Minister for Health Leo Varadkar and the Government should be wholly supported in taking steps this week to deal with the catastrophic consequences of Ireland’s unhealthy relationship with alcohol.
The publication of the Public Health (Alcohol) Bill 2015 is recognition that the way we drink in Ireland is a serious problem, causing harm to families, children and all parts of society. The Bill is a huge step forward in delivering measures that will reduce illness, death and social disorder. The legislators have listened to us and have taken action.
I believe that the measures in the Bill will help hugely in reducing the flow of cheap alcohol and that this legislation will mark a turning point in public policy. I support the Government in taking on the vested interests of the alcohol industry and putting the interests of citizens first.
One of the most difficult tasks that falls to doctors is to tell distraught family members that a loved one has suffered a dreadful illness or injury or, worse, has died, as a result of alcohol use. It is difficult for the family and for the healthcare team; and experiences such as these led to the setting up of the Royal College of Physicians of Ireland’s alcohol policy group, which has advocated measures to reduce the harm done to health by alcohol. This group has called for the introduction of minimum unit pricing, the reduction of the availability of alcohol and a ban on sponsorship of sports by drinks companies. We know that this is the way forward if we are serious about changing the way people consume alcohol.
In Ireland, we now consume twice as much as we did 50 years ago. As a consequence, the number of deaths from cirrhosis has doubled here in the past 20 years. This impels us to action as a nation. In addition, there is a social-justice argument for action here, in that the socially disadvantaged suffer disproportionately from alcohol.
Binge drinking
Sadly, binge drinking is a significant cause of dangerous incidents affecting the young people who end up in our hospitals in ever-growing numbers as a result of road traffic accidents, falls, fights and drinking games. Health workers are also increasingly caring for the almost 200,000 chronic dependent drinkers who are attending hospitals with organ damage, cancers, cirrhosis and liver failure, heart failure, and problems related to the brain and nervous system.
Minimum unit pricing is the single most effective measure that can be taken to curb binge and hazardous drinking, particularly among younger drinkers. This has been introduced in Canada, where it has been shown to have a significant positive impact, saving hundreds of lives and reducing alcohol-related crime. The minimum price set for a unit of alcohol must be realistic, and we look forward to engaging with legislators on the setting of this price.
Enforcement of regulations on the sale of alcohol, the introduction of labelling, and restrictions on advertising, marketing and sponsorship, are all potentially powerful measures that could change the culture in Ireland. Price and availability are crucial in altering behaviour.
Research shows that about 80 per cent of Irish adults consume alcohol and that more than half of those are classified as harmful drinkers. Almost 10 per cent of those who consume alcohol are dependent, and this rises to 15 per cent among 18- to 24-year-olds.
As a physician who specialises in liver disease, it is worth saying that there is no safe level of drinking. But that’s not to say that people shouldn’t drink or that I am advocating prohibition. There are low-risk levels that should be observed. If, for example, a man or woman goes out and drinks their weekly allowance in one night, that is high-risk drinking with an increased risk of adverse incidents and accidents. Likewise, a person unused to alcohol is disproportionately exposed to its effects. Location, previous experience of drinking, and levels of support and public tolerance are factors. It is important for individuals to drink in a safe way.
It is disappointing that the Public Health (Alcohol) Bill won’t contain a ban on sports sponsorship. This is something we will continue to advocate. There is very strong evidence to link promotion of alcohol through sports sponsorship with early and more problematic alcohol consumption in young people. Drinks companies are investing in advertising and sponsoring these events because they achieve their purpose: they boost alcohol sales. The alcohol industry is a powerful lobby that protects its bottom line and its wider interests.
Misery and social disorder
Equally, it is in all of our interests to reduce the awful misery alcohol abuse can bring and the social disorder many towns experience every weekend. Think of what could be done in the health services if the 30 per cent of the money put into accident and emergency departments to deal with alcohol-related illnesses and events was available to improve patient care as well as social and justice services?
We need strong Government and public policy measures now because, as a nation, we are not as good at making choices for optimal health as we’d like to think. We respond less to education campaigns on the ill-effects of tobacco use and excessive alcohol consumption than we do to increases in the prices and reduced availability of those products.
The wide availability of alcohol in almost every convenience store is nothing to be proud of either. Patients of mine with alcohol problems often speak of their difficulty in making a simple trip to the shop for basic groceries where drink at pocket-money prices is hard to avoid.
We know that initiatives on price and availability change behaviour. Indeed, Ireland led the way with the smoking ban, using this formula. Campaigns advising us to drink responsibly won’t change the drink culture; actions on price and availability will have a much greater effect, particularly on younger drinkers and harmful or hazardous drinkers.
Prof Frank Murray is a gastroenterologist and is also president of the Royal College of Physicians of Ireland and chairman of its policy group on alcohol