Minimum pricing is a promising strategy for reducing health burden
It’s not radical, it isn’t even certain when it will become law, possibly not before the general election, and there are disappointments about what it does not contain, but most important of all is that it is a start.
This is legislation on alcohol which is contained in a public health bill, and not a licensing one, and that is a very significant step in the place that is Irish la-la land in terms of acknowledging our relationship with drink and the harm it does us as a race.
Frank Murray, President of the Royal College of Physicians in Ireland and also a liver specialist is one of those at the coalface of the negative impact of alcohol abuse and the need to change the culture of drinking in Ireland. He said this week he feels the legislation is a great stride forward.
He reminded us how research shows that around 80% of Irish adults consume alcohol, and more than half of those are classified as harmful drinkers. Almost 10% of those who consume alcohol are dependent, and that figure rises to 15% among 18- to 24-year-olds.
Now I would point out to those reading these figures that they contain one hell of a lot of people who are “harmful” drinkers. So before we do the traditional thing of assuming we are not one of that number, statistically there is a very high chance that they include people like you and me. It’s this sort of denial, and deep acceptance of our booze culture which means that campaigns advising us to “drink responsibly” are worth very little, and as Prof Murray points out it takes action on price and availability to actually reduce the harm particularly to younger and harmful or hazardous drinkers.
The total cost to us all of alcohol harm in 2007 was estimated at €3.7bn. Just think what difference that would make in terms of balancing our national books, and sorting out our health system. We might reflect on who are the real “bed blockers’ in our acute hospital beds.
Alcohol is strongly linked to suicide. It is mind-blowing to think that one Irish study showed more than half of all people who died from suicide had alcohol in their blood. From 2000 to 2004, alcohol was estimated to be the major contributing factor in 823 suicides. We all agree we have a spiraling suicide problem, particularly among young men, but obviously it is not spiraling enough in that we simply refuse to allow such distasteful facts to disturb our national attitude to drink.
The most significant proposal this week is the introduction of minimum unit pricing. This means establishing a floor price below which alcohol cannot be sold, and in practice applies almost exclusively to off sales and mainly affects problem drinkers and young drinkers. The minimum unit price is based on the alcohol content of the drink, measured either in grams or units of alcohol. Other measures include enforcement, labeling, and restrictions on advertising, marketing and sponsorship.
It’s worth pointing out that, between 2002 and 2007, there was a 44% increase in the amount of lager that could be purchased with one week’s disposable income. A woman can reach her low risk weekly drinking limit for around €6, while a man can reach this weekly limit for less than €10.
While Scottishs effort to introduce minimum pricing is caught up in the European courts, the example used by those in favour of the initiative is Canada.
The experience there was examined in a study published in the American Journal of Public Health in 2012. Canadian researchers reported on the impacts on alcohol consumption following the introduction of new and increased minimum alcohol prices in Saskatchewan, Canada.
They found a 10% increase in minimum prices significantly reduced consumption of beer by over 10%, spirits by almost 6%, wine by well over 4%, and all beverages combined by 8.43%.
There were larger effects for off licence sales than for bars and restaurants, and consumption of higher strength beer and wine declined the most. A 10% increase in minimum price was associated with a 22% decrease in consumption of higher strength beer, versus over 8% for lower strength beers. The neighboring province of Alberta showed no change in per capita alcohol consumption before and after the intervention.
Unsurprisingly, the researchers from the Centre for Addictions Research of British Columbia concluded that minimum pricing is a promising strategy for reducing the public health burden associated with hazardous alcohol consumption.
I can see why people like former junior minister Roisin Shortall might be a little disappointed. She has fought long and hard to secure a ban on the sponsorship of sport by drinks companies. Now let us remind ourselves briefly of the sincerity of these companies who do not carry out this sport sponsorship to sell more product, oh no, it is for altruistic purposes. Anyway the ban just seemed a bridge too far for the politicians.
Yes, they worry about the loss of jobs in the drinks industry, and keeping the local club going, but our politicians are also acutely aware of not being viewed as a killjoy and “down” on the national pastime. There are all sorts of things they’d rather admit to than being teetotal.
The Minister for Health has made it fairly clear that it was his colleagues in the Department of Sport who refused to co-operate on this sponsorship matter, even refusing to engage with the idea that it would not take place for some time, giving the sporting organisations some time to get alternative funding in place.
The attitude from Ministers Paschal Donohoe and Michael Ring is really disappointing. We lack real political leadership on this issue; this could have been made to happen if Taoiseach Enda Kenny made it clear that he wanted it to go ahead.
This argument of sporting organisations not being able to find new sponsors was first mooted in the midst of the recession and had some traction then, but it has far less so now, especially if a realistic timeline was involved.
But the most important development this week is that something has finally happened. The soundings from the alcohol industry appear to be that they do not intend fighting the attempt to introduce minimum pricing. We can just hope now that the momentum will be maintained.
I don’t get the sense that Leo Varadkar feels particularly pioneering in relation to this issue, but if this does become legislation during his time in the Department of Health it will be a very commendable legacy.
One Irish study showed more than half of all people who died from suicide had alcohol in their blood
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