Five point plan to tackle alcohol misuse in Scotland
June 2007
Introduction
Alcohol consumption in Scotland has doubled between 1960 and 2002 (see reference 1). Whilst drinking in moderation can be a source of pleasure, the effect of excessive alcohol consumption on our health and the related social and economic impact is significant. For example, the number of patients discharged from hospital with alcoholic liver disease has more than doubled in the past ten years from 1,731 in 1996, to 3,541 in 2006 (see reference 2). BMA Scotland has published this five point plan which, as part of a wider strategy, will help to tackle Scotland’s alcohol problem. It believes that people must be encouraged to drink in moderation and that more should be done to combat teenage drinking.
The health and social impact of alcohol misuse in Scotland
Alcohol kills six people every day in Scotland (see reference 3). Alcohol Focus Scotland estimates that alcohol costs the NHS £110 million, with the overall cost to Scotland (including social work, criminal justice, emergency services and economic costs) equalling £1.1billion per year Scottish Executive (see reference 4).
In Scotland, in 2005/06, there were 39,061 general hospital discharges with an alcohol related diagnosis, which represents 4% of all general hospital discharges in that year (see reference 5). People living in deprived areas were four times more likely to die an alcohol related death than those in the least deprived areas (see reference 6). The problem is also becoming more acute for women. The number of Scottish women dying from alcohol related diseases reached 709 in 2005 (see reference 7).
There has been a 50% increase in reported drinking by 13 year olds and more than a 33% rise in drinking by 15 year olds between 1990 and 2004 (see reference 7).
Regular heavy alcohol consumption and binge drinking is associated with physical problems, antisocial behaviour, violence, accidents, suicide, injuries and road traffic accidents. They can also affect school performance and crime. Alcohol misuse is associated with a range of mental disorders and can exacerbate existing mental health problems. Adolescents report having more risky sex when they are under the influence of alcohol; they may be less likely to use contraception and more likely to have sex early or have sex they later regret (see reference 8).
These figures reflect a worrying trend of alcohol misuse and clearly demonstrate Scotland’s alcohol problem. The reasons underlying these trends require further research, but changing social attitudes, easy availability and cheap drinks promotions particularly in supermarkets and other off sales outlets all contribute to increased alcohol consumption by adults and children.
Five point plan
BMA Scotland’s plan to tackle the problems of alcohol misuse calls upon the Scottish Executive to:
1. Utilise the legislation capabilities of the 2005 Licensing (Scotland) Act, to end deep discounting of alcohol for sale in off licences, supermarkets and other off sales outlets
The relative cost of alcohol has fallen by around a third over the past 20 years (see reference 9). Cheap drinks promotions which encourage people to buy more alcohol, particularly in supermarkets and off licenses must be controlled. Some supermarkets are running alcohol products as a ‘loss leader’ which in some cases has resulted in alcohol being cheaper than bottled water.
BMA Scotland would like to see the promotions mechanism of the Licensing (Scotland) Act extended to cover supermarkets, off-licences and other off sales outlets, matched with stricter enforcement of the laws relating to alcohol sales.
BMA Scotland believes that this would have a significant impact on teenage drinking as 19% of 13 year olds and 46% of 15 years olds report purchasing alcohol from off-licences, shops and supermarkets (see reference 10).
A 2003 survey published by the Scottish Executive found that 49% of 15 year olds reported buying alcohol for their own consumption (Ref 8). But prosecution rates for under age drinking and, more importantly, for selling alcohol to under age children are low. In the BMA Scotland survey of members on Priorities for Health, 97% of doctors said that stricter enforcement of age restrictions, particularly for off sales, was an important factor in reducing drinking amongst young Scots (see reference 11).
2. Undertake research into the measures by which pricing mechanisms can be used in Scotland to discourage heavy consumption of high alcohol products
There is evidence that increasing the price of alcohol may be an effective method of reducing use by adolescents. The evidence that tax and price increases reduce alcohol related harm is stronger than that for the efficacy of educational measures. However, used alone it can prove impractical and do nothing to tackle adolescents’ attitudes (see reference 12). Any pricing strategy must form part of a wider alcohol strategy.
Almost 70% of doctors who took part in the BMA’s survey supported a strategy to increase the price of alcohol to discourage excessive drinking (see reference 13). The BMA considers that a pricing strategy which increases the tax on alcohol in direct correlation to the alcohol percentage of each product may be an effective way of addressing this.
3. End alcohol producers’ sponsorship of sporting and entertainment events with a young target audience
Sponsoring entertainment and sporting events and sports teams has become an important advertising mechanism for the alcohol industry. Sponsorship usually involves providing money to underwrite the event in return for having a logo prominently displayed or distributed on items, such as caps and T-shirts and around the event venue. Children and adults become walking billboards when they wear these items. In addition, the exposure of children to alcohol's linkage to entertainment events or sporting activities gives alcohol an innocence by association.
4. Legislate for alcohol labelling rather than relying on voluntary agreements with the drinks industry
More than eight out of 10 doctors believe that alcoholic drinks manufacturers should be compelled to clearly label their products with the number of units of alcohol in each product.
It is the responsibility of the drinks industry, both producers and retailers, to ensure that their customers are fully aware of the alcoholic content of the beverages they purchase and the potential harmful consequences of excess consumption. The BMA believes that there should be a legal requirement for all containers of alcohol offered for sale and advertisements to carry:
- A prominent common standard label which clearly outlines the alcohol content in terms of units;
- Information on the maximum recommended daily level of alcohol consumption; and
- A warning of the dangers of excessive drinking.
Drink driving continues to be a hazard on Scotland’s roads. In 2004, 40 people were killed and there were 710 accidents involving drink drivers. Legislating to reduce the drink drive limit is a matter reserved to Westminster. BMA Scotland calls upon the Scottish Executive to exert pressure on the UK government to consider reducing drink driving limits.
Scientific evidence from around the world has agreed that when a person’s alcohol level is over 50mg their driving is impaired. It has been estimated by the University College of London that a reduction to the drink driving limit from 80mg to 50mg will prevent around 65 deaths each year (see reference 14). This would bring the UK into line with other European countries including Germany, France, Finland and Holland.
The Association would also like to see provision to allow the police to carry out roadside random breath tests – currently only drivers suspected of being over the limit can be tested by police. This measure is a vital element in deterring people from drinking and driving, and could be implemented by the Scottish Parliament.
Conclusion
As part of the wider strategy to tackle Scotland’s drinking problem, BMA Scotland proposes the following five point plan:
- Utilise the legislation capabilities of the 2005 Licensing (Scotland) Act, to end deep discounting of alcohol for sale in off licences, supermarkets and corner shops
- Undertake research into the measures by which pricing mechanisms can be used in Scotland to discourage heavy consumption of high alcohol products
- End alcohol producers’ sponsorship of sporting and entertainment events with a young target audience
- Legislate for alcohol labelling, rather than relying on voluntary agreements with the drinks industry
- Reduce the drink driving limit from 80mg to 50mg and introduce random breath testing in Scotland
- Leon D A & McCambridge J (2006) Liver Cirrhosis mortality rates in Britain from 1950 to 2002, The Lancet, Vol 367, 52 - 56
- ISD, SMR01, 11 June 2007
- Health Statistics Quarterly, ONS, Spring 2007.
- Cost to Society of Alcohol Misuse in Scotland: An Update to Alcohol Misuse in Scotland Trends and Costs (Edinburgh) 2005
- Alcohol Statistics Scotland 2007, ISD Scotland
- Alcohol Focus Scotland Manifesto Promoting responsibility, reducing harm, changing culture (Glasgow) 2005
- Alcohol Statistics Scotland 2007, ISD Scotland
- Alcohol Concern Alcohol and Teenage Pregnancy (London) 2002
- Alcohol Focus Scotland Manifesto: Promoting Responsibility, Reducing Harm, Changing Culture (Glasgow) 2005
- Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) 2006 National Report; P Bradshaw Underage drinking and illegal purchase of alcohol Scottish Executive Social Research 2003
- BMA Scotland Priorities for Health survey, August 2006
- BMA Board of Science Adolescent Health (London) 2003
- BMA Scotland Priorities for Health survey, August 2006
- ‘Drink drive limit could be cut’ BBC news website (www.bbc.co.uk) 15 June 2007
BMA Scotland Public Affairs Office
Tel: 0131 247 3050/3052
Email: press.scotland@bma.org.uk