Written evidence submitted by the Academy
of Medical Sciences (AG 26)|
I write on behalf of the Academy of Medical Sciences
to draw your attention to our 2004 report Calling time: the
nation's drinking as a major health issue.
The report was the result of a working group led by Professor
Sir Michael Marmot FBA FMedSci. It sought to make an evidence-based
contribution to proposals on how to ameliorate the damage done
by alcohol. Although written some time ago, the report addressed
issues pertinent to your inquiry, and the relevant sections of
the report are highlighted in this letter.
Considering the evidence base for Government's
is a clear evidence base which supports policy aimed at reducing
alcohol consumption. Our report highlighted the strong correlation
between mean or median alcohol consumption and heavy or "problem"
drinking. Data demonstrate that changes in per capita alcohol
consumption are directly reflected in changes in harm. For instance,
in Canada a one litre per annum rise in mean alcohol consumption
was associated with a 30% increase in alcoholic cirrhosis of the
increases have been shown to impact on rates of cirrhosis mortality,
drink-driving deaths, and violent crime and some have
therefore questioned whether alcohol tax is high enough.,
Our report suggested that increasing the tax on alcoholic beverages
to restore the affordability level of 1970, and indexing the taxes
to disposable income, would be a highly effective way of turning
around not only the trend in alcohol consumption but also trends
in alcohol-related harm.
report highlighted areas where current policy may be considered
out of line with scientific evidence. The third recommendation
of our report was that the statutory blood alcohol concentration
level for drivers should be lowered from 80mg to 50mg% and that
there should be a zero statutory blood alcohol level as the limit
for young drivers up to the age of 21 (see also below). It also
drew attention to evidence from Finland which suggested that allowing
the sale of alcohol in supermarkets led to an increase in its
Could the evidence base and sources of scientific
advice to Government on alcohol be improved?
Academy recommends ensuring that all new public health policies
are supported by evidence-based decision-making, robust piloting
and rigorous evaluation throughout implementation. We have recently
emphasised that public health challenges must become cross-Departmental
In our 2004 report, we recommended that an interdepartmental alcohol
policy research programme should be funded to contribute to the
evidence-base and further develop British alcohol policy. The
committee may wish to investigate whether this recommendation
was taken forward.
the time of our report, studies of the cost-effectiveness of different
alcohol interventions were just becoming available.
For example, the study by Chisholm et al. (2003), estimated
that implementation of full enforcement of drinking-driving legislation,
including random breath testing, would reduce traffic deaths in
Western Europe by 23% among men and 4% among women.
We hope that the results of such studies
have, and continue to be, been taken into account when formulating
is a need for greater investment in biomedical research to better
understand the mechanisms of alcohol-induced harm, an area which
at the time of our report was largely ignored by funding bodies.
Other research priorities include understanding changing patterns
of drinking, their social determinants and their contribution
to increases in social problems, such as violence and other antisocial
behaviour and health problems, such as liver cirrhosis.
How do the UK government's guidelines compare
to those provided in other countries?
there are cultural differences between countries in relation to
alcohol, in many aspects of alcohol research there are high-quality
international studies that can contribute to the evidence base
for the development of policy. The Government should take into
account the wealth of international evidence, though it does not
obviate the need for UK-specific studies.
the time of our report, there had been cultural changes in countries
such as Italy and France that had led to significant drops in
mean alcohol consumption in those populations. Whereas in France
and Italy per capita consumption of alcohol had more than
halved since 1970, in the UK over the same period it had risen
the best-supported findings in alcohol policy research is the
conclusion that increasing the minimum age for purchasing alcohol
has an effect in reducing harms from drinking in the affected
While much of this literature is from
the United States, which has a relatively high minimum age of
21, studies from such countries as Canada and Denmark, with lower
age limits, also show beneficial effects.
Ireland and Luxembourg have a higher Blood Alcohol Limit (BAL)
for drivers (0.08%), than the general EU rule (0.05%). Another
exception is Sweden which has a lower BAL (0.02%). An evaluation
of the effects of lowering the BAL level to 0.02% in Sweden from
the level of 0.05%, found that, in combination with other measures
it had a significant effect on drink driving fatalities.
On this matter, the UK could be regarded as being out of step
with much of the rest of Europe and with the research literature.
Research findings suggest that reducing the British BAL could
reduce rates of traffic casualties.
The Academy of Medical Sciences is the independent
body in the UK representing the whole spectrum of medical science.
Our mission is to ensure better healthcare through the rapid application
of research to the practice of medicine. Our Fellowship includes
leading medical scientists from hospitals, academia, industry
and the public service. We look forward to the outcomes of the
Dr Rachel Quinn, Director
Medical Science Policy
Academy of Medical Sciences
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