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Posts Tagged ‘minimum pricing’

Very long faces in the West Country this week. Despite much pressure from the health lobby, Alistair Darling has chosen to ignore calls for minimum pricing of alcohol, and instead has imposed a hefty tax hike on cider. In Wednesday’s Budget statement, the Chancellor announced a duty increase of 10% above inflation for cider compared with 2% above inflation for other alcoholic drinks across the board.

In recent years cider has enjoyed something of a tax holiday, making it a firm favourite among young people with little money and big thirsts. Cider has been a cheap way to binge-drink, and the budget hike is intended to bring it back into line on duty and price.

But are above-inflation tax hikes the best fiscal strategy for tackling alcohol misuse – especially binge-drinking by young people? Why the aversion to minimum pricing as an additional measure?

The problem with hikes in duty is that they can be easily absorbed by the supermarkets, which continue to offer cheap drink as loss-leaders to draw people into their stores. Many deeply discounted drinks are currently being offered at less than the cost of VAT, and these tend to be the very lines, such as strong ciders, lagers and alcopops, that are especially popular with young people.

Minimum pricing, on the other hand, has to be passed on to the customer. By fixing a minimum price per unit of alcohol sold – in other words, banning ultra-cheap offers on booze – the government can ensure that no drink can be bought at less than, say, 50p per unit, the figure recommended by England’s Chief Medical Officer as an ‘immediate priority’ over a year ago. This would mean no less than £5.50 for a 2-litre bottle of normal-strength cider (compared with many current offers under £2), £6 for the average six-pack of lager and £4.50 for a typical bottle of wine – more for higher strength versions.

The impact on health could be considerable. Consumption is closely linked to price, and a team at Sheffield University have calculated that, with a minimum of 50p per unit, every year the UK could see: 3,393 fewer deaths, 97,900 fewer hospital admissions, 45,800 fewer crimes, 296,900 fewer sick days, and a total benefit of over £1 billion. The deterrent effect and health benefits would be greatest for the heavier drinkers, especially those with the least disposable income.

With an election in the offing, the tax versus minimum pricing issue has split the parties. The Lib Dems are likely to be for it, Labour against (after Gordon Brown’s flat refusal to accept the CMO’s recommendation last year) and the Tories somewhere in between (on selected types of drink favoured by young people). In Scotland the parties line up differently – perhaps distorted by the distilleries – and the SNP-led efforts to drive through legislation are having a rough ride.

But, after the election, there’ll be all to play for. My guess is that common sense will break out and minimum pricing will soon be on the statute book as a useful adjunct to increases in duty. It won’t be either/or, but both/and. There’s still a chance that, just as it did with smoke-free legislation, Scotland could lead the way.

Or perhaps a fresh lot of Westminster MPs will see the light, and a ban on deep discounting of booze could be one of the early benefits of a hung parliament.

Good news for the nation’s health – but maybe less so for the apple-growers and cider-makers of the West Country.

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Sir Liam Donaldson, the Chief Medical Officer has published his Annual Report 2009 this week. In the report the CMO highlights the key areas of public health requiring action and looks at progress made since previous annual reports.  One issue that he reflects on is the damage caused by “passive” drinking and the recommendation he made for a minimum price for alcohol in his last Annual Report.

FPH President Professor Alan Maryon-Davis  commented:

We’re strongly behind Sir Liam on this issue. The government should never have bottled out with minimum pricing. It makes total sense to ban ultra-cheap booze. We call on this government and future ones to reconsider all the evidence that is available.

In fact, the CMO’s Report refers to FPH’s public health manifesto calling for minimum pricing earlier this year:

The Alcohol Health Alliance UK brings together the Royal College of Physicians, the Royal College of Surgeons, the Academy of Medical Royal Colleges, the Faculty of Public Health and 20 other such organisations. To see such a group of medical bodies speaking together with one voice is very powerful. They speak in particular of the passive harms of drinking. They, too, call for a minimum price per unit.

Other professionals have echoed this call. The Faculty of Public Health represents 3,000 public health specialists from the United Kingdom and elsewhere. The Royal Society for Public Health has 6,000 members from health-related professions. In January 2010, these two institutions joined forces to publish a public health manifesto. It listed 12 actions that government could, and should, take to tackle a range of public health concerns. The first action on the list was a minimum price per unit of alcohol. (p.16)

The major challenges the Annual Report discusses this year include climate change and health, the benefits of physical activity on health and risk of cold weather on health.

FPH has produced a booklet about climate change and health called Sustaining A Healthy Future – A Special Focus on the NHS .

There is plenty of evidence about alcohol minimum pricing being the best public health intervention to problem drinking, for instance an independent review by the School of Health and Related Research at Sheffield University.

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If home is an English(wo)man’s castle, it seems it’s now also his and her local. Until now homes have been uncharted territory for studies of where, why and how people drink. But at the Royal Geographical Society’s ‘Drinking Spaces and Places’ seminar on Britons’ drinking habits in town centres and rural communities, parks and pubs, London and the regions, it was the home that took centre stage.

One of the single biggest factors in how our drinking habits and tastes have changed in the last 100 years or so has been the creation and growth of supermarkets, according to Dr James Kneale from University College London. His presentation on the history of drinking patterns in Britain also showed that the rise of the now ubiquitous stores has been phenomenal in the modern times: the number of off-licences rose by 40% in five years (1996-2001). A lot faster than on-licences. And apparently one of the fastest growing groups of ‘home-drinkers’ is women – they choose to drink at home more and more often, perhaps because alcohol harm is less visible there.

What are the reasons for drinking at home? As well as being more affordable than going down to the pub, Professor Gill Valentine from Leeds University and Dr Sarah Holloway from University of Loughborough found that their study respondents drank to relax, to entertain friends, to lift their mood and even to treat depression. Some people were also ‘aspirational’ in their drinking: having a glass of wine with a meal every night was likened to cultures in the Mediterranean. Their study also found alarming ignorance of what constitutes harmful drinking. Many respondents thought, for instance, that if they took exercise and ate a healthy diet, drinking to harmful levels wouldn’t put them at any risk.

According to Elizabeth Fuller from the National Centre for Social Research families have a significant influence over the way in which young people drink. She looked at the drinking habits of 11 to 15 year olds – the age group when most young people try alcohol – and linked them to their home environment. Apparently, children of parents who were tolerant towards their drinking are more likely to drink than children whose parents weren’t. However, if the latter did drink, they were more likely to drink outdoors, to hide their drinking, and take part in other risk-taking behaviour such as drug-taking, smoking and truancy. It could be suggested then that drinking in the home environment might lead to a more balanced and healthier relationship with alcohol – assuming of course that the parents provide their children with a responsible role model.

There’s no question, however, that drinking is a huge problem. Eric Stark from the Government Office for London highlighted that drinking behind closed doors at home can exacerbate domestic violence, another significant public health issue.

There was a clear consensus at the event that a behaviour change is necessary and the most effective intervention would be to make alcohol less available. Emilia Crighton, the Faculty’s Scottish Convenor, presented strong evidence on how alcohol minimum pricing would help curb drinking in Scotland, a particular problem spot in the UK.  But it was also agreed that minimum pricing alone wouldn’t solve everything. What is needed is for public health campaigns to challenge the image of binge drinking. The issue is, as Professor Valentine and Dr Holloway pointed out, that drinking to a harmful level in a rural community in Cumbria doesn’t match the unruly and chaotic scenes in town centres all around the country on a Friday night. The majority of people do not relate to images like this and therefore do not realise that the way they drink might be putting them and people around them at risk.

Enjoying a drink at home in front of the telly or with friends at dinner doesn’t have to be a guilty pleasure. But the rise and rise of home drinking does pose a tricky challenge to policy makers and public health practitioners alike, and needs to be looked into more if we’re to understand the nature of Britain’s booze culture.

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By Dr Emilia Crighton, chair of the Scottish committee of the Faculty of Public Health.

So the government has decided to bring in a ban on pub and club drinking promotions that encourage people to drink fast and furiously. Licensees will face fines of up to £20,000 or face a prison sentence, under this new tougher code of practice.

This is definitely a step forward in attempting to tackle a British drinking culture that encourages people to see drinking large volumes of alcohol as an achievement to crow about to friends, rather than a threat to their health.

The introduction of the mandatory code of practice banning irresponsible promotions; the need for age verification policies; and ensuring smaller measures are available, acknowledges the failure of the voluntary arrangements that have been in place until now.

Making pub and clubs offer free tap water to customers, from April, should also be welcomed. Drinking water could help drinkers slow their consumption of alcohol and tackle dehydration.

As the FPH has regularly argued, alcohol consumption in the UK has doubled over the last 40 years and the average consumption of alcohol in the population is directly linked to the amount of harm. Increases in alcohol consumption have been driven by an increase in off sales, which now represents around 51% of alcohol volume sales, up from 24% in 1980. Consumption is strongly linked to affordability: as price has fallen, consumption has risen. Alcohol is now 69% more affordable than thirty years ago. The increased affordability of alcohol has been driven by the off sales sector.

Tackling price and availability are the most effective alcohol policies aimed at reducing alcohol related harm. Research produced by the team at Sheffield University which modelled the effect of different levels of minimum pricing on alcohol consumption indicates increasing impact on consumption with increases in price. For example the introduction of a minimum price of 40 pence per unit in Scotland would have a very small effect on consumption (-2.7 per cent), while at 50 pence and 60 pence, there would be significant changes in consumption (-7.2 per cent and 12.9 per cent respectively). The higher the price, the lower the consumption, and the lower the harm caused by drinking.

However, the government needs to go further. The introduction of a minimum price per unit of alcohol sold will have the highest financial impact on harmful drinkers.  People who drink within the sensible drinking guidelines will hardly be financially affected.   For example, if a 40p minimum price was introduced, it is estimated that a moderate drinker’s spend on alcohol would go up by £11 per year (21p per week), but that of a harmful drinker, who tends to buy more, cheap alcohol, would go up by £137. The increased prices in alcohol could be offset by lower prices for food and non alcoholic drinks by the supermarkets.

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The Faculty of Public Health today publishes our joint manifesto on public health, alongside the Royal Society of Public Health. 12 Steps to Better Public Health offers a dozen practical recommendations that, if adopted by the next government, will improve the UK’s health and well-being for the new decade.

The joint public health manifesto calls for:

  1. A minimum price of 50p per unit of alcohol sold
  2. No junk food advertising in pre-watershed television
  3. Ban smoking in cars with children
  4. Chlamydia screening for university and college freshers
  5. 20 mph limit in built up areas
  6. A dedicated school nurse for every secondary school
  7. 25% increase in cycle lanes and cycle racks by 2015
  8. Compulsory and standardised front-of-pack labelling for all pre-packaged food
  9. Olympic legacy to include commitment to expand and upgrade school sports facilities and playing fields across the UK
  10. Introduce presumed consent for organ donation
  11. Free school meals for all children under 16
  12. Stop the use of transfats

The full manifesto is available to read here, and the front-page Guardian story, with an accompanying podcast from our President Alan Maryon-Davis, is available to read here.

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In the last couple of months, alcohol minimum pricing has been widely, and often fiercely, debated. To add to the discussion, the Faculty of Public Health decided to conduct a survey of its 3,000 public health specialist members to see what they thought.

Out of the 274 Faculty respondents the vast majority (87%) supported the policy of a mandatory minimum price for alcohol.

59% were in favour of raising the alcohol price to 60p per unit.  A level of 50p per unit was voted for by 35%, and only 5% thought 40p per unit was sufficient.

Professor Alan Maryon-Davis commented: “There’s a lot of evidence showing that cheap drink is fuelling Britain’s booze culture and ruining so many lives.  We need to set a minimum unit price that’s high enough to deter heavy binge drinkers without hitting too hard the much greater number of people who drink sensibly and moderately.”

The noughties saw the ban on smoking in public places.   Perhaps the next decade will witness the introduction of minimum pricing for alcohol.

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It could have been a big day for public health in Scotland. It could have been the day when notice was served on Scotland’s ugliest health blight – its rising tide of binge drinking, drunkenness and alcohol-related illness and injury.

On Thursday this week, Health Secretary Nicola Sturgeon introduced the Alcohol etc (Scotland) Bill – a raft of proposals including further restrictions on drink promotions, powers to raise the legal purchasing age to 21 and, most controversially, mandatory minimum pricing to banish all those special offers of ultra-cheap drink at ‘pocket-money prices’ lining supermarket shelves

Everyone knows Scotland has the worst alcohol problem in the UK, indeed in most of Europe. We’ve seen its alcohol-related death rates doubling in the last 15 years, and alcohol-related liver disease rising faster than almost anywhere in the world.

Drink now kills about one person in 20 in Scotland and costs the country at least £2.25 billion in extra services and lost productivity. This toll is nothing less than shocking and amounts to a huge public health crisis that demands to be tackled with steady determination.

The SNP-led Scottish Government’s Alcohol Bill looked set to do just that until it came up against the combined machinations of party politics and the drinks trade.

Just hours before the Bill was launched, the Scottish Labour Party finally decided to join the Tories and Lib-Dems in declaring themselves opposed to the minimum pricing proposal. Unless deals can be done and sensible compromises reached, this element of the Bill will fail, knocking a great hole in the new legislation.

Needless to say this is all a massive disappointment to the supporters of minimum pricing, including all four UK Chief Medical Officers, the Royal Colleges of Nursing, Physicians, Surgeons and GPs, the UK Faculty of Public Health, the BMA, the Association of Chief Police Officers in Scotland and even the Scottish Licensed Trade Association.

We at the FPH have done all we can to bring the arguments to bear, and at our recent Scottish conference have pointed out the potential gains in health, wellbeing and lives saved if the minimum price were set at various levels. Alcohol consumption is closely associated with price – and the higher the minimum is set, the more it would deter heavy drinking. But too high a price would be punitive for the great majority who drink moderately and sensibly – and could encourage crime and smuggling – so a compromise would have to be reached through rational, informed debate.

I hope that the Scottish Parliamentary process will allow such debate to take place. I hope that Labour’s newly declared position is tactical and that they will at least offer enough support to the minority SNP government to permit proper discussion. Their current argument that minority pricing is ‘probably illegal’ under EU law seems very weak when stacked up against the hugely pressing social and humanitarian issue that heavy drinking in Scotland has undoubtedly become.

This week could have seen a major step being taken on the way to better health for the people of Scotland. Despite the latest setback, perhaps it still can be.

Let us have the debate – and let us see if, once again, Scotland can set an example to the rest of the UK by taking a strong, brave and decisive step for public health.

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