Today, Public Health England has published a review of international evidence on alcohol policy and harm reduction.
The new report, based on almost two years of research and analysis, addresses a number of key policy areas.
- The price of alcohol and its effect on consumption
- The impact of both the number of alcohol outlets in a given area, and the times at which they operate, on a range of potential harms
- The effectiveness of existing controls on marketing, sponsorship and promotion
- The role of ‘brief interventions’ in preventing harmful drinking
- The effectiveness of schools-based education programmes
- The evidence on alcohol treatment in tackling harmful and dependent drinking
We welcome this important contribution to the literature on alcohol harm prevention. It provides both a resource for identifying key evidence and an evaluation of the relative effectiveness of policy interventions based on an extensive process of reflection and review.
Today’s report also provides a new analysis of drinking trends and their economic effects. It confirms that average consumption has been falling in the UK for over ten years, especially among young people. However, it also shows that trends vary between social groups, reminding us that average consumption provides only a rough guide to where harms are concentrated, and that harms can rise even when overall consumption falls.
Importantly, the report confirms previous studies showing that around one third of all the alcohol consumed is drunk by the heaviest drinking 5% of the population. This demonstrates not only how heavy drinking is concentrated, but the very high proportion of alcohol that is sold to people with serious drinking problems.
The report draws particular attention to the impact of alcohol on economic productivity: suggesting that drinking causes more years of life lost to the workforce than are caused by the top ten most common cancers combined. While the precise social costs of alcohol remain hard to quantify, this report shows clearly that heavy drinking creates an enormous burden for the wider economy.
The PHE report echoes previous evidence reviews in demonstrating that price is a key policy lever in shaping consumption. Its findings suggest that a combination of minimum pricing and more targeted taxation could reduce both harmful drinking and health inequalities (especially the so-called ‘alcohol harm paradox’). Clearly, this is a significant finding as the Scottish Government continues to deal with a prolonged legal challenge to MUP from the Scotch Whisky Association.
The report also argues that while evidence on factors such as outlet density is less compelling than is the case for price, nonetheless limiting hours of sales can reduce antisocial behaviour and drink-driving. While, in the UK, evidence on the relaxation of licensing hours since 2005 has not shown a clear effect in terms of crime, disorder or hospital admissions the authors point to international studies and reviews that show a stronger correlation.
The report also follows previous reviews in pointing to evidence that exposure to marketing can lead to earlier and higher levels of consumption among young people. It finds no robust evidence that existing marketing controls are effective in preventing youth exposure to marketing, and so will strengthen calls for a reassessment of the current regulatory framework.
It also finds no clear evidence that voluntary industry-led partnerships (including the recent ‘Responsibility Deal’) reduce alcohol harms. This is partly because there are insufficient independent and robust evaluations of such schemes to provide clear evidence of an effect, and also because it has been argued that many of the changes introduced under the Responsibility Deal would have happened anyway.
While the report confirms that, from a public health perspective, price, availability and marketing are key issues, it also addresses questions around treatment and interventions. This is especially important as the impact of austerity continues to be felt in widespread cuts to budgets for treatment services across the country.
The review finds considerable evidence that screening and brief interventions in primary care can help prevent harmful drinking. On a policy level, a key question now is how to support GPs in actually carrying out screening and delivering interventions effectively where there is a need. Currently, delivery of interventions in primary care remains low so work to better incentivise and train GPs is needed. The review, however, also notes that the evidence for the effectiveness of brief interventions in other settings (such as the workplace or local pharmacies) is much less robust..
In line with most previous reviews, the report finds that while education can play an important role in raising awareness and knowledge, the evidence for its effectiveness in changing behaviour is weak. This is not necessarily because schools-based prevention and education is wholly ineffective, but because its impact is inevitably limited (behaviours are driven by far more than simple knowledge of harms) and because the delivery of programmes is often highly inconsistent.
Finally, on drink-driving, the review finds strong evidence that reducing the blood alcohol limit is effective in reducing accidents. England and Wales currently have a BAC limit of 0.8 g/l – the highest in Europe, alongside Malta.
Overall, this report represents a key summary of the available evidence on alcohol. It confirms that there are policy levers available to Government that can have a measurable impact on alcohol harm reduction. Clearly, alcohol policy needs to balance a range of interests, but if the Government is serious about seeking to reduce the health impacts of alcohol then this evidence review is of critical importance.
The PHE report is based on a very wide-ranging analysis of available research and an extensive process of peer review. We hope that it forms a key element in the development of alcohol policies in future.