Personal restraint is unlikely to work when we’re being immersed in a culture of alcoholic excess, says Evelyn Gillan
Alcohol has been hitting the headlines again. South of the Border, Stockton will see the first “pound pub” where a pint of beer will be sold for £1.50 and a half pint for £1. The cut-price drinks will be available from 8am.
This follows hard on the heels of the news that Britain’s first motorway pub has opened for business. The Westminster government is consulting on whether or not to relax licensing hours during the World Cup, while at home, in a promotional pitch for the Commonwealth Games, the leader of Glasgow City Council told the world that Glasgow “knows how to put on a party”. Visitors may be less enamoured of the news that in Scotland, every 19 minutes, an ambulance is called out to deal with a drunken patient.
A cursory glance at these headlines demonstrates the extent to which alcohol has become embedded in our social, physical and cultural environment.
Yet it was not always this way. As recently as 1960, Scotland had one of the lowest liver cirrhosis death rates in western Europe and now we have one of the highest. The transformation of the alcohol environment over the past few decades has been nothing short of spectacular.
Most people under 30 years old in Scotland would not recognise the alcohol environment that their parents and grandparents grew up in. After all, it was only in 1960 that supermarkets were allowed to sell alcohol. And even then, it was cordoned off in a separate area, often behind a glass partition, to be sold with tobacco because there was a consensus that alcohol and tobacco were health-damaging products. They were not ordinary commodities like bread and milk, so their sale and promotion were required to be carefully regulated in order to minimise the potential harm arising from their consumption.
Today’s young people would be shocked to learn that pubs didn’t used to open until before lunch, were closed in the afternoon and you couldn’t get a drink after 11pm.
However, the biggest shock would be learning what their parents and grandparents had to pay for alcohol. One estimate suggests that a bottle of spirits in the 1970s would cost the equivalent of £45 today.
The simple truth is, the more alcohol a nation consumes, the greater the amount of harm it will do itself.
The mechanisms that have been used historically to control price, place and hours of sale in order to minimise the risk of alcohol harm have been relaxed over the past 40 years. The effect of these changes is that alcohol has become omnipresent in our culture and, even accounting for recent falls in consumption, our drinking is still at historically high levels.
Given the significant burden of harm that alcohol causes, one would imagine that politicians would want to introduce policies that are known to work in reducing overall alcohol consumption in the population.
Despite a wealth of evidence confirming that making alcohol less affordable and less available decreases overall consumption and harm, the Westminster government recently announced that it was going to freeze duty on wine, cider and spirits and cut duty on beer. So while the Chancellor, George Osborne, acknowledged that reducing the affordability of cigarettes is “key to deterring children from starting to smoke”, he was silent on what the impact might be on both consumption and harm if cheap alcohol becomes even cheaper.
Even more puzzling was the support from Scottish politicians for this position, despite their previous support for the Scottish Government’s alcohol strategy, which has at its core an acknowledgement of the link between alcohol price, consumption and harm.
All the major public health gains that have been achieved over the past few centuries have at their heart the precautionary principle: avoiding known risks to health and wellbeing when prevention is both possible and proportionate.
Elected members, whether local or national, have a duty to develop policy and legislation that is in the public interest. This is what differentiates them from corporate executives who are obliged to deliver the maximum profit to their shareholders.
The changes in the alcohol environment over the past 40 years have had a profound effect on drinking behaviour and subsequent harm.
A clear acknowledgment from policy-makers of the importance of environmental factors in influencing alcohol consumption and harm is critical. All too often the focus is on individual behaviour change.
However, asking people to exercise restraint in their drinking behaviour, in an environment that promotes both access and excess, is an approach that will always be limited in its ability to effect meaningful change.
• Dr Evelyn Gillan is chief executive of Alcohol Focus Scotland