Tuesday, 12 May 2015
Alcohol Consumption in Ireland: Statements
I thank the House for raising this issue and giving me the opportunity to discuss it. I apologise to Members for being late and thank them for their patience, but I had to take a debate on Portlaoise hospital in the Dáil and given the day that was in it I thought I should respond to it myself.
Before I start I wish to put the issue of alcohol in context. At the moment, the Department of Health and the Minister of State, Deputy Kathleen Lynch, and I are pursuing 25 actions for this year around five major themes. They are Healthy Ireland, patient outcomes and safety, universal health care reform and the modernisation of our infrastructural facilities. We put Healthy Ireland first for a particular reason, because it is our belief that we need to improve our health as individuals, as that is in our own interest, but also we need to improve our health as a nation if we are ever going to get on top of the health problems we face in this country or ever get on top of health budgets. That includes lots of different actions. The Healthy Ireland survey is now under way. It is the first survey of our nation's health since SLÁN back in 2007. Members will be aware of the actions taken by the previous Minister, Deputy James Reilly, and our forbears on tobacco and the regulation of sunbeds, which was introduced in recent months to protect children in particular from skin cancer, and also the actions that are being taken on obesity. Alcohol is just one part of the bigger Healthy Ireland picture, which in itself is only one part of a bigger effort in health.
Ireland has a serious problem. We drink too much overall and we tend to binge drink a lot. In spite of what we might like to think, alcohol is not abused by a small minority of individuals. In fact, the majority of people who drink do so in a harmful way. Our alcohol consumption is in the top five among the 28 EU member states, and although alcohol consumption per capitadeclined between 2007 and 2013, it remains high. The damaging dominance of a harmful drinking pattern remains very high by European standards and is a major public health concern. From the provisional figures available, we know that alcohol consumption per capitaincreased from 10.6 litres in 2013 to 11 litres in 2014. That is probably related to the upturn in the economy and represents the first increase in alcohol consumption in a number of years. If that is the case, it is a matter of real concern, because it indicates that without policy change, as more people return to work and they have more money in their pockets, they are likely to drink more of it.
Patterns of drinking, especially drinking to intoxication, play an important role in causing alcohol-related harm. In Ireland, as I mentioned, we tend to binge drink. Ireland was second in the WHO European region in relation to binge drinking, with 39% of the population misusing alcohol in this manner at least monthly. The Health Research Board's alcohol diary survey found that 54% of adult drinkers were classified as harmful drinkers, 75% of all alcohol consumed was done as part of a binge drinking session, and Irish drinkers underestimate their alcohol intake by 61%. The study found that more than half of adult drinkers in the population are classified as harmful drinkers, which equates to between 1.3 million and 1.4 million people. The findings lead to the conclusion that harmful drinking is the norm in Ireland, in particular for young people - men and women aged under 35 years.
This pattern of drinking is causing significant harm to individuals, their families and society. It is estimated that it was responsible for at least 83 deaths every month in 2011. It was associated with 8,836 attendances in 2012 to specialised addiction treatment centres. It was involved in one of every three poisoning deaths in Ireland in 2012 and remains the substance implicated in most poisonings. It was a contributory factor in half of all suicides and in deliberate self-harm. It is associated with a risk of developing health problems such as alcohol dependence, liver cirrhosis, cancer and injuries. It is a factor in many assaults, including sexual assaults, assaults against children, rape, domestic violence and manslaughter. It contributes to high levels of non-attendance at work and lower productivity and it is also associated with higher college drop-out rates. As we are all aware, it is a factor in 30% of road collisions and in 36.5% of fatal road collisions. The European Alcohol Policy Alliance has warned that, taking all diseases and injuries at a global level into account, the negative health impact of alcohol consumption is 31.6 times higher than the benefit that does exist from low levels of alcohol consumption.
The HSE report, Alcohol Harm to Others, examines the damage that alcohol causes in the general population, the workplace and children in families. The report says that over one in four people in Ireland reported experiencing negative consequences as a result of someone else's drinking. One in ten Irish workers experienced negative consequences due to co-workers who were heavy drinkers and one in ten Irish parents reported that children experienced harm in the past 12 months as a result of someone else's drinking. The results confirm that alcohol is causing significant damage across the population, in workplaces and to children, and carries a substantial burden to all in Irish society. Action is required to protect the health and well-being of the wider public, and especially children, from alcohol use.
The Government is committed to tackling alcohol misuse in Ireland and the widespread harm and pain it causes. A comprehensive and detailed package of measures has been approved to do so. As Members are aware, the general scheme of the public health (alcohol) Bill was published last February and my Department is currently drafting the Bill. I intend to have the Bill published before the summer recess and introduced in the Houses of the Oireachtas in autumn. This legislation is the most far-reaching proposed by any Government, with alcohol being addressed for the first time as a public health issue. The Bill is part of a comprehensive suite of measures to reduce excessive patterns of alcohol consumption, as set out in the steering group report on a national substance misuse strategy. It is also one of the measures being taken under the Healthy Ireland framework to which I referred previously. The aim is to reduce alcohol consumption in Ireland to 9.1 litres per person per annum, which is the OECD or developed world average, by 2020, and to reduce the harms associated with alcohol, particularly by reducing binge drinking.
At the recent National Alcohol Forum conference, Dr. Thomas Babor spoke about the need to tackle the problems of alcohol misuse by focusing on affordability, availability and attractiveness. The public health (alcohol) Bill provides for minimum unit pricing, to eliminate very cheap alcohol from stores, particularly supermarkets; health and calorie labelling on alcohol products to improve consumer information; structural separation in stores to reduce the availability and visibility of alcohol, so that it is no longer sold as a normal grocery product; restrictions on the advertising and marketing of alcohol; regulation of sports sponsorship; and enforcement powers for environmental health officers.
Addressing the price of alcohol is an important component of any long-term approach to tackling alcohol misuse. The price of alcohol is directly linked to consumption levels and levels of alcohol-related harm. The World Health Organization has said that there is:
...indisputable evidence that the price of alcohol matters. If the price of alcohol goes up, alcohol-related harm goes down.Despite the fact that we have relatively high excise duty rates, the price of alcohol remains very affordable, particularly in supermarkets. A woman can reach her low-risk weekly drinking limit for just €6.30 a week, while a man can reach the weekly limit for €10. The Bill will make it illegal to sell or advertise for sale alcohol at a price below a set minimum price. Minimum unit pricing, MUP, sets a minimum price per gram of alcohol and will be based on the number of grams of alcohol in the product.
I know that many Members listened to the excellent presentation given by Dr. John Holmes and Dr. Colin Angus from the University of Sheffield on minimum unit pricing, and the study they carried out in Ireland, so I will not dwell on those results. Suffice to say that the study provided robust evidence that minimum unit pricing policies would be effective in reducing alcohol consumption, alcohol harm, and the costs associated with such harm. MUP would have only a small impact on alcohol consumption for low-risk drinkers. Somewhat larger impacts would be experienced by increasing-risk drinkers, with the most substantial effects being experienced by high-risk drinkers. That is because MUP is aimed at those who drink in a harmful and hazardous manner. Alcohol products which are strong and cheap are those favoured by the heaviest drinkers, who are most at risk of alcohol-related illness and death, and young people, who have the least disposable income.
MUP is not expected to affect the price of alcohol in the on-trade, but it will prevent large multiple retailers from absorbing increases in excise rates and from using alcohol as a loss leader. Officials in my Department are also looking at possible mechanisms to ensure that some of the financial benefits of MUP, if any, may flow back to the Exchequer. Some have been calling for a ban on below-cost selling instead of MUP. I wish to take the opportunity to clarify why MUP is more effective than a ban on below-cost selling. First, there is no agreed definition of below-cost selling in Ireland or how it can be calculated. If it is interpreted as alcohol being sold below the price of VAT and excise duty, then very little alcohol is sold at that price in Ireland.The University of Sheffield study found that a ban on below-cost selling would have a negligible impact on alcohol consumption or related harms. Working out a cost price that incorporates other costs such as manufacturing, transportation and retailing is a complex and expensive exercise and might not even be accurate. Banning below-cost selling would be difficult to implement, monitor and enforce, whereas minimum unit pricing is easier to understand, measure and enforce.
Others have been calling for a general increase in excise rates. A difficulty with such a measure is that it would render premium and higher-priced alcohol more expensive, which is unnecessary for the purpose of targeting hazardous and harmful drinkers, who tend to purchase larger quantities of cheap alcohol. A tax increase would not necessarily have the same effect as a compulsory minimum price, because of the risk that taxes would not be passed on in full. MUP prevents large multiple retailers from absorbing increases in excise rates and using alcohol as a loss leader to generate footfall for other products.
As part of the process of working out what the appropriate MUP might be, we are taking into account estimates from the report of the University of Sheffield and consulting with the relevant Departments. If MUP is to be effective, the price needs to be set at a level that will reduce the burden of harm from alcohol use but not so high that it increases the cost of a pint in the pub or a glass of wine in a pizzeria. Concerns have been expressed about the impact MUP might have on cross-Border trade. The Minister for Health in Northern Ireland has also announced plans to introduce minimum unit pricing for alcohol in that jurisdiction. My officials are in contact with their counterparts in the Department of Health, Social Services and Public Safety on the matter and are cognisant of the requirement to work with the North on implementation.
Last February, the Scottish Inner Court of Sessions, that country's highest court, referred a number of questions on MUP to the European Court of Justice. The latter held a hearing on this case on 6 May and a judgment is expected by the end of the year. We intervened in the case by making a submission in writing and delivering an oral statement in Luxembourg last week. We are confident MUP will be found to be compatible with EU treaties and rules. As such, it is important that all the necessary steps are put in place to commence the legislation, if enacted.
MUP will be complemented by the making of regulations under section 16 of the Intoxicating Liquor Act 2008. This section provides for the making of regulations which may prohibit or restrict advertising, promoting, selling or supplying of alcohol at reduced prices or free of charge in order to reduce the risk of a threat to public order and health risks from the misuse of alcohol. This will allow us, for example, to prohibit volume-based offers, such as three for the price of two deals.
Protecting children from exposure to alcohol marketing is an important public health goal. There is a body of research which shows that exposure to alcohol marketing, whether on television, in movies, in public places or via alcohol-branded sponsorship, predicts future youth drinking. Longitudinal studies have found that young people who are exposed to alcohol marketing are more likely to start drinking or, if already drinking, to drink more. Research also shows that self-regulation is not able to protect young people from exposure to large volumes of alcohol marketing and appealing alcohol advertising. The Bill will make it illegal to market or advertise alcohol in a manner that is appealing to children. It provides for the making of regulations regarding the marketing and advertising of alcohol and includes provisions for restrictions on broadcast marketing and advertising, cinema advertising, outdoor advertising, print media and the regulation of sponsorship by alcohol companies. This will encompass major sporting events for the first time by putting the existing code of practice for sponsorships by drinks companies on a legal footing with enforcement powers and penalties. In addition, the legislation will contain a commitment that the provisions on marketing and advertising will be reviewed after three years.
On labelling, research shows that accurate information on the alcohol content of specific beverages is essential to promote awareness of alcohol intake. However, "standard drinks" and alcohol units are widely misunderstood by the general public. In order to address this, the Bill will provide that labels on alcohol products must contain health warnings, including for pregnancy, must indicate the amount of pure alcohol as measured in grammes, and must show the calorie count. Under the legislation, pubs and restaurants will be obliged to provide this information to customers for alcohol products sold on draught or in measures, including pints, glasses of wine and measures of spirits. Health warnings will also be included on all promotional material, including advertisements.
From a merchandising perspective, the Minister for Justice and Equality and I are examining the best way to implement the separation of alcohol products from other products in mixed-trading premises. Our aim is to ensure alcohol products cannot be displayed in the same way as ordinary grocery products, as they currently are displayed.
It is vital that any measures introduced to tackle the misuse of alcohol are enforceable. The provisions in the Bill will be enforced by environmental health officers who work for the Health Service Executive. Measures to be enforced include minimum unit pricing, health labelling, control of marketing and advertising, structural separation of alcohol from other products, and regulations relating to the sale, supply and consumption of alcohol products under section 16 of the Intoxicating Liquor Act 2008. These pertain to restrictions on advertising, promoting, selling or supplying alcohol at reduced prices or free of charge.
We must inform the public about the damage caused by alcohol abuse and explain clearly the aims of our policies in this area. We need to change our attitude to alcohol in general. I hope that by working together we can achieve and surpass our goal of reducing consumption of alcohol in Ireland to the developed world average by 2020 and reducing the significant harms caused by the misuse of alcohol. As I said earlier, I will be seeking Government approval to publish the Bill before the summer recess. I look forward to bringing it to the Seanad for debate.