1. Alcohol prevention - the uneven arena for policy and practice Andrew Brown Alcohol Programme Implementation Manager

2. 2 Revenue Business Health Social Control ValuesEvidence Political / philosophical Scientific Religious Market Explicit / implicit Empirical Legal Anecdotal Modelling Cost Impact on stakeholders Policy decisions Media Party political Public Legal BusinessPublic health Wider policy objectives

3. 4 quick charts 3

4. Alcohol duty received per quarter 4 Total alcohol receipts followed a consistent pattern from 2005 to 2007, of around £2,000m per quarter, but with a peak during the final quarter of each calendar year (usually to around £2,200m, related to the Christmas period) followed by a dip in receipts in the first quarter of each calendar year (to approximately £1,600- £1,700m per quarter). From 2008 total receipts became slightly more volatile… This may be attributable to there being two increases in duty rates in 2008 (one in March and one in December). Receipts have since trended upwards slightly, reaching their highest level recorded in Q4 2015, at close to £3,168m. In more recent years receipts from alcohol have been noticeably higher due to sustained periods of good weather, or major outdoor/sporting events, which typically increase alcohol receipts. Source: Monthly statistics on clearances of alcohol products and duty receipts (HMRC)

5. Number of licensed premises 5 37,700 premises were licensed for on-sales of alcohol – up 6.8% on 2009 52,400 premises were licensed for off-sales or supply of alcohol – up 10.3% on 2009 78,500 premises were licensed for both on- and off-sales or supply of alcohol – down 3.7% on 2009 Source: Alcohol and late night refreshment licensing England and Wales 31 March 2014Alcohol and late night refreshment licensing England and Wales 31 March 2014

6. Violence linked to alcohol 6

7. Alcohol related hospital admissions 7

8. Policy environment 8

9. Legal product Toxin Intoxicant Addictive Substance 9 Source of revenue, employment, etc. Contributor to health harms & productivity loss Increased risk or health harms, hospital admissions, violent crime, etc. Street drinkers, alcohol treatment, etc.

10. The politics of alcohol “Alcohol plays an important part in the cultural life of this country, with large numbers employed in production, retail and the hospitality industry. Pubs, bars and clubs contribute to community and family life and also generate valuable revenue to the economy. However, alcohol is a regulated product. Some individuals misuse it, contributing to crime and anti-social behaviour, preventable illness and early death.” 2010 Drug Strategy 10 “Binge drinking isn’t some fringe issue, it accounts for half of all alcohol consumed in this country. The crime and violence it causes drains resources in our hospitals, generates mayhem on our streets and spreads fear in our communities. “My message is simple. We can't go on like this. We have to tackle the scourge of violence caused by binge drinking. And we have to do it now.” PM’s forward to the 2012 alcohol strategy

11. Alcohol as a legal product 11 Overall, illicit and cross-border shopping is estimated to have resulted in a £1.5 billion loss in tax revenue from alcohol (14% of total alcohol tax revenue) in 2013–14. Source: The IFS Green Budget: February 2016The IFS Green Budget: February 2016 The government will set up a new national alcohol control room and introduce a mobile taskforce in order to tackle alcohol fraud. Summer Budget 2015

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13. Public acceptability of environmental prevention 13 Pechey R, Burge P, Mentzakis E, Suhrcke M, Marteau TM. Public acceptability of population-level interventions to reduce alcohol consumption: A discrete choice experiment. Social Science & Medicine (1982). 2014;113(100):104-109. doi:10.1016/j.socscimed.2014.05.010.

14. Measurable effects of local alcohol licensing policies on population health in England Stronger reductions in alcohol-related admission rates were observed in areas with more intense alcohol licensing policies, indicating an ‘exposure–response’ association, in the 2007–2015 period. Local areas with the most intensive licensing policies had an additional 5% reduction (p=0.006) in 2015 compared with what would have been expected had these local areas had no active licensing policy in place. 14 F de Vocht et al. J Epidemiol Community Health 2016;70:231-237 Lower tier local authority cumulative policy intensity, stratified in the four categories: none (white), low (light grey), medium (dark grey) and high (black).

15. Concluding thought 15 Overton window Unthinkable Radical Acceptable Sensible Popular Policy Popular Sensible Acceptable Radical Unthinkable The "window" of politically acceptable options is primarily defined not by what politicians prefer, but rather by what they believe they can support and still win re-election. In general, then, the window shifts to include different policy options not when ideas change among politicians, but when ideas change in the society that elects them. Source: Mackinac Center for Public Policy

16. Contact Andrew Brown Alcohol Programme Implementation Manager email – andrew.k.brown@phe.gov.ukandrew.k.brown@phe.gov.uk twitter - @andrewbrown365 @PHE_uk 16