I attended a conference today. In among some very interesting and perceptive discussions about how important parents could be in supporting young people around alcohol issues and what they needed in turn to enable them to carry out this role, there were some inaccurate or misleading assertions and selective uses of statistics. There were several fairly self-congratulatory statements about the alcohol problem getting significantly better when in fact, as a population, we are drinking vastly more than we did 20-30 years ago and levels of alcohol-related harm, though they may not be at their peak, are still a huge cause for concern. I know that the statistics in relation to alcohol use will always be debated but alcohol industry retailers do not help clarify the position by maintaining their secrecy around sales figures.
Among today’s assertions, this one:
There are fewer young people drinking than ever before.
This was based on the annual schools survey in England and Wales, exclusively self-reported, which doesn’t in fact track back to “forever”. Nonetheless, the positive impression is given when in fact, the welcome recent reductions in young people’s use have come after a period of sustained year on year increases. As well as this, even though fewer young people may be drinking now than in the recent past, the drinkers are consuming vastly greater quantities than in the past.
If we take the long view, we can see that alcohol consumption in the UK was very high at the beginning of the twentieth century and then dipped significantly mid-century. Our current, albeit improving, situation is still markedly closer to those early twentieth century figures than to the mid-century position. Now, as then and in line with other health-related issues, the harm caused to poor and socially-disadvantaged communities is disproportionate. It is inexcusable and misleading to present only positive short-term improvements and ignore the sustained and serious increases in alcohol-related harms that have crept up and overwhelmed contemporary society.
Across Europe, alcohol is the world’s number one risk factor for ill health and premature death among the 25-59 year old age group and Europe is the heaviest drinking region in the world. The UK government (2012) estimates that in a community of 100,000 people, each year:
- 2,000 people will be admitted to hospital with an alcohol-related condition;
- 1,000 people will be a victim of alcohol-related violent crime;
- Over 400 11-15 year olds will be drinking weekly;
- Over 13,000 people will binge-drink;
- Over 21,500 people will be regularly drinking above the lower-risk levels;
- Over 3,000 will be showing some signs of alcohol dependence; and
- Over 500 will be moderately or severely dependent on alcohol.
In Scotland, the alarming rise from the early 1990s has now stabilised but alcohol-related harm continues to be at historically high levels with alcohol-related deaths more than doubling since the 1980s and alcohol-related hospital discharges more than quadrupling since the early 1980s. There were over 40,000 hospital discharges in 2007 and alcohol related mortality has more than doubled in the last 15 years. In addition, Scotland has one of the fastest growing rates of liver disease and cirrhosis in the world. The Scottish government (2009) estimates that alcohol misuse costs Scotland £2.25 billion every year.
A couple of today’s speakers usefully drew attention to the impact that easy availability of alcohol has on people’s behaviours. In support of this, WHO (2011) has argued that,
Of all alcohol policy measures, the evidence is strongest for the impact of alcohol prices as an incentive to reduce heavy drinking occasions and regular harmful drinking. The health gains are greatest for heavier drinkers and there are also considerable gains in the well-being of people exposed to the heavy drinking of others.
The BMA has identified minimum price per unit as the most effective of all available price-related policy options for reducing alcohol-related harm. Yet the alcohol industry has consistently tried to block statutory regulation which would impact on sales of the cheapest, most harmful products. Indeed, the Scotch Whisky Association is currently engaged in legal action to try to block the Scottish Government’s planned introduction of Minimum Unit pricing. One of the industry’s speakers today said that he “believed that it wouldn’t work”. This flies in the face of real-life evidence from Canada of the impact of the introduction of Minimum Unit Pricing there (Stockwell et al., 2012).
We need public health focussed interventions in the markets, permitted by national and international law and to my mind, required by laws of social justice, to change our drinking cultures and behaviours.
Instead of this, the overwhelming theme today was the need for more education and information campaigns. As a champion myself for many years of alcohol education and its continuing supporter, I also know that education on its own is not going to achieve very much. We should always interrogate claims that are made about interventions that are deemed to be effective, even where there do appear to be signs of positive impacts. For example, the most notorious high-level failure in drugs and alcohol education was DARE, a high profile multi-million pound programme that was delivered across the USA for decades with no significant impact. Even with Life Skills training, Gorman et al (2007, p.585) have argued that:
far from supporting the evaluators’ claims concerning the rigour of the findings and their generalisability and public health significance, the results are very fragile, of little practical significance and quite possibly analysis-dependent.
This is not to say that Life Skills training should not be promoted – indeed I would strongly argue the contrary case. We must not, however, overclaim for it. Stothard and Ashton (2000) argue that there is insufficient consistency in the findings to be confident that implementing Life Skills will cut legal or illegal drug use, only that it can do and has done, most consistently in relation to smoking.
Regarding information campaigns, the BMA (Hastings & Angus, 2009) has argued that:
while alcohol industry- sponsored marketing seems like a good idea, its public health value is questionable, and given its stakeholder marketing agenda, the effects are likely to be counterproductive. Such activity also focuses attention on individual rather than population level solutions, and can delay more effective statutory measures.
The BMA also argues that messages such as:
We promote responsible drinking and find innovative ways to challenge the national drinking culture and tackle alcohol misuse
reinforce the idea of ‘safe limits’ rather than relative risks and the impression is erroneously given that problems only arise when the product is used in specific ways , for which it is not intended.
Today’s conference facilitator called for more accurate representation of drinking behaviours in the media, arguing that we should celebrate the fact that the numbers who do drink are (according to him) falling quite sharply. I’m sorry but I think it’s a bit premature to be thinking about cracking open the (non-alcoholic) bubbly!
BMA Board of Science 2012, Reducing the affordability of alcohol, London.
Gorman, D.M., Conde, E., & Huber Jr., J.C. (2007). The creation of “evidence-based” drug prevention: a critique of the Strengthening Families Program Plus Life Skills Training evaluation. Drug and Alcohol Review, (26), 585–593.
Hastings, G. & Angus, K. (2009). Under the influence: The damaging effect of alcohol marketing on young people British Medical Association, London.
Home Office 2012, The Government’s Alcohol Strategy, London.
Scottish Government 2009, Changing Scotland’s Relationship with Alcohol: A Framework for Action, Edinburgh.
SHAAP 2007, Price, Policy and Public Health, Edinburgh.
Stockwell, T. et al. 2012, ‘Does minimum pricing reduce alcohol consumption? The experience of a Canadian province’, Addiction, vol. 107, issue 5.
Stothard, B., & Ashton. M. (2000). Education’s Uncertain Saviour. Drug and Alcohol Findings, (3).
University of Sheffield 2012, Model based appraisal of Alcohol Minimum Pricing and Off Licensed Trade Discount Bans in Scotland using the Sheffield Alcohol Policy Model v2 – Second Update, Sheffield.
World Health Organisation 2009, Global health risks, Geneva.
World Health Organisation Europe 2011, European Alcohol Action Plan 2012-2020: Implementing regional and global alcohol strategies, Geneva.