Drinking nation: have we had enough?BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2634 (Published 17 April 2012) Cite this as: BMJ 2012;344:e2634
For economists, alcohol is a normal good; a put-the-price-up-and-demand-goes-down type of good.1 But for many people (too many?) alcohol is “normal” and “good” in the more colloquial sense. In his introduction to the UK government’s latest alcohol strategy, Prime Minister David Cameron focused on erratic and excessive imbibing: “Binge drinking isn’t some fringe issue, it accounts for half of all alcohol consumed in this country. The crime and violence it causes drains resources in our hospitals, generates mayhem on our streets, and spreads fear in our communities.”2 So, have we had enough, and is the government’s adoption of the economist’s solution—raising the (minimum) price of alcohol1—the answer?
In 2010, UK households spent around £42.1bn (€50.9bn, $66.6bn) on alcohol through off-sales (£15.2bn) and in restaurants and hotels (£26.9bn). This is equivalent to around 3% of the gross domestic product or, more dramatically perhaps, around a third of the UK’s annual spend on the NHS. On average, everyone aged 18 and over spends around £17 a week on alcohol. Is this a lot? One answer—to adapt an old joke—is that it depends if it’s more than your GP spends.
With GPs’ average incomes touching £110 0003, they may well spend more than their patients (median income before tax £19 6004) but might drink less (as they are likely to buy more expensive alcohol). These two factors, price—in particular, price relative to other goods and services—and disposable income, are not only two key factors determining the demand for alcohol; they also form the basis for calculating an alcohol affordability index. Apart from brief periods since 1980, generally coinciding with economic recessions and lower disposable incomes, alcohol is much more affordable now than it was 30 years ago (fig 1⇓).
Over nearly half a century, spending on alcohol in the UK has increased in real terms, more than doubling between 1964 and 2004. But, as figure 2⇓ shows, spending flattens or, more often, dips in times of economic recession, as personal incomes are depressed. Over the past five years spending has fallen by 17% in real terms—back to 1996 levels; in part associated with the recent recession, but in part preceding it. This pattern is reflected in similar sharp reductions in binge drinking among young men too, accelerating a generally downward trend since 1998 5.
Although spending in 2010 has increased, albeit marginally, do these figures suggest a problem with drinking in the UK? Another set of data—hospital admissions associated with alcohol—suggest that a big problem exists, with admissions wholly attributable to alcohol doubling between 2002 and 2010 to around 265 000 in England (fig 3⇓). Alcohol related deaths follow a similar pattern of constant increase between 2001 and 2008, although they fell slightly in 2009 (to 6584 in England).
Whether or not these observations constitute a substantial problem now—given the lags in health and other effects of drinking and recent falls in consumption—the impacts of various price and non-price interventions to reduce drinking have been extensively modelled, and they show significant results. For the government’s proposed minimum price tactic of 40 pence per unit of alcohol the impacts include a reduction in the mean annual consumption per drinker of 2.4%, in deaths of 1149 annually, and in hospital admissions of 38 900 annually.6 A 50 pence minimum price would more than double all these effects. Neither, however, rivals the sobering effects of a good (sic) economic recession.
Cite this as: BMJ 2012;344:e2634
Competing interests: The author has completed the ICJME unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; not externally peer reviewed.