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Helen Salisbury: Alcohol excess—time for new measures?

BMJ 2019; 365 doi: (Published 21 May 2019) Cite this as: BMJ 2019;365:l2246

Linked opinion

England must not be left behind in dealing with the scourge of cheap alcohol

Rapid Response:

Alcohol excess—time for a new positive and multifaceted strategy.

Alcohol consumption is an integral part of modern culture in this country and many others, and provides pleasure to many consumers. However, it also continues to be one of the leading risk factors for poor health globally and its harmful use has considerable social consequences.(1-4) We agree with Dr Salisbury that new measures are needed to promote sensible attitudes towards drinking and are pleased that her brief article took a balanced approach.(5) We firmly believe that a positive and multifaceted strategy is needed that targets different settings and supports different age groups.

Primary care is a key setting where much more could be done.(1,3,6) Early identification and brief advice provided by doctors and nurses can be effective in reducing alcohol consumption amongst heavy drinkers. It will not only prevent future health problems but also save the need for costly future NHS services, particularly in the acute sector. Working with housing, voluntary agencies and social services can also improve health and social care.

Although potentially there are considerable opportunities for primary care teams to improve the quality of life of people who misuse alcohol, in many cases this will not be turned into reality if investments are not made.(7,8) Factors limiting health education include: competing demands; time constraints; insufficient training; and lack of support. General practice needs to be made fit for current needs and “Fit for the Future”.(9)

Schools are another vital setting where high quality and effective alcohol education approaches are needed such as those developed by the Alcohol Education Trust.(10,11) NICE is currently updating its guideline on alcohol interventions in secondary and further education which will support the Department for Education’s plan to make alcohol education a compulsory component of personal, social and health education (PSHE) in all state-funded schools in England from September 2020.

Although some schools can receive good support from organisations such as The Alcohol Education Trust, much more is needed if all young people are to be provided with age-appropriate and accurate information and the opportunity to develop healthy attitudes and skills. Public health specialists in local authorities could provide support to ensure that teachers and nurses are properly trained about alcohol so that they become competent and confident. Funding will be needed from central government to enable this.

Though we have concentrated on professionals from two settings, primary care and schools, others need to be involved in a positive multifaceted strategy, including, the police, mental health services, housing, licensees and the media. At a local level, public health professionals are crucial to success as they could coordinate, support and galvanise people into action. At a national level they should be involved in addressing, marketing, pricing, and legislation.

It is important that the forthcoming Green Paper on Prevention not only includes alcohol as an essential element but that it also includes sufficient resources. Investment in public health must be increased so that it is adequate for local and national population health needs.(12-17)

1) BMA. Alcohol misuse: tackling the UK epidemic. London: BMA, 2008.

2) Watson M C and Lloyd J. Re: Alcohol—who is paying the price? British Medical Journal Rapid Response 17th June 2015.

3) Public Health England. The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies An evidence review. London: Public Health England, 2016.

4) World Health Organization. Global status report on alcohol and health 2018. Geneva: World Health Organization, 2018.

5) Salisbury H. Helen Salisbury: Alcohol excess—time for new measures? BMJ 2019;365:l2246 doi: 10.1136/bmj.l2246

6) Rao R, Crome I and Crome P. Managing older people’s alcohol misuse in primary care. British Journal of General Practice 2016; 66 (642): 6-7. DOI:

7) Watson M C and Forshaw M. TACKLING THE CRISIS IN GENERAL PRACTICE. Prioritising prevention and health promotion. BMJ 2016;352:i1333.

8) Watson M C and Lloyd J. Time to put GPs first by investing in general practice. British Medical Journal Rapid Response 10 May 2019.

9) RCGP Fit for the Future: a Vision for general practice. London: RCGP, 2019.

10) Lynch, S., Styles, B., Dawson, A., Worth, J., Kerr, D. and Lloyd, J. Talk About Alcohol: an Evaluation of the Alcohol Education Trust’s Intervention in Secondary Schools. Slough: NFER, 2013.

11) Lynch, S., Worth, J. and Bradshaw, S. Evaluation of the Alcohol Education Trust’s Talk about Alcohol Intervention: Longer-Term Follow up. Slough: NFER, 2015.

12) Marmot M, Allen J, Goldblatt P et al. Fair society, healthy lives: strategic review of health inequalities in England post 2010. London: Marmot Review Team, 2010

13) Watson M C and Lloyd J. Need for increased investment in public health BMJ 2016;352:i761.

14) Watson M and Tilford S, 2016. Directors of public health are pivotal in tackling health inequalities. BMJ 2016;354:i5013.

15) House of Commons Health Committee. Public health post-2013: second report of session 2016-17. House of Commons Paper No 140, 2016-17.

16) BMA. Funding for ill-health prevention and public health in the UK. London: BMA, 2017.

17) Watson M C and Thompson S, 2018. Government must get serious about prevention. BMJ 2018;360:k1279.

Competing interests: No competing interests

23 May 2019
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, Welwyn AL6 0UD, UK.