Alcohol misuse: tackling the UK epidemic - London

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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
48 BMA Board of Science The sub-sections to follow set out a range of evidence-based policies that must be collectively implemented in order to effectively tackle alcohol misuse and its associated harms. Access to alcohol – controlling price and availability Access to alcohol is an important determinant of alcohol use and misuse. This incorporates the implementation of policies that regulate the affordability of alcohol, as well as the introduction and enforcement of strict controls on the availability of alcohol to adults and young people. Taxation and traveller’s allowances In recent years, the affordability of alcohol in the UK has been increasing and this has played a significant role in the rise in alcohol consumption. 4 Figure 16 shows how the affordability of alcohol in the UK increased by 65 per cent between 1980 and 2006. 40 In the corresponding period, per capita alcohol consumption for those aged 15 and over increased from 9.4 to 10.9 litres of pure alcohol. 5 Figure 16 – the affordability o of alcohol and consumption of alcohol per capita aged 15 and over, UK, 1980-2006 Affordability (100=1980 value) 180 160 140 120 100 80 60 Source: Statistics on alcohol: England 2007 (The Information Centre, 2007), Statistical handbook 2007 (British Beer and Pub Association, 2007) Alcohol misuse: tackling the UK epidemic Year Affordability Consumption 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 o The affordability of alcohol has been calculated by comparing the relative changes in the price of alcohol (relative alcohol price index) with changes in household’s disposable income (real household’s disposable income index) over the same period (with both allowing for inflation). The base year for these data is 1980. 12 11.5 11 10.5 10 9.5 9 8.5 8 Litres of pure alcohol per capita (aged 15 and over)
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BMA Board of Science Alcohol misuse
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ii BMA Board of Science Editorial b
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iv BMA Board of Science Acknowledge
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vi BMA Board of Science Glossary No
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vi Contents Introduction...........
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2 heavier smoking, drinking and mor
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4 Nutrition, exercise and obesity N
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6 The data for 1998 shows a 21 per
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8 Interventions in adolescent nutri
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10 The efficacy of traditional educ
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12 The treatment of individuals wit
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14 Smoking, drinking and drug use A
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16 The use of illicit substances, a
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18 smoking prevalence was highest a
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20 Interventions in adolescent drug
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22 be expensive given the amount co
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24 is potential to use the media, n
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26 Summary Adolescents in the UK ar
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28 Mental health problems in adoles
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30 Risk factors for conduct, depres
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32 Currently, specialist mental hea
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34 Sexual health Adolescents and se
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36 interferes with the adolescent
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38 Interventions in adolescent sexu
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40 The timing of educational interv
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42 Helping adolescent parents The h
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44 are more difficult to reach than
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46 The way forward This report has
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48 Annex 1 BMA policy on adolescent
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50 References 1 Lobstein T J, James
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52 56 Social Exclusion Unit (1998)
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54 115 Charles Gallichan (2003) Pub
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56 173 NHS Centre for Reviews and D
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Subject: Young People and Alcohol D
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Call for Evidence: Children and You
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5. Do you know of any international
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