Cosy consensus with drinks industry mitigates against public health
Despite over 15 years of policies and strategies on how to reduce our alcohol intake as a nation, our problematic alcohol use continues. Last Friday (30 January 2010) was the closing date for public submissions to another government initiative to develop alcohol policies as part of a new overall National Substance Misuse Strategy. There have been a series of national policies on both alcohol and illicit/illegal drugs but up to now they have been separate. So what is significant about this is for the first time alcohol is being named as a drug and included in a new drugs strategy – contrary to the best intention of the drinks’ industry. But what is extraordinary is that the drinks industry is on the government’s own Steering Group to develop proposals for a National Substance Misuse Strategy. How cosy is that?For decades the public health community has been calling for alcohol and illicit drugs to be considered together because in terms of drug misuse, alcohol does far more harm than all the other illicit drugs put together. Illicit drug misuse causes very real harm but it is to a much smaller section of the population whereas alcohol’s harm is population wide.
In general all the stereo types about irish as drinkers are true
- we drink much more than our European neighbours
- we have higher rates of binge drinking – over half of all drinkers binge drink at least once a week ( 6 or more standard drinks)
- while our consumption increased consistently between the 1960s and 2001 (especially btw 1995 & 2001), it decreased between 2001 & 2003. Since 2003, it has levelled off but no need for complacency as still far to high (SLAN 07)
- All the relevant documents can be found here if you are interested
- Our excess is also evident in under age drinking which is the highest in Europe
- It is also evident in violent crime & road traffic injury and deaths,
And we know very clearly about the health impacts – the immediate and long term costs of accidents, assaults and violence from alcohol but also the longer term costs of chronic diseases such as cancer, cardio vascular diseases & mental illness. Not to mind the social impact of alcohol excess and abuse which is much harder to quantify but perhaps its harshest impact.
Our alcohol intake can be mapped clearly against hospital admissions and deaths – so there were huge increases in alcohol related hospital admissions btw 1995 and 2001, then it levelled off but has increased again since 2004 (alcohol related liver disease up by 147% btw 1995 and 2004). Alcohol related deaths doubled btw 1995 and 2004.
In terms of money, the government’s own 2004 alcohol task force report estimated it cost Ireland in excess of €2.65 billion a year.
Yet we know exactly what can be done about it, so why is it not working? We have a plethora of documents & strategies clearly outlining the issues – an alcohol policy, two strategic task force reports (02 and 04) – all from the Dept of Health. A HSE policy on alcohol related harm and a very good Report of the Government Alcohol Advisory Group from the Dept of Justice both published in 2008. But there has been very little action and no legislation from the Dept of Health, ever.
So what works is a combination of strategies. Public education is important and changing our Irish culture of drinking is crucial but unfortunately education and awareness do not work alone although it’s the one area in which we have been relatively active. Really we only change our behaviour when we see the consequences of not doing so. For example we all stopped using plastic bags when a charge for them was introduced. Drink driving is going down because people know they are much more likely to be breath tested due to randomised breath testing and to be penalised if caught – harsh enforcement combined with significant public awareness campaign alongside political leadership works. But this has been clearly missing in public health. And both Matin Culllen and Noel Dempsey provided leadership on the drink driving front.
Most of the above mentioned reports as well as a Joint Oireachtas Committee on Health have all recommended
- controlling or banning advertising – we know there is a direct relationship between advertising and intake in particular among young people eg stopping the alcohol sponsorship of sporting events would be significant, plus many of the ads and brand are directly targeting young people – although they say they do not. For more information see recent work in the BMJ
- availability is very important and instead of decreasing alcohol availability they have increased it – huge increase in off licenses and off sales – also discount selling so its easier to get a tray of beer a bottle of wine for much cheaper than before.
- Linking price to alcohol content –UK Chief Medical Officer has come out in favour of this – in Ireland we have increased the price of alcohol in the last election
- But price increase works – it is thought that the drop in consumption btw 2001 and 2003 was directly linked to increases in taxes on cider and spirits.
Yet the inaction from a public health perspective is directly connected to the role of the drinks whose power can not be under estimated. Even in the new drugs strategy ‘industry’ is at the table. It is a very powerful lobby, the drinks companies are largely, very profitable, transnational corporations who are at the table and therefore INVOLVED in developing things like Code of Advertising and sponsorship!
Now ‘industry’ says its actively against alcohol abuse and harmful consumption and they tell us all to drink sensibly plus they participate in all these voluntary codes eg with having drink sensibly at the end of their ads but the ad is so much more powerful that the little slogan at the end. Plus the codes are voluntary….
No matter how well intended government is, if the drinks industry is at the table (and they continue to be) , we will never introduce legislation to ban advertising and reduce availability. At the moment, it’s a cosy consensus between government and the drinks industry (just like the cosy consensus that exists between business and government, and banking and government)… and hence we are very ineffective in reducing the harmful effects of alcohol consumption.
It is only when laws are changed, laws like the smoking ban, the plastic bag tax, the drink driving laws, the coal ban for smog (introduced by Mary Harney in a previous life), do we actually change our behaviour. Also legislation and changing behaviour needs political leadership and this is what you get remembered for – so if our leaders want a political legacy, play hard ball, stand up to the vested interest and do it through legislation… yet unfortunately there is little evidence that this government is going to go for curbing our alcohol habit as its legacy….