SummaryOver the last 60 years English drinking habits have been transformed. In 1947 the nation consumed approximately three and a half litres of pure alcohol per head; the current figure is nine and a half litres. According to the General Household Survey data from 2006, 31% of men are drinking hazardously (more than 21 units per week) or harmfully (more than 50 units) of whom 9% are drinking harmfully. 21% of women are drinking hazardously or harmfully of whom 6% are drinking harmfully. While the consumption of alcohol has increased, taxation on spirits has declined in real terms and even more so as a fraction of average earnings.
The rising levels of alcohol consumption and their consequences have been an increasing source of concern in recent years. These involve not only the consequences of binge drinking which are a cause of many serious accidents, disorder, violence and crime, but also long term heavy drinking which causes more harm to health. The President of the Royal College of Physicians told us that alcohol was probably a significant factor in 30 to 40,000 deaths per year. The WHO has put alcohol as the third most frequent cause of death after hypertension and tobacco. UK deaths from liver cirrhosis increased more than five fold between 1970 and 2006; in contrast in France, Italy and Spain the number of deaths shrank between two and four fold; this country's deaths from cirrhosis are now above all of them.. In 2003 the P M's Strategy Unit estimated the total cost of alcohol to society to be £20 bn; another study in 2007 put the figure at 55 bn.
Faced by a mounting problem, the response of successive Governments has ranged from the non-existent to the ineffectual. In 2004 an Alcohol Strategy was published following an excellent study of the costs of alcohol by the Strategy Unit. Unfortunately, the Strategy failed to take account of the evidence which had been gathered.
The evidence showed that a rise in the price of alcohol was the most effective way of reducing consumption just as its increasing affordability since the 1960s had been the major cause of the rise in consumption. We note that minimum pricing is supported by many prominent health experts, economists and ACPO. We recommend that the Government introduce minimum pricing.
There is a myth widely propagated by parts of the drinks industry and politicians that a rise in prices would unfairly affect the majority of moderate drinkers. But precisely because they are moderate drinkers a minimum price of for example 40p per unit would have little effect. It would cost a moderate drinker 11p per week; a woman drinking the recommended maximum of 15 units could buy her weekly total of alcohol for £6.
Opponents also claim that heavier drinkers are insensitive to price changes, but as a group their consumption will be most affected by price rises since they drink so much of the alcohol purchased in the country. Minimum pricing would most affect those who drink cheap alcohol, in particular young binge-drinkers and heavy low income drinkers who suffer most from liver disease. It is estimated that a minimum price of 50p per unit would save over 3,000 lives per year, a minimum price of 40p, 1,100 lives.
Minimum pricing would have other benefits. Unlike rises in duty minimum pricing would benefit traditional pubs which sell alcohol at more than 40p or 50p per unit; unsurprisingly it is supported by CAMRA. Minimum pricing would also encourage a switch to weaker wines and beers. With a minimum price of 40p per unit, a 10% abv wine would cost a minimum of £2.80p, a 13% abv. wine £3.60p.
However, without an increase in duty minimum pricing would lead to an increase in the profits of supermarkets and the drinks industry. Alcohol duty should continue to rise year on year, but unlike in recent years duty increases should predominantly be on stronger alcoholic drinks, notably on spirits. The duty on spirits was 60% of male average manual weekly earnings in 1947; in 1973 (when VAT was imposed in addition to duty) duty was 16% of earnings; by in 1983 it was 11% and by 2002 it had fallen to 5%. We recommend that the duty on spirits be returned in stages to the same percentage of average earnings as in the 1980s. The duty on industrial white cider should also be increased. Beer under 2.8% can be taxed at a different rate and we recommend that the duty on this category of beer be reduced.
An increase in prices must be part of a wider policy aimed at changing our attitude to alcohol. The policy must be aimed at the millions who are damaging their heath by harmful drinking, but it is also time to recognise that problem drinkers reflect society's attitude to alcohol. There is a good deal of evidence to show that the number of heavy drinkers in a society is directly related to average consumption. Living in a culture which encourages drinking leads more people to drink to excess. Changing this culture will require a raft of policies.
Education, information campaigns and labelling will not directly change behaviour, but they can change attitudes and make more potent policies more acceptable. Moreover, people have a right to know the risks they are running. Unfortunately, these campaigns are poorly funded and ineffective at conveying key messages; people need to know the health risks they are running, the number of units in the drink they are buying and the recommended weekly limits, including the desirability of having two days drink-free each week. The information should be provided on the labels of alcohol containers and we recommend that all alcohol drinks containers should have labels containing this information. We doubt whether a voluntary agreement, even if it is possible to come to one, would be adequate. The Government should introduce a mandatory labelling scheme.
Expenditure on marketing by the drinks industry was estimated to be c. £600-800m in 2003. The current system of controls on alcohol advertising and promotion is failing the young people it is intended to protect. Both the procedures and the scope need to be strengthened. The regulation of alcohol promotion should be completely independent of the alcohol and advertising industries; this would match best practice in other fields such as financial services and professional conduct. In addition, young people should themselves be formally involved in the process of regulation: the best people to judge what a particular communication is saying are those in the target audience.
The current controls do not adequately cover sponsorship or new media which are becoming increasingly important in alcohol promotion. The codes must be extended to address better sponsorship. New media presents particular regulatory challenges, including the inadequacy of age controls and the problems presented by user generated content. Expert guidance should be sought on how to improve the protection offered to young people in this area. Finally, there is a pressing need to restrict alcohol advertising and promotion in places where children are likely to be affected by it.
Alcohol-related crime and anti-social behaviour have increased over the last 20 years, partly as a result of the development of the night time economy with large concentrations of vertical drinking pubs in town centres. The DCMS has shown extraordinary naivety in believing the Licensing Act 2003 would bring about 'civilised cafe culture'. In addition, the Act has failed to enable the local population to exercise adequate control of a licensing and enforcement regime which has been too feeble to deal with the problems it has faced. Some improvements have been made through the Policing and Crime Act 2009, in particular the introduction of mandatory conditions on the sale of alcohol. We urge the Government to implement them as a matter of urgency, but problems remain. It is of concern that section 141 of the Licensing Act 2003is not enforced and we call on the police to enforce it.
The 2009 Act has made it easier to review licences, giving local authorities the right to instigate a review. We support this. However, we are concerned that local people will continue to have too little control over the granting of licences and it will remain too difficult to revoke the licences of premises associated with heavy drinking. The Government should examine why the licences of such premises are not more regularly revoked.
In Scotland legislation gives licensing authorities the objective of promoting public health. Unfortunately, public health has not been a priority for DCMS. We recommend that the Government closely monitor the operation of the Scottish licensing act with a view to amending the Licensing Act 2003 to include a public health objective.
The most effective way to deal with alcohol related ill-health will be to reduce overall consumption, but existing patients deserve good treatment and a service as good as that delivered to users of illegal drugs, with similar levels of access and waiting times. As alcohol consumption and alcohol related ill health have increased, the services needed to deal which these problems have not increased; indeed, in many cases they have decreased, partly as a result of the shift in resources to dependency on illegal drugs.
Early detection and intervention is both effective and cost effective, and could be easily be built into existing healthcare screening initiatives and incentives for doing this should be provided in the QOF. However the dire state of alcohol treatment services is a significant disincentive for primary care services to detect alcohol related issues at an early stage before the serious and expensive health consequences of regular heavy drinking have developed. These services must be improved.
The alcohol problem in this country reflects a failure of will and competence on the part of government Departments and quangos. In the past Governments have had a large influence on alcohol consumption, be it from the liberalisation which encouraged the eighteenth century 'Gin Craze' to the restrictions on licensing in the First World War. Alcohol is no ordinary commodity and its regulation is an ancient function of Government.
It is time the Government listened more to the CMO and the President of the RCP and less to the drinks and retail industry. If everyone drank responsibly the alcohol industry might lose about 40% of its sales and some estimates are higher. In formulating its alcohol strategy, the Government must be more sceptical about the industry's claims that it is in favour of responsible drinking.
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