Government must get its Act together to give PHAA the renewed impetus it requires

Why the Public Health (Alcohol) Act is more relevant than ever

On 10 March 2015, in front of the Joint Oireachtas Committee on Health and Children, expert medical witnesses described Ireland’s relationship with alcohol as “at crisis point”.[1] Such a description was not an exaggeration, it was based on the facts in relation to the extremely high level of alcohol being consumed in the State and the resulting health, social, and economic harms this was causing. When TDs and Senators met to hear from these experts the data showed that for the previous year, statistically, every Irish adult had consumed 10.8 pure litres of alcohol – equivalent to about 29 litres of vodka, 116 bottles of wine, or 445 pints of beer per person.

Table 1: annual per capita alcohol use in Ireland based on Revenue breakdown of volume of alcohol sold.[2]

The reason for the Oireachtas Health Committee hearing was to begin Pre-Legislative Scrutiny on a groundbreaking piece of legislation which aimed to comprehensively address Ireland’s devastating relationship with alcohol from a health perspective. That legislation was the Public Health (Alcohol) Bill 2015, which eventually became the Public Health (Alcohol) Act 2018 (PHAA), signed into law on 3 October 2018.

What is the PHAA?

The PHAA is a far reaching and world leading piece of legislation based on the World Health Organization’s priority actions for alcohol policy – the so called ‘Best Buys’.[3] The legislation has two main aims: to reduce population level consumption and to minimise the amount of alcohol marketing children and young people are exposed to so as to reduce the normalisation of alcohol in youth culture. The measures aimed at reducing consumption at population level are:

Pricing to help regulate demand for alcoholic beverages
Restrictions or bans on alcohol advertising
Restrictions on the availability of alcoholic beverages

Essentially, the WHO contends that interventions on price, promotion and availability are the most effective public policy measures that governments can take to offset at least some of the harm caused by alcohol. The PHAA incorporates the WHO ‘Best Buys’, in addition to a range of other measures (such as alcohol health information labelling), all of which are designed to work in tandem to reduce overall alcohol consumption and curb alcohol harm in Ireland. However, not all measures of the PHAA are operational.

What sections of the Public Health (Alcohol) Act are operational?

Much of the PHAA is operational, some of the most important of which are:	The following important sections of the PHAA are not yet operational:
Section 11: This section of the legislation relates to minimum price at which an alcoholic product can be sold – known as Minimum Unit Pricing;	Section 12: This section of the legislation which outlines provisions to provide information to consumers on alcohol products, i.e. labels on products containing health and pregnancy warnings, quantity of grams, energy value and details of the HSE public health website, AskAboutAlcohol.ie, is set to come into effect on May 22, 2026.
Section 14: This section of the PHAA restricts advertising in certain places, such as at a train or bus station, in a local authority park or open space, on a public service vehicle, or within prohibited within 200 metres of the perimeter of a school, early years’ service (crèche), or a local authority playground, amongst other areas;	Section 13: This section of the Act, concerning the content of alcohol product advertisements, has not yet been commenced. The section is still awaiting publication of secondary regulations which will then have to be assessed by the European Commission. Once assessed it will be three further years before they become operational.
Section 15: This section of the Act restricts advertising during certain events, such as in or on a sports area when a sports event is taking place, at an event aimed particularly at children or at an event where the majority of individuals taking part are children;	Sections 18: This section of the PHAA, regarding the amount of advertising space permitted for alcohol products in publications, cannot be commenced until Section 13 is operational.
Section 19: This section legislates for a daytime broadcasting ban on alcohol advertising with no advertisements for alcohol products on television from 3am to 9pm and on radio on a weekday from 3pm to 10am the following morning.	Section 21: This section of the Act provides for a review of certain sections of the Act and can be commenced when the sections subject to review have been commenced.
Section 22: This section relates to the separation and visibility of alcohol products and advertisements for alcohol products in specified licensed premises – known as structural separation.

Table 2: Public Health (Alcohol) Act 2018 [4]

As can be seen from Table 1, since the introduction of the PHAA there has been moderate decreases in per capita alcohol consumption in the State. Bizarrely, the alcohol industry has sought to use these decreases to advocate for the loosening of public health measures aimed at reducing alcohol consumption and harm. As consumption decreases because of the PHAA, and other measures, a recurrent theme of industry has been the call for excise duties to be reduced – an approach which would make alcohol cheaper and inevitably see an increase in consumption and associated harms.

Why is the PHAA needed?

As we have seen, the PHAA is a set of measures designed to work in tandem to reduce alcohol consumption, and thereby alcohol harm, at a population level. However, in order for the PHAA to deliver the sea-change necessary to reduce the high levels of alcohol consumption in the State, then all measures within the legislation must be operational simultaneously.

Unfortunately, not all measures of the PHAA are operational, and this means that despite the moderate reductions in alcohol consumption volumes in the State, drinking levels and patterns remain problematic, especially when measured against modest government and Health Service Executive (HSE) targets. There is still a high level of consumption across the population, at 9.45 litres per capita over the age of 15 years.[5] This is still nearly 5% above the modest reduction target of 9.1 litres per capita which was set by government in 2013, to be achieved by 2020.[6] Very concerningly it is 35% above the level if the adult population who consume alcohol stayed within the current HSE lower risk drinking guidelines. These guidelines are acknowledged as being very high compared to other jurisdictions and are currently being examined for revision.

The outworking of such high levels of consumption are the associated harms which alcohol causes across several areas, not least health care, criminal justice, roads and transport, and economic productivity, to name but a few. For instance, alcohol harm costs high-income countries like Ireland 2.5% of GDP – €12bn annually – according to the World Health Organisation.[7] In terms of the impact on the health service – an estimated 11% of the health budget is spent on dealing with alcohol each year. While 1,500 hospital beds in daily use due to alcohol harm; almost one million people have grown up with a problem drinker in the home; 600,000 people are classified as having alcohol use disorder; 37% of driver fatalities with a toxicology result available had a positive toxicology for alcohol;[8] regional research has shown that alcohol is associated with one-third of self-harm hospital presentations[9] and is a factor in close to half of all suicide cases;[10] alcohol is a commercial driver of violence and crime, especially the crimes of domestic, sexual, and gender-based violence (DSGBV), with past research indicating that alcohol was a factor in up to 70% of cases of domestic violence against women;[11] and four people die every day in Ireland due to alcohol.[12]

What are the most important sections of the PHAA and how do they work?

Section 11: This section of the legislation relates to minimum price at which an alcoholic product can be sold – known as Minimum Unit Pricing

Central to the PHAA was the introduction of a control on pricing – the introduction of a ‘floor price’ below which alcohol could not be legally sold – this is known as Minimum Unit Pricing. Section 11 of the PHAA sets the minimum price for alcohol products – the lowest price an alcoholic drink can be legally sold.

Section 11 took effect on 4 January 2022 with the MUP for alcohol products set at €0.10 per gram of alcohol.[13] Therefore, in Ireland, a Standard Drink (10gms alcohol) cannot be sold for less than €1.[14] The MUP threshold, set in 2013 and introduced in 2022, has remained static since its introduction.

MUP aims to reduce alcohol-related harm by ensuring that the exceptionally cheap, strong alcohol, widely available throughout the off-licence sector would be curbed.[15] The underlying reason for this is we know that affordability has been an important driver in the growth of alcohol consumption in Ireland, which has nearly doubled in the past 50 years.[16] Therefore, when alcohol is cheaper, people tend to buy and consume more of it, because price is a significant factor in influencing consumption. It is important to note that MUP has no impact on the price of a pint, or any alcohol sold in pubs, clubs, or restaurants and has little or no impact on those who drink in a low-risk manner.

International research shows strong evidence that this policy lever helps reduce alcohol-related deaths and hospital admissions, thereby saving lives and easing pressure on the health service.[17]However, despite the successes of MUP in Scotland, and the early positive indications in Ireland, it is important to note that while MUP works to reduce harm, the effects of inflation will wipe out many gains if action is not taken to adjust the MUP threshold. In Ireland, the MUP rate was set over a decade ago in 2013, it was embedded in legislation in 2018, but it was only commenced in 2022. Over the course of those 15 years, inflation has served to erode the effectiveness of MUP.

Therefore, if MUP is to continue to achieve its stated public health aim of making exceptionally cheap and strong alcohol less affordable, then the rate must be increased in line with inflation. The legislation provides that the Minister for Health may do so from Jan 2025.

Section 14: This section of the PHAA restricts advertising in certain places, such as at a train or bus station, in a local authority park or open space, on a public service vehicle, or within prohibited within 200 metres of the perimeter of a school, early years’ service (crèche), or a local authority playground, amongst other areas.
Section 15: This section of the Act restricts advertising during certain events, such as in or on a sports area when a sports event is taking place, at an event aimed particularly at children or at an event where the majority of individuals taking part are children.
Section 19: This section legislates for a daytime broadcasting ban on alcohol advertising with no advertisements for alcohol products on television from 3am to 9pm and on radio on a weekday from 3pm to 10am the following morning.

We have known for some time alcohol advertising seeks to recruit new drinkers and increase sales among existing consumers of alcohol, including those with alcohol use disorder and dependency as well as amongst young people and children.[18] It was for this reason that the PHAA aimed to reduce the direct or indirect promotion of alcohol products. The most important ways the legislation sought to do this was through Sections 14, 15, and 19 which placed restriction on alcohol advertising in certain places, during certain events, and on television and radio during a broadcast watershed.[19]

These sections are particularly important in terms of protecting children, because comprehensive research clearly tells us that alcohol marketing including advertising, sponsorship and other forms of promotion, increases the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol.[20]

While further international research has revealed a positive association between exposure to alcohol sports sponsorship and increased alcohol consumption amongst schoolchildren.[21] Essentially, advertising “activates” sponsorship to increase sales.[22] Indeed, studies from Australia shows that children easily identify alcohol brands from sponsorship of sporting events, and this recognition influences children’s behaviour. Academics have documented the techniques used by industry to appeal to children, and to ensure that children associate sport with these products such as alcohol from an early age.[23]

In short, children, and younger people, navigate a tsunami of alcohol promotion every day that ensures messages about drinking are increasingly normalised. We can see this through the fact that Diageo is currently the Number 4 broadcast advertiser to children in Ireland where 50,000 children start to drink every year. Although the PHAA does endeavour to restrict alcohol advertising to young people, if we are serious about protecting children, recently enacted measures must only be considered a first step.

Indeed, the loophole in the PHAA which allows the use of identical branding for zero-alcohol and full-strength alcohol products for advertising in locations where alcohol advertising is restricted, such as near schools and on public transport, and during the broadcast watershed, must be closed. It is of note that in the outdoor space where most of the PHAA restrictions are in place, zero alcohol ads made up 25% of the spend of alcohol brand advertising in 2022, up 31% from 2021, even though these products only make up around 1 percent of the market.[24] The PHAA was designed to provide modest controls on the amount of alcohol marketing which children see. However, its intent is being subverted by the tagging on of a 0.0. This needs to be immediately addressed.

Section 22: This section relates to the separation and visibility of alcohol products and advertisements for alcohol products in specified licensed premises – known as structural separation.

Alcohol is no ordinary commodity; it is a depressant drug with significant health implications for those who use it, and it is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from crime and violence as well as road collisions, as recognised by the World Health Organisation.[25]

With this in mind, Section 22 of the PHAA legislates for the separation of alcohol products and advertisements for alcohol products in mixed trade retail outlets, such as supermarkets, convenience stores or neighbourhood shops, which means that alcohol products can no longer be displayed as routine grocery goods, and that children’s exposure to alcohol in an everyday setting is limited.

Restricting the ease of availability of, and access to, alcohol is a critical component of a public health approach to reducing alcohol use and the related harm. A significant proportion of alcohol purchased in Ireland is now accessed through the off-trade. As stated, alcohol is not an ordinary product, and this is recognised by the State’s licensing regime. De-normalising this connection, through measures such as structural separation, is critical to reducing alcohol use to within the Low-Risk Alcohol Guidelines.[26]

Unfortunately, however, structural separation is also being undermined by the advertisement and display of zero-alcohol products, using the branding of the alcohol master brand, outside structurally separated zones in mixed-retail outlets. This situation needs to be addressed and the lacuna in the law which allows this must be closed.

Section 12: This section of the legislation which outlines provisions to provide information to consumers on alcohol products, i.e. labels on products containing health and pregnancy warnings, quantity of grams, energy value and details of the HSE public health website, AskAboutAlcohol.ie, is set to come into effect on May 22, 2026.

Alcohol is the most harmful product in retail food and beverage shopping – it is a regulated, toxic, and psychoactive substance of which there is no safe amount that does not affect health[27] – yet it is sold in most of Europe and globally without appropriate warnings or essential product information.[28]

The evidence on alcohol is clear, even 1-2 drinks per day carries increased cancer risk, with around 1,000 alcohol-related cancers diagnosed annually in Ireland, liver disease death rates have steadily increased over the past 20 years and Ireland has one of the highest rates of foetal alcohol spectrum disorders in the world.[29] Additionally, at least 1,500 of hospital beds are in use daily[30] and up to 30% of Emergency Department presentations are caused by alcohol consumption.[31]

It has devastating impacts on mental health with national research indicating that alcohol may be a factor in close to half of all suicides.[32] Tragically, we also know that four people lose their lives every single day because of alcohol.[33] Moreover, not only does alcohol harm those who consume it, but consumption during pregnancy is the leading preventable cause of neurodevelopment disorder.[34]

However, public knowledge of alcohol harms is low. Therefore, Section 12 of the PHAA seeks to increase awareness and ensure the public have some of the facts about the health dangers of alcohol through the rollout of alcohol health information labelling.[35] From May 22, 2026, health information labels will ensure alcohol products carry information informing the public that alcohol causes liver disease, there is a direct link between alcohol and fatal cancers, and the dangers of alcohol consumption when pregnant.[36]

Warning labels are far from a panacea, but, at the very minimum, consumers should have the right to know when products pose a substantial, preventable risk to their health. Sadly, progress has been far slower than it might have been, due in no small part to the influence of the alcohol industry.[37]

Indeed, as with other sections of the PHAA, labelling continues to be under threat from the alcohol industry because they fear a reduction in the sales of their products. Indeed, leading producers such as Heineken have noted that health information labelling, informing the public of the health harms of alcohol, is a significant risk to their profits.[38]

Conclusion

The Public Health (Alcohol) Act matters because Ireland has a harmful relationship with alcohol. Contrary to what people may think, alcohol-related harm is determined not only by the volume of alcohol consumed, but also by the pattern of drinking.[39] This is incredibly important because Ireland has high levels of heavy episodic drinking (binging). Health Research Board (HRB) studies indicates that more than half of all who drink are classified as hazardous drinkers which reflects these patterns.[40]

Therefore, alcohol harm in Ireland is not just confined to those with an Alcohol Use Disorder, as the industry and some in the media would like you to believe, it is, in fact, across the board. Indeed, a study, the HRB found that binge drinking among low to moderate risk drinkers accounts for most alcohol-related harm in the population.[41] The research highlighted that monthly and occasional binge drinkers accounted for 62% of all drinkers in Ireland and this group consumed 70% of the alcohol, and accounted for 59% of the harms in the population.[42] Drinking in such a manner can lead to chronic harms such as liver cirrhosis, alcohol related cancers, alcohol poisoning, and injuries.

These are the harms which the PHAA seeks to address and reduce by tackling alcohol consumption at a population level. However, the legislation cannot achieve its stated aims while important aspects of the Act are not operational. Furthermore, neither can the PHAA deliver the sea change necessary while important components are being undermined and exploited by advertising of zero-alcohol products.

If government want to achieve a level of alcohol reduction that will improve public health, reduce injuries and deaths, and save the health system and taxpayer money, then all sections of the PHAA must be made operational in tandem, and any loopholes closed as a matter of urgency.

References

[1] https://www.oireachtas.ie/en/debates/debate/joint_committee_on_health_and_children/2015-03-10/2/

[2] https://www.drugsandalcohol.ie/alcohol_statistics_dashboard#

[3] https://www.who.int/news-room/fact-sheets/detail/alcohol

[4] https://www.irishstatutebook.ie/eli/2018/act/24/enacted/en/print.html

[5] https://www.irishtimes.com/ireland/social-affairs/2025/06/09/irish-people-consuming-alcohol-at-european-average-with-45-drop-last-year-figures-show/

[6] https://www.drugsandalcohol.ie/40465/1/HRB_Alcohol_overview_series_13.pdf

[7] https://iris.who.int/bitstream/handle/10665/374614/9789240086104-eng.pdf?sequence=1

[8] https://www.rsa.ie/docs/default-source/road-safety/r4.1-research-reports/safe-road-use/contributory-factors-and-driver-fatalities-examining-key-dangerous-behaviours.pdf

[9] https://www.hrb.ie/wp-content/uploads/2024/06/HRB_Alcohol_Overview_Series_13.pdf

[10] https://www.drugsandalcohol.ie/28375/

[11] https://www.drugsandalcohol.ie/15781/1/HSE_Costs_to_Society_of_Problem_Alcohol_Use_in_Ireland.pdf