Select Committee on Scottish Affairs Minutes of Evidence

Examination of witnesses (Questions 640 - 659)



Miss Begg

  640. I know that with youngsters it is very often binge drinking that they are involved in, do they grow out of that?
  (Dr Plant) Yes, some do and some do not. We followed up a group of 1,000 teenagers in Lothian at 15/16, then at 25/26 and we found almost no connection between heavy drinking at that early stage and heavy drinking later. If they were smoking at 15 they were smoking ten years later.

  641. My other question is to do with youth culture, there is a fairly sizeable subculture that take ecstasy and they do not drink, they take water. Does that mean that there is likely to be less alcohol related problems as that generation of young people grow up?
  (Dr Gruer) I would not be confident about that. It seems to me that this apparent divide between ecstasy users and drinkers has been breaking down in the last few years. There is much more a trend towards people mixing the licit drugs and illicit drugs and experimenting in different ways and there has been less of a distinct culture of one sort or other. It is hard to predict how things are going. One of the lessons of the last 20 years is it is very hard to know what the next development will be in the way in which people are using psychoactive, mind-altering substances. We are always surprised by what happens next.
  (Dr Plant) We surveyed 15 and 16 year olds in 1995 across the United Kingdom and we have just done it again and we have had quite a big drop in ecstasy use. What we also found, and everybody else has found this, is that people who use a lot of illicit drugs are also heavy drinkers and they smoke a lot, even though when you talk to them they do not present themselves in that way.

  642. They claim they have a different drug of choice from the others.
  (Dr Plant) They tend to be wide-ranging.

  643. They are just taking lots of drugs, legal and illegal. One other thing, I remember, I was fairly young at the time, when the licensing hours were changed and the argument for increasing the hours of licensed premises was to end the binge drinking. It was not just young people, older people were involved in that. From what you are saying today that really did not work, it has not helped to reeducate the Scottish public on sensible alcohol?
  (Dr Plant) It led to quite an interesting change. I reviewed this years ago with a colleague for the British Medical Journal, because people were making statements that they did not have alcohol problems any more or it had opened up the floodgates. It seemed to have a neutral effect on public health, it did not change any trends or direction. There was some evidence that certainly the one thing that disappeared visibly was the carry out, that just vanished overnight.
  (Dr Gruer) One other thing is there has been an underlying trend in Scottish drinking habits, particularly among more middle-class type people towards what you might call a "Europeanisation" of our drinking habits. We are drinking a lot more alcohol with food, particularly wine, than we used to. Wine consumption has been rocketing over the last 20 years. This is beginning to show signs in the slow rise in the liver disease, cirrhosis. Britain and Scotland is included within that, it is one of the few countries in Europe where cirrhosis trends are going in the wrong direction, they are going upwards, and in Spain, Italy and France cirrhosis levels are coming down. If you look at the graphs we are gradually moving towards France and Spain, we might meet them in terms of our cirrhosis levels in the next 15 or 20 years. That is a reflection, a change in the way that a proportion of the country are using alcohol. There are still quite a lot of people in the lower income bracket who are still drinking in typical traditional Scottish fashion on a Friday and Saturday night.

Mrs Adams

  644. In terms of the 1,000 teenagers you surveyed, were the people who tended to go on to be heavy drinkers from a particular socioeconomic group, and did that have more bearing?
  (Dr Plant) I do not know. The problem was, we started this with 15 and 16 year olds and when you do surveys in schools there are certain questions they will not let you ask, one is parental occupation and parental income, and whether their parents drink like fish, so we do not know.

Mr Brown

  645. I just want to pick up, Dr Gruer, on a point you made about stress. You were painting a picture there, and I can envisage somebody under a bit of stress who thought the answer lay in the bottle, did that go on to be a repeated trend, stress and the bottle were perhaps the answer? The fact that we are living in a society where there is so much pressure on people, we see it in stress related illnesses, court cases about people being stressed out, has that brought with it an increase in the number of people with alcohol related problems?
  (Dr Gruer) It would be hard for me to say very definitely that were the case, but I think that the co-existence of a more stressful society, which most people tend to go along with, and the rise in alcohol problems may not be a coincidence. Doctors certainly see a large proportion of their patients who have alcohol problems who have emotional problems, relationship problems and difficulty with work, money and so on. They are all mixed together.

Sir Robert Smith

  646. On closing time, in terms of, obviously, the direct health and drinking thing it may be neutral, but in terms of the social consequences and certainly from anecdotal experience of the Student Union in Aberdeen, on a Friday night it had a 1 o'clock licence and it drifted to a gentle close and everyone went home, on a Saturday night it had a 12 o'clock licence and it was a much more difficult closing time and a much more anti-social problem, did your research show any benefit in that?
  (Dr Plant) No is the straight answer. In some instances there have been clear examples of nuisance being caused by whatever the closing arrangements are in some places and a lot of senior police in Scotland and England do not like the idea of every bar in the town closing at the same time, because everyone spills out on to the streets and there is often trouble when they go from pubs to wherever else it is they are going.

Mr Clarke

  647. I think it was drugs the last time we met and now it is booze, so welcome. Advertising expenditure is what we are going to talk about. Professor Cockburn, the Chairman of Yorkhill Hospital Trust has contrasted the amount spent advertising alcohol with that spent on campaigns to reduce drinking. For example, the press reports suggest Diageo has plans to spend about £200 million alone in advertising Johnnie Walker, and Allied Distillers have informed the Committee they will spend £277 million on advertising and promotions in 1999-2000, how important is advertising in promoting alcohol consumption?
  (Dr Plant) First of all, there has been quite a lot of effort put into looking at these very important issues over the last 20 years. The results of this evidence are very disappointing, the first thing relating to the impact of advertising is it is clear that beverage alcohol advertising can persuade people to switch their brand preference, to switch from one kind of alcohol to another. There is no clear evidence, either way, on whether this has an impact on overall consumption. The other thing I think is really depressing is there are now hundreds of studies worldwide into the effects of campaigns on alcohol and drugs from the point of view of health promotion. These do not discourage people from drinking heavily, they do not discourage young people from experimenting with alcohol, and most researchers, including me, feel that is a waste of public money, it does not work.

  648. The other thing I want personally to ask you is in relation to the trend of television. The first thing that some people do when they come home is get the decanter out and get themselves a drink. When I think back to my childhood there were no decanters and there was no drink at all in my house, it was taboo. The situation is that it is the in-thing to do, to have wine with a meal. That is all being promoted as a natural thing to do. Do you think that has an effect on people who drink or does it encourage people to drink?
  (Dr Gruer) I would say that certainly alcohol enjoys a very privileged position among drugs. You said you had seen me last time in relation to drugs, alcohol is a drug, let us not beat about the bush. It is the only drug that gets good publicity in the sense that it is widely advertised, it is part of the sponsorship for so many things, it is seen in all sorts of circumstances as very much part of soap opera culture, whereas tobacco has now been largely vilified and they are struggling to keep their end up, and obviously illegal drugs are vilified at every turn. Alcohol has a particular situation where it is given a pretty good press and there is a lot of good mood music around alcohol which I think does influence how it is seen. It is seen as generally a good thing, for most people it is associated with pleasure and socialisation and so on. That aspect of it tends to be very much to the fore. The more damaging aspects of alcohol do not get much of a look-in in terms of any counter advertising. As Martin says, there is very little evidence, unfortunately, that education in school on alcohol makes much of a difference. Also there is not much publicity about the damaging effects of alcohol with the clear exception of drinking and driving, where there has been a lot of emphasis and a lot of success in changing attitudes. There is much more talk about lung cancer and heart disease from tobacco and all the problems about Ecstasy and heroin and so on, very little about what alcohol is doing to you.
  (Dr Plant) I think one quite important difference between alcohol and tobacco is with tobacco the evidence is pretty clear, "don't do it, it is bad for you", but with alcohol we know that low level consumption is either harmless or it is actually beneficial in terms of heart disease and stroke. I think this means that the message is a bit more complicated and a bit more confusing and everybody naturally defines "harm" as one unit more than they themselves drink. There has been a change in drinking habits in our lifetimes. My parents hardly ever drank, alcohol was not available at home when I was a child. We have seen a huge sea change since the Second World War, people do drink more now than they did in the recent historical past, but not as much as they did in the previous century, for example.

Mr Sarwar

  649. You have partly answered my question. I am very interested to know a bit more from Dr Gruer because he made two very interesting points. One was that campaigning for alcohol does not increase the consumption and, in effect, what you were saying was that if somebody is campaigning for vodka or whisky people do not switch over to another brand, but how do you compare that with the argument from the tobacco industry campaigning for tobacco to switch over from one brand to another brand? The other point you made was that excessive alcohol advertising does not make any difference. What statistics do you have at your disposal on which you can say so heavily that it does not make any difference whatsoever? Unless the dangers of excessive drinking are told to people there might be a consumption increase.
  (Dr Plant) First of all, companies sometimes advertise quite a lot and spend quite a lot on advertising when they are in trouble or when they are starting a new brand. I can use the dramatic example of a brand coming from nowhere and becoming popular years ago: the Smirnoff campaign. What clearly seems to happen is they take a bigger share of the market if they do this. Sometimes if companies feel that their market share is dwindling they can try to boost it by spending a lot. I think a Scottish jury would find not proven on this because there have been a number of econometric studies into advertising and alcohol consumption and they have all been pretty much inconclusive. As far as health promotion and health education is concerned, some of the biggest and most elaborate campaigns have been in America and in Australia aimed largely at young people in school. You can increase people's knowledge and change their attitudes for a bit but changing their behaviour is quite hard. In the Australian Life Skills Campaign, teenagers who were exposed to this finished up drinking, smoking and using drugs more than those who did not, which was a very unfortunate and embarrassing outcome, but sadly not a unique one. I think in a sense the jury is out on the effects of advertising but at the moment it is rather inconclusive.
  (Dr Gruer) On the specific effects of alcohol I would amplify Martin's comment that alcohol consumption in the 19th Century in Scotland was vastly higher than it is now and I think it would be fair to say there was very little advertising of the type we have now at that time. Much more important is the availability of the stuff, the culture that you live in and the price and the extent to which it is regulated, and in those days it was virtually unregulated and very cheap.

  650. It might have been cheaper at that time.
  (Dr Gruer) At one stage it was very, very cheap.
  (Dr Plant) Alcohol has cheapened in price since the Second World War, it has roughly halved. The thing that has had the biggest effect on tobacco consumption is the periodic price hikes.

Mr Clarke

  651. How does the amount spent on advertising compare to health boards' own promotional budgets? Can you tell us how much budget the Glasgow Health Board has, for instance, for anti-drinking?
  (Dr Gruer) It is minuscule. By comparison it bears absolutely no relation whatsoever. In terms of health promotion against alcohol you are talking about less than £100,000 per year in Greater Glasgow, very small sums indeed. The health board gets virtually nothing really in terms of specific money allocated for anti-alcohol advertising. There is a Drinks Wise Campaign which comes up with several tens of thousands a year but that is about it.
  (Dr Plant) Nationally the Health Education Board for Scotland has very few people working on alcohol.

Miss Begg

  652. You said, Dr Plant, that there was no point in spending public money on advertising to change people's behaviour on alcohol. How should we spend it then? Assuming that we want to spend public money on alcohol and we want to reduce the consumption of alcohol and alcohol-related disease, what is your advice?
  (Dr Plant) I think first of all health promotion is very important and it is a moral thing we have to do to teach young people about the potential dangers of a number of things they might do, including their drinking. There are effective ways that have been demonstrated to bring down rates of alcohol problems, and these all come under the heading of harm minimisation. The kinds of things that we know have worked because they have actually produced dramatic results in the past range from enforcing existing licensing laws, laws related to selling to people when they are intoxicated, which should not happen but it does, laws related to the supply of alcohol to people under age on licensed premises, and in a number of cases in England and Scotland local byelaws have actually brought about a big, big drop in rates of certain kinds of alcohol-related nuisance. The problem is that these tend not to be widely discussed. In Torquay years ago they brought down not just alcohol-related crime but all crime by 20 per cent with a successful one year experiment that was so successful that it was immediately abandoned. I think there are a number of things that people can do. We have seen an enormous fall across the whole industrial world in alcohol involvement in driving but we do not really know why because it has happened in different places with different systems. The down-side of this is that this success has almost been balanced out by an increase in road accidents amongst pedestrians. I would rather drunks walked home than drove home. There are examples of ways in which we can get a handle on this.

  653. You are saying that the regulation is there but it is not applied?
  (Dr Plant) Yes, it is often not a high priority.

Mr Tynan

  654. I really think we have covered the question, does advertising cause particular problems among young drinkers? The perception is that advertising is not all that important, is that your view?
  (Dr Plant) That is what comes out of available evidence. We organised a conference with the Scotch Whisky Association and brought together many of those who had done research into this and that was the view then. I do not think the evidence base has changed very much since then. I am sure that the fact that alcohol is so much part of our wallpaper, it is part of our social life, young people form very strong impressions about drinking very early on and this has a tremendously big, profound, long-lasting effect on people.

  655. As regarding advertising you do not think it would make much difference?
  (Dr Plant) I cannot be sure. One classic example that is always given is that under the Soviet system they did not have much resembling alcohol advertising in the USSR, but they certainly did have a big alcohol problem. There the reason was that alcohol was the only thing you could buy in the shops.

  656. On the question of alcohol education, do you think it is a waste of money?
  (Dr Plant) No. I would distinguish between alcohol education, which is the guidance teachers do in schools, and big mass media campaigns about alcohol. The latter do not seem to achieve anything, even though I can understand they might be quite attractive because they are a visible sign that people are committed. I think alcohol education is tremendously important, as with any other kind of health promotion education, it is one thing to tell people about the potential dangers. Young people, in particular, feel it is not going to happen to me, I am invulnerable. It is very, very difficult to make any connection between that and having a long-term influence on the way somebody handles alcohol at a later stage in their life, particularly when you are talking to young people because the potential dangers seem so remote. When you are 12 or 13, you cannot imagine being a drunk driver or getting liver cirrhosis or being alcohol dependent, it is something which seems quite alien.

  657. Are there any lessons to be learned as regards the French attitude towards alcohol? They have children drinking at a younger age than in this country. Is there a case there for lowering the age at which people are allowed to drink alcohol?
  (Dr Plant) You can drink alcohol in the United Kingdom when you are five. I have always been very strongly in favour of us doing what they have been doing pretty successfully in Southern Europe for centuries, which is teaching your children to drink in moderation and at home. The problem is that some people, because of their religious backgrounds, do not want to do that. We did a study of the western isles a few years ago and a fifth of teenagers come from backgrounds where alcohol is not used at all and a third drank very considerable amounts. In France and Italy they have always had a family-centred, home-centred approach to drinking. One thing we found out from the new International Teenagers Study is that French teenagers say their parents know where they spend their spare time, British teenagers often say they do not. What goes on in the family is tremendously important.
  (Dr Gruer) It is important if parents are going to teach their children not to abuse alcohol they teach them the right way. You have to have adults behaving sensibly with alcohol first to pass on the right message, rather than adults boozing on a Friday or Saturday night with their kids alongside them, and they are learning how to do it when they are only ten. We have still a long way to go in many parts of Scottish society before we would recommend parents to teach their kids to do as they do.

  658. It is the question of the chicken and egg, if the children have learned from seeing their parents introduce alcohol on a regular basis to excess, compared to sensible drinking, it is how you do that balance.
  (Dr Gruer) That is right. We are an evolving society. We are, as I said earlier, Europeanising slowly the way we drink, that may be more hopeful for the future.

  Mrs Adams: We are going to move on now to duty.

Mr Sarwar

  659. The Greater Glasgow Health Board memorandum argued that taxation of alcohol is a public health measure of wide potential effectiveness. United Kingdom alcohol taxes are among the highest in Europe. The recent document produced by the Greater Glasgow Health Board suggested that some proportion of excise duty could be hypothecated to combat alcohol abuse. This might help to put the health boards on more of a level playing field than the alcohol industry. What level of tax should be set on alcohol?
  (Dr Gruer) I am not a tax expert, I think that virtually all of the studies that have been done throughout the world have demonstrated that there is relationship between alcohol consumption and price. The higher the price related to income, the less alcohol is bought and consumed. In a general way, if you want to reduce alcohol consumption you make it more expensive. The situation, however, is much more complex than that in the world in which we live, because of the problems of leakage. I think what we have been seeing in Britain in the last 10 to 15 years, as the European Union has developed and the common market has extended, we have more expensive alcohol than our neighbours, so people are doing all they can to get round our high price by bringing in alcohol, not just for their own personal consumption but for sale illegally by avoiding revenue. It does seem now that in many area of Scotland, and this was brought home to us in our Drug Action Team by Customs & Excise, that as much as a quarter or a third of alcohol consumed is being smuggled in and tax has not been paid on it. There is this difficulty about, if you set too high a level then you get the smuggled stuff and you lose control. I think it is a problem that we are having to face in Britain as part of the European Union. I would expect that if we are going to have more harmonisation and have lower taxes on alcohol we will have to anticipate a higher general level of alcohol consumption as being almost an inevitable corollary of that. It is not an easy question to answer. If we could have strict control over alcohol pricing and we could sustain that through controls at our borders then we could anticipate reducing consumption by hiking the price.

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