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.  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 until now they have been separate. 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 wishes of the drinks’ industry.  

It is extraordinary 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 between 1995 and 2001), it decreased between 2001 and 2003. Since 2003, it has leveled off but is still far to high (SLAN 07)
• All the relevant documents can be found here if you are interested
• Our excess is also evident in underage drinking, which is the highest in Europe
• It is also evident in violent crime and road traffic injury and deaths

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 mention the social impact of alcohol excess and abuse, which is much harder to quantify but has devastating effect.

Our alcohol intake can be mapped clearly against hospital admissions and deaths – so there were huge increases in alcohol related hospital admissions between 1995 and 2001, then it levelled off but has increased again since 2004 (alcohol related liver disease rose by 147 per cent between 1995 and 2004).  Alcohol related deaths doubled between 1995 and 2004.

In terms of money, the government’s own 2004 alcohol task force report estimated that alcohol abuse 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 Department of Health. A HSE policy on alcohol related harm and a very good report of the Government Alcohol Advisory Group from the Department of Justice, both published in 2008. But there has been very little action and no legislation from the Department of Health, ever.

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 will 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. For more information see recent work in the BMJ
• Reducing availability - instead of decreasing alcohol availability they have increased it – huge increase in off licenses and off sales – also discount selling so it’s 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
• price increases work – it is thought that the drop in consumption between 2001 and 2003 was directly linked to increases in taxes on cider and spirits

The inaction from a public health perspective is directly connected to the role of the drinks industry, whose power cannot 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 centrally involved in developing things like Code of Advertising and sponsorship.

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.

Only when laws are changed, laws like the smoking ban, the plastic bag tax, the drink driving laws, do we actually change our behaviour. 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 those with vested interests and do it through legislation. Unfortunately there is little evidence that this government is going to go for curbing our alcohol habit as its legacy….