In the last few years alcohol has become the leading cause of death in men under 50 years of age, and it will soon achieve a similar deadly status in women. Alcohol-induced liver deaths have quadrupled in the past 40 years whereas deaths from heart and lung disease have halved.
The reasons for this are well established – alcohol is cheaper and more easily available than it has been since the gin-epidemic of the 1700s and half of all 15-16 year olds are becoming dangerously intoxicated at least once a month. A 21 year woman was recently given a liver transplant for cirrhosis induced by her having essentially an alcohol-only diet since aged ten.
Alcohol misuse costs the UK about £30 billion per year of which about £3.5 billion is in health care costs with over 1 million hospital admissions for alcohol-related disorders at the last count. Policing public disorder and alcohol road accidents cost the taxpayer over £6 billion a year.
Despite the scale of the problem alcohol is easily the most tractable health problem in Britain since there are a number of proven interventions. Alcohol treatments give a remarkable return on investment or over 500 per cent — every £1 spent gives £5 in health-cost savings.
But, as with other medical disorders, prevention is preferred to treatment and here we have a number of proven strategies that focus on reducing dangerous levels of consumption. The easiest and least intrusive of these is minimum unit pricing of alcohol (setting a floor price below which a unit of alcohol can’t be sold by law, with a unit being 8 gm of alcohol so 1/2 pint of ordinary beer or half a glass of wine).
However whenever this is discussed publicly it provokes a barrage of attacks from the right-wing press, probably driven by lobbying from the drinks industry with claims of ‘punishing the responsible drinker’ and politicians of both colours meekly accede. The truth is exactly the opposite, minimum unit pricing of 50p per unit would in practice save the ‘responsible’ drinker significant amounts of money.
To understand how this works we need to realise that almost every drinker – and certainly every subscriber to the Spectator – will already be drinking alcohol that is priced at more than 50p/unit as this translates into £3.50 per bottle of wine or £15 per bottle of spirits. In fact the only people drinking alcohol that costs less than 50p per unit are those that contribute the most costs of alcohol harm to our society. These are the young binge drinker and the older alcoholic. Increasing the minimum price of alcohol to these two groups would reduce consumption and harm.
Today the cost of alcohol misuse in the UK is around £30 billion per year —about £1000 per tax-payer. This sum might be thought acceptable to those who drink heavily but surely not to responsible drinkers. The 10 per cent of the population who are non-drinkers are particularly penalised since they get no benefit from using alcohol at all.
Estimates from the Sheffield centre that has modelled the value of minimum pricing suggest that a 50p unit price would lead to at least a 10 per cent reduction in consumption. The relationship between alcohol intake and harm shows an exponential curve; drinking a litre of wine each day is 5 times (not twice) more harmful than drinking half a litre. Reducing consumption in those who drink a litre of wine a day (or its equivalents in other alcohol products) by 10% would reduce harms by 25 per cent. Real life experience in a province in Canada showed that introduced minimum pricing recently found a 10% increase in minimum unit price led to a 30% reduction in alcohol deaths.
Our two groups of consumers of cheap alcohol (the young and the alcohol dependent) contribute about 30 per cent the total burden of costs of alcohol (about £10bill/year) so reducing this by a quarter would save around £2.50 billion a year — the price of 8 new hospitals – or a tax-rebate of £100 or so per taxpayer.
What this analysis tells us is that current policy means that each taxpayer is contributing a significant amount of money to in effect subsidise drinking in these two groups of people so allowing them to damage themselves more and create huge costs to society. Truly a lose-lose situation!
Properly pricing alcohol can lead to a virtuous circle of health and wealth. France is a remarkable example of this. Twenty five years ago the French made three significant changes to their alcohol policy. They priced out cheap alcohol, reduced the drink-driving limit to 50mg and banned broadcast alcohol advertising including in sport.
These changes have had a major impact to reduce deaths on the road and from alcohol-induced medical disorders with cirrhosis. Amazingly where in the 1970s the French had deaths rates from liver cirrhosis five-fold greater than the UK, now they are only a third of ours. What is even more remarkable is the fact that the French alcohol industry has become more profitable; more expensive wine has greater profit margins.
The UK alcohol industry is well aware of these data, and must accept that they would be more profitable under a more-expensive minimum-priced alcohol policy. So why do they resist any attempt to develop a more rational policy even one as minor as minimum pricing? One view is that they rely on the cheap super-strength ciders and lagers that have come on to the market in recent years to get young drinkers addicted.
My view is that they have taken a collective position to oppose any change in drink regulations on principle even if it would in the long run benefit them. Their profits are so enormous; they just can’t be bothered to innovate. Moreover they fear that accepting the need for change might open a sensible debate about broader alcohol policies.
If we can’t improve alcohol harms from rational minimum pricing then what other alternatives are there? One way would be to allow controlled and taxed access to other intoxicant drugs that are less harmful than alcohol such a cannabis and MDMA [ecstasy]. An argument can be made that a society that actively encourages the use of alcohol to provide tax income as the UK does has a moral (as well as utilitarian) obligation to allow its citizens access to other safer recreational drugs. These would also bring in tax revenue and because they are safer and less violence-inducing than alcohol would reduce the net cost to UK taxpayers.
In effect the Dutch have been doing this for 30 years and have reaped significant benefits in terms of reduced harms, less alcohol damage and, in the case of cannabis, improved medical care for patients needing medical cannabis which despite the 2000 House of Lords recommendations supported by the recently resigned Drugs Minister Norman Baker is still banned in the UK.
Professor David Nutt is professor of Neuropsychopharmacology at Imperial College London, Chair of DrugScience.org.uk and a former Chair of the Advisory Council on the Misuse of Drugs.