Presentation Transcript

1. Eric Carlin, DirectorSHAAP (Scottish Health Action on Alcohol Problems) “The Scottish Experience” Big Alcohol, Big Tobacco, Big Influence Seminar, Palace of Westminster, 1st April 2014
2. I will: Provide a description of Scotland and Alcohol and SHAAP Discuss Scotland’s Alcohol Problem and historical antecedents Explain how evidence-based policy was formulated and adopted Note the persistent opposition of the Alcohol industry to this Illustrate why Minimum Unit Pricing policy is vitally important Challenge 6 of the myths and lies perpetrated by its opponents Call on the industry – MUP legislation should have been enacted a year ago to the day - to cease its opposition
3. Scotland
4. Scotland and Alcohol
5. SHAAP Established by Scottish Medical Royal Colleges in 2006. Our function: To provide a coherent and authoritative medical voice on reducing the impact of alcohol on the health and wellbeing of the people of Scotland and to promote measures that can be adopted to reduce this harm.
6. Membership – SHAAP/SIGA Royal College of Physicians of Edinburgh Royal College of Psychiatrists of Scotland Royal College of Paediatrics & Child Health in Scotland Royal College of GPs in Scotland Royal College of Nursing Royal College of Physicians & Surgeons of Glasgow Faculty of General Dental Practice Royal College of Surgeons of Edinburgh Royal College of Public Health Royal College of Emergency Medicine
7. Alcohol is not simply a Public Health issue 70% of assaults presenting to hospital emergency departments alcohol-related Half of Scottish prisoners drunk when committing the offence Cost to the Scottish estimated at £3.6 billion per year (4.3 billion Euros) 96% of Scots see alcohol abuse as a problem
8. Dundee - 1922 General Election Edwin Scrymgeour - Winston Churchill - Prohibition Party Liberal Party 32, 578 votes 20,466 votes
9. Per capita (litres per head per year) consumption of pure alcohol in the UK population, 1900–2010 Sources: BBPA Statistical Handbook; Cancer Research UK
10. Litres of pure alcohol sold per adult (aged ≥16 years) in Scotland and England & Wales, by market sector, 1994-2011 Source: Nielsen/CGA (Data for 1995-2000 not available)
11. Alcohol Hospitalisations and Deaths in Scotland 1982-2012 Why have Scottish Health Professionals become so concerned about Alcohol?
12. Chronic Liver Disease mortality rates 1950-2006 How does Scotland compare to other countries? Updated from Leon and McCambridge, Lancet 367 (2006)
13. Alcohol Treatment in Scotland Current practice and service provision across the country is varied Comorbid mental and physical disorders are common. Between 2008/9 and 2011/12, 272,040 Alcohol Brief Interventions (ABIs), exceeding cumulative target of 210,530 In 2011-12, 97,830 Alcohol Brief Interventions (ABIs), exceeding target of 61,081
14. Costs and savings per 100,000 population
15. UK AFFORDABILITY TRENDS Health Scotland 2011
16. Alcohol affordability and alcohol-related hospital admissions, 1982-2011
17. McCambridge et al (2013): “Alcohol industry actors…have consistently opposed whole-population approaches,…favouring instead targeted interventions that focus on a supposedly problematic minority of drinkers and emphasising the role of individual responsibility. Industry actors have been strongly criticised for producing incomplete and distorted views of the evidence and influencing research funding and publications in biased ways. These tactics mirror those of the tobacco industry, to which some producer organisations are closely related.”
18. Lies and Misinformation re Minimum Unit Pricing (MUP) No evidence for effectiveness Punishes the ‘responsible’ majority for the behaviour of a few Tax would be better than MUP Regressive – unfairly affects the poor Everything’s getting better so no need for new regulation It’s illegal
19. 1. Lies and Misinformation: No evidence for effectiveness Sheffield Modelling (2009): Increasing levels of minimum pricing show steep increases in effectiveness: overall. Estimated changes in consumption are: 40p -2.7% 45p -4.7% 50p -7.2% Stockwell et al, study using empirical data: British Columbia, 2002-2009: 3 increases in minimum prices for beer & 4 for spirits 10% increase in average minimum price associated with 9% reduction alcohol-related hospital admissions and 32% reduction in wholly alcohol related deaths
20. 2. Lies and Misinformation: MUP punishes the ‘responsible’ majority for the behaviour of a few Holmes et al The Lancet 2013: “Irrespective of income, moderate drinkers were little affected by a minimum unit price of £0·45 in our model, with the greatest effects noted for harmful drinkers.”
21. 3. Lies and Misinformation: Tax would be better than MUP The constraints in EU excise duty directives mean that excise duty can’t be used to achieve the same outcomes as MUP. A system which results in higher prices for higher strength alcohol is more consistent with health aims than one which results in similar prices for alcohol of significantly different strengths. As well as this, it’s not either/or. The Tax system should work wth MUP
22. 4. Lies and Misinformation: MUP is regressive – unfairly affects the poor Holmes et al (2013): “Because harmful drinkers on low incomes purchase more alcohol at less than the minimum unit price threshold compared with other groups, they would be affected most by this policy. Large reductions in consumption in this group would however coincide with substantial health gains in terms of morbidity and mortality related to reduced alcohol consumption.”
23. Reduced Alcohol Affordability can be linked to reduced Health Inequalities
24. 5. Lies and Misinformation: Everything’s getting better so no need for new regulation Ignores historic size of Scotland’s problem Recent reductions relate to affordability, in fact reinforcing the arguments for MUP
25. ALCOHOL DEATHS ARE STARTING TO FALL …..AFTER A 20 YEARS’ RISE
26. 6. Lies and Misinformation: MUP is illegal Court of Session ruling (2013): “The views of the Commission and of the Member States who submitted comments or opinions are, of course, of interest; but no more than that.” “I do not consider it necessary or appropriate to refer any question to the Court of Justice for a preliminary ruling.” “I am in no doubt that reduction of alcohol consumption generally, and reduction of consumption by hazardous and harmful drinkers in particular, are both legitimate aims …There is not the slightest suggestion that it is a disguised restriction on trade…it is clear that the initiative has been conceived and developed as a health initiative and that it enjoys prodigious support from health professionals and health agencies.” “In my opinion none of the challenges to the minimum pricing measures is well founded. There is no proper basis for the petitioners being granted any of the remedies which they seek. The petition is refused.”
27. Thank you! shaap.director@rcpe.ac.uk www.shaap.org.uk