It is recognised that the three established ways of reducing excessive alcohol consumption are as follows: Increase price; Restrict availability; Control marketing
The three activities are largely determined ad controlled by government and political fiat. Until very recently, the political emphasis has been on the law and order issues concerning excessive drinking which meant that the relevant government office was the Home Office. However, from about 2010 onwards there has been much more interest from the Department of Health and from Public Health England. This change of emphasis is very much to be welcomed.
There has been a steady succession of government policies and strategies concerning alcohol since 2000. The main ones have been are outlined below.
The 2003 Licencing Act, was key legislation, but was mainly concerned with the licensing of premises. Only in Scotland was there a specific aim of improving public health. The Act catered for flexible opening hours including 24 hour licensing ad invested these powers in local authorities rather than Justices of the Peace. This typifies the main thrust of legislation on alcohol where the government is more concerned with the maintenance of law and order rather than the health benefits of reducing alcohol consumption.
This was followed by various government reports, for example in 2007 ‘Safe, Sensible, Sociable – the Next Steps in national Alcohol Strategy’ was published by the Dept. of Health, the Home Office, Dept, of Education and Dept. of Culture, media and Sport. This aimed to ensure that existing laws on alcohol consumption were used widely and effectively; it focused on the minority of drinkers, and especially young people who misuse alcohol. Reducing binge drinking and disorder in town centres was very much the driving motive.
In 2010 the House of Commons Health Select Committee reported on alcohol consumption. It was a comprehensive report dealing with all aspects of alcohol harm but at long last focusing on the health issues around drinking, mentioning, for example, alcohol as a cause of breast cancer. This changed the focus of debate to take a more comprehensive view of alcohol as opposed to considering it purely as a law and order issue.
The Alcohol Strategy 2012 underpins much of the current alcohol environment. This strategy was based on previous government strategies with a forward by the Prime Minister and forms the basis for current policies. It aimed at both the social harm and medical harm done by alcohol. It recognised that cheap alcohol had changed behaviour in recent years and acknowledged that the government had failed to tackle the problem.
A range of initiatives was brought in, mostly in the hands of local government to tackle the problem.
However, the strategy also aimed to share responsibility with industry. The key element to this was the Dept. of Health Responsibility Deal by which the alcohol industry has adopted a core commitment to foster a culture of responsible drinking through its won voluntary behaviour.
Industry took action by: Developing better product labelling; combatting under age sales; funding the Drinkaware website; reducing advertising; supporting local alcohol reduction schemes.
Taxation and Price Regulation
Evidence has shown that a rise in the price of alcohol is the most effective way of reducing consumption of alcohol, just as its increasing affordability since the 1960s has been the major cause of the rise in consumption. Alcohol taxes are included in the retail price of alcohol and VAT is included at the standard rate of 20%. Duty and VAT account for about 56% of an average bottle of wine in the shops and about 77% of a bottle of spirit.
However, due to reductions in duty, alcohol in the UK is now 60% more affordable than it was in 1980. It is now possible to exceed the lower risk guidelines for alcohol (14 units a week) for less than £2.50.
On a longer timeframe the following is notable: the duty on spirits was 60% of male average manual weekly earnings in 1947; in 1973 (when VAT was imposed in addition to duty) duty was 16% of earnings; by 1983 it was 11% and by 2002 it had fallen to 5%.
In general, an increase in price must be part of a wider policy aimed at changing attitudes to alcohol. There is a good deal of evidence to show that the number of heavy drinkers in society is directly related to average consumption. Living in a culture that encourages drinking leads to more people to drink to excess.
The Alcohol Duty Escalator
The duty escalator was first introduced by the Labour Government in 2008, and required alcohol duties to rise 2% above inflation, automatically each year. This was abolished in the 2014 budget by the Chancellor of the Exchequer, after extensive lobbying by the alcohol industry. In the same budget he also reduced the duty on beer and froze it on spirits and ordinary cider. Cuts cost the government at a time of austerity some £5bn.
In the 2017 budget, the duty on alcohol was restored to rising in line with inflation.
Minimum Unit Pricing (MUP)
MUP is floor price beneath which alcohol cannot be sold and is based o the amount of pure alcohol in a product measured in units or grams. Thus the more grams of pure alcohol in a bottle/can, the higher its price. It hits the biggest and hardest consumer and on-site trade. Large retailers cannot simply absorb price increases as can happen with other pricing policies.
MUP for alcohol was originally due to come into force in Scotland in 2013. However, the EU objected as it considered MUP to be a trade restrictive measure and that alcohol tax increases can achieve the same impact as MUP in reducing alcohol-related harm. The issue was sent back to the Scottish courts where there was further opposition from the drinks industry. In the end, the UK Supreme Court confirmed that the Scottish legislation was lawful and MUP was introduced in Scotland in May 2018 at 50p per unit of alcohol. Other parts of the UK are following suite although England has no intention of introducing MUP at the moment.
A further policy to address cheap alcohol is to restrict the use of multi-buy promotions such as ‘buy one get one free’ or ‘two for the price of one’ deals. Multi-buy discounts were banned by the Scottish governement in 2011. However, under the 2012 alcohol strategy in England the government came to the conclusion that such promotions had negligible effect and price promotions were not banned elsewhere.
Alcohol advertising in the UK is subject to controls that seek to prevent alcohol being attractive to young people. The control cover broadcast, print and online advertising and are a mixture of co-regulation (with Ofcom) and self regulation administered by the Advertisement Standards Authority (ASA) and the industry financed Portman Group. The latter covers marketing such as promotion, sponsorship and packaging.
There has been ongoing criticism of the alcohol advertising code for being ineffective and there have been constant calls for tougher laws such as the French Loi Evin which is clearer and tougher in its approach. There is no doubt that the procedures ad scope of marketing by the drinks industry needs to be reviewed especially with respect to new social media sites and sponsorship.
Information and Education
Information and education strategies are often viewed as the most popular approaches to the prevention of alcohol-related health problems. However, evidence suggests that without the support of other interventions such as controls of affordability, availability and promotions of alcohol, education does not lead to a sustained change in drinking behaviours. Nevertheless, although such strategies may not directly change behaviour, they can change attitudes and make more potent policies more acceptable.
Health Information on Alcohol Labels
In 2007, the Dept. of Health reached a UK wide voluntary agreement with the alcohol industry to include specified unit and health information on alcohol labels. This expectation has since been absorbed into the Alcohol Responsibility Deal which was designed to ensure that over 80% of products on the shelf by 2013 would have labels with clear unit content, health guidlines and a warning about drinking when pregnant.
In practice many of these warnings use such small fond size that they are almost illegible, and they are well below the standards applied to say, supermarket food. Additionally, measurements of alcohol used in labelling are little understood by the general public. There has been a tendency to ‘tick the box’ with respect to alcohol labelling rather than an honest attempt to deliver information.
Local Government – Direct Action
Implementation of public health policy has been under the aegis of local government since 2012. In practice they have very few tools at their disposal. The main tool with respect to alcohol policy are the licensing laws, the main one being the 2003 legislation, where except in Scotland, there is no mention of a health objective. The legislation was primarily for the implementation of law and order. It is difficult to see how local government can have much effect on the reduction of harm from alcohol.