Transcript Alcohol policy

Alcohol policy
Dr Bruce Ritson
SHAAP
Alcohol policies in a public
health perspective
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Alcohol problems are not only prevalent
throughout the world they are preventable
Alcohol
problems
affect
the
whole
spectrum of drinkers not just alcoholics
Average amount of alcohol consumed in a
society affects the prevalence of problems
One of the most effective ways to prevent
alcohol related problems is through
policies that reduce average alcohol
consumption,especially
limitations
on
physical and economic availability.
Bruun et al 1975
What works?
International Review of Policy Measures
Authored by Public Health Academics
Sponsored by WHO
Population Consumption and Harm
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The more alcohol a nation consumes, the
greater the burden of harm it will
experience, and vice versa.
Changes is per capita consumption are
reflected in changes in harm.
There is a statistically significant
relationship between changes in per capita
alcohol consumption and liver cirrhosis
mortality.
(Calling Time: The nation’s drinking as a major
health issue, Academy of Medical Sciences, March
2004)
Population Measures
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International evidence confirms that if overall alcohol
consumption falls, reductions in alcohol-related harm can
follow within a relatively short time.
Efforts to reduce alcohol harm need to reach the majority of
drinkers and not just high risk groups.
It is the greater number of risky drinkers in a population
who account for most of the alcohol-related harm.
More harm associated with the acute effects (drinking to
intoxication) rather than chronic effects (sustained drinking
over a period of time).
A reduction in overall consumption can be expected to have
a positive effect on the whole population as well as
reducing harm in high risk groups.
(Evidence-based strategies and Interventions to reduce alcohol-related harm,
WHO A60/14 Add.1, 5 April 2007)
“The only purpose for which power can be
rightfully exercised over any member of a
civilised community against his will is to
prevent harm to others. His own good, either
physical or moral is not a sufficient warrant. He
cannot rightfully be compelled to do or forbear
because it will be better for him to do so
because it will make him happier, because in
the opinion of others, to do so would be wise or
even right. The only part of the conduct of
anyone for which he is amenable to society is
that which concerns others. In the part which
merely concerns himself this independence is of
right absolute; over himself, over his own body
and mind the individual is sovereign”.
JS Mill (1859)
No man is an island, intire
of it selfe: every man is a
peece of the Continent,
apart
of
the
maine.
John Donne (1624)
Prevention; What measures
work best?
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Price
Availability (licensing Act)
Drink driving counter measures
Community action (night time
economy)
Early recognition plus Brief
interventions
The UK’s concentration on binge-drinking
youngsters and the antisocial or criminal
consequences of heavy drinking has allowed
politicians to project the problem onto a
small part of the population, which no doubt
suits the marketing strategies of the drinks
industry. When the Chief Medical Officer in
England called for a minimum unit price for
alcohol,
the
proposal
was
instantly
dismissed by Prime Minister Gordon Brown
in saying we “don’t want the responsible,
sensible majority of moderate drinkers to
have to pay more or suffer because of the
excesses of a small minority”.
Sir Ian Gilmour, Lancet, 2009
“We have decided to reverse the
previous Government’s plan to
increase the duty on cider by 10 per
cent above inflation and the
reduction will come intoeffect at the
end of this month – just in time to
celebrate England’s progress to the
quarter finals, or else to drown our
sorrows.”
George Osborne, Budget Statement
The Big Society Can Solve
Problems of Binge Drinking
“The truth is that problems associated with
excessive irresponsible drinking requires
that the new government recognise it. The
new government has rightly recognised that
the solution lies not in heavy handed state
action but a more nuanced approach that
seeks to utilise the powerful influences that
drive behavioural change.”
Chris Sorek, Telegraph, 7/9/10
UK Alcohol Consumption
Litres of pure alcohol consumption per capita in the UK,
1900-2006 [Tighe Brewer’s Statistical Handbook 2007]
Price & Consumption Trends
The Scottish Parliament
Established July 1999
Proportional representation
Reserved for Westminster :
Foreign Policy, Defence, Social Security, most fiscal
issues, Excise Duties, Drug Legislation
Devolved : Health, Education, Justice, Agriculture
Health Spend £10 Billion out of total £26 billion budget.
Scottish Strategy 2008
SCOTTISH PROPOSALS 2008
•No discount for multiple purchase
•Minimum retail price per unit
•No off sales to under 21s
•Social responsibility fee
•Separate alcohol retail areas
•Separate alcohol checkouts
•No under 18s to sell alcohol
• Lower driving limit and random testing
• Introduce widespread screening and brief
Intervention in Primary Care
• Substantial investment in care and
treatment services
Office National Statistics 2007
Liver Cirrhosis Death Rates 1950 - 2006
Updated for Scottish Alcohol Consultation. 2008
ALCOHOL RELATED DEATHS IN SCOTLAND 1990-2003
Mortality rates - Liver cirrhosis all ages per 100,000 per year
1957-1961
1987-1991
1997-2001
Men
Women
Men
Women
Men
Women
England
& Wales
3.4
2.2
8.3
5.4
14.1
7.7
Finland
9.9
5.5
23.8
8.1
28.7
9.9
France
48.4
19.9
31.9
14.1
28.1
10.8
Ireland
5.4
3.9
7.8
5.3
11.1
6.5
Scotland
8.2
6.1
16.9
11.1
34.4
16.1
Sweden
9.2
4.7
13.7
6.2
13.5
5.6
Source: Leon & McCambridge
Sales Data Neilsen analysis
2008
Population Scotland
16 +
2005
2006
Litres
11.9
11.6
pure
alcohol
England
10.1
10.0
2007
11.8
9.9
What is SHAAP?
 An independent medical advocacy body
 Set up in November 2006 by the Scottish
Medical Royal Colleges and Faculties with
start-up funding provided by the Scottish
Executive
 To provide authoritative medical opinion
on the impact of alcohol on health.
SHAAP Advocacy
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Influencing policy for whole population
approaches including regulatory policies such as
controls on price and availability.
Promoting the public health case for protecting
young people from experiencing alcohol-related
harm.
Highlighting third party damage caused by
alcohol.
Advocating for effective treatment for people with
alcohol-related problems and appropriate training
for clinicians.
Collaborating with UK, European and
international colleagues to advocate for the public
health interest in alcohol policy.
Tackling the Issue - Price and Availability
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Alcohol 62% more affordable in 2005 than in 1980.
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Large increase in the amount of alcohol bought in shops,
supermarkets and off-licences.
SHAAP would like to see:
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New Licensing (Scotland) Act, restricting the ability of pubs and
clubs to run cheap drinks promotions, extended to cover
supermarkets, off-licences and corner shops
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The discretionary code in the Act requiring alcohol to be displayed
separately from other goods made a mandatory condition
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Stricter enforcement of laws relating to alcohol sales.
Who drinks the cheap booze?
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64% of all cheap off-trade alcohol is consumed
by harmful drinkers (only 9% by moderate
drinkers).
26% of harmful drinkers’ alcohol is “cheap”,
17% of moderate drinkers’.
Meier 2008
The Licensing Objectives
- Prevention of Crime and Disorder
- Securing Public Safety
- Preventing Public Nuisance
- Protecting and Improving Public Health
- Protecting Children from Harm.
Tackling the Issue
-Treating People with Alcohol Problems
SHAAP would like to see:
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Effective treatments from brief interventions to
residential programmes available to people with
alcohol problems
Staff trained and supported to deliver evidencebased interventions
Services of sufficient capacity to meet the needs
of the populations they serve.
SCOTTISH GOVERNMENT PUBLIC HEALTH ALLOCATIONS 08/09
Increased screening for alcohol misuse will have a knock-on
effect on the volume of downstream services required. As a
consequence the overall package delivers a considerable
uplift in funding for early intervention and treatment
(including support for newly identified dependent drinkers),
and for prevention activities.
Where appropriate, services should comply with guidance
contained in the Health Technology Assessment Report 3
on Prevention and Relapse in Alcohol Dependence.
Tackling the Issue
- Educating Doctors about alcohol
Doctors of tomorrow need to be educated about alcohol
problems to be able to detect problems and treat patients.
SHAAP would like to see:
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A core curriculum on alcohol for both undergraduate and
postgraduate medical education
The five Scottish Medical Schools, the Deaneries, the Royal
Colleges and NHS Education Scotland collaborating to
deliver a core curriculum on alcohol across the career span
Training for medical students and doctors on the potential
for alcohol-related impairment in themselves and accessing
help for a medical student or doctor.
MINIMUM PRICING – WHO WINS?
- The public’s health
- Deprived communities
- Heavy drinkers or their families
- Moderate drinkers
- Pubs and restaurants
- Premium Brands
- Small retailers
ALL OF THE ABOVE
SCOTTISH GOVERNMENT PROPOSALS 2009
- A Minimum Price for Alcohol
(Example of 40p per unit.)
- No discounts for multiple purchase. (3 for 2, 20 for 12)
Age limit of 21 in off sales.
Social responsibility fee to pay for city centre management.
More support and treatment.
Trends in Drinking Venue
Scot Gov / Nielsen 2010
The 1990s
35p per unit
The 2000s
30p per unit
20p per unit
Perception of Alcohol as a
Problem
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60% Adults (16+) viewed alcohol as
a serious issue in Scotland
46% reported that people being
drunk or rowdy in public places had
an effect on their own quality of life
People living in the most deprived
areas were more likely to be affected
by alcohol use
(SCVS)
What do you need for a public health strategy ?
-Involvement
NHS public health, Local authority health
Improvement, Police, retailers and producers.
-Information
National and local. Health, crime, sales data
-Monitoring
Key performance indicators. (Improved health,
Less crime, child welfare, reduced consumption.)
Inequalities and Mortality in Scotland
Death Rate per
100,000 population
2001
Leyland et al, Medical Research Council 2007
SHAAP
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www.shaap.org.uk
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Tel 01312473667
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Tom Roberts
12 Queen Street,
Edinburgh. EH2 1JQ