1. Dr Raffaella Margherita MIlani
UK Alcohol Policies
moving forward
Dr Raffaella Margherita MIlani

2. UK Alcohol Policies -2015 onwards
The Policy framework
Priorities for Public Health England and key documents
Lower drinking guidelines
Evidence on tax and minimum price
Anything missing?

3. Government Alcohol Strategy 2010-2015 Framework Policy
Localization
Shared responsibility with the industry
Reducing availability of cheap alcohol
Providing more information about the risks
Reduction in Crime
Harm reduction approach
Treatment and Recovery
Mental Health
increased focus on families

4. Key documents “Provide estimates of the number of children likely
to be affected by the drug or alcohol use of their
parents, and provide advice to national and local
government on where action could have the
greatest impact on improving life chances”

5. 7 key priorities to be achieved by 2020
PHE will focus on securing improvements against seven priorities:
• tackling obesity particularly among children
• reducing smoking and stopping children starting
• reducing harmful drinking and alcohol-related hospital admissions
• ensuring every child has the best start in life
• reducing the risk of dementia, its incidence and prevalence in year olds
• tackling the growth in antimicrobial resistance
• achieving a year-on-year decline in tuberculosis incidence

6. Reducing Alcohol Drinking
use alcohol as the trailblazer for a new whole system approach that establishes what works and is clear on the return on investment, enabling government, local authorities and the NHS to invest with confidence in evidence based policies, prevention and treatment interventions
• produce an independent report for government on the public health impacts of alcohol and on evidence-based solutions
• produce a framework on liver disease outlining public health actions to tackle liver disease, including alcohol
• expand the Longer Lives web tool to include indicators on alcohol treatment and recovery, and to identify variations in performance
• launch Liver Disease Profiles to support local authority health and wellbeing boards to understand liver disease and its risk factors in their area and, in turn, design effective local population level interventions
• continue to set out the evidence base for the introduction of a minimum unit price for alcohol
• consider the evidence for the inclusion of health as a licensing objective

7. Emphasis on reducing inequalities
“People with mental illness are more likely to misuse alcohol;
and the most deprived fifth of the population of the country suffers two to three times greater loss of life attributable to alcohol.”
Public Health England, 2014
Alcohol dependence
Psychiatric Disorders
85%
(Crome et al 2009)

8. Revision of safe drinking guidelines
KEY EVIDENCE
Benefits apply to a smaller group of the population than previously thought: women over the age of 55 (especially if drinking around 5 units a week or less);
There are adverse effects from drinking alcohol on a range of cancers, and these risks start from any level of regular drinking and then rise with the amounts of alcohol being drunk.
Overall health risks are similar for men and women, with short term risks being greater for men and long term risks being greater for women on average.
No level of drinking can be considered completely safe
As well as taking account of the point at which the risk of death from alcohol outweighs any potential health benefits, the group’s report also took account of research showing levels of drinking where alcohol would be expected to cause an overall8 1% lifetime risk of death in setting the proposed guideline on regular drinking. The guideline is at a level around or a little below this 1% risk. Base on this calculation the safe weekly limit for both men and women is 14 units.

9. New guidelines – main changes
Recommended limits are the same for men and women: 14 Units per week (instead of 3 units x day for women and 4 units per day for men)
More detailed guidelines for safe drinking in a single episode, not only amount but also modality: e.g. drinking slowly and with food, avoiding risky activities
Individual vulnerability are highlighted
••young adults
••older people
••those with low body weight
••those with other health problems
••those on medicines or other drugs
Clear information about the increased risk of cancer
Emphasis on alcohol free days
The safest approach during pregnancy is no alcohol at all
(DoH , 2016)

10. Whole population approach
The theory underpinning the Government's approach on reducing irresponsible drinking in the general population is based on Rose’s model

11. There are three standard reasons why governments tax alcohol:
Externality Correction: to ensure that alcohol prices reflect the cost to third parties who are harmed by drinking
Paternalism: to reduce people’s consumption for their own good
Revenue Raising: to fund the Government
Institute of Alcohol Studies (IAS) (2016)

12. The UK Government estimates that externalities associated with alcohol cost England and Wales £21 billion every year.
Alcohol duty in England and Wales currently generates only £9 billion, less than half of the value of these externalities
This suggests higher alcohol taxes can be justified on the basis of the harm drinking causes to wider society alone, without considering the impact on the drinker themselves.
Institute of Alcohol Studies (IAS) (2016)

13. Categorisation of private and external costs and benefits
Source: IAS (2016) Dereliction of duty: Are UK alcohol taxes too low? p,9

14. ”We also estimate that alcohol-content-based taxation and minimum unit pricing would have the largest impact on harmful drinking, with minimal effects on those drinking in moderation”
(Meier et al. 2016)
“The duty escalator was dropped in Furthermore, incomes are starting to rise again, and alcohol duty was cut by a further 2% for spirits and cheap cider. Therefore, the authors predict the "relentless rise“ of alcohol deaths in England once again.”
(Nick Sheron and Ian Gilmore, BMJ Public Release, April 2016)

15. Would change in price affect the whole population?
A study on taxation and price policies found that alcohol- content-based taxation and minimum unit pricing would have the largest impact on harmful drinking, with minimal effects on those drinking in moderation. (Meier et al., 2015)

16. Alcohol as a driver of crime
Emphasis on
Partnership with local authorities, NHS, licensing authorities and local businesses
Day and night economy
Equipping police and local authorities with more power

17. The Zero Alcohol Award initiative

18. PHE will continue to support

20. “There is a need for economic analysis from UK implementations of prevention programmes. “
“As the benefits of prevention are often long term, and are sometimes difficult to relate to policy priorities, additional considerations may be seen as more important than questions of (cost) effectiveness. These include politics, public demand for action, and media pressure.”
“There is strong evidence of prevention approaches that have consistently been shown to be ineffective at improving drug use outcomes. These include information provision (standalone school-based curricula designed only to increase knowledge about illegal drugs), fear arousal approaches (including ‘scared straight’ approaches), and stand-alone mass media campaigns. “

21. Anything missing?
Here is an increase in Sexual Transmitted Diseases amongst young people in UK (PHE 2015)
Alcohol consumption is strongly associated with unplanned and unsafe sexual practices
Interventions should be implemented in order to raise awareness and facilitate beaviour change (Independent Advisory Group on Sexual Health and HIV, 2007)
Milani RM, Townshend JM, Hunt F, Griffin (2013) A Binge drinking, alcohol expectancies and unplanned sexual behaviour: an exploration of gender differences. BPS Health Psychology Conference, Brighton, Sept 2013
Townshend, J.M., Kampouropolous, N., Griffin, A., Hunt, F.J. & Milani, R.M. (2014) Impulsivity, binge drinking and unplanned sexual behaviour. Alcoholism: Clinical and Experimental Research 38 (4), 1143–1150

22. Points for discussion
Quality of the evidence used to develop national guidelines
Who should be involved?
Are we missing the point?
Perception of national guidelines, what does research say
Knowledge, intention and action to change…a complex interaction

23. References
Ally A, Lovatt M, Meier PS, Brennan A, Holmes J. (2016) Developing a social practice-based typology of British drinking culture in : Implications for alcohol policy analysis. Addiction, DOI: /add (Open Access) 
Brown J, West R,  Angus C, Beard E, Brennan A, Drummond C, Hickman M, Holmes J, Kaner E and Michie S. (2016). Comparison of brief interventions in primary care on smoking and excessive alcohol consumption: a population survey in England, British Journal of General Practice. 66(642):e1-9.
Baumberg Geiger B and MacKerron G (2016) Can alcohol make you happy? A subjective wellbeing approach', Social Science and Medicine, 156, pp.184-9
Crome I.et al (2009) SCIE Research briefing 30: The relationship between dual diagnosis: substance misuse and dealing with mental health issues. Social Care Institute for Excellence, London.
 Department of Health (2006) Dual Diagnosis in Mental Health Inpatient and Day Hospital Settings. London: DH. tinyurl.com/dual-inpatient
Department of Health (2016) Alcohol Guidelines Review – Report from the Guidelines development group to the UK Chief Medical Officers. London: DoH.
Meier PS, Holmes J, Angus C, Ally AK, Meng Y and Brennan A. (2016) Estimated effects of different alcohol taxation and price policies on health inequalities: A mathematical modelling study, PLOS Medicine, 13 (2), e (Open Access)
Public Health England, From evidence into action: opportunities to protect and improve the nation’s health, October 2014
Sheron N, Gilmore I (2016). Effect of policy, economics, and the changing alcohol marketplace on alcohol related deaths in England and Wales. BMJ, 2016; i1860 DOI:  /bmj.i1860