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‘WE STILL DON’T TALK ABOUT IT
ENOUGH – NATIONALLY, AT HOME
OR IN THE WORKPLACE,’
said
Alcohol Concern chair Richard Sumray
of his organisation’s conference theme,
Conversations about alcohol
. Many
people were unaware of the impact of
their own habits, he said, while the
industry had ‘held sway’ on minimum
pricing. ‘But it’s not something we
intend to give up on. We don’t intend
to stay quiet.’
Although alcohol consumption in
Europe had fallen in the 20 years to
2010, there were huge differences
between countries, said alcohol and
illicit drugs programme manager at the
WHO regional office for Europe, Dr
Lars Møller, with the UK’s consumption
rising over the same period. ‘Even
though it’s now stabilising, that’s still a
message that should be concerning
politicians, particularly with regard to
groups like younger women,’ he said.
Britain was losing the fight against
alcoholic liver disease, said Professor
Sir Ian Gilmore of the Alcohol Health
Alliance, with a ‘meteoric’ rise since
1970 and the standard death rate for
liver disease in under-65s dramatically
bucking the trend for other conditions.
Alcohol-induced cirrhosis at 35 was no
longer uncommon, he added. ‘When I
became a hepatologist, cirrhosis was a
disease of elderly and middle-aged
men. But we can do something about
it. We have a secretary of state for
health who’s committed to reducing
premature death, but he’s not following
the evidence when it comes to things
like pricing. Why does the
precautionary principle not apply to
alcohol – why is the onus on health
advocates to prove harm? Because
industry advocacy is more effective.’
The drinks industry ‘pushed the
paradigm’ that harm was a problem of
small specific groups like young binge
drinkers, he said, rather than the
product itself. ‘But alcohol is not an
ordinary product. It’s a psychoactive
substance and a drug of dependence.
We need to begin to reframe the
questions, and we do have the tools to
change the culture. We need to work
harder to bring society to where it will
be ready to accept tougher regulation
by working on the key messages of
alcohol harm.’
‘I’m very keen that Public Health
England (PHE) shapes up to do
something about the alcohol agenda,’
its director of alcohol and drugs,
Rosanna O’Connor, told the
conference. ‘We all know the problems
are widespread, and that this isn’t new.
So why is it so difficult?’ Alcohol was
legal, provided jobs and was
associated with very powerful vested
interests, she said. ‘And it’s very much
part and parcel of people’s lives and
culture. It’s absolutely ingrained, and
excess use is condoned on many
fronts. It’s in our face, all the time.’
PHE expected alcohol to be one of
its top priorities for next year, she
said, and the organisation would
continue to ‘advocate the evidence
base and challenge government on
minimum pricing. Just because things
are quiet doesn’t mean it’s gone away
– there’s a lot of work going on to get
it back up the agenda.’
PHE would also be producing
guidance on using local health
information to inform licensing
decisions, she said, as well as
encouraging people to drink within
lower risk levels and working to reduce
the impact on people who already
experienced harm. ‘Most of the
population is kidding itself,’ she told
delegates. ‘There needs to be a big
debate and turnaround of people’s
attitudes. Alcohol is complex issue that
needs a multi-layered approach at
national and local level, but I take real
heart in the way things have changed
around smoking. I thought there’d be
huge resistance to the smoking ban
but people have really embraced the
changes in policy.’
‘The next 18 months are going to
be crucial,’ Alcohol Concern chief
executive Eric Appleby told the
conference. ‘Is localism going to work,
or will the lack of national direction
leave local areas with too much of a
challenge?’ However, local authorities
had a better understanding of, and
links with, communities than PCTs,
stated cabinet member for health,
social care and culture at Hackney
council, Jonathan McShane, and there
was also great potential with health
and wellbeing boards.
Scotland had decided to take a
whole population approach to alcohol,
which inevitably meant minimum
pricing, said head of the Scottish
Government’s public health division,
Donald Henderson. ‘Price and afford-
ability are an essential element. Lower
prices equal higher consumption – that’s
a truth within a market economy.’
The greatest benefit came from
targeting what the heaviest drinkers
consumed, he said, which was the
cheapest alcohol. ‘We have a
confidence in this policy, and we agree
that if it doesn’t have an impact it
shouldn’t be there.’ There was to be a
review of its effectiveness after five
years, and the ‘sunset clause’ meant
that without a positive parliamentary
vote the legislation would
‘automatically die’, he pointed out.
‘We’ve had minimum pricing for
years,’ director of the Centre for
Addictions Research of British
Columbia, Tim Stockwell, told
delegates. ‘All of Canada’s provinces
have some kind of minimum pricing for
off-sales and/or bars, but they’re not
there for health reasons – they’re to
protect local businesses and
government revenue.’ However, when
Saskatchewan had increased all of its
minimum prices simultaneously in
2010 – and graded the increases
according to strength – the results had
been dramatic, he said.
A 10 per cent increase in minimum
price had been associated with an 8.4
per cent overall reduction in consum-
ption – 10.1 per cent for beer, 5.9 per
cent for spirits and 4.6 per cent for
wine. ‘There was a significant shift
away from higher-strength drinks, and
deaths and hospital admissions were
down in two to three years.’ This
meant that the Sheffield model for
mapping the impact of alcohol policies
[
DDN
, June 2012, page 4] was actually
conservative, he stressed, as it saw
the chronic disease benefits of
minimum pricing only becoming
apparent after ten years. ‘Minimum
pricing targets in a very focused way
the people who are drinking the most
and suffering the most harm.’
Ten per cent of the population
drank around 47 per cent of all the
alcohol consumed, said public health
research fellow at the University of
Sheffield, Dr John Holmes, part of the
team that produced the model.
Although it was frequently argued that
minimum pricing would have an
adverse impact on moderate drinkers
on low incomes, ‘the benefits of this
policy largely accrue to lower socio-
economic groups,’ he said. ‘Lower
income people aren’t in general heavy
Delegates at Alcohol Concern’s conference heard about the need to reframe debate on
alcohol, and how the call for minimum pricing was not going away.
DDN
reports
News focus |
Analysis
CHANGING THE
CONVERSATION
6 |
drinkanddrugsnews
| December 2013
www.drinkanddrugsnews.com