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Few would disagree that the UK has a serious problem in relation to alcohol and alcohol-related illness.1 The last three decades have seen alcohol consumption rise by 50%, and currently, an estimated 7.5% of men and 2.1% of women are physically addicted to alcohol, among the highest rates in the European Union.2 With rising rates of liver cirrhosis and a huge social burden of violence, accidents, and family disruption, the annual cost to the economy is conservatively estimated at £30 billion.3 How many new hospitals could be built with this money?
In 2005 Tony Blair's government liberalised licensing laws in England and Wales, effectively allowing pubs, bars, and clubs to serve alcohol 24 hours a day. They embraced the paradoxical idea that allowing people unrestricted drinking time would moderate binge drinking and the attendant public disorder. This caused consternation among large sections of the public, and even more so, judges, the police, and the medical profession. More than 2 years on, we can justifiably whisper ‘I told you so’, with no let-up in the pools of vomit, blood, and other detritus blighting town centres and emergency departments, especially on Friday and Saturday nights. In fact the drinking weekend now begins on a Thursday.
In formulating their alcohol reduction strategy,3 the government was more open to criticism of the process by which it reached its conclusions, than the decision itself. In the face of rising consumption, increasing availability further seemed unwise. Certainly, that was the opinion of the Academy of Medical Sciences, a respected professional body, whose report published in March 2004 concluded that control of consumption was essential to reduce health and social problems associated with heavy drinking.4 However, presented with the same evidence the government's strategy unit came up with quite different proposals, essentially eschewing increased taxation and promoting increased availability. It furthermore embraced a ‘partnership’ with the drinks industry, siding with the industry's view that reasonable control rests on public education, better policing, and self-regulation by the industry,3 none of which unilaterally have been shown to work effectively.
It is not unreasonable for governments to balance (often conflicting) interests in formulating policy. Alcohol is embedded in our society and, in contrast to tobacco and to cocaine, the safest amount of alcohol is not zero; no great clamour for prohibition exists. Nevertheless, the government policy has all the hallmarks of regulatory capture, and the suspicion that the alcohol industry successfully lobbied the government to tell it what it wanted to hear remains: policy-based evidence replacing evidence-based policy.5 Therefore the current dictum embraces remedies that research evidence and common sense suggest are least likely to work.6 These, and their implicit assumptions, are worthy of closer analysis.
Drinking cultures vary considerably within and between countries, an interplay of diverse factors including social fabric and working patterns. The likelihood of a Mediterranean pattern being widely adopted in the UK seems the wishful thinking of a metropolitan elite with access to café society. This is no slant on the majority. Denmark would rank highly on most people's list of civilised countries; however, its high rate of alcohol dependence was cited as an unwelcome precedent when the EU ratified proposals to change drinking laws in Sweden.7
The government's policy document is woefully bereft of ambition to reduce current levels of problem drinking, its stated aim being merely to prevent ‘further increase in alcohol-related harms in England’.3 It is also disingenuous of the multi-billion pound drinks industry to expect the health service and the judiciary, both cash-strapped public bodies already contending with a considerable burden in this area, to release yet more resources to the fallout from alcohol misuse.
Alcohol problems are remarkably democratic, for they affect the whole socioeconomic spectrum. Worryingly, many societal trends may be exacerbating the problem. True, alcohol misuse is most rife in deprived communities,8 and the stereotype of the violent, booze-fuelled young male with poor life prospects is embedded in the psyche. But what of the well-off housewife whose husband works a long day, and who begins drinking as solace from the loneliness of the gilded prison that was meant to be the family's dream home? These are the silent middle-class drinkers who by the time they realise they have a problem it is often too late. Middle-class life choices are predictable, but not shorn of subtle dangers. For example, the trend to move out of cities to more distant suburbia and rural areas means that social isolation is more rife; individuals and families seem content to trade old social networks for a more atomised existence. Yet it is in the much-maligned cities that one finds the theatres and museums which form a cultured counterbalance to purely materialistic aspiration, and from which their children are separated. A middle class, defined solely in economic terms and whose main hobbies appear to be shopping and drinking, is a regrettable trend that extracts a personal toll, for it perpetuates a one-dimensional view of success, which leaves no safety nets should the economy worsen, either individually or nationally.
What, then, are the solutions? Firstly, the government should honour its promise to assess the effects of its policy in a genuinely unbiased manner. A policy U-turn is neither politically feasible nor likely to be effective, given the high levels of problem drinking before the liberalisation of drinking laws. One strategy likely to yield benefit over the medium term is control of advertising and promotion, which has proved effective with tobacco. Another would be differential taxation, that is, lowering taxes on low-strength beverages and increasing those on more potent ones using the Australian model that has been successful in reducing overall consumption in another country with a heavy drinking culture.9,10 Another would be to make being drunk socially unacceptable and ‘untrendy’. If the government truly wishes to reduce the huge fallout from problem drinking, it must have the courage of its convictions to resist corporate pressure.
As Chancellor, Gordon Brown oversaw a decade-long sustained economic boom, albeit one that was always more fragile than the government and City economists acknowledged, dependent as it was on high street spending, in turn financed by colossal personal debt. As Prime Minister, Brown and his government must cope with a clearly worsening economy. Against this backdrop, some high-profile successes with social problems would be timely. Taking steps to correct a deeply-flawed policy on alcohol would be a high-profile hit, and win some lost respect in professional circles for not dancing to the corporate Pied Piper's tune.