Ladies and Gentlemen. It is an honour for me to be asked to open this important conference. I want to thank the CEO and Chair of Alcohol Action Ireland for the kind invitation.
It will be, I’m sure, a timely and worthwhile contribution to public debate about alcohol, its harms and what we can do to mitigate them. For those of you visiting for the first time, welcome to Ireland and to Dublin.
We in Ireland are famous the world over for our drinking culture – just about every city in the world celebrates the Irish fondness for drink with an ‘Irish Pub’. Drinking is associated with our ‘gift of the gab’, our sociability and our artistic nature.
And it is true that there are some positives in relation to alcohol, some level of social lubrication and some health benefits. But these benefits are derived only from low levels of alcohol consumption. And this is not the way we drink alcohol in this country. Somehow we have let ourselves believe that alcohol is not really a problem in Ireland. We are complacent. We choose to ignore evidence of the huge and avoidable extent of the problem that alcohol wreaks on our society.
It is time to stop turning a blind eye to the alcohol problem, or accepting it as an inevitability of being Irish. It is time to look at the evidence of how alcohol is really affecting Irish individuals, families and society as a whole. It is time, therefore, for us to take action.
The Irish population are the third highest consumers of alcohol in the world. We drink more per occasion (i.e. binge drink) than any other country in Europe. Our teenagers and young adults drink more in total and drink more per occasion than young people in any other country in Europe.
The World Health Organisation has stated that alcohol is the third most significant lifestyle risk factor for disease. Through research and study, we know a lot about it many and varied health and social consequences.
Alcohol, even in small amounts, increases the risk of cancer of the mouth, oesophagus, breast, colon, liver and pancreas. On the other hand, alcohol in very low quantities spread over time may indeed have a protective effect against cancer and cardiovascular disease. However, higher levels consumed over shorter periods, not only have no protective effect against heart disease but in fact increase the risk. Alcohol, even at moderate levels, can lead to injury and death in the short term from accidental and non-accidental injuries. Alcohol can cause a wide range of family problems from marital breakdown to child abuse and domestic violence. Children of alcoholic parents can suffer the effects of alcohol throughout their lives. Alcohol leads to loss of work productivity and absenteeism and is associated with crime.
But just how big is the problem in Ireland and who does it affect?
In Ireland, if we look at the outcomes due both entirely to alcohol, such as alcoholic liver disease, and the outcomes partially due to alcohol, such as road traffic accidents and cancers, alcohol is responsible for approximately 100 deaths per month, 2000 beds occupied every night in hospitals around the country, 3 out of every 10 emergency department attendances and 7% of GP consultations. These health effects are avoidable and preventable.
If we look at young people in particular one in four deaths in young men (15-34) is due to alcohol compared with 1 in 12 deaths due to cancers and one in 25 deaths due to circulatory disease. We no longer accept that people have to die from cancer and heart disease, so how can we ignore the fact that so many more of our young people are dying from alcohol than anything else?
There are more than 4 times as many deaths due to alcohol as due to all other drugs combined.
If we look at suicide, an ever increasing problem in Ireland and a problem that costs dearly in terms of the loss of life and the effect that it has on the family and community involved. Suicide rates have doubled in Ireland in the last 20 years. Nearly half of all young male suicides are due to alcohol.
One may argue that consumption of alcohol is the choice of the individual. Consider the following however.
- Children born to mothers who drank heavily during pregnancy may develop a range of disorders, known as fetal alcohol syndrome disorders, which can have devastating effects on their entire lives
- One in every six cases of child abuse in Ireland is attributed to alcohol.
- Approximately half of perpetrators and victims of sexual assault were drinking at the time of the assault.
So I really do not believe that we can say that it is a personal choice for someone to drink to excess and to accept the consequences of their actions. We must protect our babies, our children and the men and women of this country from the external effects imposed on them by the alcohol consumption of others.
As the CMO the health of the Irish population is my first priority. However, no-one can deny the huge economic challenge we are experiencing now. In the current economic climate the health service will be forced to make difficult choices. In this context we can no longer afford the negative consequence of alcohol use.
Over 10% of all general inpatient hospital costs, 14% of psychiatric hospital costs, 7% of GP costs and up to 30% of emergency department costs are due to the effects of alcohol. For 2007, the total costs imposed by alcohol on the public health care system were 1.2 billion.
This country just cannot afford this anymore in terms of money, never mind in terms of the loss of health and happiness.
As well as the health and social costs I have mentioned, alcohol leads to a very real reduction in economic productivity. In 2007, loss of productivity and work absences are estimated to have cost the economy €330 million.
The alcohol industry will espouse the benefits to society of the employment and income that the industry generates. However, this argument is based on the assumption that if people didn’t drink the money spent on alcohol would not be spent on other goods or services.
Economists would agree that in a well functioning market economy, a reduction on spend in one area merely releases resources to be spent in another area- goods and services which might also directly bring benefit to our economy.
We need to think of other ways in which we can spend our time and money that will benefit our social lives, our health and our society in general. We have a distinguished culture of music, drama and sport that long preceded our drinking culture. We need to build on these and disentangle them from what is a relatively recent association with alcohol.
But I am optimistic. We are a country with a proven track record of an ability to change our ways for the improvement of our society. We have shown for example, in relation to cigarettes, that we put the health of our population first. We led the world in terms of regulatory and pricing measures to control consumption of tobacco. We have acted decisively and gained significant success in our fight against smoking which has reduced from 46% and 36% of men and women smoking in the 1970s to 31% and 27% of men and women respectively, currently smoking.
Even in relation to alcohol, we have seen how we can change our culture for the better. Any of us who grew up in the 70 and 80s remember what it was like. People thought nothing of getting into a car after a few pints- it was accepted and expected. You got a clap on the back to say, Well Done! Most of us would now refuse to get into a car with someone who has been drinking. The drink driver is the modern day social pariah. And it is no surprise that this change in attitude is associated with a reduction in road fatality rate per population of nearly a third in the last 10 years.
If we were able to achieve success to the extent that has been achieved in road safety i.e a reduction of harm of 30% we would save 30 lives per month, 600 overnight hospital admissions per day and a cost saving to the exchequer of one billion euro.
In 2009, the Government approved the development of a combined national substance misuse strategy to cover both alcohol and drugs. The National Substance Misuse Strategy Steering Group, under my joint chairmanship with the Director of the Office of the Minister for Drugs has been tasked with developing a strategy based on proven methods to reduce alcohol related harm and to bring it into line with our national drugs strategy.
This group is a multi-disciplinary group involving all the relevant stakeholders, from the alcohol industry to health, to community agencies to the Gardai to road safety to other government departments.
As part of this process, we have looked at the evidence of where and why harm is being caused by alcohol. We have examined our existing measures on pricing, enforcement, and support for drinkers who are attempting to quit. We have looked at the examples of best national and international practice and from this, we are developing key action areas.
In setting out our approach, I want to be clear about a few things. Firstly, we are doing our best to recommend on the basis of what evidence and international practice supports. Secondly, we recognise that many aspects of an overall comprehensive policy have already been articulated or about to be- with particular exemplars in relation to prevention of road traffic accidents due to alcohol, through enacting legislation to reduce blood alcohol limits for driving and to allow random blood alcohol testing. And thirdly, we recognise that a significant challenge will be in the translation of knowledge and evidence into policy and practice- a challenge that is more or less the same for all aspects of health policy.
There is a wealth of international experience and evidence on effective measures for alcohol control. These relate to changing attitudes towards alcohol use, supporting and empowering drinkers to quit, as well as pricing and other regulatory mechanisms to reduce harmful alcohol consumption and delay the onset of consumption, and reduce overall level of consumption. With all this knowledge and certainty, it should be straightforward and easy. But it isn’t. We all live in the real world.
There are those who do not share the same desire to protect public health and our social well-being who will criticize our process, label it as biased, call for more debate, call for more research, call for more evidence, selectively and self-servingly use evidence and generally seek to obfuscate and confuse the public debate. Some will seek to use these time-honoured tactics to lobby with the aim frustrating, undermining and circumventing effective policy and health promotion measures.
In conclusion, the international experience, as you will no doubt hear it outlined during the day, is that there is no single intervention that alone can work to reduce the impacts of alcohol on our society. A sustained multisectoral approach to the alcohol epidemic, backed by a strong political and societal consensus, is required to reduce alcohol consumption levels. As they say, where there is a will there is a way. We know we can change in Ireland, but we have to want to. We must now say that we will no longer accept this burden that alcohol is placing on our families, our society, our health and our lives. And we must act now.
I want to thank you, again, for the invitation and the opportunity to open this conference. I look forward to hearing some of your eminent speakers and to hearing from you in relation to the outcome of the meeting. I wish you a very successful meeting over the course of the day. I now declare the meeting open.
Dr Tony Holohan, Chief Medical Officer, officially opened the Alcohol Action Ireland conference, Have We Bottled It? Alcohol Marketing and Young People, which took place on September 15, 2010, at the Royal College of Physicians of Ireland.
