Alcohol-related morbidity and mortality are increasing in the UK. Between 1991 and 2004 the number of alcohol-related deaths almost doubled. Over the past 30 years, liver cirrhosis mortality has risen by over 450% across the population, as well as peaking at a younger age. In Scotland, there was a 52% increase in alcoholic liver disease between 1998 and 2002. According to the Scottish Health Survey in 2003, 27% of men and 14% of women reported drinking more than the recommended weekly limits. Alcohol-related problems are estimated to cost Scotland over one billion pounds every year.

 

In the past 40 years, alcohol consumption in the UK has doubled, rising from 5.7 litres of pure alcohol per person aged 16 or over in 1960 to 11.3 litres in 2005. Another significant change in recent years is the shift away from drinking outside the home to drinking at home. Sales by the off-trade sector now account for nearly half of all the alcohol sold in the UK.

 

Alcohol is price sensitive, and research shows that an increase in price will lead to a decrease in consumption, and vice versa. Even though the sale price has increased, the real price of alcohol has been in steady decline. Because households’ disposable income had increased by 97% in real terms, alcohol was 62% more affordable in 2005 than in 1980. Competition between sellers of alcohol has also driven down prices. In 2007, 10 grocery retailers, including Tesco, Aldi and Lidl, reported to an inquiry by the UK Competition Commission that they sold alcohol below cost, and used temporary promotions as a means of attracting customers into the store and increasing total sales. Supermarkets accounted for more than 60% of the volume of alcohol sold in the off-trade market in 2006.

 

Alcohol policy has tended to focus on the minority of the drinking population who are the heaviest drinkers. In reality, it is the much greater number of drinkers in a population who drink to excess on occasion that accounts for most of the alcohol-related problems. A Finnish study revealed that the majority of problems were found in the 90% of the population who were moderate consumers, rather than in the 10% who drank heavily.2

 

The World Health Organization has stated that the most effective alcohol policies include alcohol-control measures (price and availability), drink-driving laws, and brief interventions for hazardous and harmful drinkers. In the UK, by contrast, strategies aimed at reducing escalating levels of alcohol-related harm have focused predominantly on specific groups of ‘problem’ drinkers, identified as under-18s and young ‘binge drinkers’. A strategy which targets only these groups, without addressing the wider drinking culture and environment, ignores the fact that young people do not form their views and attitudes towards alcohol use in isolation, but are influenced by their parents’ drinking habits and the culture of drinking in their own area. The UK strategies also rely heavily on policies with the weakest evidence base – education and voluntary regulation by the alcohol industry – in attempting to effect change. They are further undermined by action taken by government to relax controls on the supply of alcohol. Alcohol is now available in more places, for longer periods, and at more affordable prices.

 

A lot of emphasis in UK alcohol strategies is placed on individual responsibility for appropriate drinking behaviour, with some commentators arguing that alcohol consumption is entirely a matter of individual responsibility, not an area to be regulated by government intervention. Harmful alcohol use is rarely, if ever an ‘individual’ problem; it impacts on family, friends, work colleagues, and ultimately society as a whole.

 

The SHAAP report advocates using price as a lever to reduce alcohol consumption and related harm. Based on estimates by the Academy of Medical Sciences, a 10% rise in alcohol price would save the lives of 479 men and 265 women in Scotland each year. The report recommends that the Scottish government:
• Ends irresponsible alcohol promotions in all licensed premises
• Establishes minimum prices for alcoholic drinks
• Makes representation to Westminster (a) to increase alcohol duty and link alcohol taxes to inflation, and (b) to link levels of taxation to alcohol strength
• Reconvenes the National Licensing Forum with appropriate health representation
• Considers whether there is a need to create an independent, regulatory body to protect the health of the nation in relation to alcohol
• Considers jointly initiating a Parliamentary inquiry into the health and social harm caused by alcohol in Scotland.

 

While this report concentrates on Scotland, many of the issues addressed are relevant to the current situation in Ireland, where the rise in alcohol consumption in the past decade has coincided with an increase in alcohol-related morbidity and mortality. There has been a shift from drinking in licensed premises to drinking at home, and the real price of alcohol has fallen, particularly in the off-trade sector. In its efforts to reduce alcohol-related harm in Ireland, the government should consider introducing policy measures similar to those recommended in this report. (Deirdre Mongan)

 

1. Gillan E and Macnaughton P (2007) Alcohol: price, policy and public health. Edinburgh: Scottish Health Action on Alcohol Problems (SHAAP).
2. Poikolainen K, Paljärvi T and Makela P (2007) Alcohol and the preventive paradox: serious harms and drinking patterns. Addiction, 102: 571–578.