Nick Sheron, a liver specialist from Southampton, unwittingly provided the creative spark that led to me writing My Name Is, my novel about alcoholism, from the perspective of a young woman. When I made a BBC documentary about middle-class alcoholism, he was one of our interviewees, and he made the point that whereas once his patients were nine men to one woman, now they were evenly split. This revealed a societal shift. But it also exposed the extent to which alcohol, and the alcohol industry, now have a real grip across all ages and social groups. I have got to know Dr Sheron and other liver specialists better since then, and have also seen for myself the wards where they are having to deal with the horrific fallout of Britain’s booze culture.
The issue came to light again recently when the British Medical Journal exposed the extent of lobbying by the drinks industry on the government. It led to Dr Sheron calling Health Secretary Jeremy Hunt and his colleages ‘The Ministers for the Health of the Drinks Industry,’ and I asked him to write a guest blog on the subject. I hope that someone inside the health department draws it to Mr Hunt’s attention, and I hope other ministers see it too. Both Mr Hunt and Chancellor George Osborne have read my book and have said kind things about it. But I really hope they will understand the need for a real policy shift, so that the country’s approach to this is dictated not by the drinks industry, or by people’s desire to have a bit of fun in these austere times, but by that fact that alcohol is destroying so many lives, taking up so much of NHS resources, and giving Britain a dreadful reputation as the new booze capital of the world. And to those who resist the idea of Minimum Unit Pricing with the question ‘why should I pay more just because some people can’t control themselves?’ the answer is here – you are already paying for it, effectively subsidising the drinks industry to carry on harming.
The anniversary of the First World War is also the anniversary of legislation which brought an end to the second great UK alcohol epidemic. The first was the 18th century gin craze. The second in the 19th century led to the Temperance Movement and was curtailed by the Licensing Acts of 1904 and 1910, and the Defence of the Realm Act of 1914. Alcohol consumption dropped and was kept at low and stable levels for decades by progressive increases in alcohol duty in every budget, particularly on stronger alcohol – wine and spirits. How things have changed; relaxation of licensing laws, supermarket alcohol sales and the marketing of alcoholic drinks designed for children have transformed the drinking culture of the UK. The British population expected the Chancellor to put up the duty of booze and fags in every budget, but in the 1980’s and 1990’s this pretty much stopped, with the result that a litre of vodka which would have cost £37.40 in 1981 in real terms now costs £11.28.
Young binge drinkers are merely the tip of the iceberg. The real damage is done behind the scenes as a new generation of middle aged daily drinkers succumb to the health consequences of alcohol, resulting in the loss of around 97,000 years of working life, more perhaps even than smoking for which the equivalent figure seems to be around 84,000 years. Liver disease used to be rare in the UK and even as late as the 1980’s the UK had practically the lowest level of alcohol consumption in Europe, together with lowest liver death rates. For decades since the 1920’s cirrhosis was a disease of the rich because one needed to be relatively wealthy to consume enough strong alcohol to develop cirrhosis. Since the 1970s the picture has transformed completely, liver death rates in working age have increased 500% and liver disease is now a disease of deprivation alongside smoking and obesity. The collective personality of UK citizens hasn’t changed in this time. These are not diseases of ‘inadequate behaviours’, they are diseases of unhealthy environments and of extremely healthy profitability for the corporate shareholders. As such they are the health challenge of the 21st century and the corporations and investors who profit can be viewed as vectors, just as mosquitoes are the vectors of malaria.
To develop alcohol related cirrhosis takes a certain level of application and a lot of alcohol. The mean weekly consumption of patients with alcohol related cirrhosis is around 15 bottles of white wine or 5 bottles of vodka, 20 litres of super strong lager, or 20 litres of strong white cider. As a result, irrespective of income, these very heavy drinkers opt for the cheapest possible alcohol — currently around 30 pence per unit. In comparison the average low risk drinker pays around £1 per unit and in pubs considerably more. Rigorously tested evidence, independent scientific studies by the World Health Organisation, the Academy of Medical Sciences and the Organisation for Economic Cooperation and Development have shown that the most effective and cost effective means to reduce alcohol related harm is to increase the price of alcohol through taxation
It has to be acknowledged that taxation has a downside – all purchase taxes are regressive, they affect deprived communities more severely. But the effect of alcohol related harm on deprived communities is far more savage — a threefold excess mortality between the most deprived and least deprived socio-economic groups and so UK taxpayers are already paying for the harm that alcohol causes. According to the OECD, alcohol misuse currently costs the UK 2-3% of gross domestic product; this equates to around £12 a week for each of the 60 million or so UK inhabitants, of which £3 comes back from the drinks industry in taxes. Non-drinkers and low risk drinkers in the UK are effectively subsidising the drinks industry to the tune of around £9 a week. Furthermore, generalised duty increases impact on everyone who drinks alcohol, albeit in proportion to their alcohol consumption, including hard pressed pubs where the additional costs of staff and VAT mean that the price of a pint is already quite high enough. The solution is to set a price threshold for strong cheap booze by setting a minimum unit price PER UNIT OF ALCOHOL, impacting primarily on ultra-cheap white spirits, lager and the ‘electric soup’ cider brewed from apple residue and fructose syrup; drinks whose key consumers are people with a serious drink problem. Because minimum unit price (MUP) only affects the cheapest booze it is exquisitely targeted at problem drinkers. In fact it is the type of policy that the drinks industry claim to have wanted for years, and it is phenomenally successful. In Canada they have had minimum pricing for decades; the state of British Columbia recently increased the MUP by 10%, the result was an almost immediate 32% fall in alcohol related deaths.
The government were convinced; MUP was the centrepiece of the alcohol strategy announced by the Home Office in 2012. But then in the summer of 2013 came a policy reversal, MUP was dropped and then denounced by a Health Minister spouting a script which could have been written by the chief executive of Diageo. As health advocates it seemed to be an incomprehensible decision that defied all of the evidence. The government no longer had an alcohol strategy; instead they had a bunch of ‘promises’ from the drinks industry termed the Responsibility Deal Alcohol Network (RDAN). As co-chair of the RDAN I made it clear, for example, that none of the industry pledges would be likely to prevent a single death from liver disease, the single largest cause of mortality. Although there were industry players that wished to reduce the harmful impact of their commercial activities, it was never at the expense of profitability, there was always a conflict of interest.
Partnership with the drinks industry is not part of the solution, it is part of the problem – the evidence is clear. In an excellent piece of forensic investigation (www. bmj.com/alcohol) the BMJ has outlined the trail of evidence linking this policy reversal to a campaign of misinformation and malign influence from the drinks industry involving Ministers, MPs and even the Department of Health where a freedom of information request uncovered 130 separate meetings between DH officials and the drinks industry. As a health community we can only dream of this level of access to the Department of Health. The result was a policy reversal of such cynicism that even coming from an administration that has made more U-bends than Armitage Shanks, it seemed like a step too far.
It is clearly naïve to think that drinks industry lobbying was the only factor in this capitulation to vested interests, political calculations were made. Interesting the same political calculations were made prior to the 2012 strategy announcement, in the meantime a new political analyst was appointed whose company has lobbied on behalf of the tobacco and alcohol industries and who has denied directly influencing the process. Whatever the truth, it is utterly naïve to expect that the huge influence of the drinks industry and their supporters within the government had no impact at all on this decision.
Perhaps a more interesting question is why the drinks industries are rabidly opposed to MUP. The answer can be found in the work of an obscure 19th century Italian economist, Ernesto Pareto from whom derives the Pareto Principle or 80:20 rule of marketing -‘20% of consumers consume 80% of the value of any product’- whether the products are crisps or industrial strength white cider. For the drinks industry this means that around three quarters of their profits come from hazardous and harmful drinkers, and around one third come from the most harmful drinkers whose health is being actively damaged, and they are simply not prepared to lose their money regardless of the tragic human cost.
The Scotch Whisky Association state paradoxically on their website “Distillers believe minimum pricing, as proposed by the Scottish Government, would have little impact on alcohol harm but would violate EU and international trade rules, leading to copycat trade barriers in export markets “.
Now clearly a policy that has ‘little impact’ could not lead to copycat trade barriers, the drinks industry know that MUP is an effective health policy and once implemented in Scotland deaths will plummet within a year or so, just as they do whenever a truly effective alcohol policy has been introduced. But in one respect they are correct, MUP will be taken up elsewhere and until the drinks industry shift their business model from one based on quantity to one based on quality, as they have done in France, MUP will reduce their profits temporarily – of course it will. The real concern is that Ministers given the sacred duty of protecting the health of their electorate give every impression of putting the health of the drinks industry first.