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"Supermarkets exhibiting the morality of a crack dealer" Select Committee told

The House of Commons Health Select Committee was told that “supermarkets are exhibiting the morality of a crack dealer” by expert witness Professor Martin Plant and he stated bluntly “Cheap alcohol kills people.” Professor Plant added ‘I think the option that the Chief Medical Officer and also the Scottish Government have picked of minimum unit pricing is very powerful because it has a trivial effect on the great majority of people who would only have to pay five or six pounds a year more for their alcohol; it would save 3000 lives a year; it would cut the number of days lost in absenteeism; it would cut hospital admissions and alcohol-related crimes by many, many thousands; it would also save a million pounds a year.”

The Committee has considered evidence from medical and public health experts, academics working in addiction and substance misuse research, and experts in the historical and geographical context of alcohol misuse.

Witnesses pointed out that the problem of alcohol-related harm is significantly underestimated.

Professor Ian Gilmore, President of the Royal College of Physicians, stated that the 8000 deaths per year from alcohol quoted by the ONS relate “almost entirely to alcoholic sclerosis. It does not pick up the accidents, the violence and so on. If you include cases where alcohol is named on the death certificate as a contributory cause then the fi gures rise to about 15,000 but if you criteria for obesity the figures would …. probably be about 300,000.”

Dr Peter Anderson said that Government policy had allowed alcohol to become much more affordable, with supermarkets selling alcohol at undercut prices, and that marketing had had a major impact: “…price and availability matters – if price goes down, consumption and harm go up, if availability is restricted there is less harm.”

The witnesses from the health lobby agreed that education and information campaigns on their own don’t work but that putting in good legislation and enforcing it would shift people’s behaviour, adding that regulatory controls on advertising would be much more effective than self regulation (as Dr Anderson put it, “don’t ask a bird to clip its wings”). Professor Gilmore suggested that tax relief on drinks industry advertising should be abolished, and that the resulting money could be used for public health campaigns run by the Government. Witnesses also suggested that focus should be put on the harms done to people other than the drinker with at least 15% of crime on Friday and Saturday night being alcohol-related. The Committee heard that 30% of patients have been drinking before an attendance at an A & E department, rising to 70% on a Saturday night, that 6% of ambulance calls were alcohol related (an 11% increase from last year) and that between 10pm and 2am in the morning on Thursday, Friday and Saturday nights 20% of ambulance work is alcohol-related.

The Committee considered the findings of Dr Petra Meier’s research for the Department of Health*, evaluating the effect different policies would have on drinking levels and associated harm, together with a research report produced by RAND for the European Commission which looked at the link between alcohol affordability, consumption and harms across the whole of the EU.

Dr Meier said that school based education, public service messages and product labelling were not very effective policies but that linking taxation to strength of alcohol was a very good idea in public health terms and Ms Rabinovitch, of RAND, agreed, saying that an increase in taxation where it leads to significant increases in price can have a very important effect in terms of reducing consumption and harm.

Discussion about point of sale information and layout of stores revealed differing views on the subject of separate alcohol areas in stores. Jeremy Beadles, of the Wine and Spirit Trade Association, said that the policy would increase alcohol sales if people had to go through a separate purchasing experience. This opinion was contrary to evidence from the Sheffield University research that the policy would result in a 40% decrease in sales.

The Industry view on minimum pricing was that heavy drinkers are less sensitive to pricing than moderate drinkers and the industry also asserted that alcohol was already more expensive in the UK than in other EU countries. However, Mr North, speaking on behalf of Tesco, stated:

“we are very prepared to play an active and constructive role in discussions on minimum pricing, or, indeed, the whole issue of pricing … for that to be effective it has to be done across the industry rather than on a unilateral basis.” *Independent Review of the effects of alcohol pricing and promotion.


 

Comments

Dr Peter Anderson:
A unit of alcohol -

“In scientific terms it is eight grams or ten millilitres of pure alcohol and that equates to a half pint of ordinary beer, a small glass of wine (about 110 or 120 millilitres of 10% wine) and a single pub measure of spirits. However, as you know, glasses are getting bigger and drinks are getting stronger. A significant number of pubs and restaurants will offer only 250 millilitre glasses of wine which is one third of a bottle. If it is a 14% red wine that will contain about four units......We should think rather more in terms of risk related to consumption…there is no safe level; there is a lower risk of harm.”

Alcohol related harm as a problem for the NHS:

“…there are nearly a million alcohol related hospital admissions a year, you convert the 75%-plus of presentations after midnight (which) are alcohol related, the burden on the NHS is absolutely huge. It is a preventable problem.”

 

Dr Petra Meier:

“50p per unit minimum price would add just £12 a year for moderate drinkers but £163 a year or more for someone drinking at harmful levels.”

Findings from Dr Meier’s research:

  • Minimum pricing would affect supermarkets and off licenses more than bars, clubs and restaurants because they tend to sell alcohol at cheaper prices.
  • 50p minimum would prevent 3,400 deaths and reduce the number of hospital admissions by 98,000 per year.
  • Different tax rates for strengths of alcoholic drinks would have a positive effect on public health and reduce binge drinking.


Professor Robin Touquet:

“…alcohol has, pro rata, got cheaper;… the availability, and the perniciousness is that young people feel, “No government would give 24-hour availability at cheap prices if alcohol was dangerous; after all, they would not do that for heroin or cocaine. They do it for alcohol; alcohol must be safe.” … it sends a wrong message to the young that alcohol must be safe; and alcohol is not safe.”

 

Expert witnesses on the health side have, so far, included:

Professor Ian Gilmore, President, RCP
Dr Peter Anderson, Public Health Consultant
Professor Martin Plant, Professor of Addiction Studies, UWE
Dr James Nicholls, Senior Lecturer, Bath Spa University
Dr James Kneale, Lecturer in Human Geography, UCL
Professor Mike Kelly, Director, CPHE, NICE
Dr Lynn Owens, Nurse Consultant, Liverpool PCT
Professor Robin Touquet, St Mary’s Hospital, London
Dr Petra Meier, Senior Lecturer in Public Health, Sheffield University
Ms Lila Rabinovitch, Analyst, RAND Europe

And representing the industry:

Mr David North, Community and Government Director, Tesco
Mr Jeremy Blood, Chief Executive, S & N, BBPA
Mr Jeremy Beadles, Chief Executive, WSTA

 

What the public health witnesses felt should be done to reduce alcohol-related harm:

  • Minimum unit price
  • Adjustments to the tax structure
  • Take action on price promotions and city centres
  • Have separate areas for alcohol in supermarkets, with separate tills
  • Restrict the marketing of alcohol
  • Increase government work in licensing, labelling and taxation
  • Have a national strategy based on bringing down overall consumption levels in the population as a whole, especially among people who consider themselves to be sensible drinkers
  • Take public health into account when granting licenses
  • Make a major investment in helping family doctors and nurses do more to help people who are at risk in drinking
  • Increase numbers of alcohol health workers – in primary and secondary care
  • Increase screening intervention in primary care
  • Change culture to recognise alcohol as a population-based problem
  • Have a designated clinical lead who can help patients navigate systems