The Westminster Forum on the future of alcohol policy took place in Whitehall, London on 23 May. Lord Bilimoria chaired the conference and began by speaking of some of India’s problems related to alcohol centred around high strength, poor quality, sugar-based flavoured spirit products. Lord Bilimoria stated that these products, often 60% abv “...cause huge social problems and health problems...” he added ”quite frankly it’s a scourge and one of my ambitions is that Country Liquor should not be allowed to be sold in India at all, and some of the States have already banned it”.
Dr Linda Harris of CIC Public Health England presented on the public health challenge of alcohol misuse in a reformed NHS. The establishment of Public Health England has resulted in 211 new statutory NHS bodies, commissioning over £65bn of services for local populations across England. Their brief is: commissioning, improving quality, reducing inequality, being efficient, and hence delivering better outcomes within their resources.
Dr Harris outlined the Public Health Outcome Framework. There are five key priorities:
1. helping people to live longer by reducing preventable deaths from conditions such as heart disease, stroke, cancer and liver disease
2. increasing healthy life expectancy by tackling conditions which place a burden on many lives, such as anxiety, depression and back pain
3. protecting the population from infectious diseases and environmental hazards, including emerging risks and the growing problem of antimicrobial resistance
4. supporting families to give children the best start in life, through working with health visitors, Family Nurse Partnerships and the Troubled Families Programme
5. helping employers to facilitate and encourage their staff to make healthy choices.
Dr Harris quoted Duncan Selbie “For the first time in 40 years local authorities will have a legal responsibility for improving the health of their communities. Local government is the natural leader for this task – they will be able to place health and wellbeing in the wider context of the local economy, housing, leisure, education, crime and community resilience, and have the skills, knowledge and passion to provide public health services designed for the needs of their local population”.
A priority is brief interventions, which ‘significantly lower alcohol consumption, compared to no intervention’ and Alcohol Liaison Services in hospital, which ‘can make a significant contribution to reducing the burden of hospital based care and securing timely intervention to people presenting in crisis’.
Dr Harris concluded “We really do need to act and localities, I think, do want to act, people are living longer with more complex needs, we need to shift from a National Health Service to a National Wellness Service. There probably is an overemphasis on a medical model, and therefore we need to build capacity in our communities to achieve resilience. A great way of being a capacity community is to know how to drink sensibly.”
David Wilson, Director of Public Affairs, British Beer and Pub Association spoke on public order, licensing and support for the on trade: challenges and strategies. He highlighted the encouraging drop in consumption and binge drinking in the UK as well as alcohol related crime and violence.
Wilson then reported on what the brewers are doing to reduce alcohol related harm, through local partnerships such as Best Bar None, Pub Watch, Purple Flag and Community Alcohol Partnerships and responsible server training, The Association prefers targeted approaches as opposed to blanket measures for reducing alcohol consumption. He believes a combination of measures are working as consumption has fallen by 16% since 2004 and alcohol related crime by 23%. Partnership and targeted measures are key.
Henry Ashworth, Chief Executive of the Portman Group spoke on the Responsibility Deal and the effectiveness of the ‘Nudge’ policy of removing one billion units of alcohol from annual consumption in the UK without reducing purchase or enjoyment by consumers. With key producers agreeing to reduce alcohol levels in brand leaders, consumers can drink less alcohol without a loss of pleasure - the key is maintaining product quality and consumers on site. He commented ”in other words, using the power of brands as a force for good. People are very loyal to brands and where a little bit of alcohol is taken out of an established brand, the consumers, provided that the flavour and the taste remains consistent, will support their favourite brands. It’s about thinking about serving sizes, so the Government changed the law last year to allow a schooner, a two thirds of a pint glass to be used, and it’s about encouraging bars and pubs to take up schooners... and I think linking the serving size to the alcohol content is an important thing that we need to be looking at. It’s also applicable in terms of how wine is offered, should wine be offered as standard in a 175ml glass, should an organisation be up selling to 250ml glass or a third of bottle in a glass? .....If we go into a restaurant or a bar, we may ask for a glass of house wine, we may ask for a bottle of house wine, we will probably get round to telling them whether we want red or white, we will probably not go any further than that. Is that bottle of wine 14% alcohol, is it 12% alcohol, that’s almost a 20% difference in alcohol content. Coming back to nudge, to help people to enjoy a drink, still to enjoy a sociable drink but remove a little bit of the alcohol they consume. This is all about encouraging more people to drink within Government guidelines, it’s about opening up a lower alcohol market, making lower alcohol options easier to find and there’s a significant amount of innovation going on across the industry and connecting that at a local level, I think, is a really important area”.
Andy Bruce Head of Tobacco, Alcohol & Diet Scottish Government told the Forum of the progress of the Bill passed by Scottish Parliament in May 2012, which included a minimum price for alcohol.
The Bill was passed by the Scottish Parliament in May 2012, receiving Royal Assent as an Act about a month later. As the Bill made its way through the Parliament, it was amended to include a sunset clause, which effectively means that the Act will fall off the statute books after 6 years unless the Scottish Parliament make a positive decision to continue it. There is a big evaluation and monitoring framework around the implementation of the minimum price to make sure that as and when it does come into existence, that it is working effectively. The Scottish government also made clear that the preferred minimum unit price was going to be set at 50p and that price would remain fixed for 2 years, giving industry a period to adapt to it. After the initial two year period, any other changes would be adapted according to a policy review.
The Scottish government notified the Draft Order setting that price to the European Commission under the technical standards notification. Following this there was a judicial review from the Scotch Whisky Association and other partners that was heard just after Christmas, and in January 2013. In May the petition was dismissed by Lord Doherty in the outer house of the Court of Session. The Scottish government have given a voluntary undertaking not to implement minimum pricing until all the legal challenges have been concluded. The Scotch Whisky Association have said they intend to appeal, so the implementation of minimum pricing won’t be proceeding until all those challenges have been concluded.
Dr Ellen Nolte, Director, Health and Healthcare, RAND Europe presented findings of a study published earlier this year which assessed the exposure to advertising amongst young people in three countries. The study looked at the quantity and the quality of exposure and quality in terms of content. RAND used commercially available data, on viewership and advertising occurrence and brought these together to create or calculate an indicator called incidence rate ratio, which measures the relative exposure of young people to alcohol advertising compared to others, taking viewership patterns into account.
The study found “a positive correlation between alcohol advert intensity and teenage viewership. Juxtaposing what we call the advert intensity against viewership patterns in the age group 10-15, we find that the proportion of viewers in this age group is actually quite small but some of these see a very high number of adverts; the colours indicate the channels, for example, the purple one is Channel 4. We have taken this analysis further by calculating the incidence rate ratio. We show that young people aged 10-15 are 11% more likely to be exposed to alcohol advertising compared to an adult age group, age 25 years plus. We do not see the same phenomenon for children, where exposure is much less than among adults. When we disaggregate by type of beverage, we find that exposure among young people is particularly high for so called alcopops, ready mixed drinks, with young people aged 10-15 50% more likely to be exposed to alcohol advertising’.
The Netherlands showed similar findings, however in Germany young people were not significantly more likely to be exposed to alcohol advertising. “The conclusions from our study showed that adolescents aged 10-15 in the UK were significantly more exposed to alcohol advertising, whereas children under the age of 10 were significantly less exposed to alcohol advertising and the findings suggest that current regulations on advertising do not seem to be sufficient to protect young people from exposure to alcohol advertising.”
Shane Brennan, Public Affairs Director, Association of Convenience Stores
ACS represents 33,500 shops. These are the smaller shops, not the supermarkets (who are 70-80% of the sales of alcohol in the market). Brennan emphasised that one of the dynamics always important to bear in mind is that whilst 70-80% of alcohol sales stem from 10/12 companies, the rest of that market is tens of thousands of individual businesses, all with their own decision making structures around how they comply with license legislation and how they view some of the issues around responsibility - It’s a very different and very disparate part of the market.
In terms of minimum pricing, Brennan said that in England and Wales we often talk about how bad things are and we often forget what the direction of travel is in terms of what we’re achieving. In 2004 the previous Government’s Alcohol Harm Reduction Strategy identified three specific areas where it wanted to see progress: underage drinkers, 16-24 year old binge drinkers and chronic drinkers. In all three of those areas we’ve seen substantial success since that Strategy came into place; the number of young people drinking has halved; the number of binge drinkers is down 10% and chronic drinking, more than 5 times a week, is reducing. So what we are doing is working.
Shane Brennan emphasised that there are lots of reasons why success is being achieved. Education has changed hugely: the public think differently about alcohol, things like know your limits, and other education campaigns have had some impact, such as those initiatives being run by the Drinkaware Trust. Ultimately cultural attitudes have changed. Brennan said “I think the way that young people view alcohol today compared to how they did 10 years ago, is increasingly different. And licensing reform, much criticised, much bemoaned as a political argument, has changed the dynamics of the relationship at a local level between retailers, local authorities and the police. Partnership working has come on leaps and bounds from where it was before the 2004 Alcohol Strategy and before the Licensing Act changes in England and Wales”.