Monday, 24 July 2017

Time to act on price of alcohol?

Is it time to enforce minimum unit pricing for alcohol in the United Kingdom? The latest evidence provides further impetus to those campaigning to limit the sale of alcoholic drinks.

Alcohol misuse is the biggest risk factor for death, ill-health and disability among 15-49 year-olds in the UK, and the fifth biggest risk factor across all ages, and alcohol related problems are estimated to cost the NHS around £3.5 billion annually. In 2015, there were over 8,000 casualties of drink driving accidents in the UK including 220 fatalities and 1,160 serious injuries. Alcohol kills. So does price matter?

Alcohol is now 60% more affordable than it was in the 1980s, particularly because of big discounting of price in the major supermarkets.

Responding to the latest findings that almost 63,000 people in England will die over the next five years due to alcohol misuse, Professor Dame Parveen Kumar, BMA board of science chair, said:

“The BMA has repeatedly called for the introduction of minimum unit pricing across the UK – a call that is all the more urgent as 35 people a day in England are expected to die from alcohol misuse in the next five years.

“Minimum unit pricing in Canada has already seen a significant reduction in wholly alcohol related deaths. Time and again, it has been decisive, if overdue, action by successive governments, such as the public smoking ban, that has had more impact than a single doctor can have in a lifetime.

“While minimum pricing alone won’t solve all alcohol misuse problems, combined with work on education, marketing and the availability of alcohol, it will play an important role in reducing alcohol related harm and the financial burden this places on an already overstretched NHS.”

A 2008 model produced by the University of Sheffield suggested that a high enough minimum price could significantly reduce the impact and cost of alcohol to society. They also argued that drinking behaviour could be profoundly influenced by price as problem drinkers seek out the cheapest drinks.

The evidence that alcohol consumption goes down when price goes up is fairly strong, and government health advisers have concluded that ministers should introduce minimum unit pricing. In their report published last year the concluded:

“Policies that reduce the affordability of alcohol are the most effective, and cost-effective, approaches to prevention and health improvement … Implementing an MUP [minimum unit price] is a highly targeted measure which ensures any resulting price increases are passed on to the consumer, improving the health of the heaviest drinkers who experience the greatest amount of harm. MUP would have a negligible impact on moderate drinkers and the price of alcohol sold in pubs, bars and restaurants.”

The previous coalition government originally committed to implementing minimum unit pricing, but this has since been dropped. The alcohol industry and the supermarkets form a powerful lobby. But the promise to introduce minimum pricing was welcomed by Tesco because its own survey had found excessive drinking and the anti-social behaviour it causes is one of the public's most serious concerns. It was also backed by the British Liver Trust.

Then Health Secretary Andrew Lansley welcomed Tesco's "swift decision" to support introduction of MUP, saying:

"There is a vast social and financial cost attached to irresponsible drinking. We need to tackle not only issues of supply but also the behavioural drivers that lead to irresponsible behaviour".

There are of course arguments on all sides of the issue. It is a balanced choice. The consideration is whether the benefits of MUP outweigh any concerns. Some point out that alcohol is not a 'disease' of the poor, and price isn't the only factor. That is certainly true. Most adults in the UK consume alcohol and its use both influences, and is influenced by, social and cultural norms.

As a report published last year by the Centre for Public Health points out "there are no figures available to determine what proportion of the estimated 13 million adults who live in poverty overlap with the categories of problem drinkers". Nevertheless it concludes that interventions that target price are likely to have the greatest impact on national consumption and reduction in alcohol related harms.

It is no doubt one of those issues that get kicked around because of 'insufficient evidence'. This was also said repeatedly by the tobacco lobby when concern was raised about smoking and health. It took decades before effective action was taken on cigarette sales, and while that debate went on more people died necessarily from smoking related cancers and cardiovascular disease.











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