National Alcohol Awareness Week 18-22 March 2013
Alcohol Forum Conference: The power of local Community in reducing harmful drinking, 20 March, National Convention Centre, Dublin.

Keynote Speaker: Dr Ann Hope, Department of Public Health and Primary Care, Trinity College Dublin

One of our key public health problems in Ireland is that alcohol is too cheap, very convenient to buy and marketed in every way possible. The evidence of the most effective measures to prevent and reduce harm has been known for over two decades, and is constantly being strengthened. We know what does not work to reduce harm, such as information and education campaigns and self-regulation – although these may be very popular but they are ineffective in reducing harm. However, when government does implement an evidence-based measure, alcohol harm is reduced as has happened with random breath testing since 2006.

The latest research on alcohol price, undertaken in BC Canada, reported that a 10% increase in average minimum price for all alcohol beverages resulted in a reduction of 32% in wholly alcohol attributable deaths. The same study also reported that increases in the density of private liquor stores selling alcohol led to increased alcohol mortality. The threat of digital marketing is growing and its impact on young people is significant. The lines between user generated and industry marketing material is blurred. Diageo’s deal with Facebook allowed the drinks company products to be advertised on the social media and resulted in a 20% increase in sales of five of their key brands in the USA. The AMPHORA EU research project investigated associations between exposure to online alcohol marketing and binge drinking among 9,000 adolescents (14 yrs) in Germany, Netherland, Italy and Poland. These findings showed that higher exposure to online marketing was associated with higher odds of being a binge drinker, indicating a dose response effect. A second part of the study examined the link between alcohol branded sports sponsorship and its impact on alcohol use and alcohol expectancies over time. Exposure to alcohol branded sports sponsorship showed that 14 year olds were more likely to consume alcohol more frequently. It also indirectly influenced alcohol expectancies, in other words increased their expectation that alcohol will make them feel more positive because of exposure to alcohol branded sports sponsorship and therefore more likely to drink. There is a strong body of research evidence which shows that exposure to alcohol marketing, whether it is on TV, online, in movies, in public places or alcohol branded sports sponsorship, predicts future youth drinking.

In Ireland, we have seen a major shift in easier accessibility to alcohol and cheaper alcohol due to poor policy decisions by government in 2002 and 2006. An increase in the number of supermarkets, grocery stores and petrol stations (off-licences) selling alcohol and a decline in the number of pubs (on-licences) which was recorded from 2000 onwards was due to the abolition of geographical restrictions, which allowed movement of licences around Ireland. This increased accessibility of alcohol in supermarkets was compounded in 2006 by the abolition of the Groceries Order, which led to below cost selling of alcohol.

There is good evidence to show that local community action with multiple components can be successful in preventing and reducing alcohol related harm, provided it is based on the evidence of what works. Community action is about changing the collective rather than the individual behaviour, which means changing the environmental factors such as social, cultural and policy practices in the local community that contribute to alcohol harm. The key ingredients for success at community level are to have an agreed common goal, an action plan that is guided by the evidence and is planned in response to local needs and integrated into local structures. However, central legislation can restrict local alcohol policies. In the case of Ireland, a national framework is essential to allow effective community action on alcohol to take place. The three major issues of price, availability and marketing require effective policy decisions at national level. What is urgently needed is the introduction of minimum pricing which would provide for a floor price of alcohol and has a different function from alcohol tax. Minimum price is targeted at cheap alcohol products, while alcohol tax increase applies to all alcohol products. Minimum unit price (MUP) is an effective measure to reduce harmful drinking among the heavier drinkers and young drinkers. A ban on promotions that encourage harmful drinking such as quantity discounts etc. would also support the minimum price measure. An equitable licensing fee structure is needed. Currently the on- trade (pubs) license fee is based on turnover, yet off-trade (supermarkets) pay just a fixed fee (max about €1,500) irrespective of how much alcohol they sell. This is not equitable and creates conditions where selling cheap alcohol is made easier. Equally, the VAT refund facility for off-trade should be abolished. Currently, supermarkets who sell alcohol below cost price are entitled to a VAT refund on the differences between the cost price and the below cost price which would suggest that the state is subsidizing below cost selling of alcohol.

Major changes are required to better regulate the availability of alcohol and to reduce the overprovision of outlets selling alcohol, in particular the number of off-licences in local communities. The liquor Licensing laws need to be amended to include objectives to protect and improve the public health of communities and to protect children from harm. The Scottish Licensing laws (2005) provide good guidance where all licensing decisions must be made with reference to five objectives: prevent crime and disorder, secure public safety, prevent public nuisance, protect and improve public health and protect children from harm. In 1988, structural separation in off-licences was part of the Liquor Licensing Act 1988. This was dropped (2003) and reinstated (2008), but has yet to be implemented. Ireland has failed to deliver on its commitments (WHO European Charter on Alcohol 1995) “to ensure that children and adolescents have the right to grow up in an environment protected from the negative consequences of alcohol consumption”. We need to protect children from exposure to alcohol marketing with a ban on alcohol advertising in public places and the phasing-out of alcohol branded sport sponsorship.

To facilitate effective local alcohol policy development, local government need powers to protect and improve public health and the opportunity is there with the reform of local government. Putting People First (DOE policy) is committed to enhancing the well-being and quality of life of citizens and local communities. There are also many other agencies and community groups that are part of the local community action plan and require the power to regular promotions, outlet density and alcohol advertising to respond to local needs. Several community groups have already called for a national framework to enable them in their communities to prevent and reduce harm (Dublin city, University sector, Galway Health Cities Project). Communities have the power to prevent and reduce alcohol harm but we need an effective national framework for local initiatives to succeed.