government criticised for funding cuts amid ‘drug and alcohol crisis’

Labour accuse SNP of slashing budgets in an emergency

17 July 2019 – Scottish Labour has condemned the SNP Government for its failure to protect funding for regional Alcohol and Drug Partnerships (ADPs) following a significant rise in drug deaths in 2018. ADPs coordinate health boards, local authorities, police and charities in 31 different areas in their efforts to reduce harm from alcohol and drugs. According Labour, ADP funding has fallen by 6.3% between 2014/15 and 2018/19, accounting for inflation.

Responding to the news that drug-related deaths in Scotland rose 27% in 2018, to a level higher than the USA or any other EU nation, Labour’s health spokesperson, Monica Lennon said: ‘It is unbelievable that in the middle of Scotland’s drug and alcohol crisis the SNP government has cut funding to vital support networks. They should be investing in Alcohol and Drug Partnership funding, not slashing support to those who badly need help.’

She called on the SNP Government to ‘declare a public health emergency and use every power available to prevent drug and alcohol-related deaths.’

A government spokesperson pointed to its continued investment in alcohol and drug services, but seemed to pass responsibility to the NHS: ‘In 2016-17 a portion of funding for alcohol and drug services was baselined with NHS boards, and we were clear with boards that these services should be protected within their increased investment from the Scottish Government.’

The government insisted: ‘We want to encourage a shift in thinking and practice in how services are designed and delivered, with the aim of improving the quality and provision of services for those who are most at risk.’

Prevention green paper has little to say on alcohol

Long-awaited release quietly slipped out

22 July 2019 – The much-delayed green paper Advancing our health: prevention in the 2020s was finally published under controversial circumstances on the evening of the 22 July, and left public health groups bemoaning a ‘missed opportunity’, with the government’s proposals for new alcohol policies few in number and modest in scope.

Health Secretary Matt Hancock originally announced his intention to publish the green paper last November, indicating a shift in priorities towards prevention. Yet as Theresa May’s tenure as Prime Minister came to a close, the draft paper became a victim of ‘Whitehall inertia’, according to officials. The paper was originally supposed to have been released on 08 July, but its publication was repeatedly delayed and it did not appear until Theresa May’s penultimate full day as prime minister before being succeeded by Boris Johnson.

According to media reports (most notably in The Guardian and the Financial Times), Hancock sought to block the release of the green paper so close to the end May’s tenure, leading to a heated argument between the two and Hancock threatening to remove his Department of Health and Social Care’s (DHSC) name from the document, even though DHSC had been responsible for drafting the report. Reports also suggest that Hancock’s intransigence may have been an effort to win favour with the new Prime Minister Johnson, who has indicated his opposition to ‘the creep of the nanny state’.

The most eye-catching proposals in the green paper include a target for a complete end to tobacco sales by 2030, a levy on tobacco firms to pay for treating people with smoking-related illnesses, a ban on the sale of energy drinks to children and the possibility of extending the sugar tax to milkshakes.

The document had relatively little to say about alcohol, however. While it noted that ‘the harm caused by problem drinking is rising’, it also stressed that ‘most people who drink, do so responsibly’.

It recapitulated some of the government’s existing activities to reduce alcohol harm, specifically: supporting the One You health awareness campaign, including alcohol risk assessment in NHS Health Checks and providing £6 million in funding to help children living with alcohol dependent parents.

The only new alcohol policy proposals were:

  • Plans to work with the industry to increase the availability of alcohol-free and low-alcohol products by 2025, including a review of the evidence on permitting drinks with up to 0.5% ABV to be described as alcohol-free
  • Establishing more specialist alcohol care teams in hospitals with high rates of alcohol-related admissions

The scant reference to alcohol in the document comes a slap in the face to the British Medical Association and other leading healthcare organisations who called on the government to prioritise alcohol prevention ahead of the green paper’s release.

In the letter to Public Health Minister Seema Kennedy MP, the BMA board of science chair, Professor Dame Parveen Kumar, along with the chairs of the Royal Colleges, wrote:

‘Since 2014/15, the number of alcohol-related hospital admissions each year has increased by over 100,000, a worryingly high increase of 8%. Despite this, fewer people are accessing treatment even though evidence shows that it is effective for an increasing proportion of people.’

Labour’s Shadow Health Secretary, Jonathan Ashworth was damning in his assessment: ‘Sadly this green paper is a missed opportunity, raises disturbing questions about the role of lobbyists in watering it down, and isn’t worth the paper it’s written on.’

Sir Ian Gilmore, chair of the Alcohol Health Alliance, lamented the government’s apparent inconsistency: ‘the Government wants the UK to lead the world in tobacco control but won’t apply pressures to alcohol harms.’

He claimed: ‘It’s shocking that the only proposal in the paper is to relax the rules on what constitutes an alcohol-free drink. Once again, the government puts the alcohol industry first and consumers last.’

Sir Ian demanded a more ambitious approach to alcohol policy: ‘We are calling for the Government to think again: to review the evidence emerging from Scotland on minimum unit pricing, to review duty rates across the board so that drinks of high alcohol volume always cost more, to ensure that consumers have accurate on-product information as well as the chief medical officers’ consumption guidelines, to adequately fund treatment for people with addiction – saving taxpayers’ money in the long run – and to curb marketing practices that make cheap alcohol ubiquitous.

‘It’s time that the government stood up for children, families and communities. It’s a shame it missed the chance to do that in its Prevention Green Paper today. We will be calling for the new ministerial team to take the opportunity to start afresh and to give the issue the seriousness it deserves.’

It remains unclear how many of these policies will eventually be adopted by the new administration. The green paper is out for consultation until 14 October, and the government is expected to respond next spring.

Southwark to apply late night levy

Becomes 11th council to do so

22 July 2019 – All licensed premises in Southwark authorised to sell alcohol between 00:01 and 06:00 hours must pay an annual levy of between £299 and £4,400, as of 01 September.

The late night levy was approved by Southwark Borough Council on 17 July. Businesses subject to the charge when it comes into force must pay within 14 days.

The levy is paid along with the annual premises licence fee. The exact amount paid per business will depend on its rateable value and whether the premises are primarily or exclusively used to sell alcohol for consumption on the premises.

It is estimated the levy’s introduction will add more than £400,000 to the council’s coffers per year, with the funds raised intended to support a night-time economy team of police and council workers expected to cost £335,500. Use of remaining revenue will then be determined by a board of police, council staff, operators and residents.

The Morning Advertiser reports that the decision makes Southwark the 11th council to date to adopt a late-night levy – half of which are London boroughs such as Hackney and Tower Hamlets. A review of the levy will be held after the first year.

Premier League partners with Budweiser

Brewer deepens ties with English football

23 July 2019 – ‘The King of Beers meets the Kings of the Game’ boasted Budweiser as it announced the start of a multi-year partnership with the Premier League as its official beer.

The deal to sponsor the top tier of the English professional football league is another boost for the brewer’s portfolio, which already includes LaLiga in Spain. It will stretch across five continents and in more than 20 countries and aims ‘to bring fans closer to their footballing heroes through a series of unique programmes across the globe’.

However, this deal has come under fire from NGOs focused on the health aspects of sport promotion. In response to the announcement, Healthy Stadia tweeted: ‘We need stronger regulation on the marketing of health-harming products, including alcohol, to help protect children and young people.’

Services failing vulnerable people with alcohol problems

Abridged from Drink and Drugs News

24 July 2019 – Vulnerable adults’ alcohol use is frequently being ‘missed or poorly managed’, says a report from Alcohol Change UK. Mismanaging severe alcohol problems among people with complex needs is increasing their risk of harm and even death, says Learning from tragedies: an analysis of alcohol-related safeguarding adult reviews.

The report analyses eleven different safeguarding adult reviews from 2017 where alcohol was identified as a significant factor, and ‘charts the stories of people who died in the most tragic of circumstances at a time when they were at their most vulnerable’.

All professionals working with alcohol-dependent people should be fully trained to recognise the ‘complicated role that alcohol plays in adult safeguarding’, says the document, and stresses that a person’s refusal of care needs to be ‘constantly challenged’. The refusal of alcohol treatment should not lead to someone being deemed beyond help, it says, and treatment services may need to adapt their models, for example through home visits.

Training of social workers, paramedics, police and others should also challenge the view that alcohol misuse is a ‘lifestyle choice’ that must be respected. Many of the people described in the report had ‘dozens or even hundreds’ of interactions with professionals who failed to recognise the risks posed by alcohol and treated dependency and self-neglect as personal choices. Professionals also need more guidance to help them use legal powers to mandate alcohol-related interventions, says the report, with the recent Mental Capacity (Amendment) Act 2019 an opportunity for change.

‘Our report reveals the tragic stories of lives lost in some of the most terrible of circumstances,’ said Alcohol Change UK Chief Executive Dr Richard Piper. ‘We as a society owe it to the memories of the people who have died and their families to make the most of the learning from this review to prevent such tragedies in future.

‘The recommendations that we offer are workable and urgent, especially for those people who are alive today and are at risk of being the subject of a future safeguarding adult review. Most importantly, professionals who are working hard in the most difficult of circumstances need to receive proper legal backing and much better training in how to handle the genuine complexities of an alcohol problem when it is entwined with other challenging issues.’

For the full article, please visit the Drink and Drugs News website.

Half of young drinkers unaware of alcohol packaging health messages

Result occurs despite being target market for health info

24 July 2019 – Just half of 11-19-year-old drinkers recall seeing health messages or warnings on alcohol packaging – despite being an important target market for this information, according to new research.

Published in the Journal of Public Health, the research – led by the University of Stirling and the Cancer Policy Research Centre at Cancer Research UK – investigated to what extent 11-19-year-olds in the UK were aware of product information, health messaging or warnings on alcohol packaging during the previous month.

The research team found that, of those who identified themselves as ‘current drinkers’, just half had recalled seeing such information – and that fell to just one third of the entire age group, regardless of their current drinking status.

It is the first study to examine awareness and recall of such messaging in a large and demographically representative sample of young people across the UK – and experts believe the findings will support the debate around the design, effectiveness, and regulation of alcohol labelling in the UK.

The study used data from the 2017 Youth Alcohol Policy Survey – a cross-sectional, YouGov-conducted survey with 11-to-19-year-olds across the UK. Participants were asked whether they had seen any product information, health messages or warnings on alcohol packaging in the past month and, if so, what messages they recalled. This age group is particularly important as exposure to clear and effective messaging during their formative drinking experiences may have a sustained impact on alcohol-related knowledge, attitudes and behaviour.

Dr Nathan Critchlow, research fellow at the University of Stirling’s Institute for Social Marketing (ISM), led the study. He explained: ‘We explored awareness of such information and differences between population groups and different levels of alcohol consumption, such as whether a young person currently drank alcohol or not.

‘Only a third of 11-19-year-olds recalled seeing product information, health messages or warnings on alcohol packaging in the past month. In particular, only around half of current drinkers were aware of such messaging, despite being an important target market for this information.

‘Recall of specific messages was also low; almost half of young people were unsure what messages they had seen and most specific messages were only recalled by a minority of young people. This included those related to drinking guidelines, health effects, or alcohol being an age-restricted product.’

Co-author Dr Jyotsna Vohra, Cancer Research UK’s head of cancer policy research, said: ‘Beyond the fact that children are drinking underage, it’s worrying that only half can recall seeing important health warnings. And what is just as concerning is that many of these labels don’t give all the information the CMO [Chief Medical Officer] says they should, including highlighting the risk between alcohol and cancer. Alcohol is linked to seven types of cancer in adults and is responsible for over 12,000 cases annually, yet only one in 10 people are aware of this risk.

‘The more a person drinks, the greater their risk of cancer. This is why it’s important to do more to reduce drinking in the UK. All labelling must also clearly note that people should not drink more than 14 units per week. And while not everyone who drinks will go on to develop cancer, there’s no harm in cutting down.’

Facebook tightens alcohol sale rules

Social media giant to extend ban to ‘organic content’

24 July 2019 – Facebook have announced a new policy to restrict sales and limit content related to alcohol and tobacco products.

According to CNN, the new policy will prohibit all private sales, trades, transfers and gifting of alcohol and tobacco products on Facebook and Instagram. Any brands that post content related to the sale or transfer of these products will have to restrict that to adults only.

A Facebook spokesperson told AdWeek: ‘We are updating our regulated goods policy to prohibit the sale of alcohol and tobacco products between private individuals on Facebook and Instagram. Our commerce policies already prohibit the sale of tobacco or alcohol in places like Marketplace, but we’re now extending this to organic content.’

The company will use a combination of technology, human review and reports from users to find and remove any content that violates their policies.

The new policy will also apply to any Facebook groups created specifically to sell alcohol or tobacco products. The social network said they will alert group administrators about the changes.

Facebook and Instagram users of all ages can still post content related to alcohol, tobacco and vape products, as long as there is no intent to sell or exchange them.

Welsh Rugby Union: Alcohol-free zone to stay

Boss: National stadium trials ‘prove’ there is demand

29 July 2019 – Wales’ rugby internationals at the Principality Stadium will have a permanent alcohol-free zone (AFZ), it has been confirmed, thanks to a successful trial of several internationals over the past year.

Following on from a number of alcohol-related incidents of anti-social behaviour, a total of 4,200 seats behind the posts in the North Stand were designated alcohol-free for several rugby fixtures, including four autumn internationals and Judgement Day events last year and this year.

The Welsh Rugby Union say the alcohol-free zone will now be upgraded and enhanced as it becomes a permanent feature at all WRU-owned events at the stadium, starting with Wales’ clash with the Barbarians in November.

The alcohol-free zone will then remain in place for the home games in the 2020 Six Nations title defence against Italy, France and Scotland, the first time in the Championship.

Martyn Phillips, Welsh Rugby Union CEO, says the trial proves the demand is there and there is further investment planned. He said:

‘Our alcohol free zone trial has proved that there is a demand out there for this kind of offer and also that the current 4,200 seat provision is meeting that demand, so we are delighted to announce the zone will be here to stay at all future Welsh rugby internationals and WRU-owned events at Principality Stadium.

‘The zone will become a permanent offering from the 2020 Six Nations, and will be in place for the first time in that competition when Wales face Italy in the opening round.

‘We also will be further investing in our current offering and infrastructure over the coming months to ensure that it meets the expectations of a Championship audience, this means improved choice in terms of food and non-alcoholic beverages and installing new concourse outlets in order to present a wider range of options for supporters in the zone.

‘We know that the AFZ will now be a permanent fixture, but we are not going to stop here – as our customer expectations evolve so will our offering.

‘We are determined to listen to our customers and examine all available options to continue to improve our customer experience.

‘The AFZ trial is a great example of our modern iconic stadium reacting to customer feedback and finding a workable solution which caters for a varying range of supporter requirements.

‘A key takeaway lesson from the process has been that we must continue to listen in this way and continue to be responsive to a changing audience in changing times, in order to continue to provide the very best experience possible to all visitors.’

Alcohol addiction services central to public health approach

Home Affairs Committee responds to Serious violence inquiry

31 July 2019 – The Home Affairs Select Committee recommends that government and local authorities must ‘address urgently the widening gap between demand for and provision of public health services, in the context of links between alcohol and susceptibility to serious violence’, in its response to the Serious violence inquiry.

Funding for alcohol treatment services has seen substantial falls in recent years, with some areas reporting cuts of up to 58%. Indeed, 2018 research from Alcohol Change UK (formerly Alcohol Concern) found that ‘only 12% of respondents felt resources were sufficient in their area’. The Home Affairs Select Committee noted in light of evidence linking alcohol to violent crime, that ‘consideration of the impact of the government’s funding of and guidance around the provision of drug and alcohol addiction services is… central to appraising its public health approach to tackling serious violence.’

The Institute of Alcohol Studies’s written evidence to the inquiry also raised concerns over the government’s exclusion of alcohol-related violence from the purview of its Serious Violence Strategy, released in 2018. IAS questioned why ‘any strategy hoping to address violence would overlook this major driver of crime, injury, and loss’ – especially considering measures such as action on the price and availability of alcohol have been demonstrated to produce considerable reductions in alcohol-related violence, and would free up police man-hours and funds to deal with other more complex and intractable violent incidents. These ‘promising, cheap to implement, interventions’ would service to ‘reduce the staggering levels of alcohol-related violence currently being perpetrated against the British public – and cut the bill to police services at the same time’. These are measures ‘the government cannot afford to ignore’.

ALCOHOL SNAPSHOT – Unlike other risk factors, the burden of disease from alcohol has risen since 1990

Ending the Blame Game, a recent report from the Institute for Public Policy Research (IPPR), a left-leaning think tank, reviews the UK’s recent record in addressing preventable disease and calls for a new approach to public health policy. The report describes a general pattern: significant health improvements between 1990 to 2010, and limited progress in the years since. In 1990, the UK had one of the worst rates of preventable deaths among comparable countries, ranking 29th out of 35 OECD countries. By 2010, the UK had risen to 21st, but by 2017, it had moved only one position further up the table to 20th.

Yet as the chart above, using data from the Global Burden of Disease study, shows, the story is rather different for alcohol. Whereas the number of disability adjusted life years (DALYs) lost per 100,000 people in the UK due to smoking, diet and metabolic risks halved through the 1990s and 2000s, the DALYs lost due to alcohol almost doubled over the same period. Over the last 10 years or so, the rate of harm caused by all these factors has been fairly steady, with both the rise in alcohol harm and the fall in tobacco, dietary and metabolic related health issues stalled.

The IPPR make a number of policy recommendations to get public health working again, including investment in public health funding, raising the minimum smoking age and stricter regulation of advertising for unhealthy foods. Yet the report remains curiously silent on ways to tackle alcohol harm, despite providing clear evidence of the substantial contribution of alcohol to the UK’s public health problems.