Guest blog by Dr Catherine Conlon
A new report this month from the Lancet commission states that alcohol price controls should be among the steps used to reduce high alcohol consumption, to prevent or delay two out of five dementia cases.
The report follows mounting evidence that alcohol is a major modifiable risk factor for dementia, including early-onset dementia; and adds to the urgent need to raise awareness of the long-term consequences of alcohol on brain health.
With alcohol being more affordable now than it was two decades ago, the public health benefit of alcohol excise duty – which has not changed in a decade – has been eroded. The Government must increase alcohol excise duty to prevent or delay dementia, reduce road deaths and challenge the national global ranking as one of the top three countries for Foetal Alcohol Spectrum Disorder.
The most recent data on the effect of drink-driving on road deaths (from 2015-2019) indicates a third of all deaths in those years included a positive toxicology test for alcohol. Of those, the road deaths typically involved males under 45, with the fatalities occurring in the late evening or early morning and at the weekend.
A study in France found drivers under the influence of alcohol are 18 times more likely to be responsible for a fatal accident.
And it’s not just dementia and road fatalities where alcohol consumption is causing life-long damage. Ireland has the third highest of Foetal Alcohol Spectrum Disorder (FASD) in the world. Recent research has shown damage to infants can occur prior to conception based on consumption patterns of both father and mother.
This might appear incongruous, but the evidence demonstrates how alcohol disrupts the normal DNA methylation of sperm, which may impact on the way genes are expressed in the resulting embryo.
While the impact of alcohol consumption by both parents before conception is interesting and important, the real issue centres on the place of alcohol in Irish society that turns each occasion into an excuse to drink.
Dr Mary O’ Mahony, Consultant in Public Health Medicine, Cork and Kerry, and national clinical lead on FASD prevention, said in April at the Irish Medical Organisation’s annual general meeting, that alcohol should be blamed, and not women, outlining that 40% of pregnancies are unplanned with mothers left feeling guilt over harm inadvertently caused.
“I’ve learned it’s not a woman’s problem. It’s an alcohol problem. And the sooner we recognise it is an alcohol problem, the sooner we might be able to do something about it,” she said.
Dr O’Mahony outlined how almost one in twenty (4.7%) of all children born in Ireland are born with FASD.
‘The greatest predictor of drinking alcohol during pregnancy is people’s drinking habits before pregnancy. The most effective measure to reduce the incidence of FASD is therefore to reduce the population’s alcohol per capita (APC) consumption.
“A cross societal approach is needed to prevent FASD. It’s not a woman’s problem; 74% of alcohol is consumed by men,” she added.
The reality is stark. “It takes just 13 women to drink during pregnancy for a child to be born with FASD,” reports Dr O’Mahony, citing research based on a systematic review and meta-analysis published in the Lancet in 2017. The greater the quantity consumed, the higher the risk.
FASD can present with a spectrum of disease. At the more severe end, babies will be born smaller than expected, with particular facial features including small eyes, a thin upper lip, and the lack of a vertical groove between nose and lip.
Other children will present later on in national school with attention and memory deficits, difficulty with abstract concepts such as maths and time; poor problem-solving skills; and difficulties learning from the consequences of their actions.
In its pre-Budget 2025 submission, Alcohol Action Ireland (AAI) called for a 15% increase in excise duty on alcohol and said that going forward it should be automatically linked to inflation. Evidence from across the EU has shown a 10% increase in the price of alcohol leads to a 7% reduction in road deaths – for 2023, that’s 13 people who might still be alive today.
“There is a body of evidence showing a robust link between price of alcohol and road deaths. A 10% increase in pricing across the EU has been shown to lead to a 7% drop in road deaths,” said AAI.
A key driver of consumption is affordability. AAI state that reports of high alcohol prices in Ireland do not allow for the relative price of alcohol compared to other goods and disposable household income. When these factors are accounted for, the OECD has found Ireland’s alcohol is the second most affordable within OECD members and has the highest level of affordability for young people aged 16-24.
Shop-bought alcohol is the same price today as it was two decades ago, meaning it is now 70% more affordable than in 2003. Even alcohol bought in pubs is 14% more affordable that it was 20 years ago. AAI report that alcohol excise duty has not changed in a decade, meaning its public health benefit has been significantly eroded by inflation.
The Health Research Board’s 2023 Alcohol Treatment Report, published in July, highlighted that 14.8% of the population in Ireland have an alcohol use disorder (AUD) with 90,000 them having a severe AUD problem. The report shows that per capita alcohol use stood at 9.9 litres in 2023, down from close to 11 litres annually between 2014 and 2019.
“Although there has been a decline in per capita alcohol use in Ireland in the last number of years, we are increasingly seeing the legacy of the exceptionally high alcohol use in the late 1990s and early 2000s,” the Health Research Board report said.
A 15% rise in excise duty would go some way to simply bringing back alcohol’s value to where it was 10 years ago, and could have a significant impact on multiple alcohol harms – including drink-driving and FASD.
Alcohol business interests say the marketing of alcohol is a fundamental freedom. This may be true, but it must be balanced against the profound loss of freedom for many from the consequences of consumption.
Those calling ‘nanny state’ must include in their rebukes the cost to the state alcohol consumption invokes in terms of the exorbitant costs of health and personal care required by people living with alcohol addiction, dementia, brain damage from road deaths, and foetal alcohol spectrum disorder. Other life-changing consequences include addiction, incarceration, injury and violence as well as incapacitating mental health issues for whole families.
The need for life-long care in every age and stratum of society in a nation consumed by alcohol is not freeing either for the patient, their caregivers or for the State required to fund it.
An increase in excise duty on alcohol is not ‘nannying’ – it’s a Government doing its job protecting the health and welfare of its people. It is time to put the health of road users, unborn babies and all of Irish society before the private wealth of the alcohol industry.
Dr Catherine Conlon is a public health doctor with the HSE and former director of human health and nutrition, safefood
Follow Catherine on X at https://x.com/catheri70835198
