Health Research Board: “In order for it to have a real impact, the Public Health (Alcohol) Act needs to be implemented in full as soon as possible.”
The Health Research Board’s latest report on alcohol consumption and harm, Alcohol consumption, alcohol-related harm and alcohol policy in Ireland, starkly outlines how the continuing high level of alcohol consumption in Ireland is affecting the nation’s health and well-being.
Despite having laws on our statute books aimed at curbing high levels of drinking, the Public Health (Alcohol) Act (PHAA) has not been implemented in full. Based on the alarming data in the report, this blog lays out the case for full and immediate commencement of the Act, as called for by the HRB. The urgency of these measures cannot be underestimated – lives depend on it, not just the lives of those who drink harmfully, but the health and wellbeing of their children and families too.
Currently in Ireland, drinkers consume 10.8 litres of pure alcohol; this corresponds to 40 (700ml) bottles of vodka, 113 (750ml) bottles of wine, or 436 pints of beer.
This means that consumption levels are 19% higher than the stated aim of the Irish Government to reduce per capita alcohol consumption in Ireland to 9.1 litres by 2020.
This high level of per capita consumption means that a majority of drinkers in Ireland consume alcohol in a manner that is risky to their health.
As the HRB reports points out, the consequences of our drinking patterns are reflected in our mortality data, which show that, on average, there have been three alcohol-related deaths every day since 2008 and at least 40,000 alcohol-related hospital discharges each year.
Not only that, the HRB data finds that the greatest burden of health harm is experienced by younger people; two in three people who die in Ireland of alcohol-related causes are aged under 65 years and a similar trend is observed for hospital discharges. Adolescents and young adults in Ireland also experience alcohol-related harm.
As the report states:
“Our data indicate a clear link between harmful patterns of alcohol consumption and psychological distress. A number of studies have consistently demonstrated the involvement of alcohol in the majority of sexual assault incidents in Ireland, while the implication of alcohol in self-harm presentations is most likely to occur among those aged 25–34 years.”
The Public Health (Alcohol) Act (PHAA)
Despite the overwhelming evidence of risky level of alcohol consumption in Ireland and alcohol-related harm, PHAA had a difficult birth because of opposition from vested interests, namely the alcohol industry and its surrogates – and indeed politicians who appeared to value economic arguments over public health. In spite of that, it was finally signed into law in 2018.
The main provisions of the Act include minimum unit pricing (MUP), structural separation of alcohol products in mixed retail outlets, restrictions around alcohol advertising, and labelling of alcohol products.
Since 2018, implementation has been incremental and frustratingly slow. That said, progress is being made. Separation and visibility of alcohol products began in November 2020 with all mixed-trade retailers now obliged by law to separate alcohol products from other grocery items. Additionally, in 2019, a ban on advertising alcohol products near schools, in parks, on public transport and stations, and during certain films at cinemas, came into force. From November 2021 there will be some controls on alcohol references at sporting events, a ban on alcohol advertising at sporting events aimed at children, and a ban on ads at events involving driving or racing motor vehicles. There have also been measures brought in around sale and supply promotions of alcohol.
Additionally, this week (May 2021) Minimum Unit Pricing – MUP, a significant price measure within the Act, has been commenced. This measure is already in operation in other jurisdictions including Scotland, Wales, eight nations of the WHO Europe region, provinces of Canada and a state of Australia. It will save lives and reduce hospital admissions as it targets the heaviest and more harmful drinkers.
Labelling of alcohol products: health information and warnings
As the HRB notes, the evidence shows that there could “be significant benefits for people’s health and a reduction of pressure on the health system and fewer premature deaths if all aspects of the Public Health (Alcohol) Act 2018 were implemented in full.”
With MUP implementation in sight, eyes will quickly turn to another central issue – health warning labels on alcohol products, which require further scrutiny by European Commission.
The Act requires all alcohol products to display: health warning labels, including warnings on the link between alcohol and certain cancers and on the risk of alcohol consumption during pregnancy; the calorie content; and details of a HSE website, which provides public health information in relation to alcohol.
Informing the public of the health risk with alcohol use is important given that the level of Foetal Alcohol Spectrum Disorders is the third highest in the world while research shows that public awareness of the links between cancer and alcohol, especially breast cancer, is low. A label that informs and directs people to access public health information from a government website, rather than an industry funded organisation: Drinkaware, would allow people to make more informed choices about the risk.
As the HRB report states:
“Given the strong pro-alcohol social norms in Ireland, it is therefore probably not too surprising that the majority of drinkers engaging in regular heavy episodic drinking are unaware of their harmful drinking patterns. Given the low level of awareness of the negative health effects of alcohol consumption among the Irish public, the introduction of alcohol warning labels, as provided for in the Public Health (Alcohol) Act 2018 would constitute an important step in improving knowledge regarding alcohol-related harm, as well as increasing levels of awareness of the negative health effects of alcohol consumption among Irish people.”
The World Health Organisation has identified regulations restricting the advertising and marketing of alcoholic beverages as one of its “best-buys” alcohol policies. There is established evidence for the effectiveness of such regulations in reducing alcohol harm and its contribution to the overall burden of disease.
PHAA contains a range of restrictions that will apply to the advertisement of alcohol products, with a particular emphasis on protecting children and young people. These include establishing a statutory code on the content of advertisements ending decades of industry self regulation, restrictions on advertising of alcohol in print media in relation to volume and type of publication, a 9.00pm broadcast watershed for advertisements on television and radio, and the aforementioned bans on areas near to children’s amenities and on public transport. Perhaps the most effective of these will be the measure relating to the Content of Advertisements which will transform the nature of future adverts ensuring a utilitarian presentation depicting basic aspects of the product and its production.
However, as the HRB notes: “Measures introduced by the Public Health (Alcohol) Act 2018 represent a promising effort to reduce young people’s exposure to alcohol marketing in Ireland…advertising regulations do not extend to cover online alcohol marketing, which is increasingly being used to target young audiences.”
Another serious oversight of PHAA is the fact that the Act does not ban alcohol sponsorship of sports events where the majority of participants are adults. (Alcohol sports sponsorship where most participants are children will be banned under the Public Act as will alcohol advertising in sports grounds during events where the majority of competitors are children.) We know though that children watch adult sports on TV much more than they would watch a sport of their peers perhaps at school or in the community.
The HRB study notes: “There is also evidence to indicate that alcohol sponsorship of major sporting events leads to increased drinking among young people, with France and Norway already banning this practice. A systematic review of seven studies, comprising 12,760 participants, showed that all studies reported positive associations between exposure to alcohol sports sponsorship and self-reported alcohol consumption.”
Based on international evidence linking alcohol sponsorship of sports to increased consumption in young people, the HRB researchers conclude: “Given the available evidence and the large number of children following alcohol-sponsored events in Ireland, including the Six Nations, one of Ireland’s must popular sporting tournaments, this is a concerning omission from the Act.”
The research and evidence laid out in this blog is just the tip of the iceberg of the HRB’s excellent report on the harm caused by alcohol in Ireland. We have not even begun to talk about harms to children from others’ drinking, children living with parents with harmful drinking patterns, alcohol and suicide and self-harm, domestic abuse and other health and life limiting effects.
This report should be yet another wake up call for politicians and policy makers and adds further weight to the case for full and urgent implementation of PHAA. The question as always remains – why do we have to wait so long for these already decided-upon and proven public health measures? Who benefits? Certainly not the population the laws were designed to protect.