Preventing alcohol related harm to healthBMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c372 (Published 21 January 2010) Cite this as: BMJ 2010;340:c372
Alcohol misuse poses a huge public health problem, particularly in Europe. More than a fifth of European adults admit to binge drinking (five or more drinks on one occasion, or 50 g alcohol) at least once a week; of all World Health Organization regions Europe has the greatest proportion of alcohol related ill health and premature death; and the overall social cost of alcohol to the European Union is around €125bn (£110bn; $180bn) a year.1 In Scotland alone, adults drink the equivalent of 46 bottles of vodka, or 537 pints of beer, or 130 bottles of wine each a year.2 In England, more than a quarter of adults drink at hazardous levels, and the NHS spends £2.7bn a year on treating alcohol related conditions,3 while the overall cost to society of alcohol use each year amounts to around £20bn. 4 It is no wonder, however, that so many people drink so much. Since 1980 the real price of alcohol has fallen by nearly 70% in the United Kingdom, the liberalisation of licensing laws has made alcohol more widely available, and fierce competition between supermarket chains has led to discounts and promotions. So alcohol can now be bought for as little as 11p a unit. 5 This price is far too low and its cost to society is far too high.
The government is spending £17.6m on alcohol education and information in 2009-10, but this is dwarfed by the UK drinks industry’s £600-800m annual spend on promoting alcohol. 3 It is not just the money that keeps the industry a step ahead. In a linked article (doi:10.1136/bmj.b5659), Miller explains how the alcohol industry and trade organisations such as the Portman Group are well placed in UK policy circles to defend their position.6 In another linked article (doi:10.1136/bmj.b5650), Hastings and colleagues report how they analysed, on behalf of the House of Commons Health Select Committee, internal marketing documents from four alcohol producers and their communications agencies.7 The authors reviewed the companies’ strategies on alcohol sponsorship, use of new media in marketing, and choice of marketing themes and concluded that attempts to control content and adjust targeting—particularly to young people—simply result in more cryptic and imaginative campaigns. The BMA’s Board of Science has called for a total ban on alcohol advertising and sponsorship,8 a feat already achieved in a handful of countries, and at least partly enacted in France. Guidance from the National Institute for Health and Clinical Excellence on the prevention and early identification of alcohol use disorders—now in draft but due to be finalised by March—also calls for a total ban on all forms of alcohol advertising and marketing, including sports sponsorship, but then turns off the pressure for change by labelling this a long term goal.9
So what should be done to prevent the rise of alcohol related ill health? The health committee report on the government’s alcohol policies that came out earlier this month has some tough evidence based recommendations.4 The MPs criticised ministers for focusing too much on the least effective policies (education and information for individuals) and too little on the most effective ones (pricing and controls of availability and marketing) (table 1⇓). They called for tightened licensing laws that include an objective to protect public health, independent regulation of alcohol promotion, extension of advertising controls to alcohol sponsorship, and several specific restrictions on alcohol advertising and promotion in places where children are likely to be affected by it.
Good evidence exists for introducing a minimum price for alcohol to reduce consumption,1 9 so much so that it features prominently in the Alcohol Bill recently put forward by the Scottish government,10 and, moreover, is already operating in eight out of 10 provinces in Canada.5 And the association works in both directions. After Finland joined the European Union in 1995 it had to relax its rules; this led to lower alcohol prices, and over the next decade mortality from cirrhosis rose by 50%.11 The alcohol industry and others opposed to minimum pricing in the UK cite two objections: that it would break EU laws on restriction of trade—which the Royal College of Physicians refutes5—and that it would unfairly penalise moderate drinkers. But a systematic review and economic modelling study by the school of health and related research at the University of Sheffield showed that a minimum price of 40p per unit of alcohol would increase the overall weekly bill of someone consuming six units by only about 11p, and a woman drinking the recommended maximum of 14 units would be able to buy her weekly total of alcohol for £6.12
Our society has strangely mixed feelings about alcohol. It is still our favourite drug, and drinking is highly socially acceptable across society. Few drinkers seem to notice or care that concentrations of alcohol in beer and wine have increased greatly over the past few years or want to drink smaller quantities.13 Yet, having an obviously alcohol related disorder—or even saying you want to stop drinking—is stigmatised far more than having a tobacco related problem. It is time to put away the rhetoric, popular with the drinks industry, that alcohol misuse is largely an individual problem best avoided and managed through education, counselling, and medical treatment. Instead, the UK needs to embrace the idea that the health and societal costs of alcohol misuse are best prevented through legislation on pricing and marketing.
Cite this as: BMJ 2010;340:c372
Competing interests: TG drinks seven units of wine a week on average. In 2008, she wrote a personal view in the BMJ, calling for wider availability of half bottles of wine, and Waitrose sent her four to try. She doesn’t expect any donations this time.
Provenance and peer review: Commissioned; not externally peer reviewed.