Alcohol misuse: tackling the UK epidemic - London

BMA Board of Science
Effective policies to reduce alcoholrelated
harm in the UK
There is a substantial body of evidence demonstrating that targeted and population-wide alcohol
control policies can reduce alcohol-related harm. Historically, changes in alcohol control policies in
the UK have been accompanied by fluctuations in alcohol consumption levels and associated
problems. In the 18th century, a dramatic increase in the consumption of gin in the UK occurred
following a reduction in taxation levels, leading to a period of widespread chronic mass
intoxication, drunken violence, disease, alcohol dependence and premature mortality. 103
It was not
until 1743 that the ‘gin epidemic’ was brought under control through moderate taxation and
strong enforcement. During the 19th century, deregulation of the sale of beer, ale and cider led to
the proliferation of premises selling alcoholic drinks and an accompanying increase in drunkenness
and alcohol-related problems. 4
This in turn brought about the introduction of licensing controls in
the late 19th century. During the First and Second World Wars and the inter-war period,
restrictions on the sale of alcoholic beverages and increased taxation – together with the removal
of large numbers of young men by wartime duty or premature death – led to dramatically reduced
national per capita consumption and alcohol-related problems. 4
“”
I see more and more alcohol-attributable deaths. ‘There is nothing more we can do’
is a hard discussion to have with a patient and their family. Excessive drinking has a
wide range of adverse effects – medical, personal and social. The government needs
to take tougher action to address these problems and it needs to happen now.
BMA member
Since the Second World War, there has been considerable deregulation and liberalisation of alcohol
control policies in the UK. This has been accompanied by an increase in consumption levels and
alcohol-related problems as discussed earlier. Information on current UK governmental alcohol
control strategies can be found in Appendix 2. These strategies have been the subject of much
criticism due to the lack of governmental commitment to evidence-based harm reduction
57, 104-111
policies. The primary criticism is the focus of the UK Government on interventions that are
popular (eg educational programmes and media campaigns) but argued to be ineffective, and the
rejection of policies such as increased taxation and reduced availability that have been found to
reduce alcohol consumption and related problems. These criticisms are supported by analysis and
comparison of the strength of alcohol control policies internationally. A recent study of alcohol
control policies among countries in Europe, Asia, North America, and Australia found the strongest
alcohol control policies to be in Norway and Poland while the UK was ranked 20th out of the
30 countries examined in the study. 112
Lessening the burden of alcohol misuse in the UK requires strong leadership and the implementation
of effective alcohol control policies that reduce overall consumption levels and minimise the harm to
the public and the individual. It is worth noting that while the devolved UK nations have developed
independent strategies, there is no overarching strategy for the UK. Developing comprehensive alcohol
control policies therefore requires partnership between governmental agencies and organisations
throughout the UK. A coordinated approach is also required to increase the popularity and acceptance
of such policies among the general public. The UK Government’s emphasis on partnership with the
alcohol industry and self-regulation has at its heart a fundamental conflict of interest that does not
adequately address individual and public health. The alcohol industry clearly has a vested interest in the
development of control policies. It is essential, that the UK Government moves away from partnership
with the alcohol industry and looks at effective alternatives to self-regulation that will ensure there is a
transparent policy development process that is based on reducing the harm related to alcohol misuse.
Alcohol misuse: tackling the UK epidemic 47