In the UK, alcohol abuse is a prime cause of morbidity & mortality, a burden on Accident & Emergency hospital admissions, and a major cause of antisocial behaviour. Last Friday (March 14) at the British Medical Association (BMA) Public Health Medicine annual conference in London, the Minister of State for Public Health, Dawn Primorolo, announced that the government intends to build upon its recent hike in alcohol tax. Their aim: to minimise alcohol- related harm and antisocial behaviour whilst enabling the enjoyment of social drinking.…
Antisocial behaviour is not the only concern: the serious health impacts now hitting both the 18-24 year and 35-40 year old groups in the population include liver disease, increased risk of cancer and cardiovascular disease. Ethically and fiscally the UK government is worried, and so is the public health community.
Though the increased price of alcohol is reckoned to affect most of the 7% of the population that drinks 1/3 of all the alcohol consumed in the UK, more needs to be done if we are to change public attitudes to make it unacceptable to drink to excess.
With this in mind, the Minister announced four new initiatives, all warmly welcomed by the meeting’s delegates:
- Commissioning of a study to be conducted by Sheffield University into price, promotion and the harm due to alcohol
- Introduction of a new health indicator by the end of 2008 which will measure hospital admissions due to alcohol misuse and related harms. This indicator will incentivise Primary Care Trusts to intervene earlier (she noted that many were already making alcohol a priority)
- Alcohol & drug abuse courses to be introduced over the next 3 years into the undergraduate medical curriculum
- For 2008/2009, immediate support for qualified doctors to receive evidence based e-learning training for identifying alcohol risk behaviour
Other measures are a £10 million national campaign to raise public awareness of what actually constitutes a unit of alcohol and a £3.2 million trailblazer study which will produce a toolkit to help and advise both GPs and the criminal system in handling clients with alcohol related problems.
Government policy on alcohol has been influenced by the WHO Report 2002 which rates alcohol as the 3rd highest risk factor for the top 10 diseases and injuries in developed countries, the recent BMA report Alcohol Misuse: Tackling the UK epidemic, as well as the health impact now seen in A& E admissions.
The BMA meeting itself was not dominated totally by the alcohol issue but considering the main topic of her address, all but one of the questions put to Dawn Primorolo concerned new ideas linked to reducing alcohol consumption. These included the removal of tax deductibility as a business expense for alcohol and sweets; the reduction in tax on smoothies and fruit drinks; licensing of pubs to serve food and drink, combined with equal promotion of non-alcoholic drinks; and to tax alcoholic drinks on the basis of actual alcohol content rather than by group, thereby making it cheaper to drink low alcohol drinks. The Minister’s treasury experience showed in her answers & was particularly appreciated by her audience.
Later discussion amongst the delegates raised the point that in mediterranean Europe and elsewhere, there is no concept of "buying rounds" and that a ban on doing this could make a substantial difference to consumption.
It’s ironic that over the North Sea in a country called Sweden, a culture of drinking to excess was successfully brought under control through a state-run brewery monopoly and strict alcohol control! Indeed the Nordic experience of random roadside breath testing of motorists whereby they reduced drink-driving by 30%, was used to support a conference motion that this be introduced into the UK! Sweden is now under pressure from the EU to relax its existing controls as the monopoly was "against the EU principle of free movement of goods, and that it was therefore not compatible with EU law". No wonder their public health community is worried…if their own experience hadn’t taught them already, they only have to look at the UK which expanded to 24 hour opening to create a " Mediterranean café attitude to drinking", with cheaper alcohol than 40 years ago thanks to supermarkets, and now is forced to deal with the consequences.
The BMA Public Health Medicine annual meeting is a way for members to set practice for their specialty and to influence health policy of the BMA, which in turn influences the government. Motions setting goals or providing specific interventions to improve public health are debated and carried forward to committee before passing to the BMA or are given more thought & researched over the next year. Most motions have their opponents so one can be assured that all aspects including "the nanny state" and increased government surveillance are considered. Areas debated this year were childhood obesity/poverty, advertising, health inequalities, transport, sexual health, primary care, health at work, health infrastructure, alcohol, health protection & policy & research, fluoridation.
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I can’t believe that in the twenty-first century it’s legal to consume anything that can make someone incoherent, unstable, out of control, and potentially dangerous to themselves and others. If we took booze as a pill, or smoked it, I bet it wouldn’t be legal then! But so important is it as a social stimulant, that whenever we need to go on medication of any kind, one of the first things people ask the doctor is, ‘Can I drink while taking this?’. Quite amazing!