Professor Frank Murray:

I thank the Chairman. I am here to speak on behalf of my fellow liver colleagues here, as well as the other people in the medical profession represented by the Royal College of Physicians of Ireland, RCPI. I thank the joint committee for the opportunity to speak about the heads of the public health (alcohol) Bill 2015. I am representing the RCPI's policy group on alcohol, which has made a submission to the joint committee. Our college represents more than 10,000 members and fellows who work as hospital consultants, registrars and senior house officers in hospitals, as well as in other health care settings at home and abroad. RCPI doctors work in 27 specialties treating all types of medical condition including cancer and liver diseases in both hospital and community settings. They work on the front line of the health services with nurses and other colleagues caring for patients, many of whom have come to us as a result of hazardous or problem drinking. That really is why we are here today.

It has been estimated that approximately 1,500 hospital beds are occupied every night in hospitals directly because of alcohol harm. This costs approximately €1.2 billion per year, and in view of the current crisis in beds, with hundreds of patients on trolleys in accident and emergency departments, it is a national shame. As liver specialists, I and the three doctors present are saddened and shocked by the increased number of deaths due to cirrhosis of the liver, which has doubled in the last 20 years. This doubling in the death rate from liver cirrhosis and liver failure reflects the doubling in alcohol consumption in Ireland that had taken place in the preceding years, because we now are drinking more than twice what we drank in the 1960s. Alcohol also is classed as one of the most important causes of cancer in Ireland, primarily breast, colon and oesophageal. Alcohol also is a factor in suicide, domestic abuse and incidents and accidents. One in ten first admissions to Irish psychiatric hospitals in Ireland are alcohol-related, and more than 25% of all injuries presenting to accident and emergency departments are alcohol-related.

We believe Ireland’s relationship with alcohol is at crisis point. The World Health Organization tells us that almost half of all Irish drinkers engage in heavy episodic drinking on a regular basis and that Ireland is close to the top of the binge drinking league worldwide. Research also has shown that approximately 80% of Irish adults consume alcohol and that more than half of those are classified as harmful drinkers by their own admission. Approximately 10% of those who consume alcohol are dependent on it, and this percentage rises to 15% in the 18 to 24 year old age group. This means we live in a country where virtually every family is affected by alcohol, and I doubt there is anyone in this room who does not have a family member or friend who is affected by problems related to alcohol.

As doctors, we are increasingly caring for more than 200,000 chronic dependent drinkers who are attending with organ damage, cancers, cirrhosis and liver failure, heart failure and problems related to the brain and nervous system.

Every weekend parents worry about their children getting involved in drinking games or being hurt or killed in road traffic accidents or fights when they go out with their friends. Everyone is affected by the social disorder in towns and cities late at night. There is also an enormous economic cost that we are all bearing. It costs €3.7 billion a year to provide health care and public order enforcement as a result of problem drinking. About a third of that, just over €1 billion, is spent annually by the Government on providing care in accident and emergency departments. This is an enormous sum that has the potential to do much good in many other areas of society if it could be otherwise deployed.

As an advocate of public health measures, the RCPI has commended the Minister for Health, Deputy Leo Varadkar, and the Government on its introduction of this legislation, which is an important and major step in tackling Ireland’s problem drinking. Legislators have listened to us and have taken action. We wish to support them fully. RCPI has come together with Alcohol Action Ireland to form the Alcohol Health Alliance Ireland to advocate for the adoption of this Bill. The Bill contains many of the evidence-based measures for which our policy group, made up of experts caring for people affected by alcohol use, including liver specialists such as myself and my colleagues, psychiatrists, paediatricians and general practitioners, has called.

We know there are powerful and well resourced vested interests who will be working to dilute some aspects of this legislation to safeguard the profits they are required to deliver for their shareholders. It feels like a David versus Goliath situation in that we are not funded from the public purse, but there is a groundswell of support for this legislation. Research by the Health Research Board showed that a majority of the public are supportive of measures to tackle problem drinking, even if they are not the most vocal in this debate. It is a kind of silent majority. There is plenty of public discourse about alcohol and unease about our image as a nation of heavy drinkers. This is not something of which we are generally proud. I believe the time is right to implement radical solutions to address the awful problem of alcohol in Ireland.

There are many looking to the committee as legislators to step up and grasp this opportunity to introduce new laws that will immediately save lives. Committee members should be confident that not only is this legislation necessary but it is what the public demands. The introduction of a minimum unit price for alcohol, reducing the availability of alcohol and restrictions on advertising and labelling of alcohol products are the way forward if we are serious about changing the way people consume alcohol.

Although we are supportive of the legislation, we are concerned about the lack of timelines provided in it for the implementation of minimum unit pricing, as well as for a sports sponsorship ban and the statutory code on the display of alcohol. We call on the committee to ensure that these measures will be enforced once the legislation is enacted.

Minimum unit pricing is the single most important aspect of this legislation. It will reduce the flood of cheap alcohol that tends to be disproportionately consumed by young drinkers as well as problem drinkers. Robust evidence from Canada shows that it will immediately mean that lives are saved and that fewer people are harmed as a result of their use of alcohol. It also has the beneficial effect of reductions in crime levels.

It is worth reflecting that Ireland made history and showed great leadership in introducing the workplace smoking ban in 2004 in the face of a powerful tobacco lobby. We have the opportunity again, particularly as a small country, to take a lead role in regulating the sale of alcohol. As well as saving lives here, the adoption of minimum unit pricing would facilitate the implementation of similar legislation in the UK and further afield. We support setting a minimum unit price of at least €1, the same price as a litre of milk. It needs to be around this price to be effective. Whenever this issue gets discussed, the debate quickly seems to focus on how much a bottle of wine will cost. As there are eight to ten units in a bottle of wine, that would price it between €8 and €10.

It is important to reflect on what has happened elsewhere. Interestingly, countries such as France and Italy, which are major wine producers, have managed to dramatically reduce national consumption of alcohol in recent years at a time when the amount of alcohol being consumed in Ireland has been rising rapidly. Consumers in France and Italy tend to drink better or higher quality wine but less of it. Italians used to drink twice as much as Irish people per capitabut now they drink less than half. We are not prohibitionists and most of us take a drink. It is important, however, to state that there is no safe level at which to consume alcohol. Just in the past few weeks, research published in the British Medical Journaldebunked old myths about a drink being good for us with findings that drinking alcohol is of no benefit to anyone’s health.

One does not have to be addicted to alcohol to get cirrhosis of the liver. Forming a habit of regularly drinking pints or glasses of wine will damage one’s liver and other organs in a serious way over time. We care for many patients who have found themselves unwittingly in the tragic situation of not being addicted to alcohol but drinking heavily and habitually and developing organ failure as a result.

Tackling the price and availability of alcohol is the most effective way to change our relationship with alcohol. This is why we want to see separation of sales of alcohol so that it is not displayed beside everyday groceries. It is not an ordinary commodity. We also welcome the intention to enable better enforcement of a ban on selling to those who are underage. We can see how well environmental health officers have enforced the smoking ban. We want to see similar resources and priority given to policing sales to those who are underage as part of the new legislative package. The Bill should include provisions for strict regulation and enforcement around online drinks promotions, a reduction in the number of outlets where alcohol can be purchased, and further restrictions on opening times.

We also want to see a timeframe introduced for the phasing out of sponsorship of sports events by the alcohol industry. The tobacco industry opposed the move to ban advertising of its products in 2003, claiming it would result in damage to sport. Clearly that did not happen, but this argument is again being rolled out to protect lucrative campaigns that are enormously effective in terms of recruiting the next generation of drinkers. It is disappointing that the public health (alcohol) Bill will not contain a ban on sports sponsorship. This is a provision we will continue to advocate.

There is very strong evidence to link promotion of alcohol through sports sponsorship with early and more problematic alcohol consumption in young people. Drinks companies are investing in advertising and sponsoring these events because they achieve their purpose - namely, they boost alcohol sales. We strongly recommend that a commencement date be set for the phasing out of alcohol sponsorship of sport in the medium term and a target date for the ending of all alcohol sport sponsorship in the longer term.

In the weeks and months ahead, the committee will hear about the nanny state and will be asked why it is necessary to introduce measures that affect the entire population when hazardous drinking affects only a few. There are more than 200,000 chronically dependent drinkers, which represents a large number of people requiring care and support, whatever way one looks at it. International research, as well as doctors, nurses and those on the health care front line, can say that Irish people generally drink in excess of recommended low-risk limits.

There are also important issues of social justice in introducing the measures in this Bill.

The socially disadvantaged suffer disproportionately from the effects of alcohol. The proposed measures will help these individuals and reduce health inequality. While we have made great strides in extending life expectancy, quality of life can be infinitely improved by drinking less alcohol.

One of the leading public health advocates, Professor Geoffrey Rose, tells us that the best way to address large-scale public health problems is to manipulate the environment and context. In this case we are looking to members, as legislators, to control the price and availability of alcohol and seize the opportunity to finally help us to banish the image of the drunken Irish and save the next generation from certain health harms. Let us grasp the opportunity to turn off the tap of cheap, harmful alcohol and set a constructive path for drinking alcohol in Ireland.