The Rising Tide of Alcohol

Once one recognises that the health of a population is influenced by a wide array of influences outside the health sector, much becomes relevant. One's reading tastes therefore expand. Broad as they might be, these tastes are rarely likely to be stimulated by a publication with the unpromising title: Draft Guidance issued under Section 182 of the Licensing Act 2003. Thank heavens for Robin Room! [1] He reads everything connected with alcohol, remembers it, assesses its relevance, and connects it up with everything else that is being produced on the subject. He does us a great service, precisely because, as he points out, such a publication has great relevance for the public health. Were it not for him, the rest of us might have missed it. We have a curious situation in Britain. Alcohol consumption of the population is increasing, as is the level of problems associated with alcohol. [2] Yet, as Room points out, the government is heading on a course of liberalising the supply of alcohol. It is as if the villagers, living downstream, were being drowned by water plummeting through the open dam. Instead of reducing the flow, the government sends in the police to mop up the problems caused by the rising water level. To slow the flow would represent unacceptable interference by the nanny state. Poor analogy, might be the argument of those who see alcohol as a sacred matter for the individual. Individuals choose freely how and what to drink; it is no business of anybody else to interfere with the inalienable right of the individual to determine his own fate. Even if he harms himself and others? It is an old argument about the role of society, played out most recently in relation to fluoridation, seat belts, motor cycle helmets, speed cameras, and smoking, to name a few. Suppose society were made up of two groups: alcohol abusers and everybody else. An appropriate strategy for dealing with alcohol problems would then be to tackle the abusers in some way—although making alcohol cheaper in real terms and more readily available seems an odd place to start. But that is not what the evidence shows. There is a relation between overall consumption of the population and the problems associated with alcohol. That suggests that the 50% rise in mean alcohol consumption in Britain over the last 30 years is not an epiphenomenon but is causally related to an increase in cirrhosis of the liver, for example. Tackling alcohol problems must include paying attention to the supply. As the Cabinet Office report on alcohol rightly states, there are many drivers of alcohol consumption in a population. [3] We might broadly divide them into three: socio-cultural influences, price and availability. It is quite reasonable to speculate that alcohol consumption has fallen in France and Italy because of socio-cultural change. In Britain, the increase has had much to do with the falling real price. It may well be that the long-term aim should be socio-cultural change: a culture of sensible, enjoyable and, yes, healthy eating and drinking. In the short to medium term, however, other measures are needed. Good candidates are to reverse the trend of falling real prices and ever easier availability.