Living Healthier and Longer: The Role of Alcohol

Overview

The Faculty of Public Health’s Special Interest Group on alcohol is committed to reducing the substantial ill health and premature mortality attributable to alcohol, and wider impacts of alcohol use such as domestic violence and accidents.

Despite the harmful effects of alcohol, it is widely accepted, available, promoted and advertised to such an extent it is difficult to avoid. It is essential that we tackle availability, affordability, advertising, promotion, and support for dependent drinkers, to reduce the harms associated with alcohol across the UK. We have highlighted some key recommendations for public health action and policy development.

FPH policy recommendations

Affordability:

• The successful introduction of minimum unit pricing (MUP) in Scotland, Wales and Ireland flags an ongoing anomaly in the efforts to restrict cheap high strength alcohol in England. We urge the adoption of a MUP throughout the UK.
• The effectiveness of 50p per unit has been eroded by inflation since its implementation in 2012. FPH therefore supports the recommendations of Alcohol Focus Scotland (AFS) and Scottish Health Action on Alcohol Problems (SHAAP)[1] that the MUP level is uprated to at least 65p per unit, and a mechanism is introduced to automatically uprate the price in the future. This will optimise the effectiveness of MUP in saving and improving lives.

Availability:

• To limit the display and promotion of alcohol within shops so that it is only visible to those seeking to purchase alcohol.
• To support public health teams to continue to restrict the availability of alcohol and reduce population health harms, by accounting for of the health and wider adverse impacts of alcohol in local decision-making processes around alcohol licensing.
• To address the imbalance of restrictions around availability and licensing activities focused on the on-trade sector, when the majority of harmful alcohol is purchased from the off-trade and supermarkets. Licensing boards should exercise additional scrutiny and control over any new sales license where an area has an excess of alcohol harms. In Scotland the mechanism for integrating this would be an overprovision assessment.[2] For the rest of the UK, this would be through the establishment of cumulative impact assessments/zones[3].

Advertising/marketing/promotion:

• To restrict the advertising and promotion of alcohol, including television, sports, public events, and small-scale community or sporting events where alcohol is offered as a prize or promotion.
• To be mindful of the potential adverse ‘industry-framing’ of No & Low alcohol products[4] to evade marketing restrictions and expand into new ‘lifestyle’ territories and age-cohorts by virtue of being alcohol free (e.g. under 18s).

Treatment and support for those who need it:

• Across all areas, people who need support for alcohol problems should be routinely referred to specialist local alcohol services for appropriate assessment and treatment.
• FPH are concerned by substantial reductions in funding to addiction treatment services, across England, Wales[5] and Scotland[6]. Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance UK, has emphasised the importance of treatment in helping those with alcohol dependence towards recovery, stating that “continual cuts to services denies help to some of the most vulnerable people in our society” and that “urgent action must be taken to save lives.” [7]

Prevention & Early Intervention:

• All health and social care professionals should be trained to routinely provide early identification and brief alcohol advice to their clients. Non-clinical settings also offer the opportunity to reach those who may not regularly come into contact with health-care services[8].
• Given the degree to which potentially harmful patterns of alcohol consumption is effectively ‘normalised’ across UK society[9] and recent compelling evidence around alcohol as a risk factor in major cancers,[10] there should be support for the continued evaluation of the best means of facilitating brief interventions and conversations around alcohol harm with the population.