Alcohol Policy in Scotland and Ireland: European Trailblazers or Celtic Fringes?
Last month Scottish Health Action on Alcohol Problems (SHAAP) released a briefing exploring alcohol policy in Scotland and Ireland. The briefing follows an event at which several speakers considered the positions of the two countries; some of the key points made are described below.
Clare Beeston of NHS Health Scotland provided a review of MESAS (Monitoring and Evaluating Scotland’s Alcohol Strategy) which had used a Theory of Change (TOC) model to account for changes in the levels of Scotland's alcohol consumption and harm. A downward trend in consumption up until 2012 was driven by the heaviest drinkers and an increase in the rate of abstinence in young adults. Alcohol-related mortality rates though rose rapidly in the early 2000s, then fell in the middle of the decade. Mortality rates have been consistently highest amongst adults aged 55-64 and were eight times higher in the 10% most deprived than in the least deprived areas in 2014.
Beeston reviewed Scotland's strategy actions, including a range of licensing changes, national roll-out of brief interventions, and some changes from the Alcohol Act 2011 such as a ban on multi-buy discounts and restrictions on in-store alcohol displays - though not Minimum Unit Pricing yet. In conclusion Beeston said the implementation of Scotland's Alcohol Strategy has 'led to some positive change in intermediate outcomes', but 'worryingly, consumption is flattening and there has been no decline in mortality or morbidity in the last two years'.
Alison Douglas, Chief Executive of Alcohol Focus Scotland, spoke of alcohol as 'a river running through society' which 'has grown stronger, deeper, and wider over the years'. She described the key challenges facing alcohol policy and the need to take upstream action on price, availability and marketing as the three 'best buys' for preventative action. Douglas posed whether a national target to reduce alcohol consumption would be helpful in providing 'a clear and concerted focus for action across all agencies in Scotland'. She highlighted Ireland had done so through the new Alcohol Bill and establishing a target as part of the new Scottish alcohol strategy would be a 'logical next step'.
Douglas spoke out on the UK Government's policy approach, which she criticised for relying on 'softer "responsibility deal" arrangements with industry'. However she said the industry 'does have a role to play' in sharing the insight and understanding of alcohol consumption - 'if you are serious about helping to prevent alcohol-related harm; let us see your data', she challenged.
Suzanne Costello, Chief Executive of Alcohol Action Ireland, gave an overview of the context of drinking in Ireland and the Public Health (Alcohol) Bill - 'the first time that alcohol misuse has been addressed as a public health issue by an Irish Government'. The Bill aims to reduce alcohol consumption in Ireland to 9.1 litres per person per annum (the OECD average) by 2020 and reduce the harms associated with alcohol.
Costello said a lot of discussion had taken place in Ireland around issues of stigma, pain, loss and heartache associated with suicide, and that 'binge drinking is a driver of depression in young men'. As such, a more integrated approach to substance misuse and mental health services was an important ambition.
However Costello explored how alcohol advertising and the wider industry makes a significant contribution to Irish life and some brands are seen as intrinsic to Irish culture. Challenging attitudes though is difficult and 'one of the biggest barriers is the high levels of tolerance for alcohol harm'. She stated it can also be 'remarkably difficult to be a non-drinker in Ireland', despite around 20% of the population being abstinent.
Costello said much emphasis had been placed on the contribution of the alcohol industry to the economy in Ireland, especially for jobs and tourism, but whilst acknowledging this contribution 'the significant health and social costs cannot be ignored'. Current alcohol advertising codes in Ireland are voluntary and self regulated - Costello said 'we feel that this is ineffective and statutory regulation of alcohol advertising is necessary'. However political changes following recent elections suggest health ambitions are now more realistic, she concluded.
Marian Skarr, Secretary General of Eurocare at he European Alcohol Policy Alliance spoke of the challenges in faciliating European level action. Despite there being no current EU alcohol strategy, Skarr suggested the possibility of a Framework Convention for Non-communicable Diseases (NCDs) may be the most realistic prospect, within which alcohol should be sought as integral. Focusing on 'crossborder issues, including price, marketing, information to consumers, drink-drivers, and monitoring' were highlighted as priority areas, which she explored in further detail including various examples across the continent.
See the full briefing here [pdf] which includes discussion from a question and answer session.
The new Scottish Health Survey (SHS) has also recently been released, highlighting differences in drinking patterns across regions and socio-economic status. The richest Scottish households are roughly twice as likely to consume hazardous amounts of alcohol (35%) compared with 18% of the poorest - as reported in the media. As seen in other consumption data, since 2003 there have been falls in the average number of units consumed and binge drinking, but with evidence of an end to the downward trends in more recent years.
Alcohol's harm to others in Wales
Public Health Wales haves released a new report exploring the harms from other people’s alcohol consumption in Wales. It identifies nearly two-thirds (59.7%) of adults in Wales have suffered some form of harm or negative experience in the last year as a result of someone else being under the influence of alcohol, which equates to over 1.4 million Welsh adults.
Based on a survey of 1,071 adults key findings included:
- 18% had felt physically threatened by someone who had been drinking;
- 11% had their property damaged by a drinker;
- 11% had to contact the police
- 5.5% had suffered physical violence at the hands of someone under the influence of alcohol
In 2014 the Public Health Wales Observatory published Alcohol and health in Wales 2014.
Alcohol policy across the UK
Last year a report, 'Four Nations: How evidence–based are alcohol policies and programmes across the UK?', was released by the Alliance for Useful Evidence exploring the extent to which alcohol policies across the UK nations were considered to be evidence-based.
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