September 2024

False equivalence and ‘empty rhetoric’ – podcast feature

The Institute of Alcohol Studies (IAS) was established in 1983 by the United Kingdom Temperance Alliance, UKTA, which was set up by the United Kingdom Alliance. The UKTA changed its name to the Alliance House Foundation (AHF) in 2003, from which IAS receives most of its funding. IAS has always been transparent about its background and funding. There are several other alcohol control organisations that also have historical links to temperance groups.

Some representatives of the alcohol industry point to these temperance links as a means of discrediting IAS and like-minded organisations, often alongside accusations of being ‘puritanical’. For instance, in early August this year, the Chief Executive of the industry body The Portman Group stated that a call from IAS and leading alcohol control experts for the government to exclude the alcohol industry from developing health policy was a:

narrow-minded suggestion put forward by an organisation funded by the temperance movement, and it completely fails to take into account the longstanding, tangible work of initiatives funded by the alcohol industry in tackling alcohol harms, encouraging moderation and enforcing responsible marketing.

Implicit in the mentioning of ‘temperance’ is the assumption that those with links to such movements have a conflict-of-interest and therefore should not be listened to, and that temperance was and is a wholly negative approach.

In this month’s podcast we spoke to Dr James Kneale, Associate Professor in Geography at University College London, about the history of temperance. We discussed:

• The many manifestations of different temperance groups and movements
• Why temperance movements emerged in the 19^th Century
• How they provided alternative public spaces to drinking establishments
• The links they often had with working class social movements, including football clubs
• The UKA and its links with IAS
• And the links between Sporty Spice and temperance

Commenting on the Portman Group highlighting IAS’s temperance links, Dr Kneale stated that:

I do think it’s a lazy word in that kind of context and someone has deliberately weaponised it. I don’t know whether people that read it would have taken it as anything other than the empty rhetoric of a lobbying group. The use of the word temperance is intellectually lazy. But what were [the Portman Group] saying, that they were trying to minimise harm, they were trying to get people to drink responsibly? That’s a temperance argument.

They are thinking that the IAS is a prohibition/teetotal movement, I don’t think it is. I think the Alliance wasn’t entirely that itself. And you are not the Alliance. It’s been a long time since 1853.

Scottish alcohol deaths remain at highest level since 2008

There were 1,277 alcohol-specific deaths in Scotland in 2023, according to a report by the National Records of Scotland (NRS). This is an increase of one death from 2022, meaning deaths remain at the highest level since 2008.

Male deaths continue to account for around two thirds of the deaths, increasing by 25, while female deaths decreased by 24.

Alcohol-specific deaths were 4.5 times as high in the most deprived areas of Scotland compared to the least deprived areas in 2023.

However, NRS highlighted that the difference between Scotland and other UK countries has narrowed over the last 20 years:

In 2001, the alcohol-specific mortality rate for Scotland was between 2.1 and 2.9 times as high as other UK countries. The rate for Scotland was between 1.2 and 1.6 times as high in 2022.

IAS’s chair, Dr Peter Rice, spoke to The Herald and highlighted that Scots aged 65-74 now have the highest mortality rate, instead of middle-aged drinkers:

This is about chronic health harms, and liver disease is our best indicator of that, and that comes mainly from home drinking. That’s the type of drinking we need to be particularly worried about in Scotland. Low cost alcohol in the supermarkets and people drinking that at home and running into chronic health problems. The last figures I heard were that 85% of alcohol sales are in off sales in Scotland. It was about 73% before the pandemic.

He added that amalgamating alcohol and other drug services together had made them “less attractive” to some drinkers, especially older Scots, and drew attention to the fall in those accessing treatment.

Laura Mahon, Deputy Chief Executive of Alcohol Focus Scotland stated that deaths remain “alarmingly and unacceptably high” and called for an emergency response, including re-introducing the Public Health Supplement, improving access to treatment, and restricting alcohol marketing.

Minimum unit pricing

Discussing the death statistics, Justina Murray of Scottish Families Affected by Alcohol and Drugs, said minimum unit pricing had “underdelivered” as it wasn’t uprated in time and wasn’t combined with other preventative measures. She said the Scottish Government has:

gone from being a global alcohol policy leader at that point to then saying a lot of stuff, saying they’re going to do something about marketing and availability and treatment, but that has really just been words. Even when it was introduced, it was never going to have the impact it was supposed to because it was six years out of date in terms of the price point. Pricing, availability and marketing are supposed to be looked at together.

Dr Sandesh Gulhane, health spokesperson for the Scottish Conservatives, said that these figures should lead the SNP to “finally accept that [minimum unit pricing] has monumentally failed”.

Jenni Minto, the SNP public health minister, responded that:

Research commended by internationally renowned public health experts estimated that our world-leading Minimum Unit Pricing policy has saved hundreds of lives, likely averted hundreds of alcohol-attributable hospital admissions and contributed to tackling health inequalities,” and that the increase in the minimum alcohol price to 65p would have a positive impact on future statistics.

Scottish marketing consultation

In related news, Scotland’s Cabinet Secretary for Health and Social Care, Neil Gray, has announced that the second consultation on alcohol marketing restrictions is to be further delayed pending an evidence review by Public Health Scotland.

Alcohol Focus Scotland said it was “deeply disappointed” by the news and it meant that “it will now be impossible for the Scottish Government to fulfil its commitment to legislate to protect children and young people from pervasive alcohol marketing during the course of this parliament”.

Laura Mahon stated that:

Further delaying the promised consultation on alcohol marketing restrictions is in no doubt another small victory for the alcohol industry, using entirely predictable tactics to create ‘policy chill’.

Sue Webber, the Conservative spokeswoman on drugs policy, said:

Do you really believe the right level of response to learning that alcohol deaths are at their highest level in 15 years is to commission a review into adverts?

Emma McClarkin of the British Beer and Pub Association said:

It is surprising that the Scottish Government have decided to revisit this area, especially after the previous proposals were rightly withdrawn after the consultation analysis showed overwhelming opposition to every single measure.

It is worth noting that this opposition was almost entirely from the alcohol industry and those who receive money from alcohol sales.

Lord Darzi: NHS ‘in critical condition’ – now here’s the cure

Lord Darzi’s report on the state of the NHS in England – commissioned by the Labour government – has been published, and highlights that the service is “in critical condition”. He argues that much of the issue stems from the deteriorating health of the nation and social determinants of health moving in the wrong direction.

Darzi writes that while good progress has been made on tackling tobacco harm, “bold action has been sorely lacking on obesity and regulation of the food industry”. Further, he states that:

When tough action was taken on the harm caused by alcohol, deaths attributed to it stabilised. As the chart below shows, alcohol is becoming more affordable over time, and deaths are rising at an alarming rate. In the pandemic, there was a 10.8 per cent annual increase between 2019 and 2022.

“My report on the NHS diagnosed its dire condition. Now here’s the cure.”

Quickly following up the independent review was a report by the Institute for Public Policy Research’s (IPPR) Commission on Health and Prosperity, which laid out the programme government should take to improve the nation’s health. The report was co-chaired by Lord Darzi and the former England Chief Medical Office (CMO) Dame Sally Davies.

The report’s central contention is that better health will only be possible if we move from a sickness model of health policy to a health creation one. It advocates for a ‘polluter pays’ approach to unhealthy products of tobacco, alcohol, and junk food, to raise £10bn by the end of parliament. Health Secretary Wes Streeting welcomed the report and spoke at the launch event.

Lord Darzi lays out the recommendations in a piece in The Guardian. He says there must be a “pivot to prevention” with three key tactics:

1. Make healthy life expectancy a central focus in government, similar to the targets on climate. “With that target established, we should then test government spending and investment decisions against their health impact at every fiscal event.”
2. Government needs to make health a cross-society endeavour, with businesses and employers on board. “Let me be clear: if a business profits at the expense of our health, it should pay the societal cost. Using levies to enshrine a “health polluter pays” principle would act as a powerful new incentive on the market, encouraging businesses to prioritise healthier products. Where they resist change, the tax they pay would be a valuable new source of revenue, providing billions of pounds that could be invested in prevention.”
3. Use the revenue from health levies to invest in foundations of good health.

A flurry of articles were published at the time, including one in The Times stating that CMO Chris Whitty has been pressing the case for sugar taxes and minimum pricing, although Streeting is said to be resistant at the prospect of making shopping more expensive in a cost-of-living crisis.

Professor Jonathan Shepherd, of the Violence Research Group at Cardiff University and IAS Advisor, responded in a letter to The Times that increasing alcohol taxes would reduce alcohol-related violence as well as improving health.

Ending cider’s preferential tax treatment would save thousands of lives

A study by the Sheffield Addictions Research Group has modelled the effect of the reform to alcohol duties on alcohol consumption, health, and economic outcomes.

The group has estimated that compared to no policy change, over 20 years:

The authors state that: “removing cider exceptionalism would deliver substantial public health benefits”.

A cider escalator could deliver substantially improved outcomes, whereas equalising duty rates across all beverage types between 3·5% ABV and 8·4% ABV could lead to much greater and more immediate effects with an approximate 17% reduction in alcohol consumption in 2023 and 74,000 fewer deaths during 20 years.

The Daily Telegraph campaign against the ‘nanny state’

A number of articles in the Telegraph this month have sought to put pressure on the new government regarding alcohol control measures. With murmurings that Labour is considering minimum unit pricing in England, the paper stated that: ‘Pub bosses warned to expect minimum alcohol pricing’. This is despite the pricing policy not affecting the on-trade, which almost always already sells alcohol well above any conceivable minimum price. The Scottish Licensed Trade Association has always been supportive of the measure as it closes the gap in price between supermarket and on-trade alcohol.

Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance, responded in a letter that:

Cheap alcohol from supermarkets has turned us into a nation of home-drinkers, reducing foot traffic to local pubs and bars and threatening the closure of important social spaces. By setting a minimum price, the Government can level the playing field, making pubs a more attractive option for those who might otherwise choose to drink cheaply at home.

A government spokesperson responded: “we have no plans to introduce minimum unit pricing for alcohol.”

More recently, the paper published a story that Chancellor Rachel Reeves has been presented with forecasts that show increasing alcohol duty would raise an extra £800m next year. Industry sources claim this would equate to a 6% increase, well above current RPI inflation. Many other news outlets repeated the story.

The Wine and Spirit Trade Association, along with other industry trade groups, claimed that doing so would lead to lower sales and would cost the Treasury. They claim that £1.3 billion was lost to the Treasury due to the increase in duty last August. HMRC figures show that from September 2023 to August 2024 alcohol duty raised £11.8 billion, down from £13.1 billion in the same period the year before. However, across the whole year, receipts were slightly higher than 2022/23. A similar story was in The Scotsman, with the Scotch Whisky Association’s Chief Executive claiming that the Office for Budget Responsibility’s forecasts have been wrong for a decade on alcohol duty. We’ve discussed this misinformation as an alcohol industry tactic in a previous Alert.

And last but not least, The Telegraph reported from the Labour Party conference that public health minister Andrew Gwynne is considering “tightening up operating hours” of pubs and bars, to improve health and reduce alcohol-related crime and anti-social behaviour.

Again, a government spokesman stated that: “It is categorically untrue that the Government is considering changing alcohol licensing hours”. Although the article states that Gwynne said:

These are discussions that we have got to have – even if it’s just about tightening up on some of the hours of operation; particularly where there are concerns that people are drinking too much.

Professor Sir Ian Gilmore said:

We welcome any move by this Government to reduce alcohol harm using evidence-based policies such as tackling licensing hours. However, this must include off-trade premises as well as pubs and bars. It is scandalous that a bottle of vodka can still be bought at 2am in a petrol station.

The right calls it the ‘nanny state’ – I call it standing up to rich corporations and protecting people’s health

In related news, Devi Sridhar, Professor of Global Public Health at the University of Edinburgh, wrote in her Guardian column that “public health is about providing freedom,” particularly the freedom to live healthily.

We have the benefit of living in a democracy where the government is concerned about our health and wants to give us the most freedom to live our life disease-free and pain-free… [individuals are] fighting against a corporate push to sell cigarettes or unhealthy foods, which is about maximising profits and not the welfare of the public. Do any of us, especially children, stand a chance on our own against these forces?

How risky is drinking alcohol?

In a recent episode of The Food Chain on BBC Radio 4, the presenter investigated the risks of drinking at certain levels. She spoke to Professor Tim Stockwell (University of Victoria, Canada) about studies that have suggested low to moderate drinking is good for people’s health. He explained the many issues of such studies, for instance that people who drink are compared to those who don’t, but that abstainers often don’t drink due to existing health issues, making drinking look healthier.

In a related study, published in Alcohol at the start of the month, researchers found that 44% of people who declared in a survey that they were lifetime abstainers in 2020 had reported in 2019 to have drunk at some point in their life. 2.4% of respondents who said they were lifetime abstainers had previously been diagnosed with an alcohol-related health condition. This highlights the issue observational studies have relying on data from self-reported surveys.

Back to The Food Chain episode, Professor Sir David Spiegelhalter (University of Cambridge) weighed in against public health messaging that states there is ‘no safe level of alcohol consumption’, as he said it exaggerates the harm alcohol can cause. He said there is a risk of harm to the reputation of public health messaging as people then won’t believe anything public health advocates say.

This led to a brief conversation on X/Twitter between Spiegelhalter and Professor John Holmes (University of Sheffield), in which Holmes pointed out that at a population level the increased risk of cancer at low levels of consumption do matter.

Alcohol Toolkit Study: update

The monthly data collected is from English households and began in March 2014. Each month involves a new representative sample of approximately 1,700 adults aged 16 and over.

See more data on the project website here.

Prevalence of increasing and higher risk drinking (AUDIT-C)

Increasing and higher risk drinking defined as those scoring >4 AUDIT-C. A-C1: Professional to clerical occupation C2-E: Manual occupation

Currently trying to restrict consumption

A-C1: Professional to clerical occupation C2-E: Manual occupation; Question: Are you currently trying to restrict your alcohol consumption e.g. by drinking less, choosing lower strength alcohol or using smaller glasses? Are you currently trying to restrict your alcohol consumption e.g. by drinking less, choosing lower strength alcohol or using smaller glasses?

Serious past-year attempts to cut down or stop

Question 1: How many attempts to restrict your alcohol consumption have you made in the last 12 months (e.g. by drinking less, choosing lower strength alcohol or using smaller glasses)? Please include all attempts you have made in the last 12 months, whether or not they were successful, AND any attempt that you are currently making. Q2: During your most recent attempt to restrict your alcohol consumption, was it a serious attempt to cut down on your drinking permanently? A-C1: Professional to clerical occupation C2-E: Manual occupation