Alcohol Policy UK

News & updates Feb 2012: MPs debate alcohol policy; Scotland's 45 minimum pricing impact revised

Alcohol strategy gets Westminster debate

A Westminster debate on alcohol policy and the forthcoming strategy has been highlighted by Alcohol Concern - see part 1 and part 2 of the debate which includes statements from MPs across the parties.

Public health Minister Anne Milton said the forthcoming national strategy included ambition to "remove a significant number of units of alcohol from the UK market through changes in how alcohol is produced and sold". See a Morning Advertiser (MA) report or the the Daily Mail's take. See recent news on lower strength drinks here.

After calling for the debate, Dr Sarah Wollaston, a Conservative MP who has previously called for tougher regulatory and pricing measures re-iterated the case for stronger action. An open letter from health groups has also asked MPs to support minimum pricing following Alcohol Concern's call on the public to push MPs to support it.

Scotland

The University of Sheffield have produced an updated review into the likely impacts of minimum pricing in Scotland (report here). It suggests a slightly smaller effect on consumption than first estimated, but would still be expected to save thousands of lives and millions of pounds. A minimum price of 45p per unit of alcohol would reduce consumption by 4.3% rather than the previously estimated 4.7%. See BBC and Guardian reports.

Controversy over whether the European Commission had given a supportive indication to the Scottish Health Secretary over the legality of minimum pricing within EU law is outlined in a BBC report.

A Scottish Government alcohol campaign is encouraging women to 'drop a glass size', warning of the risks of regular consumption, similar to England's recent Change4Life campaign. A ‘drinking time machine’ app is also part of the campaign.

Other news

Portman Group Chief Executive Henry Ashworth, Chair of the Responsibility Deal’s Alcohol Network (RDAN), has said the Responsibility Deal will suffer without health partners involvement - see MA story.

National Pubwatch has teamed up with drinks giant Diageo to launch an awards scheme to recognise responsible drinking - MA report. The introduction of the Late Night Levy could cost the industry as much as £25 million according to the Home Office consultation, the MA reports.

Liverpool may go for local minimum pricing, following in the footsteps of Manchester hoping to introduce it via local by-law changes. Ireland could also be going for minimum pricing according to the MA.

'Don't let drink sneak up on you' - new Change4Life alcohol campaign launched

A new Change 4 Life alcohol campaign, 'Don't let the drinks sneak up on you', has been launched - see the press release, TV advert and Change4Life alcohol pages including a new tool to check your drinking.

The campaign warns against drinking above lower risk guidelines, highlighting the potential impacts on long term health. A TV advert warns that regularly drinking just 2 large glasses of wine or 2 strong pints of lager a day can triple the risk of developing mouth cancer and double the risk of getting high blood pressure. A supporting leaflet [pdf] is also available to order.

A survey as part of the campaign revealed that most people are unaware of the serious illnesses caused by regularly drinking above the guidelines. For example 85% of people did not realise it increases the risk of developing breast cancer and 59% did not realise it increases the risk of mouth, throat and neck cancer (see press release for more). The campaign follows a recent call for recognition of the need for at least 2 alcohol-free days per week.

Secretary of State, Andrew Lansley said: 

 “It’s crucial we support people to know about how drinking too much poses risks to their health and how they can take control of their drinking. It can be easy to slip into the habit of having a few extra drinks each day, especially when drinking at home. But there can be serious health risks. Don't let drinking sneak up on you.”

Chief Medical Officer Professor Dame Sally Davis said:

"Drinking too much is a major public health issue. This campaign highlights how easy it can be to use a glass of wine or beer to unwind at the end of a busy day but these drinks stack up and can increase your risk of high blood pressure, cancer or liver disease.”

See reports in the Guardian, BBC and The Telegraph.

The campaign follows previous Government-led activity such as the alcohol effects, Know Your Limits (materials here) and support for areas to develop local social marketing activity. Existing alcohol communications are also run through NHS Choices and the industry funded Drinkaware trust.

The campaign had been previously announced as part of the Government's new alcohol strategy to be released later this year. But may health policy groups have expressed concern over an excessive focus on on 'nudge' or 'personal responsibility' approaches delivered in part through the Responsibility Deal. They warn that to significantly reduce alcohol misuse multi-strand action that includes addressing price, availability and marketing must also take place. 

'Tackling alcohol misuse: Should abstinence be our preferred approach?' British Liver Trust call for public health action on alcohol

The British Liver Trust have released a new report outlining the need for a comprehensive approach to tackling alcohol misuse. It warns against a "one size fits all approach for treatment" for a range of problem drinkers "each of whom will need tailored approach with the interventions and appropriate treatment goals."

Download 'Reducing alcohol harm: recovery and informed choice for those with alcohol related health problems'

A supporting commentary piece by Andrew Langford, Chief Executive of the British Liver Trust also appeared in the Guardian.

The report highlights that alcohol accounts for 80% of all deaths from liver disease, the prevention of which should be the core focus of alcohol policy debates. GPs, nurses and other health professionals should screen for alcohol misuse more widely, to ensure that those drinking at harmful levels are identified and offered appropriate support, advice and treatment.

The report chimes with a recent call from 2020 health to focus on 'risky drinking' and the prevention of alcohol problems, as well as a more traditional focus on treatment for a smaller number of dependent drinkers. Both reports call for public health approaches in response to the growing impact of alcohol related harm, as also set out in NICE public health alcohol guidance, Alcohol Concern reports, Department of Health commissioning guidance and calls to mainstream brief interventions.

Further information on alcohol and 'risky drinking' can be found from NHS Choices alcohol pages, Drinkaware, and resources and guidance are available from the Alcohol Learning Centre.

Alcohol Concern urges action on minimum pricing ahead of new national alcohol strategy

Alcohol Concern are calling on the public to urge MPs to push for minimum pricing ahead of the forthcoming national alcohol strategy. Alcohol Concern state:

The next few weeks will be our last chance to influence the shape of the alcohol strategy, which will shape public policy on reducing alcohol harm for years to come. We must act now to counteract the lobbying power of the drinks industry and major retailers.

The Prime Minister has come out in support of minimum pricing, but the Secretary of State for Health has not- this is the moment when we need MPs to call for minimum pricing and help ensure that it becomes government policy.

Up until now, the government has relied largely on voluntary measures by the drinks industry to reduce consumption. Given that the turnover and profitability of the drinks industry is entirely reliant on maintaining or increasing alcohol consumption, there is a clear conflict of interest involved in this approach.

Alcohol Concern are urging people to write to their MP to call for minimum pricing, stating the business case for action. The charity have provided a list of key facts and possible questions to include and a minimum pricing briefing paper. They are also promoting a Twitter hashtag #ActNowOnAlcohol

The Prime Minister David Cameron recently instructed Whitehall officials to look at minimum pricing options according to a Daily Telegraph report. Cameron has repeatedly spoken out on the issue of cheap alcohol, but the Health Secretary Andrew Lansley prefers voluntary action through the controversial Responsibility Deal. The public appear divided on the subject.

Minimum pricing has been at the forefront of the national alcohol policy debate, particularly since the release of research from the University of Sheffield modelling the likely benefits. Supporters cite the link between rising consumption with the falling relative price of alcohol.

However opponents of minimum pricing, such as sections of the alcohol industry and retailers, argue minimum pricing is a blunt measure and could contravene EU legislation. Scotland is currently seeking to introduce a minimum price and so could soon test this, whilst the IFS advise lobbying for EU law changes to allow tax restructuring to achieve a minimum pricing effect.

A 'below cost ban' is due to come in under forthcoming Licensing changes, but  the ban is not expected to not expected to affect prices under a 'Duty + VAT' definition of cost. See here for information on why a below cost ban is not minimum pricing and further reports.

Lower strength drinks heralded as Stella Artois, Becks and Budweiser switch to 4.8% & 'mid-strength' 2.8% Guinness announced

Brewing giants AB InBev will reduce the strength of popular lagers in the UK from the end of this month to keep line with "evolving UK category trends". The world's largest brewer will reduce the % Alcohol By Volume (ABV) of Stella Artois, Budweiser and Becks from 5% ABV to 4.8% ABV. See Daily Mail report.

The move will reportedly save AB inBev up to £8.6 million a year in duty on off-trade sales alone, but follows an £11.6 million decline in Stella Artois sales. Sales of 'triple filtered' 4% ABV Stella have also suffered after an initial good start. The news comes after the All Party Parliamentary Beer Group recently enjoyed a tasting session of lower strength drinks. But brewers have been suffering from the effects of rising costs, with off-trade beer sales reportedly plummeting faster than on-trade sales for the first time in 15 years.

Daigeo has also just announced a 2.8% mid-strength Guinness to be released for the off-trade. By dropping from the standard 4.1%, the new line will take advantage of the 50% duty discount on beers with an abv of 2.8% or below, introduced in October last year. High-strength beers of 7.5% abv and above must now pay an additional 25% tax. Under the Responsibility Deal, Heineken is expected to reduce the alcohol content of Strongbow by 1% (currently 5.3%) by 2013.

Whether or not such changes in the strength of drinks can have significant impacts on public health, the structure of taxation and pricing levers will remain central to alcohol policy debates. Recently the IFS called for taxation over minimum pricing approaches, and "to tax all alcohols at an equivalent rate per unit" which "would require policy action at the EU level which the Government should pursue."

The British Beer and Pub Association (BBPA) however have continued to speak out against the the alcohol duty escalator after the 2011 budget confirmed the Government would continue with alcohol taxed at 2% above the rate of inflation (RPI). The BBPA highlight duty on beer has increased by 60% since 1995, compared with a 15% increase in duty on spirits, and instead call for a tax system which encourages consumption of lower strength drinks in pubs as supervised environments.

Public Health Outcomes Framework released: spend should reflect local needs; alcohol admissions data to be reviewed

The NHS Public Health Outcomes Framework has been published, aiming to tackle public health challenges through moving public health back into local government. It outlines 'a shift away from the focus of process targets' to a framework that describes two 'high level' outcomes: an increase in healthy life expectancy and a reduction in life expectancy gaps across communities.

A DH press release, states:

'Public health will be measured against a framework which sets out 66 health measures so councils and the Government are able to see real improvements being made and take any action needed.

From April next year, councils will be given a ring-fenced budget – a share of around £5.2 billion based on 2012/13 funding – and will be able to choose how they spend it according to the needs of their population. Those who make the most improvements will be rewarded with a cash incentive.'

Investment in alcohol treatment and prevention will be locally determined, and should be reflected in each area's Joint Strategic Needs Assessment and Joint Health and Well-being Strategy.

The 66 indicators will be grouped into four main domains: 'Improving the wider determinants of health'; 'Health Improvement'; 'Health Protection' and lastly, 'Healthcare public health and preventing premature mortality'. Alcohol is addressed within the Health Improvement domain, alongside other lifestyles factors. A set of indicators on premature mortality includes preventable mortality from liver disease.

A specific alcohol indicator will remain for alcohol-related hospital admissions, though the indicator definition is due to be reviewed by NWPHO - 2.18 of the technical specifications states: 'the preferred option is for an indicator based on just alcohol-related primary diagnoses, to minimise the risk of perverse consequences from any changes in coding practice so the indicator rewards local areas for good performance.'

Recently the Health Committee warned over risks to public health budgets within the changes, concerns echoed by the Shadow Health Minister Diane Abbott - see a Press Association release. The Responsibility Deal, a key strand of Lansley's public health strategy, has also been heavily controversial and the 'nudge' focus has been criticised by a Lord's committee.

Last month the DH released a series of factsheets about the new public health system. See news reports in the Daily Mail and Daily Telegraph.

Scientists gleam further insight into alcohol's effect on brain reward system

Further insight into the effect of alcohol on the brain's reward system has been reported in the journal of Science Translational Medicine. It found alcohol effects the orbitofrontal cortex and results in a release of endorphins, previously only proven in animal studies. These naturally produced pain relieving proteins have an action akin to morphine, leading to drinkers experiencing pleasurable feelings.

The study found that heavier drinkers found alcohol more pleasant than non-drinkers. It also describes how the endogenous opioid function in the brains of chronic drinkers appears to change, in a sense 'over-learning' problem drinking behaviours. See reports in the Telegraph and Daily Mail.

The study may help to explain the mechanism by which antagonists such as Naltrexone work successfully, which could lead to the further development of pharmacological treatment approaches. Nonetheless, from the position that environment and learned behaviours also contribute to the development of problem drinking, successful alcohol treatment approaches emphasise the role of psychosocial as well as medical interventions. See here for the review into the effectiveness of alcohol treatment and NICE guidance.

Recently the message of a little but not often came out for preventing the development of alcohol problems. Sir Iain Gilmore, Chair of the Alcohol Health Alliance stated that having at least 2 alcohol free days each week was "a very good indicator of not being addicted". He emphasised the key is not to let regular consumption and rising tolerance end up as daily dependence, as experienced by as many as 1.6 million people in England.

This echoes calls from the Science and Technology Committee of MPs recently to urgently review alcohol guidelines and help the public to understand units better. The Change4Life website now contains public health messages about alcohol use within the context of a healthy lifestyle, and NHS Choices has useful tips for cutting down.

Home Office consultation on late night levy & restriction orders as trade warns of on-trade burden

The Home Office have opened a consultation on new powers due to be brought in under Licensing Act reforms. The consultation is seeking specific responses on the late night levy and Early Morning Restriction Orders (EMROs) as measures to help curb late night drinking problems. See the press release here. 

The consultation asks which types of premises should be covered by Early Morning Restriction Orders, a measure which will allow authorities to restrict the sale of alcohol to any time between midnight and 6am. It also ask which services a licensing authority may fund with the 30 per cent of levy revenue it will retain. The rest of the levy will go to funding police activity.

However BBPA Chief Executive Brigid Simmonds warned the Government against excessive action on the on-trade: “More and more alcohol is drunk at home, yet more and more red tape is heaped on pubs." Concern about the level of regulation being imposed on the pub trade were also raised during pubco debate in the House of Commons last week. 

Health Minister Anne Milton however defended Government action at an event in Parliament where brewers showcased a range of 2.8% ABV beers. Milton said “As a government we do not want to be killjoys but we do have some health problems. We do have a problem with alcohol but it is complicated." Milton said “We are supportive of the pub industry, we are supportive of people having a good time", and expressed hope that the forthcoming alcohol strategy will strike the right balance.

A list of Home Office factsheets on the full licensing changes due are available.

Alcohol Policy Comment: The Grocer-isation of Alcohol Brands & policy contradictions

In this guest post, Chris Hackley, a Professor of Marketing at the University of London discusses 'The Grocer-isation of Alcohol Brands and the Contradictions of Alcohol Policy in the UK':

In the UK, the government first issued ‘safe’ alcohol consumption guidelines in 1987. Coincidentally, the 1980s also saw the first UK advertising campaign for alcohol to use imagery previously only seen in pre-school TV programming. The bar-cruising, wise-cracking, girl-chasing Hofmeister Bear (an actor in a trilby-wearing bear suit) became an icon of the times and a symbol of the lager-isation of Britain’s nightlife. Some 24 years later, doctors in the North East recently reported a 400% rise in hospital admissions for advanced liver disease among people in their early thirties, against a UK rise of 61%. 

Coincidence? Clearly, it would be going too far to blame the UK’s alcohol problem on John Webster, advertising agency BMP DDB’s resident creative genius. For Webster, it was simply the case that his Honey Monster sold a lot of Sugar Puffs, so why not do it with beer? What is more, today, the UK advertising regulator, the Advertising Standards Authority, would probably disallow the campaign on the grounds that the imagery appeals to children.

But the juxtaposition of the two events, the Hofmeister Bear campaign and the UK government issuing drinking guidelines, neatly illustrates a contradiction in UK alcohol policy we are yet to resolve. That is, the intensification of alcohol marketing has grown hand-in-hand with the intensification of government-led initiatives to persuade people to drink less. While government convenes committees to ‘look into’ alcohol, children and young people have to negotiate a culture in which alcohol is celebrated as never before. Alcohol brands adorn major sports events and team strips; mixer drinks, which boomed in the 1980s as the notorious ‘alco-pops’, sell 40% proof vodka that tastes like fruit juice; while the country’s leading supermarket chains all treat alcohol brands as if they are normal grocery items, discounting them, promoting them heavily and stacking them in pyramids by the checkouts.     

Alcohol industry lobbyists such as the Portman Group will point to the relatively small numbers of alcohol-related deaths in the UK relative to other countries. As a nation, we do not have a generalised alcohol problem in terms of consumption per capita. But we do have unusual rates of alcohol-related disease and disorder in certain socio-demographic and age groups. The rising numbers and falling age of liver disease victims seems particularly shocking, and hints at worse to come. Under current policy, they bear the whole responsibility for their predicament. They were told to drink ‘sensibly’. They didn’t. They are, in effect, collateral damage in a battle for higher profits from alcohol sales.

Over the past three decades our policy makers have assisted the alcohol industry in shifting the emphasis from steady but unexciting pub on-sales to huge volume, highly profitable, powerfully branded, 24/7, retail off-sales. This grocer-isation of alcohol brands is the elephant in the room in UK alcohol policy debates. The paralysing policy contradiction this creates needs to be acknowledged.

Chris Hackley is Professor Marketing at the School of Management, Royal Holloway University of London. He recently appeared on Channel 4 news discussing the call to review alcohol guidelines. See here for a round up on media and policy engagement in alcohol policy issues and a collection of papers here.

Ministers back call for NHS staff to make "every contact count" to improve health

The Health Secretary Andrew Lansley has accepted recommendations for NHS staff to take every opportunity to promote good health. The NHS Future Forum called for action to ensure that "every contact counts" in helping address the impact of alcohol misuse, poor diet, smoking and lack of exercise. See here for the Forum's Public Health report and coverage from the BBC and The Telegraph.

The report warns millions of opportunities to improve patients' health and well-being are missed - every day GPs and practice nurses see over 800,000 people, dentists see over 250,000 and 1.6 million people visit a pharmacy. A recent report by Cancer Research UK suggested 40% of cancers were preventable through lifestyle changes, and over one million  hospital admissions each year are alcohol-related - and rising.

However, Dr Clare Gerada, Chair of the RCGP, expressed concerns suggesting that not every contact is an appropriate time to question lifestyle behaviours. Other concerns have highlighted that helping patients to change does not address the wider causes such as health inequalities, poverty and poor housing.

Making "every contact count" is based on brief intervention principles of behaviour change - motivating an individual to explore the pros and cons of unhealthy behaviours. This often leads to change where an individual further realises the benefits of acting, or the risks of not changing.

Brief interventions for alcohol - or 'Identification and Brief Advice' (IBA) - have been shown to be the most effective health behaviour intervention. However challenges to mainstreaming IBA appear to include staff's fears about raising the subject, although NICE suggests 62% of people will accept alcohol advice when offered it.

North East Lincolnshire have developed an Every Contact Counts website and the West Midlands have developed an E Learning package. Yorkshire and Humber have developed a competence framework to underpin the Every Contact Counts agenda.