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Coalition's alcohol policy comes under attack

The Coalition Government’s alcohol policy has come under sustained attack by the Insitutue of Alcohol Studies and other health aligned organisations, which have decided to boycott the Government’s Responsibility Deal with the alcohol industry.

The Government’s policy to ban ‘below cost’ sales of alcohol has been dismissed as almost wholly ineffective in reducing alcohol harm by alcohol and health NGOs and even by sections of the alcohol industry.

And the Government has been condemned by the road safety community for refusing to heed the advice of its own experts and the police, and lower the drink drive limit.

Six alcohol and health organisations, led by the British Medical Association, that had been involved in a Coalition Government policy initiative, the Responsibility Deal for Alcohol (RDA), did their best to wreck its official launch by very publicly walking out of it. In briefings to the media they accused the Deal of being no more than diversion from the evidence-based alcohol policies likely to achieve a real reduction in alcohol harm, such as policies on pricing and availability of alcohol.

The other five organisations are the IAS, Alcohol Concern, the Royal College of Physicians, the British Liver Trust, and the British Association for the Study of the Liver. Later, Diabetes UK and the British Heart Foundation also withdrew their support from the Responsibility Deal, though their involvement had been with health issues other than alcohol.

At the time of writing, it appears that the remaining health groups in the Alcohol Network will continue to support the initiative despite some reservations. These are the Faculty of Public Health, Cancer Research UK and the National Heart Forum. The move coincided with a broader attack by the medical profession on the Coalition Government’s health policy, its plans for reform of the National Health Service in particular. On the day the RDA was officially launched, an emergency meeting of the British Medical Association urged ministers to withdraw the bill to reform the NHS so the plans could be looked at again. A motion of no confidence in Health Secretary Andrew Lansley was only narrowly defeated.

The Walk-out

The health organisations criticised the Coalition Government and the Responsibility Deal for being too close to the alcohol industry and for promoting policies lacking evidence of effectiveness. Don Shenker, Chief Executive of Alcohol Concern said it was “the worst possible deal for everyone who wants to see alcohol harm reduced. There are no firm targets or any sanctions if the drinks industry fails to fulfill its pledges. It’s all carrot and no stick for the drinks industry and supermarkets.”

However, Health Secretary Andrew Lansley rebutted the criticisms. He said that, in regard to tackling the alcohol issue, the Coalition was achieving more in months than the previous Labour Government had managed in years, and that it did the health organisations no credit to refuse to co-operate. He also defended the voluntary approach. He said: “We know that regulation is costly, can take years and is often only determined at an EU wide level anyway. That’s why we have to introduce new ways of achieving better results. The deals published today demonstrate the effectiveness of our radical partnership approach to deliver more and sooner.”

The Responsibility Deal

The RDA forms one part of a wider Responsibility Deal promoted by the Department of Health, which also takes in nutrition and obesity, physical fitness, health at work and behaviour change. The essential idea is to persuade the various industries relevant to these areas of health behaviour to sign up to the process of improving health by making pledges to undertake actions seen as helpful, for example in relation to improved labelling of food and drink products.

Launching the Deal, Mr Lansley said it showed how partnership and challenge can be the most effective way of tackling some public health objectives. Since September, five groups working on food, alcohol, behavioural change, physical activity and health at work had developed a series of pledges for action.

Key collective pledges agreed included:

  • Calories on menus from September 2011
  • Reducing salt in food so people eat 1g less per day by the end of 2012
  • Removal of artificial transfats by the end of 2011
  • Achieving clear unit labelling on more than 80 per cent of alcohol by 2013
  • Increasing physical activity through the workplace; and
  • Improving workplace health.

Supermarkets including ASDA, the Co-operative, Morrisons, Marks and Spencer, Sainsbury’s, Tesco and Waitrose are among more than 170 organisations which have signed up to the Deal. High street food outlets including McDonald’s, Pizza Hut and KFC have pledged to remove trans-fats and to put in place calorie labelling. Specifically in regard to alcohol, as part of the deal, Heineken is expected to announce it will reduce the alcohol strength of one of its leading brands, thought to be Strongbow, by 1% (currently 5.3%) by 2013. Asda has pledged to end front-of-store alcohol displays by the end of April and it will also give £1 million to community alcohol prevention projects.

The Responsibility Deal for Alcohol

The Responsibility Deal for Alcohol (RDA) is designed to provide a forum for discussing how agreed measures can be delivered across the whole of the alcohol industry, particularly at point of sale. It is co-chaired by Jeremy Beadles, Chief Executive, Wine and Spirit Trade Association and Professor Mark Bellis, Faculty of Public Health, and is supported by Paul Burstow MP, Minister of State for Care Services at the Department of Health.

The Coalition Government describes the alcohol pledges as showing how industry, along with health group partners and government, can help deliver the commitment to ‘foster a culture of responsible drinking to help drinkers stay within the NHS drinking guidelines’.

Drink producers and retailers, including Diageo, Carlsberg, Majestic Wine and Constellation, the producer of well-known brands including Hardys, Echo Falls and Stowells, have pledged to provide clear unit labelling, support awareness campaigns and develop a new sponsorship code on responsible drinking. The pledges open up the possibility of alcohol health messages appearing on alcohol products and in settings where alcohol is sold and consumed.

The main alcohol pledges are

We support tackling the misuse of alcohol in order to reduce the resulting harms to individuals’ health and to society, in particular through the implementation of the following pledges:

  • A1. We will ensure that over 80% of products on shelf (by December 2013) will have labels with clear unit content, NHS guidelines and a warning about drinking when pregnant.
  • A2. We will provide simple and consistent information in the on-trade (e.g. pubs and clubs), to raise awareness of the unit content of alcoholic drinks, and we will also explore together with health bodies how messages around drinking guidelines and the associated health harms might be communicated.
  • A3. We will provide simple and consistent information as appropriate in the off-trade (supermarkets and off-licences) as well as other marketing channels (e.g. in-store magazines), to raise awareness of the units, calorie content of alcoholic drinks, NHS drinking guidelines, and the health harms associated with exceeding guidelines.
  • A4. We commit to ensuring effective action is taken in all premises to reduce and prevent under-age sales of alcohol (primarily through rigorous application of Challenge 21 and Challenge 25).
  • A5. We commit to maintaining the levels of financial support and in-kind funding for Drinkaware and the “Why let the Good times go bad?” campaign as set out in the Memoranda of Understanding between Industry, Government and Drinkaware.
  • A6. We commit to further action on advertising and marketing, namely the development of a new sponsorship code requiring the promotion of responsible drinking, not putting alcohol adverts on outdoor poster sites within 100m of schools and adhering to the Drinkaware brand guidelines to ensure clear and consistent usage.
  • A7. In local communities we will provide support for schemes appropriate for local areas that wish to use them to address issues around social and health harms, and will act together to improve joined up working between such schemes operating in local areas as:
    • Best Bar None and Pubwatch, which set standards for on-trade premises
    • Purple Flag which make awards to safe, consumer friendly areas
    • Community Alcohol Partnerships, which currently support local partnership working to address issues such as under-age sales and alcohol related crime, are to be extended to work with health and education partners in local Government
    • Business Improvement Districts, which can improve the local commercial environment.

A full list of the companies signed up to the alcohol pledges is available at: http://responsibilitydeal.dh.gov.uk

The attack on the Deal

In a statement, IAS and the other health organisations said that they were unable to support the RDA for a range of reasons:

  • The overall RDA policy objective to ‘foster a culture of responsible drinking’ does not adequately address the need to reduce alcohol-related mortality and morbidity.
  • The RDA drinks industry pledges are not specific or measurable and have no evidence of success.
  • The RDA process has prioritised industry views and not considered alternative pledges put forward by the health community. These have included proposed pledges:
    • not to advertise alcohol based on price,
    • not to advertise in cinemas for under-18 films
    • and to include health warnings on all drinks products.
  • The scope of the RDA is extremely limited. It does not tackle issues of affordability, availability or promotion of alcohol, and focuses on voluntary interventions with no evidence of effectiveness. There is no evidence that we have seen to show that Government is working towards a comprehensive, cross-departmental strategy to reduce alcohol harm, based on evidence of what works, with rigorous evaluation metrics. There has been no commitment made on what alternative actions Government will take if the RDA pledges do not significantly reduce levels of alcohol-related harm.

The organisations called on Government to provide:

  • A clear and firm commitment on how it intends – via evidence based policy – to tackle affordability, availability and promotion of alcohol as part of a cross-government strategy, with rigorous evaluation metrics
  • A clear presentation of the steps that will be taken if the current RDA objectives are not met in 12 months time
  • A firm commitment to consider change - including through regulation - if voluntary commitments from business are not met after an agreed time period.

Katherine Brown, Head of Research and Communications at IAS, said:

“We have serious reservations about the level of importance placed on the Responsibility Deal as providing a solution to the problem of alcohol in the UK. The RDA pledges are not based on evidence of what works, and were largely written by Government and industry officials before the health community was invited to join the proceedings. Furthermore, there are no hard outcomes attached to the pledges, which rely heavily on evaluation by the industry.

“We cannot endorse a process in which the alcohol industry is invited to co-create and self-regulate health policy. There is clearly a conflict of interest between industry economic objectives and public health goals of reducing alcohol consumption and associated harms. This has been highlighted by two Parliamentary Select Committees and the World Health Organisation. The most effective means of reducing alcohol related harm is through adjustments in affordability, availability and promotion. These policies are supported by a broad evidence base and have been recommended to Government by a recent cross party House of Commons Health Committee report. The Responsibility Deal fails to address any of these policy areas and we are yet to see any real proof that Government is looking into developing a cross departmental comprehensive alcohol strategy, based on evidence of what works.” As well as issuing the statement, the new Director of IAS, Dr Adrian Bonner, also wrote a letter to Health Secretary Andrew Lansley formally withdrawing from the initiative and elaborating on the reasons for doing so. Similar letters were sent from the other health organisations. Most of these letters stated that “policies outlined in the current RDA pledges – product labelling, workplace policies, unit information, education and voluntary marketing codes- have little if any impact on alcohol related harm.” The BMA letter also criticised the Coalition Government for appearing to ‘start from scratch’ in regard to alcohol policy, when in fact there had been two previous attempts by government to deal with the alcohol problem, and the evidence and experience required was readily available.

Government Response

In reply, Mr Lansley said that while the BMA and others were criticising the level of importance placed on the Responsibility Deal, the Government had made it clear from the start that it was just one strand of the Government’s public health policy.

He said that the Treasury had announced the results of their review of taxation, including the introduction of a new tax on super-strength beers. The Home Office had made their announcement on a ban on sales of alcohol below duty plus VAT, “an important first step in linking price to alcoholic strength”. And the Home Office had also introduced legislation to overhaul the Licensing Act to give stronger powers to local areas “and end the 24-hour drinking culture”. All this action, Mr Lansley said, had been taken within less than a year of office, as promised in the Coalition programme for Government just last May. Far from ‘starting from scratch’, the Government was making rapid progress where necessary, and amending poor legislation where required. On the commitments contained in the Responsibility Deal, Mr Lansley said: “you say there is little evidence that labelling and consumer education will deliver public health benefits on their own. Yet even the Health Select Committee on Alcohol from last year says people have a right to know the risks they are running. We recommend that information and education policies be improved by giving more emphasis to the number of units in drinks.”

Mr Lansley continued:

“…….The Responsibility Deal has achieved more in the last six months than the previous Government’s Coalition for Better Health did in a year and a half. What is more, this is only the first step. …..I would have liked the health partners to make more of their role within the Alcohol Network to challenge industry to be more ambitious. Instead, I understand valuable time was taken up repeatedly going over arguments around pricing, which we made clear at the outset would be addressed elsewhere. It does no credit to health partners to throw away a chance to play a constructive part in developing challenging targets with industry. I would also like to point out that we have also taken on board the concerns of health partners that they were not being given an equal voice in the network. Mark Bellis of the Faculty for Public Health has been appointed as a Co-Chair of the Alcohol Network Group. I hope you would continue to assist Mark with the necessary input and support from health partners to carry out this function effectively.”

In regard to the need for a cross-cutting, evidence based Government Alcohol Strategy, Mr Lansley pointed out that he had already announced his intention to publish such a strategy. He hoped the BMA and other health groups would co-operate in helping to determine its scope and content.

Origin of the Deal

When first announced, the Responsibility Deal was seen as controversial and it received considerable adverse publicity. Sections of the media, as well as opposition politicians, accused the Coalition of ‘selling out’ public health interests to big business. The Guardian newspaper ran a campaign against the Deal. It reported that ‘Public health interest experts are still trying to absorb the scale of Lansley’s pro-business shakeup’, and suggested that ‘Lansley’s public health reforms are seen as a test case for wider Conservative policies on replacing state intervention with private and corporate action’. The newspaper quoted Professor Sir Ian Gilmore, Chairman of the Alcohol Health Alliance, as saying “I am very concerned with the emphasis on voluntary partnerships with industry. We have to understand that their agenda is very different.” The Labour Shadow Public Health Minister, Dianne Abbott, who was reported to be shocked by the Deal, actually demanded an inquiry by the health select committee to review the Responsibility Deal “that gives industry a key role in deciding Government action on alcohol misuse and obesity.” Presumably, however, Ms Abbott’s Labour Party colleagues had failed to inform either her, or the Guardian, that the policy that so shocked her was actually their own, for the Responsibility Deal is, in reality, the Coalition’s version of Labour’s ‘Coalition for Better Health’. This brought together senior decision makers from across the health agenda, including major industry, public sector and NGO partners, and was designed to bring together “those organisations serious about playing a part in tackling the big health and wellbeing challenges facing us today”, with an initial focus on precisely the same policy areas featured in the Responsibility Deal: alcohol, work and health, obesity and physical activity.

The stated objectives were:

  • Alcohol - How can we support the third of adults who drink too much, to change their behaviour?
  • Obesity - How should we be reversing the rising tide of adult obesity?
  • Health & work - How can we use workplaces significantly to improve the health of employees?
  • Physical activity - How do we get 2 million people more active by 2012?

The Labour Government set up Leadership Groups on each of these areas, comprising leading figures from business, NGOs and professional organisations. These groups were intended to convene two to four times a year for half-day working sessions, with the first meetings taking place in autumn 2009. Coalition members would chair the groups and the Department of Health would provide venues, resources and secretariat support.

See also: Partnerships for better health

The bodies involved in the alcohol section of the Coalition for Better Health were largely the same as those who would later participate in the Responsibility Deal, such as the Portman Group and the BMA.

However, there was no media campaign against Labour’s Coalition for Better Health, and there were no walk-outs by any of the participating organisations. A record of one of the meetings by a representative of one of the health groups noted “Initial discussions revealed an acute awareness of conflicts within the group, but a willingness to seek common ground.” However, it may simply be that the coming general election put a stop to Labour’s initiative before it reached the point when the divisions between the different factions became too great.

Labour’s Alcohol Strategy

The Responsibility Deal on Alcohol is also the direct descendant of the specific partnership arrangements between Government and alcohol industry that were at the heart of the Labour Government’s National Alcohol Strategy. The Memorandum of Understanding in regard to the industry-funded Drinkaware Trust, referred to in the RDA agreement, was drawn up by the Labour Government and signed on 29 June 2006 by the head of the Portman Group and Government Ministers from the Department of Health, the Home Office, the Scottish Executive, the Welsh Assembly Government and the Northern Ireland Office.

There was an additional Memorandum of Understanding drawn up in 2007 by the Labour Government, in the person of the then Public Health Minister, Caroline Flint, and the alcohol industry in regard to the labeling of alcohol products with information on alcohol units and the sensible drinking message, including a warning in regard to the dangers of alcohol in pregnancy. The Memorandum stated that “The Government intends to work in partnership with and with the support of the alcohol industry and with Drinkaware to raise awareness of the sensible drinking message (SDM), and to progress relevant actions arising from the new English Alcohol Strategy expected to be published in June 2007.”

It is these very proposals for product labelling which have now been resuscitated by the Coalition Government through the RDA. Moreover, the Labour Government’s move towards unit labeling of alcohol products was a response to years of pressure from the alcohol and health lobby, both in the UK and at European level. For example, despite now appearing to dismiss unit alcohol labelling as having little or no effect on alcohol harm, on its web site the BMA itself is still calling for “Details of the unit content of the drink, along with safe maximum intake levels and a warning about the health risks of excessive drinking (to be) printed on standardised labels on all alcoholic products. Also in all printed and electronic advertisements and at the point of sale.”

The alcohol industry’s reaction to the prospect of improved labelling has been mixed. While some drinks companies and trade associations have sometimes come round to supporting the idea, and to undertake labelling voluntarily, somewhat ironically, in view of the current attitude of the health organisations, others have opposed it as an expensive waste of time, which could not be expected actually to reduce alcohol harm.