Alcohol Policy UK

Smoking ban shows reduction in alcohol consumption in Scotland

A study by the American Yale University on the impact of smoking bans in the US and Scotland has found they reduced alcohol consumption amongst smokers. In Scotland, 525 smokers were studied before and after the ban and compared with a control group south of the border. It found that moderate drinking smokers in Scotland reduced their alcohol consumption by four drinks a week whilst heavy drinking smokers drank on average six fewer drinks in the pub per week. Sherry McKee, of Yale University, said:

"That is a benefit for public health in that it reduces the alcohol consumption of a category of people who are at most risk from disease. This is the first time it has been demonstrated that smoking bans have an affect on alcohol consumption."

Meanwhile in England and Wales, whilst the smoking ban has increased the number of people quitting smoking, research shows it has further reduced business for the declining on-trade. Questions are therefore being raised about whether the ban has contributed to increased home consumption as off-sales rise and supermarkets continue to use alcohol as a significant loss-leader. Other reports indicate that the smoking ban has caused crime and disorder problems outside premises.

For more on the Yale University research see Scotland on Sunday report.

Budget 2009: 2% duty increase on alcohol

Chancellor Alistair Darling annouced yesterday in his budget that alcohol duty would rise as expected (see p76) by 2% from today.  The Treasury said this will add one penny to the price of a pint of beer, 13 pence to the price of a bottle of spirits and 4 pence to the price of a bottle of wine.

Reaction from the trade here.

Consultation deadline: alcohol and young people information and guidance

The 23rd April is the last day to submit consultation responses on a range of information, guidance and recommendations on children and young people's alcohol use. Guidance and drafted documents can be found on the Department for Children Schools and Families page here. This includes the Chief Medical Officer's guidance which outlines recommendations for an alcohol free childhood for under 15s.

The deadline draws in after a recent furore over advice made by the young people's drugs advice and support line FRANK that 'cannabis was safer than alcohol', as reported by the Sunday Telegraph. Last month also saw the release of the EPSAD report which found British teenagers were amongst the heaviest drinkers in Europe.

NHS Health checks - a missed opportunity for alcohol interventions

NHS Health Checks, which Health Secretary Alan Johnson says could prevent 1600 heart attacks and strokes each year and help save 650 lives, began at the beginning of April. Everyone aged between 40-74 in England will begin to be invited for a free health check as part of a national programme to identify their risk of diseases such as coronary heart disease, stroke, diabetes and kidney disease.

The checks are part of a drive to ensure that people from this age group have the necessary information about their health in order to make important lifestyle changes and reduce their risks of developing diseases like diabetes and coronary heart disease, which currently affect the lives of 4 million people in England and are responsible for a fifth of all hospital admissions.

The NHS Health Check will consist of:

• Straightforward questions to patients on their health and diet, exercise habits and family medical history
• Height and weight measurements taken from patients
• A simple blood test for cholesterol and in some cases for glucose levels
• A follow up, personal assessment setting out the individual's level of risk and what they can do to reduce this
• Recommendations of what could be done to reduce risk including: weight management programmes, stop smoking, physical activity programmes

Local Primary Care Trusts are designing their own local implementation plans to make sure that they can deliver the checks and follow up services that will be best suit the needs of the local population.

Given the links between coronary heart disease and stroke (over half of alcohol-related hospital admissions are for heart disease), there is surpisingly little emphasis on alcohol use within the Health Check, other than as a topic that may be raised.  According to the guidance Putting Prevention First NHS Health Check: Vascular Risk Assessment and Management:

Providing information and brief advice on lower risk drinking is not an intervention required within the NHS Health Check programme. However, it is recommended as part of the guidance on lifestyle interventions within the NICE clinical guideline on hypertension. It is also a topic likely to be raised in discussing lifestyle issues as part of this programme.

The NICE hypertension guidance does at least call for clinicians to "ascertain patients’ alcohol consumption and encourage a reduced intake if patients drink excessively, because this can reduce blood pressure and has broader health benefits." 

New stats on calorie intake from alcohol

The Department of Health has published statistics collected via an online Know Your Limits survey on what drinkers know about the calorific content of alcoholic drinks. Nearly 2000 people took part in the survey.

• 42% of women surveyed admitted they didn't know that a glass of white wine has the same calorie content as a bag of crisps
• 40% aren't aware that a pint of lager has as many calories as a sausage roll
• 37% admit they are likely to eat more than they usually would or ditch the healthy diet when drinking above their recommended daily limits

The British Beer and Pub Association was quick to criticise the presentation of this data.

Health professionals add more support for pricing controls on alcohol

The Royal College of Physicians and Royal College of Nursing Survey on Alcohol Treatment Services published last week asked gastroenterologists, hepatologists, acute physicians and nurses for their expert opinion on Government policy initiatives and national strategies to tackle alcohol related harm, the provision of service for people with alcohol related health problems and the scale of alcohol related health harms in their particular clinical environment. 

Key findings (it is not clear how many people responded):

• 73% felt action on low priced alcohol was needed to tackle alcohol related problems
• 71% believed that greater investment in treatment services was needed
• 88% felt that the national strategies for reducing harm were not effective

The editorial in this week's Lancet supports minimum pricing, as proposed by Chief Medical Officer Liam Donaldson (pictured), suggesting that opposition is political and not based on understanding of the evidence:

As yet, no European country has a minimum price-per-unit policy, although the Scottish Government is considering it. If introduced in the UK, the scheme would signal good news for the population's health and for the public purse, and money saved by the scheme could be put into health services. Ignoring the evidence on  price increases may prove a popular political decision for Brown, but it will be a costly one for public health.

Previous Lancet articles on alcohol here.

London off-licences may restrict alcohol sales to over 21

The Evening Standard has reported that London Mayor Boris Johnson is backing a scheme that will see off-licences voluntarily raising the age to 21 for purchasing alcohol. A pilot is to take place in Croydon and other Tory councils have reportedly come out in support, including Kensington and Chelsea, Hammersmith and Fulham, Westminster and Ealing.

A pilot in Scotland last year banned sales to under 21s in West Lothian and was reported to reduce alcohol-related crime and anti-social behaviour significantly . This year the Scottish National Party released a national framework for action which includes plans to raise the legal purchase age to 21 across the country.

Get treatment or lose benefits - government turns attention to alcoholics

BBC News reports: 'Alcoholics face having their benefits docked if they do not get treatment, under government plans. Minister James Purnell has announced a review into the idea to be carried out jointly by the Department of Health and Department for Work and Pensions.

Measures that require drug addicts to get treatment in order to keep receiving benefits are currently going through Parliament. Mr Purnell said they wanted to help people get the help they needed.  Speaking on a visit to Dewsbury Moor in West Yorkshire, he said:

We have introduced a new policy that will mean heroin and crack addicts get treatment in return for benefits. We will actually help them rather than simply handing them money which ends up in pockets of drug dealers. But we can't abandon anyone to long periods on benefits without help to overcome problems.

So that's why we are going to look at the arrangements for alcoholics on benefits, just as we did for problem drug users, so that people get the help they need to get sober, to get their life back and get back to work.

Mr Purnell has previously said that the plans to cut drug addicts' benefits would give them the chance to "turn their lives around".'

Quite how this approach can be justified when alcohol treatment provision in England is so patchy and relatively underfunded compared to drug treatment remains to be seen.  Only last year the National Audit Office report Reducing Alcohol Harm: Health services in England for alcohol misuse  was critical of the way alcohol treatment is commissioned and organised:

Local provision of specialist services is not based on a good understanding of communities’ needs and there are wide variations between localities. There is also much scope for better integration of hospital services with follow-on and support services, such as psychiatry or self-help groups, to improve recovery rates and prevent patients relapsing into their previous drinking patterns.

The Department of Health Alcohol Needs Assessment Research Project (ANARP) found that:

• Drug Action Teams (DATs) receive funding from a range of sources including primary care trusts, local authorities and charitable funds. In the quantitative survey of DAT professionals, 86% of respondents said that their alcohol treatment budgets are much lower than drug budgets [although there are many more people with alcohol problems than there are problem drug users]
• In the qualitative research with DAT professionals, this group was aware of a ‘very large gap’ between the provision of alcohol treatment and need or demand, however it is expressed.

Bath saturation zone effective says licensing authority

Bath city council has claimed that its licensing saturation zone, applied through a Cumulative Impact Policy (CIP) has positively impacted on new licensing applications. Local media have reported that the policy has 'forced a change in the mindset of those making new applications'. A Bath licensing officer said:

The cumulative impact policy has had a very marked effect on licensing applications that have been submitted since its introduction.

Applicants for grants and variations are well aware that there is a reasonable presumption that applications will be refused unless they can show that there will be no negative cumulative effect on one or more of the licensing objectives.

However, only a small number of reports (see for example this one about Southwark) have indicated the effective use of such policies.  Many areas are already saturated and the policy cannot be used retrospectively.  Addressing the public's understanding of the Licensing Act powers and managing expectations as to the potential impact of saturation policies are also challenges. A commenter on the Bath situation points out that the smoking ban and the economic downturn have played a more significant role in reducing the number of premises and associated problems.

The 2003 Licensing act, which transferred licensing responsibilities from magistrate courts to local authorities, introduced a range of measures to help prevent alcohol related crime and disorder. Saturation zones were an option aimed at controlling the growth of licensed premises where existing problems were already evident.  However enforcement agencies may not be making full use of the powers, such as the opportunities to review and impose conditions on problematic premises.

See here for 'A guide to cumulative impact and saturation policies' produced by Southwark Licensing team.

See here for Home Office guiance on tackling alcohol related problems.

Job: East Midlands Regional Alcohol Manager

East Midlands Regional Alcohol Manager

• 1 year secondment or fixed term contract
• Salary: £37,106 to £44,527 pa
• Closing Date: 15/04/2009

An exciting opportunity is available to join the Regional Directorate of Public Health team in the East Midlands if you are committed to preventing and reducing alcohol related harm. Against a background of increasing alcohol related hospital admissions across the region, the postholder will provide expertise and support to PCTs, Local Authorities and Strategic Partnerships to accelerate improvements in prevention and treatment services.

With a minimum of three years experience at a senior level, you will need to demonstrate evidence of strategic leadership and the ability to manage complex projects. As an effective change agent, you will have excellent communication, influencing and relationship building skills with the ability to work across traditional boundaries. In commissioning and providing improvement support, you will have the ability to interpret data and an understanding of evidence based approaches to reducing alcohol harm.

This post is based in Nottingham, with some expectation of travel within the region and to Department of Health offices in London. Informal discussion for this post is encouraged, please contact Kath Childs, Senior Public Health Specialist Manager on 0115 971 4786. For an offline application please call 0116 295 1173 and quote the vacancy reference or you can access further details here, quoting reference: 592-WCCS-0241-B