It is probably no surprise to say that alcohol harms permeate multiple areas of Irish society. Just some of these harms include the ill health of individuals with sadly over 1500 losing their lives annually and alcohol costing 11% of the health budget; the trauma of children impacted by alcohol harm in the home with 25% of the adult population living with its legacy; the very hidden harm of Fetal Alcohol Spectrum Disorders affecting up to 7% of the population, drink driving causing devastation on our roads with one in 10 drivers admitting to driving while intoxicated; the massive level of alcohol-related crime – around 21% of all crime; and the loss of work place productivity with 14% of workers impacted by a colleague’s alcohol use.
What is surprising is the lack of a coherent response across government to comprehensively address these issues. Increasingly we are seeing contradictory policy actions from a range of government departments and the question must be asked – why is no-one in charge of addressing all aspects alcohol harm?
What’s working
In recent years Ireland has been attracting international interest for progress in alcohol policy. In 2018, the Oireachtas passed the Public Health (Alcohol) Act – a series of modest measures based on the World Health Organisation’s (WHO) ‘best buys’ on reducing non-communicable diseases via lowering alcohol consumption i.e. controls on price, marketing and availability. The legislation was advanced by the Minister for Health and represents the first time that a public health approach was taken to alcohol control in Ireland. It contains measures such as Minimum Unit Pricing, restrictions on alcohol advertising, structural separation of alcohol products in mixed retail outlets, plus comprehensive health information labelling on alcohol products including cancer warnings. The measures aim to reduce alcohol marketing to children and to bring about an overall reduction of 20% in population-wide alcohol consumption.
This legislation, which was, and continues to be, fiercely resisted by global vested interests, took over 1000 days to pass through all stages. Determined advocacy by an alliance of public health bodies, led by Alcohol Action Ireland (AAI) was essential to its passage. Implementation, though, has been slow with some important elements not being progressed at all and other parts being undermined by a flood of zero-alcohol product advertising in the few areas which are restricted for alcohol brand advertising. However, there are encouraging signs with per capita alcohol consumption having dropped by 10% since it was enacted although that target of a 20% reduction is still some way off.
Progress under threat
Unfortunately, this progress is now under threat from another government department – Justice, via the Sale of Alcohol Bill, with an attack on the third pillar of the ‘best buys’. This new legislation aims to increase alcohol availability by extending licensing hours of all bars/restaurants from 11.30pm to 12.30am, facilitating late-night opening of bars to 2.30am, extending nightclub hours to 6am and introducing a new cultural amenity license. The international evidence is overwhelming that even a one-hour extension is associated with a 17% increase in alcohol related crime, up to a 30% increase in road collisions and a 34% increase in alcohol related injuries requiring hospital treatment.
The impetus for this legislation came from the report of the Taskforce on the Night-time Economy which had representation from multiple government departments, including Enterprise, Justice, Tourism, Transport etc but none from the Department of Health. The report points to the necessity of ‘modernising Ireland’s antiquated alcohol licensing laws’ in order to achieve a vibrant night-time economy. There was no mention of widespread public unease about the impact of increased alcohol availability on public services or that more than 50% of the population had experienced harm from a stranger’s drinking in the past year.
Policy confusion
This is not the only example of glaring policy incoherence around alcohol. Alcohol is conservatively estimated by the World Health Organisation to cost high income countries up to 2.5% of GDP, which for Ireland would be around €12 billion annually. While the state has a system of alcohol excise duties, these only raise about a tenth of that amount and have not changed in ten years. Indeed policy options provided to the Minister for Finance have included direct quotes from industry representatives seeking excise duty rate cuts. No similar advice from the tobacco industry was included and indeed tobacco taxes have been consistently raised following significant discussions with the Department of Health.
Freedom of information requests, though, have highlighted the lack of interaction between the Departments of Health and Finance on alcohol. Not only that, the government actually provides assistance to the alcohol industry through grants and investments estimated at over €115 million in the past decade. For example, Enterprise Ireland recently gave a grant of €7.5 million to one of the most profitable global alcohol giants, Diageo, towards their new ‘sustainable’ production plant which was recently launched with much political fanfare.
Alcohol government partnership
Much of this is explainable in terms of how the alcohol industry is able to insert itself into the development of government policy – a key goal of the industry as illustrated in a recent publication from Drinks Ireland – Pride of Place, which emphasizes the importance of partnership with government – pointing to the drop in alcohol consumption which they attribute to their own innovations such as zero alcohol products as opposed to the proven measures which they resisted. They now call for ‘modernisation of alcohol policy’ and the removal of restrictive regulations.
A textbook example of this partnership is that the Chair of Diageo Ireland was part of the group which developed the government’s 2021 policy on sustainable food production and exports, Food Vision 2030, despite alcohol not being a food and alcohol only representing less than1% of Ireland’s total exports. The resulting report featured a number of glowing case studies of alcohol production in Ireland notwithstanding alcohol being a threat to at least 14 of the UN’s Sustainable Development Goals.
The report also contained warnings about labelling of products that these should not create ‘unintended barriers to trade’. This very industry friendly language can certainly be read as a direct attack on the already agreed government policy of health information labelling of alcohol.
Food Vision 2030 then became a guide as to where the state would invest. For example, Ireland’s multi-billion-euro Strategic Investment Fund will not invest in tobacco or fossil fuels but bizarrely will invest in alcohol.
What is clear, is that firstly industry friendly language and talking points get adopted across government and are repeated uncritically in many policy arenas. The alcohol industry is seen then as an essential partner to government ambitions and is included in discussions across multiple areas from agriculture to finance.
Office for Alcohol Harm Reduction
A major goal of Alcohol Action Ireland is the establishment of an Office for Alcohol Harm Reduction which would drive coherent government policy development on alcohol and would particularly seek to coordinate across departments to address these and many other anomalies. Just some of the areas include alcohol taxation, development of services, licensing, online alcohol advertising currently being developed through Coimisiún na Meán and the domestic, sexual and gender-based violence strategy from the Department of Justice, which doesn’t even include the word alcohol.
In the first instance we are advocating that the Office would be established within the Department of Health with a remit to gather the data and develop the research base to inform policy development and to set and achieve targets to reduce alcohol consumption in line with public health needs. We have set out the structure of such an office estimating annual costs of the order of €1.5 million.
This is an approach that is very much in keeping with advice from the WHO. Recognising the power of vested interests to thwart public health measures, the WHO, in its most recent Global Action Plan 2022-2030 on alcohol further emphasizes the need for governments to strengthen their capacity to support the implementation of practical and focused technical packages that can ensure returns on investments within “Health for All” and “whole-of-society” approaches. They highlight the need for increased coordination between health and other sectors, such as social welfare, finance, transport, sport, culture, communication, education, trade, agriculture, customs and law enforcement, as well as multisectoral accountability frameworks, which are required for the implementation of effective measures to reduce alcohol consumption and ensure policy coherence.
Common sense approach
Such an Office is surely just common sense and as to why Ireland hasn’t yet taken such an approach is maybe not such a mystery. It certainly serves vested interests to have a multitude of government bodies with no clear oversight of the issues around alcohol harm reduction.
More than two decades ago, Ireland faced down the tobacco industry to introduce the smoking ban in public places. Then Minister of Health, Micheál Martin, recognised the need for determined action and in particular to have the resources to act in this area. He made the significant appointment of Tom Power to head a newly established office of tobacco control noting recently, “that meant we could hire people to do research. It gave us capacity to deal with the issue.”
Alcohol is Ireland’s most widely available and harmful drug with costs likely twice that of tobacco and impacts from the cradle to the grave. With that in mind, we are calling on all political parties to include this proposal in their manifestos for the next general election. This modest outlay could be a game changer in recalibrating Ireland’s relationship with alcohol.
