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National Alcohol Strategy - Challenge to Government

There has been a huge increase in drinking among women and teenagers and a comprehensive national strategy is essential if the problem is to be tackled.

Alcohol Concern in its newly published Proposals for a National Alcohol Strategy for England points out that 11 to 15 year old are consuming on average 8.4 units a week - an increase from 5.4 units between 1990 and 1996. At the same time women's consumption rose from an average of 5.4 units to 6.3 units a week.

At the launch of the report in the House of Commons, Don Touhig, MP, the joint chairman of the all-party alcohol misuse committee, stressed the need for a national strategy, especially since, at the moment, 12 separate government departments had some say in alcohol policy. Mr Touhig also said that it was important to involve all interested parties. A wide range of agencies and organisations contributed to the report, including the Institute of Alcohol Studies, but the Portman Group, which speaks for the drink industry, refused an invitation. The alcohol manufacturers are anxious to avoid any measures which might restrict their operation and hope to convince the government that the alcohol problem is confined to a small body of abusive drinkers. The Brewers and Licensed Retailers Association (BLRA), whilst declining to participate in the Alcohol Concern exercise, has made a submission to the Department of Health on what it calls a Strategy to Combat Alcohol Misuse. One of the main aims of this is to disparage the argument, accepted by almost every European government and by the World Health Organization (WHO), that a reduction in per capita consumption has a direct effect on the level of alcohol-related problems. Sources close to Tessa Jowell, the Public Health Minister, state that the present British Government is at one with the drinks industry on this.

Alcohol Concern's report, reflecting an awareness of this situation, treads carefully when discussing any lowering of the national level of consumption. One proposal is that there should be a "taxation trigger to prevent serious escalation in alcohol consumption and alcohol misuse: excise duties continue to rise broadly in line with inflation, but if consumption of pure alcohol rises substantially to more than 8 litres per head of the population, excise duties should be set at a rate designed to return levels of consumption to those existing at the introduction of the Strategy." The most recent figures show that the current rate of consumption per head of the population is 7.6 litres per annum (9.4 litres for those aged 15 and over). Clearly, Alcohol Concern's proposal for a taxation trigger set at 8 litres is extremely modest but, even so, it is by no means certain that it will find favour with Mrs Jowell whose public statements have echoed the vocabulary of the Portman Group and who is anxious, above all, to avoid the accusation of nanny-statism. There is no mention in the document of the WHO's first European Action Plan on Alcohol which envisaged a 25 per cent decrease in alcohol consumption starting from a base line of 1980, a target which most wine-producing countries have met. There has been some speculation as to why the UK has chosen to take a lone stance on this issue.

The report states that the "operational Aims which inform the whole Strategy are:

  • To reduce the level of alcohol induced ill health

  • To reduce the number of alcohol related injuries

  • To reduce the rate of alcohol related crime

  • To reduce the number of alcohol related road accidents

  • To reduce economic loss in the workplace due to alcohol misuse."

It is certainly difficult to see how these will be achieved without a reduction in overall consumption.

The Government is anxious to reform the Licensing Laws and in this context, the report says:

"Licensing continues to be needed to regulate the sale and consumption of alcohol because of its intoxicating and addictive properties, its potential to damage health and contribute to nuisance and disorder. Determining within a legal framework the ages, times and location of purchase and consumption, the three primary aims of licensing should be to protect the young, to prevent disturbance and disorder, and to control excessive consumption in the interests of health and safety."

The Home Office's proposals will be presented towards the end of the year and the key points made in Alcohol Concern's report will be taken into consideration. They see the aim of any changes to the licensing laws as needing to reduce "alcohol related assaults, criminal damage, nuisance, public disorder and underage drinking, and promoting health and discouraging intoxication through the following measures:

  • The creation of a system of two licences - a premises licence and a personal licence - to be granted by a trained licensing panel of locally elected councillors and magistrates.

  • The local authority membership to be responsible for the premises licence, linking licensing decisions with local plans made under the Crime and Disorder Act (1998) and with town planning. Decisions to reflect annual local licensing plans, developed within the parameters of national criteria which require that the drinking environment, management procedures and location of licensed premises promote the safety of drinkers and the public. Supported by the introduction of a national set of licensed premises conditions which provide options to enable local circumstances to be met.

  • Magistrates to have responsibility for the personal licence attached to the licensee and portable between premises. Affecting a person's character and livelihood, this will be a judicial decision made according to national criteria setting out standards of personal integrity, former management and retail conduct, experience, and training.

  • Introduction of obligatory training for licensees, encouragement of training of other staff through a requirement on licensees to draw up a staff training plan, and the obligatory registration of licensed premises' door staff.

  • National promotion of the voluntary 'Citizencard' designed to prove age when buying products with an age limit: the purchase or supply of alcohol on behalf of under 18s for public, unsupervised consumption to be made illegal."

ALERT Comment

Alcohol Concern has necessarily had to reconcile divergent views. It has succeeded in producing a coherent strategy which the government would be well-advised to implement. It is regrettable, of course, that the industry and the Portman Group chose to stand aloof and rely on their own influence to argue such case as they have to the Public Health Minister, Tessa Jowell. There is, of course, no absolute necessity for them to be involved in a national strategy if the government is willing to use legislation and has the resolution to do something effective about the alcohol problem. However, this is unlikely to prove the case. Already Mrs Jowell has called for public health organisations to work more closely with the drink industry.

The government, we are told, is against the per capita consumption argument. This in itself indicates that it is firmly on the side of the drink industry and against the weight of medical and scientific opinion. Mrs Jowell recently launched the product labelling initiative. As part of this, a new leaflet prepared by the Health Education Authority, Think About Drink, which promotes the sensible drinking message, will be distributed in 70 per cent of supermarkets and off-licenses in the United Kingdom. Retailers who have signed up to the initiative and will ensure that unit content will be displayed on alcoholic drink include Asda, Safeway, Sainsbury's, Tesco's, Unwin's, Oddbins, Marks and Spencer, First Quench, Budgens, Somerfield, the Co-op, and Waitrose. The industry's contribution is being co-ordinated by the Director of External Affairs of Seagram. Seagram, of course, is the company which has been particularly aggressive in its approach to liquor advertising in the United States and which has been generous in its funding of front organisations. The parent company will no doubt be delighted to see its influence being so effectively exercised in this country.

The Conservative Party has always been criticised for its indebtedness to the brewers, although in 'Health of the Nation' it at least attempted to achieve a more coherent alcohol policy than previous governments had managed. It will be ironic if the Labour government proves to be even more compliant with the alcohol industry than their predecessors.

Closely connected with licensing laws is community safety. According to the report, the aim should be to reduce alcohol related crime and disturbance in public places and around drinking places. Alcohol Concern suggests the following measures:

  • A requirement that alcohol misuse is addressed in local audits and plans made under the Crime and Disorder Act (1998).

  • Providing good practice guidance to local authorities and the police, with particular emphasis on prevention practice in relation to the management of the environment in and around drinking venues.

  • Developing proposals to enhance the role of public transport in preventing alcohol related disorder.

  • Introducing a toughened glass requirement and a ban on the sale of alcohol in glass bottles in on-licensed premises.

The industry and its agents dislike the phrase "alcohol related" and question the association, obvious to anyone else and clearly proved in numerous pieces of research, of alcohol with violence and crime. Speaking at the launch of Proposals for a National Alcohol Strategy for England, Chief Superintendent Martin Jauch, of the Association of Chief Police Officers emphasised the importance of adopting strategies for dealing with the variety of offences which are alcohol related. He also made the point that "enforcement alone cannot work. Changes of culture are needed." Drinking patterns needed to change. Superintendent Jauch pointed to the success of legislation in the case of drink driving. Thirty years ago prosecution for this offence tended to elicit sympathy whereas now it is regarded as the consequence of totally unacceptable behaviour. Dr O'Neill, representing the British Medical Association (BMA), said that he favoured the 50mg limit and random breath testing, but he also said that there should be a link between penalty and treatment.

In discussing drink driving, Alcohol Concern makes proposals to reduce the number of alcohol related road accidents through:

  • The permissible level of alcohol in the blood when driving to 50 mgs of alcohol per 100 mls of blood.

  • Introducing general breath testing powers for the police, with guidelines to prevent harassment. Developing proposals for public transport designed to reduce the incidence of drink-driving, with particular emphasis on late night provision.

  • Introducing a requirement that pre-sentence assessments in drink-driving cases include consideration of making a treatment order: increasing scrutiny of high risk offenders' drinking problems prior to their being regranted a licence.

  • Continuing public education in relation to drink-driving, to include an increased component within driving test training and alcohol education in schools."

Dr Bill O'Neill also emphasised the need for a change in society's attitude to alcohol when he spoke at the launch. He stressed the need to refer to alcohol as a drug. Dr O'Neill brought up the subject of advertising and marketing and the question of whom the industry is targeting. He was in favour of labelling, health warnings, and the education of licensees in their responsibilities and the dangers inherent in their trade.

Alcohol Concern addresses the subject of the promotion of alcohol in the report and says that alcohol publicity regulations should balance the right to freedom of speech with the need to protect the young and to provide the public with balanced information to enable informed choices to be made in relation to health and safety. Its proposals are intended to promote "a more balanced portrayal of alcohol consumption and its outcomes in the media, together with the protection of young people from product promotion or media influences which may encourage them to drink alcohol prematurely or to excess in later life, through the following measures:

  • Introduction of proposals to encourage a more balanced portrayal of alcohol and to reduce the volume of references to alcohol in broadcasting.

  • Proposals to reduce alcohol advertising in the cinema particularly in relation to films with certificates permitting under 18s to attend.

  • A review of the content and interpretation of the advertising codes in order to reduce the numbers of advertisements likely to appeal to young people; the establishment of independent monitoring and adjudication arrangements to regulate sponsorship, packaging and merchandising of alcoholic drinks, with a view to protecting the young.

  • Regular monitoring of alcohol promotion by trading standards departments nationally.

Allied to this are the measures suggested to help in a change of attitudes to alcohol. Here the aim is to enhance people's capacity to make informed choices about their drinking habits and to increase awareness of the full range of support facilities available, through:

  • An annual national campaign involving television and other media, posters and leaflets, supported by complementary local initiatives and tailored campaigns.

  • Government guidance to health and local authorities recommending the inclusion of alcohol misuse public education within Health Improvement Programmes and crime and disorder plans.

  • Strengthening alcohol education for young people through specific guidance to schools; the development of parent education initiatives; an audit and update of alcohol teaching materials; an evaluation of alcohol education methods and recommending of most effective practice; and enhancing the role of youth work in alcohol education.

  • Establishing a network of major employers to develop flagship alcohol education programmes, increase the number of employers with effective polices, and develop ways of accessing the unemployed.

  • A statutory requirement that the packaging and promotion of alcoholic drinks includes information on the unit content of the product, set in the context of the sensible drinking message.

Jean Coussins, the director of the Portman Group, said that the government should not "interfere unfairly with the responsible drinking majority." She was opposed to "blanket solutions" and was in favour of targeting those she described as "the minority who abuse alcohol," reflecting the drink industry's desire to narrow the definition of "alcohol abuse". The alcohol problem is an issue with far wider implications than those arising from addiction or severe abuse. Alcohol Concern's proposals do, of course, deal with the extremes of abuse. They make clear that those in need of support and treatment, whether they are in the early stages of the development an alcohol problem or are already dependent drinkers, should have access to appropriate and quality alcohol services. At the moment, provision is unco-ordinated and falls short of providing those in need with access to minimum core services. "Core services should include," says the report, "outreach work; screening for alcohol problems in primary care and hospital settings, minimal interventions and brief treatments within primary health care, hospital and alcohol service settings; longer term specialist remedial treatment, including detoxification and counselling services in supported and day care settings, or in residential units for severe cases where support is lacking; self-help support groups; support for the children and partners of problem drinkers."

One of the problems of the current situation is that the funding of alcohol services comes from a range of sources - local authorities, the health service, the probation service. The services are provided by a variety of statutory and non-statutory agencies and there is a pressing need for effective co-ordination.

The report's proposals are aimed at providing "access to core alcohol support and treatment services through:

  • Funding the additional costs of providing minimum levels of access to core services.

  • Placing a requirement on local and heath authorities to provide alcohol services, produce annual plans and establish joint commissioning arrangements.

  • Supporting this requirement with guidance recommending:

    1. The range of core services to be provided (services targeting hard to access population groups to be developed once core services have been established);

    1. The establishment of an alcohol co-ordinating resource in each area to facilitate delivery of packages of care which address multiple needs, including the interface with mental health, illicit drug use and social welfare problems;

    1. good practice in respect of dual diagnosis (mental health/alcohol) cases;

    1. a requirement that each general hospital has a strategy for detecting and responding to alcohol problems;

    1. the provision of stable core funding for services with contracts of a minimum three years duration;

    1. the promotion of minimum service standards;

    1. the inclusion of alcohol targets within Health Improvement Programmes, with targets set for each agency responsible for funding alcohol services, including the health authority and Primary Care Groups, social services and the probation service.

  • Ensuring that health authorities rather than Primary Care Groups have the principal planning role in relation to health service provision in order to prevent fragmentation.

  • Developing pump prime funding options for alcohol services in general hospitals and primary health care settings.

  • Expanding the courts' drugs testing and treatment orders to include alcohol.

  • Including alcohol support and treatment in the service specification of prisons.

  • Undertaking a review of specialist and generic training.

  • Ensuring that alcohol is addressed in all national and local strategic developments relating to health and social welfare.

Alcohol Concern, presuming that the government follows all the proposals, estimates that by the end of the strategy's first five year term there would be a 5 per cent reduction in the level of alcohol abuse and a consequent minimum annual saving of £542.7 million. The report concedes that 5 per cent is a conservative target but the sums involved indicate the vast cost alcohol abuse is to society and are a reflection of the burden of pain and despair on the individual.

The Government's white paper, Saving Lives: Our Healthier Nation, published on 6th July, 1999, states that the broad aims in tackling alcohol abuse are:

  • to encourage people who drink to do so sensibly in line with out guidance, so as to avoid alcohol-related problems

  • to protect individuals and communities from anti-social and criminal behaviour related to alcohol misuse

  • to provide services of proven effectiveness that enable people to overcome their alcohol misuse problems

The white paper echoes recent statements by Public Health Minister, Tessa Jowell. that there is a rôle for the drink industry in constructing an alcohol strategy. Consultation will begin later in the summer and and the strategy will be published early next year.