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Rob Poole is Professor of Social Psychiatry at Bangor University, north Wales and Honorary Consultant Psychiatrist in Wrexham. He is also the co-director of the Centre for Mental Health and Society at Bangor University.
In Alcohol Awareness Week, I wanted to draw attention to the public health disaster caused by high alcohol consumption in the UK. Not only has the Westminster Government resisted taking effective action, it is also obstructing the Welsh Government’s plans to do so.
The relationship between the price of alcohol and patterns of consumption is well understood. When price drops, as it has in recent decades, consumption rises. This affects everyone who consumes alcohol, not just so called “problem drinkers”. There is no demarcation between harmful and non-harmful use of alcohol, no true safe limit. Many people whose consumption appears to be modest suffer health problems related to alcohol. Fatal accidents involving alcohol, such as head injury after falling down stairs when intoxicated, frequently befall people who are not alcohol dependent.
I cannot recall a public health policy volte-face as dramatic as David Cameron’s 2013 decision to abandon plans for minimum unit pricing for alcohol. He appeared to suddenly decide that there was a lack of evidence. To me, this resembles claims of a lack of evidence that climate change is due to carbon emissions. There is plentiful evidence in both cases, but full empirical evidence can only be available after public policy has been in operation for some time. Definitive evidence requires policy implementation, so there is inadequate evidence to implement policy.
It is hard to ignore the fact that this arises in the context of the deep involvement of the alcohol industry in the formation of alcohol policy, in contradiction of WHO recommendations. Government and industry have tended to emphasise the role of responsible drinking behaviour, and have tended to approach alcohol policy as a policing issue. There is positive evidence that such approaches are ineffective.
The Scottish Government has been trying to introduce minimum unit pricing for some years, but progress has been delayed by legal challenges by the alcohol industry. The Scottish Government is likely to prevail eventually. The Welsh Government, and many Welsh health organisations want to implement minimum unit pricing. The UK Government want to reserve powers over alcohol policy to Westminster, preventing this.
I am a psychiatrist. The impact of alcohol looms large in my work. Depressive illness is often worsened by alcohol. Suicide and deliberate self-harm are strongly associated with alcohol consumption. Most general adult psychiatrists see increasing numbers of patients with alcohol related cerebral damage. The health impacts of alcohol are tragedies for patients and their families, and they impose costs far in excess of revenues from alcohol duty and taxation.
Smoking, and its related harm, has become less common through a combination of high prices, restrictions on availability and changes to public attitudes. All three are necessary to achieve an improvement in public health. I find it dispiriting to see the UK Government thwarting appropriate action by a democratically elected devolved Government.