Tackling alcohol harm

Alcohol harm encompasses a broad range of health, social, and financial impacts that can affect individuals, families and society as a whole.

Public Health England published its review on the evidence on the public health burden of alcohol in England in December 2016. This reported that “amongst those aged 15 to 49 in England, alcohol is now the leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill-health across all age groups.”

Many indicators of alcohol-related harm have increased in recent years, and those dying from alcohol related disease die over 20 years earlier than the average age of death:

In recent years, many indicators of alcohol-related harm have increased. There are now over 1 million hospital admissions relating to alcohol each year, half of which occur in the lowest three socioeconomic deciles. Alcohol-related mortality has also increased, particularly for liver disease which has seen a 400% increase since 1970, and this trend is in stark contrast to much of Western Europe. In England, the average age at death of those dying from an alcohol-specific cause is 54.3 years. The average age of death from all causes is 77.6 years. More working years of life are lost in England as a result of alcohol-related deaths than from cancer of the lung, bronchus, trachea, colon, rectum, brain, pancreas, skin, ovary, kidney, stomach, bladder and prostate, combined.Despite this burden of harm, some positive trends have emerged over this period, particularly indicators which relate to alcohol consumption among those aged less than 18 years, and there have been steady reductions in alcohol-related road traffic crashes.[1]

The report highlights the wide ranging impacts of alcohol use- this can affect the individual themselves, their family and children, the local community and wider society. Poorer communities seems to be disproportionately affected by alcohol harm.

A recent report produced by the APPG on Alcohol Harm highlighted the impacts of alcohol harm on the emergency services. It reported that over 50% of police officers say that alcohol related incidents make up most of their workload, and over 70% of attendances at A&E on a weekend are alcohol related.[2]

The PHE review reported that the economic burden of alcohol is substantial. Estimates show that the annual cost is between 1.3% and 2.7% of GDP. It also reports on the difficulties in accurately assessing the impacts of the wide variety of costs- for example there are few studies produced on the costs to people other than the drinker.

The review proposes a number of local and national policies to tackle alcohol harm. These include controls on prices of alcohol, marketing restrictions and regulating availability.

An update to the alcohol strategy?

In their submission to the Backbench Business Committee, the Members tabling the debate said that this could give an opportunity to enquire about an update to the Government’s alcohol strategy.[3]

The current strategy was published in 2012[4] and focused on targeting binge drinking culture and alcohol related violence. It committed to a consultation on minimum unit pricing (MUP) on alcohol and to look at a number of other measures to tackle excessive drinking and alcohol-related crime. These included making the mandatory licensing conditions more effective, particularly those regulating irresponsible sales and promotions. More information is provided in the Government webpages on alcohol policy (2010-15) and licencing. The taxation elements of the strategy apply across the UK, but other parts relating to policing, licencing and pricing only apply in England and Wales

The Scottish Government’s Alcohol Framework for Action was published in 2009, this includes measures aiming to reduce alcohol consumption, and improve treatment and support.[5] A Scottish Government webpage provides more information on alcohol policy.

Information about alcohol policy in Northern Ireland is provided on a Department of Health webpage.

Parliamentary Question responses have stated that the Government is working to achieve the outcomes in the 2012 strategy and there are no plans to publish an update. [6]

An October 2016 Parliamentary Question response from the then Parliamentary Under - Secretary of State for Health, Lord Prior of Brampton provides an overview of government policy aimed at reducing admissions to hospital with conditions relating to alcohol use:

The new UK Chief Medical Officers’ Low Risk Drinking Guidelines provide the public with the most up to date scientific information to help people make informed decisions about their own drinking. A copy of the guidelines is attached.

The Department and Public Health England (PHE) will be reviewing the advice on higher risk drinking, in light of the new guidelines, at a United Kingdom level through a consensus process in partnership with the Devolved Administrations.

PHE is using its One You campaign to motivate people to take steps to improve their health through tackling the main risk factors such as smoking, inactivity, obesity, and alcohol. One You provides a Drinks Tracker app to help drinkers identify risky behaviour and lower their alcohol consumption.

Local government has been given the responsibility to improve people’s health. This includes responsibility for tackling problem drinking and commissioning appropriate prevention and treatment services for their local population’s needs. Over the next five years, we will invest more than £16 billion in local government public health services.

NHS England’s NHS Five Year Forward View commits the National Health Service to support national action on alcohol. The National Commissioning for Quality and Innovation (CQUIN) payments framework was set up in 2009-10 to encourage services providers to continually improve the quality of care provided to patients and to achieve transparency. To help deliver their commitment to reduce harmful alcohol consumption NHS England has published a CQUIN to incentivise interventions to reduce risky behaviours, and prevent ill health through alcohol and tobacco consumption. This has a number of components, including alcohol screening, brief advice and referral to specialist services.

CMO Low Risk Drinking Guidelines (PDF Document, 323.19 KB) [7]

Minimum Unit Pricing

The UK Government have said that the introduction of minimum unit pricing remains under review pending the “outcome of the legal case between the Scotch Whisky Association and the Scottish Government and the impact of the implementation of this policy in Scotland.” [8] In May 2012 the Scottish Government passed legislation that would enable it to introduce MUP in Scotland. An intended price of 50p has not yet been implemented as the Scottish Whisky Association is challenging the legislation in the European and Scottish courts.

The December 2016 PHE evidence review looked at MUP and said that “empirical evidence and modelling studies have shown that setting a minimum price for alcohol can reduce alcohol-related harm while saving health-care costs.”[9] Following the publication of the PHE review, 43 representatives of medical organisations and charities wrote to the Chancellor of the Exchequer, Phillip Hammond, calling on him to take action in the Budget to address alcohol prices.[10]

For more information on Minimum Unit Pricing, the Library briefing paper may be useful:

http://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN05021

For more information on alcohol statistics, the Library briefing may be useful:

http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7626

[1] PHE, The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies An evidence review, December 2016

[2] APPG on Alcohol harm, The Frontline Battle An Inquiry into the Impact of Alcohol on Emergency Services by the All-Party Parliamentary Group on Alcohol Harm, December 2016

[3] Backbench Business Committee, MPs debate tackling alcohol harm, 27 January 2017

[4] The Government’s Alcohol Strategy, 2012

[5] Scottish Government, Alcohol Framework for Action, 2009

[6] HC Written Question 12330, Alcoholic Drinks, October 2015

[7] HL Written Question: HL2376, 31 October 2016

[8] HL Deb 6 December 2016 c600

[9] PHE, The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies An evidence review, December 2016

[10] Letter to the Chancellor of the Exchequer, December 2016