Halt the epidemic of alcohol misuse

By Norma Beavers

Doctors' leaders are calling for tougher government action to halt the epidemic of alcohol misuse that has hit all sectors of the health service. While Alistair Darling, the Chancellor of the Exchequer, has increased the tax on alcohol much more remains to be done, said Dr Vivienne Nathanson, BMA Head of Science and Ethics. In his first budget Mr Darling said alcohol tax will go up by six per cent above inflation followed by two per cent above inflation for the next four years. This should boost Treasury coffers by 635m annually by 2010.

 The first alcohol price increases came into effect 16 March putting four pence on a pint of beer, 14 pence on a bottle of wine and 55 pence on a bottle of spirits. “These tax increases may be unpopular with some members of the public but we hope that they will look at the wider issue and recognise that the UK has a real problem on its hands regarding alcohol misuse. Tough action is needed. The UK is one of the heaviest alcohol consuming countries in Europe,” Dr Nathanson said.

Alcohol misuse not only costs lives it also costs the country many millions of pounds. The NHS spends millions every year on treating and dealing with alcohol problems and the criminal justice system also spends similarly large amounts dealing with alcohol-related and drink-driving offences. “The BMA is very worried about alcohol consumption among young people, particularly young girls. It is shocking that in Europe, the UK’s teenagers are most likely to be heavy drinkers,” she added.

Harpal Kumar, Chief Executive of Cancer Research UK, commented, “We are very pleased to see the significant increases on alcohol duty. Alcohol increases the risk for a number of cancers, including breast, bowel and mouth cancer. These increases in duty may help reinforce the message that people should drink moderately.”

To reverse the trend of heavy drinking tougher measures are needed to reduce the ease with which alcohol is purchased and its consumption by young people and children. Supermarket chain Tesco says it wants to see the government ban the sale of cut price alcohol especially to youngsters. Health Minister Ben Bradshaw said the government is willing to consider legislation if voluntary restraint fails. Ministers have already commissioned specialist research from KPMG, with a final decision due out this summer.

The BMA argues the government must now begin to show “leadership and implement a full range of effective control policies that will reduce the burden of alcohol misuse.” Dr Nathanson said: “As doctors we see first hand how alcohol misuse destroys lives. It causes family breakdowns, is a major factor in domestic violence, ruins job prospects, is often related to crime and disorderly behaviour and it kills. Alcohol misuse is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems. The government approach has led to increased consumption levels and alcohol-related problems and demonstrates a failure in the political drive to improve public health and order.”

In a just published report titled Alcohol Misuse: Tackling the UK Epidemic, the BMA puts forward its recommendations to reverse the trend of misuse. Recommendations include:

• higher taxes on alcoholic drinks. This has been enacted in the budget
• an end to “irresponsible promotional activities like Happy Hours and Two-for-One offers”
• standard labels should be displayed on all alcoholic products that clearly state alcohol units, recommended guidelines for consumption and a warning message advising that exceeding these guidelines may cause the individual and others harm
• the legal limit for the level of alcohol permitted while driving should be reduced from 80mg/100ml to 50mg/100ml throughout the UK.

Dr Hamish Meldrum, BMA Chairman of Council, said the report makes tough recommendations “but if the government is serious about tackling this issue this is what is needed. Since 1997, taxes on wine and beer in the UK have only increased in line with inflation while taxes on spirits have not increased at all. There is strong and consistent evidence that price increases result in reduced consumption and that increased opening hours are associated with increased alcohol consumption and alcohol-related problems. The government needs to act on this evidence.”

The Department of Health has pledged to improve public understanding of alcohol units and a national communications campaign is being planned to begin in April.

Don Shenker, Director of Policy and Services at Alcohol Concern, said: “The alcohol indicator in the new NHS indicator set ‘Vital Signs’ represents a real milestone for the appropriate prioritization of alcohol interventions. This is the first ever alcohol indicator for the NHS and provides a measure of both the impact of alcohol on health and NHS costs and the success of PCTs in tackling these issues. The fact that the indicator, ‘reducing the trend in alcohol-related hospital admissions’ also appears within the National Indicator Set for local authorities and the inclusion in Public Service Agreement (PSA) 25 is a real opportunity for local areas to tackle alcohol across the local planning spectrum through LAAs.”

PCTs are implementing local plans to educate their populations about the dangers of alcohol misuse. Liverpool PCT, for example, is investing  an additional £10 million over the next three years in alcohol programmes. The PCT has commissioned the Centre for Public Health John Moore’s University (JMU) to do data analysis of a wide range of research evidence. Public health intelligence and service data is reported to the PCT’s Alcohol Strategy Group. The information is then being used to commission and performance manage the Liverpool Alcohol Strategy and action plans. This intelligence is also used to monitor progress against the Local Area Agreement target to reduce alcohol related admissions to the Royal Liverpool and Broadgreen University Hospital NHS Trust resulting in a 24-hour hospital stay by five per cent within the next three years.