House of Commons - Science and Technology Committee

Alcohol Guidelines - Science and Technology Committee Contents

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.[64] 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 guidelines

— There 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 liver.[65]

— Tax increases have been shown to impact on rates of cirrhosis mortality, drink-driving deaths, and violent crimeand some have therefore questioned whether alcohol tax is high enough.[66]^,[67] 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.

— Our 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 consumption.

Could the evidence base and sources of scientific advice to Government on alcohol be improved?

— The 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 priorities.[68] 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.

— At the time of our report, studies of the cost-effectiveness of different alcohol interventions were just becoming available.[69] 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.[70]We hope that the results of such studies have, and continue to be, been taken into account when formulating policy.

— There 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.[71]

How do the UK government's guidelines compare to those provided in other countries?

— Although 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.

— At 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 by 50%.

— Among 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 ages.[72]^,[73]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.[74]

— Britain, 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.[75] 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 inquiry.

Dr Rachel Quinn, Director
Medical Science Policy
Academy of Medical Sciences

September 2011

64 Academy of Medical Sciences (2004). Calling time: the nation's drinking as a major health issue. http://www.acmedsci.ac.uk/p48prid16.html Back

65 Ramstedt M (2003). Alcohol consumption and liver cirrhosis mortality with and without mention of alcohol-the case of Canada. Addiction, 98, 1267-1276. Back

66 Cook P (1981). The effect of liquor taxes on drinking, cirrhosis, and auto accidents. In Moore MH and Gerstein DR (eds). Alcohol and Public Policy. National Academy Press, Washington DC, 255-285. Back

67 Cook PJ and Moore M J (1993). Violence reduction through restrictions on alcohol availability. Alcohol Health and Research World, 17, 151-156. Back

68 Academy of Medical Sciences (2010). Reaping the rewards: a vision for UK medical science. http://www.acmedsci.ac.uk/p99puid172.html Back

69 Ludbrook A et al (2001). Effective and Cost-Effective Measures to Reduce Alcohol Misuse in Scotland: A Literature Review http://www.scotland.gov.uk. Back

70 Chisholm D et al on behalf of WHO-CHOICE (2003). Reducing the global burden of heavy alcohol use: a comparative cost-effectiveness analysis. WHO (working paper), Geneva. Back

71 Home Office (2000). Report of Policy Action Team 8: Anti-Social Behaviour. http://www.neighbourhood.gov.uk. Back

72 Wagenaar A C and Toomey T L (2002). Effects of minimum drinking age laws: Review and analyses of the literature from 1960 to 2000. Journal of Studies on Alcohol, Supplement 14, 206-225. Back

73 Shults R et al (2001). Reviews of evidence regarding interventions to reduce alcohol-impaired driving. American Journal of Preventive Medicine, 21, supplement 4, 66-88. Back