I write this on a day when London is experiencing, what is for us, exceptional temperatures. Overhead power lines and train tracks have warped. On some routes passengers have been advised to avoid travelling if possible, and many employers have encouraged staff to work from home. I suspect many who did travel to their workplaces were drawn by the prospect of effective air conditioning as much as personal work ethic. This great City was unusually quiet, apart from the pubs and bars who were doing a roaring trade. Who would begrudge people a pint of beer or a glass of wine when it’s so damn warm, especially when by delaying travelling an hour or two, the journey home may be made a little more tolerable?

This set me to thinking about what we do- and what we don’t do- in terms of engaging with people, managing alcohol sales, and the consequences to our cities. I have been involved in many campaigns that have sought to reduce the negative consequences of excessive alcohol consumption. With the exception of a few drink driving campaigns, these have all been run over the Christmas party period. Whilst we do see big spikes in the demands placed on the ambulance service, police, and Accident and Emergency departments on peak party days in the weeks running up to Christmas and the New Year, it’s not the time of year when we see the highest level of alcohol consumption. No- that’s summer, when it’s warmer, when there are more weddings, BBQs, and outdoor parties; when the opportunity for a drink after work is often just too good to resist. Once we are home that bottle chilled in the fridge can also seem much more desirable (when exactly did it become normal for domestic fridges to have special sections for wine bottles?).

More people drinking, and those consuming more than usual, provide challenges for both health messaging and the management of venues and outlets selling alcohol. On the former it remains the case that our advice lacks nuance. Not regularly drinking more than 14 units per week, so about six pints of average strength beer, or less than two bottles of wine, is clearly advisable. We are also advised to spread this out over three or more days which, while valid, presents a significant challenge to the reality and culture of how many drink.

Drinking more than two pints in one evening may elevate risk, but in terms of engaging with the drinking public it’s not very helpful. Most people in the UK will have personal experience, or know someone, where the booze has caused problems; be that the occasional “hangover from hell”; an accident or incident when intoxicated; seeing or being the person who makes an idiot of themselves at the work party; losing a driving license; acquiring a criminal record; the misery caused by alcohol dependency or the serious health consequences and death that alcohol can cause. But alcohol is also an important part of how we socialise, celebrate, and enjoy life for many people. We can and should develop more nuanced messages, such as countering the idea that eating is cheating or that non-alcoholic drinks ruin a good night out. Both can clearly contribute to a much more pleasant night and certainly day after.

Around the world countries and cities struggle to strike a balance between measures and regulations to reduce harm, and allowing people to indulge. And, of course, the alcohol industry is an important sector of the economy- especially at a time when many of our urban centres are under pressure- generating tax revenue and providing employment. It is not a simple policy arena in which to operate, as adverse unintended consequences can lurk around the best-intentioned legal changes. Nor can we leave the market to its own devices. In London and the UK improvements in licensing policy and enforcement have shown demonstrable improvements in terms of health and crime outcomes. However, we have also seen isolated examples where problems have been displaced and outcomes worsened. We also need to remain agile as behaviours and fashions change. Concerns and measures to deal with high strength beers that were valid 8 years ago are not necessarily fit for purpose when managing the global craft beer revolution.

Despite the harms directly caused and linked to alcohol it does remain our favourite drug. City Health 2019 in Melbourne is looking at this issue in the session entitled Glass Half Full and I know that as much as London has to share there, we also have much to learn from. Not least in how to survive, and drink moderately, when it’s hot!