As I write we are about to enjoy a long weekend, Monday is a public holiday and the weather forecast promises warm weather and sunshine. This will inevitably see many people enjoying a BBQ and a significant amount of alcohol consumed as people have fun with friends and family. It is also certain we will see an increase in alcohol related accidents, violence, and many of us may make another down payment on potential future health problems. Yet alcohol does play a central role in how many of us socialise and, lets be frank, we enjoy it.
This week has also seen the introduction of a new approach, by a government with very limited powers, to try and reduce the harm associated with our over fondness of alcohol. It was strongly resisted by elements of the alcohol industry, taking 5 years to progress through an obstacle course of legal and political challenges. The measure is acknowledged by its proponents as being “no silver bullet”, public support is very evenly split. Its hard to see any votes in it. It is enough to make you wonder why politicians would bother with it.
Of course, the global burden of death and ill health associated with alcohol is massive. According to the World Health Organisation alcohol is responsible for over 3 million, nearly 6%, of all global deaths. It is also responsible for 5% of the global burden of disease and injury. Millions are affected by alcoholism, As with nearly all public health issues these harms do not fall evenly across nations or within them.
So, while Belarus may come top of many international league tables for alcohol consumption, the equivalent of over 17 litres of pure alcohol per adult per year, there are many countries where this falls to 100ml. It doesn’t actually tell us much about the scale or the nature of the harms associated. Low population prevalence can disguise very high rates of harm is specific communities. In Europe, which dominates this league table, alcohol consumption is relatively high amongst the well off. Yet the burdens of ill health and harm fall on the least well off and the young. Around a quarter of all deaths in the 20-39 age group worldwide are linked to alcohol.
Now in Europe, certainly within the UK, we have been talking about alcohol related harm for many years. Progress has been made in many places to improve how, where, when and to who alcohol is served. There are restrictions on driving under the influence. Efforts are made to encourage “responsible drinking”, with national guidance and occasional public information campaigns. Possibly this is bearing some fruit. Younger populations are drinking less. But the toll on health, the burden of crime and harm associated with alcohol remains disturbingly high.
In 2016 the UK saw 7,327 alcohol-specific deaths. This figure has been similar for the last few years. These deaths were significantly higher in the most deprived areas. Within the UK, Scotland saw alcohol related deaths at some 50% higher than in England and Wales. These deaths were six times higher in the areas which have the greatest deprivation than in well off areas. Cheap alcohol outlets proliferate. Strong cider and lager are as accessible as milk. It is the way things have become. However, there is not much sign of mass, popular demand to change things, no 21st century temperance movement. Voices of concern come from health bodies and the voluntary sector, not residents.
So, is the decision by the Scottish government to introduce a minimum unit price (MUP) for alcohol an example of politics and public health being good friends (the topic for plenary two at this years City Health Conference) or will it join the ranks of well intentioned policies that achieved little or proved to worsen a problem? Time will tell, but it is promising that the Scottish Government recognise other approaches will be needed and are supporting these. At a visceral level it has seemed wrong to me that alcohol can be cheaper to purchase than water. Especially in a country as rich in H2O as Scotland. So, while enjoying the promised good weather, I will raise a glass, responsibly, to Scotland this weekend and watch with interest the impact of MUP and whether it encourages others to improve our relationship with alcohol.
(Slainte Mhath is Gaelic and literally means good health, but is most commonly used as a toast when drinking)