Public health: cutting a deal on the minimum price of alcohol

Brighton & Hove council has a complex relationship with alcohol: it poses public health risks but businesses rely on the night-time economy. Photograph: Chris Rout/Alamy

The fallout from the government u-turn on plain cigarette packaging and a minimum unit price for alcohol continues. To date, the Faculty of Public Health, the Association of Directors of Public Health and Birmingham city council have all withdrawn from the "public health responsibility deal". This "framework of trust and expectation" between the government, public sector and businesses, first launched in March 2011, includes a number of pledges across several public health issues. I would suggest these pledges were offered as much to ward off punitive legislation as in an effort to promote the wider public good.

The chief medical officer, Prof Dame Sally Davies, has remained mute on the matter, despite drawing attention last year to an epidemic of premature liver failure in women, fuelled in large part by alcohol consumption. Public Health England, the government's flagship leadership organisation for public health, has expressed its "disappointment" – a euphemism that probably says less about a failure to satisfy hopes, desires and expectations and more about the humbling experience of having been simply ignored.

Disappointment is understandable: the consultation on the government's draft alcohol strategy was after all about at what level the minimum price would be set – not on whether or not there would be a minimum price at all.

The draft strategy was very clear ("we will introduce a minimum price for alcohol," it stated) and the scientific evidence that supported the policy has not become any weaker in the meantime.

But will the health establishment refusing to play ball with the government, proclaiming their disappointment, have any effect? Will it put any pressure on the alcohol industry to put its house in better order?

The alcohol industry hardly speaks with one voice on this matter, and there is considerable tension between retail off sales and on sales in bars, pubs and clubs. The proposed minimum price met with mixed views.

The British Beer and Pub Association (BBPA), the Craft Brewing Association, BrewDog, Greene King and the Campaign for Real Ale all voiced their support. The Association for Licensed Multiple Retailers actually wanted the strategy to go further and "get a grip on bulk sales, price-led advertising and in-store promotions".

But the Wine and Spirits Trade Association, the British Retail Consortium and Budvar UK all voiced strong opposition – as did the UK Independence party.

The moral rectitude that brings many of us into public health means while we understand the "responsibility" element of a public health responsibility deal, we don't always get the "deal" bit.

Working in Brighton & Hove council, we know that alcohol presents us with a social and economic dichotomy. On the one hand the estimated annual health, social and criminal costs from alcohol total £107m; but on the other, the annual economic turnover from its sale in the city is a massive £329m. While in the NHS the message on alcohol may be pretty straightforward – don't drink so much – for local authorities it's more tricky.

Local public health is no longer the responsibility of the NHS; it belongs to local authorities. So if we are to have any success in solving both sides of an impossible equation, we need to get our heads around the "deal" we're expected to broker.

At the local level that is what we are doing: working with pubs, clubs and retailers on initiatives to curb consumption at high-risk public events; reducing the sale of high strength beers and cider; asking businesss to sign up to codes of good practice. We have a "cumulative impact zone" where we prohibit the establishment of any new licensed premises. We don't always agree and the public health team doesn't win every dispute, but we are sitting around the table together rather than walking away.

That national picture is different, and there may be something to be made from august bodies taking a stand, but public health and the government missed the opportunity to make a genunine deal.

As part of the original responsibility deal, 30 alcohol companies including major brands such as Heineken have pledged to take 1bn units of alcohol out of the market by December 2015 through the promotion of lower strength drinks. Why not compensate for the loss of a minimum price by arguing for a pledge to take yet more units out of the market, and tie any failure to future market restrictions?

Public health has an advocacy role but it isn't an NGO – many of which walked away from the responsibility deal early on. The moral high ground will not get us far, or far enough.

But let's not beat ourselves up about this (another tendency in public health). It was, after all, the government that chose to make a u-turn, not local authorities. It's time for a bit more reflection and to come back to the discussion table with new ideas.

Dr Tom Scanlon is director of public health at Brighton & Hove council

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

Public health: cutting a deal on the minimum price of alcohol

Brighton & Hove council has a complex relationship with alcohol: it poses public health risks but businesses rely on the night-time economy. Photograph: Chris Rout/Alamy

The fallout from the government u-turn on plain cigarette packaging and a minimum unit price for alcohol continues. To date, the Faculty of Public Health, the Association of Directors of Public Health and Birmingham city council have all withdrawn from the "public health responsibility deal". This "framework of trust and expectation" between the government, public sector and businesses, first launched in March 2011, includes a number of pledges across several public health issues. I would suggest these pledges were offered as much to ward off punitive legislation as in an effort to promote the wider public good.

The chief medical officer, Prof Dame Sally Davies, has remained mute on the matter, despite drawing attention last year to an epidemic of premature liver failure in women, fuelled in large part by alcohol consumption. Public Health England, the government's flagship leadership organisation for public health, has expressed its "disappointment" – a euphemism that probably says less about a failure to satisfy hopes, desires and expectations and more about the humbling experience of having been simply ignored.

Disappointment is understandable: the consultation on the government's draft alcohol strategy was after all about at what level the minimum price would be set – not on whether or not there would be a minimum price at all.

The draft strategy was very clear ("we will introduce a minimum price for alcohol," it stated) and the scientific evidence that supported the policy has not become any weaker in the meantime.

But will the health establishment refusing to play ball with the government, proclaiming their disappointment, have any effect? Will it put any pressure on the alcohol industry to put its house in better order?

The alcohol industry hardly speaks with one voice on this matter, and there is considerable tension between retail off sales and on sales in bars, pubs and clubs. The proposed minimum price met with mixed views.

The British Beer and Pub Association (BBPA), the Craft Brewing Association, BrewDog, Greene King and the Campaign for Real Ale all voiced their support. The Association for Licensed Multiple Retailers actually wanted the strategy to go further and "get a grip on bulk sales, price-led advertising and in-store promotions".

But the Wine and Spirits Trade Association, the British Retail Consortium and Budvar UK all voiced strong opposition – as did the UK Independence party.

The moral rectitude that brings many of us into public health means while we understand the "responsibility" element of a public health responsibility deal, we don't always get the "deal" bit.

Working in Brighton & Hove council, we know that alcohol presents us with a social and economic dichotomy. On the one hand the estimated annual health, social and criminal costs from alcohol total £107m; but on the other, the annual economic turnover from its sale in the city is a massive £329m. While in the NHS the message on alcohol may be pretty straightforward – don't drink so much – for local authorities it's more tricky.

Local public health is no longer the responsibility of the NHS; it belongs to local authorities. So if we are to have any success in solving both sides of an impossible equation, we need to get our heads around the "deal" we're expected to broker.

At the local level that is what we are doing: working with pubs, clubs and retailers on initiatives to curb consumption at high-risk public events; reducing the sale of high strength beers and cider; asking businesss to sign up to codes of good practice. We have a "cumulative impact zone" where we prohibit the establishment of any new licensed premises. We don't always agree and the public health team doesn't win every dispute, but we are sitting around the table together rather than walking away.

That national picture is different, and there may be something to be made from august bodies taking a stand, but public health and the government missed the opportunity to make a genunine deal.

As part of the original responsibility deal, 30 alcohol companies including major brands such as Heineken have pledged to take 1bn units of alcohol out of the market by December 2015 through the promotion of lower strength drinks. Why not compensate for the loss of a minimum price by arguing for a pledge to take yet more units out of the market, and tie any failure to future market restrictions?

Public health has an advocacy role but it isn't an NGO – many of which walked away from the responsibility deal early on. The moral high ground will not get us far, or far enough.

But let's not beat ourselves up about this (another tendency in public health). It was, after all, the government that chose to make a u-turn, not local authorities. It's time for a bit more reflection and to come back to the discussion table with new ideas.

Dr Tom Scanlon is director of public health at Brighton & Hove council

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

Public health: cutting a deal on the minimum price of alcohol

Brighton & Hove council has a complex relationship with alcohol: it poses public health risks but businesses rely on the night-time economy. Photograph: Chris Rout/Alamy

The fallout from the government u-turn on plain cigarette packaging and a minimum unit price for alcohol continues. To date, the Faculty of Public Health, the Association of Directors of Public Health and Birmingham city council have all withdrawn from the "public health responsibility deal". This "framework of trust and expectation" between the government, public sector and businesses, first launched in March 2011, includes a number of pledges across several public health issues. I would suggest these pledges were offered as much to ward off punitive legislation as in an effort to promote the wider public good.

The chief medical officer, Prof Dame Sally Davies, has remained mute on the matter, despite drawing attention last year to an epidemic of premature liver failure in women, fuelled in large part by alcohol consumption. Public Health England, the government's flagship leadership organisation for public health, has expressed its "disappointment" – a euphemism that probably says less about a failure to satisfy hopes, desires and expectations and more about the humbling experience of having been simply ignored.

Disappointment is understandable: the consultation on the government's draft alcohol strategy was after all about at what level the minimum price would be set – not on whether or not there would be a minimum price at all.

The draft strategy was very clear ("we will introduce a minimum price for alcohol," it stated) and the scientific evidence that supported the policy has not become any weaker in the meantime.

But will the health establishment refusing to play ball with the government, proclaiming their disappointment, have any effect? Will it put any pressure on the alcohol industry to put its house in better order?

The alcohol industry hardly speaks with one voice on this matter, and there is considerable tension between retail off sales and on sales in bars, pubs and clubs. The proposed minimum price met with mixed views.

The British Beer and Pub Association (BBPA), the Craft Brewing Association, BrewDog, Greene King and the Campaign for Real Ale all voiced their support. The Association for Licensed Multiple Retailers actually wanted the strategy to go further and "get a grip on bulk sales, price-led advertising and in-store promotions".

But the Wine and Spirits Trade Association, the British Retail Consortium and Budvar UK all voiced strong opposition – as did the UK Independence party.

The moral rectitude that brings many of us into public health means while we understand the "responsibility" element of a public health responsibility deal, we don't always get the "deal" bit.

Working in Brighton & Hove council, we know that alcohol presents us with a social and economic dichotomy. On the one hand the estimated annual health, social and criminal costs from alcohol total £107m; but on the other, the annual economic turnover from its sale in the city is a massive £329m. While in the NHS the message on alcohol may be pretty straightforward – don't drink so much – for local authorities it's more tricky.

Local public health is no longer the responsibility of the NHS; it belongs to local authorities. So if we are to have any success in solving both sides of an impossible equation, we need to get our heads around the "deal" we're expected to broker.

At the local level that is what we are doing: working with pubs, clubs and retailers on initiatives to curb consumption at high-risk public events; reducing the sale of high strength beers and cider; asking businesss to sign up to codes of good practice. We have a "cumulative impact zone" where we prohibit the establishment of any new licensed premises. We don't always agree and the public health team doesn't win every dispute, but we are sitting around the table together rather than walking away.

That national picture is different, and there may be something to be made from august bodies taking a stand, but public health and the government missed the opportunity to make a genunine deal.

As part of the original responsibility deal, 30 alcohol companies including major brands such as Heineken have pledged to take 1bn units of alcohol out of the market by December 2015 through the promotion of lower strength drinks. Why not compensate for the loss of a minimum price by arguing for a pledge to take yet more units out of the market, and tie any failure to future market restrictions?

Public health has an advocacy role but it isn't an NGO – many of which walked away from the responsibility deal early on. The moral high ground will not get us far, or far enough.

But let's not beat ourselves up about this (another tendency in public health). It was, after all, the government that chose to make a u-turn, not local authorities. It's time for a bit more reflection and to come back to the discussion table with new ideas.

Dr Tom Scanlon is director of public health at Brighton & Hove council

• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.

Not already a member? Join us now for more comment, analysis and the latest job opportunities in local government.

View the original article here

Reinforcing commercial host liability helps reduce excessive alcohol consumption

Main Category: Alcohol / Addiction / Illegal Drugs
Also Included In: Public Health
Article Date: 31 Jul 2013 - 1:00 PDT Current ratings for:
Reinforcing commercial host liability helps reduce excessive alcohol consumption

Fewer states are holding alcohol retailers liable for harms caused by customers who were served illegally, according to a new report from researchers at Alcohol Policy Consultations and the Center on Alcohol Marketing and Youth (CAMY) at the Johns Hopkins Bloomberg School of Public Health. Published online by the American Journal of Preventive Medicine, the legal research study documents the gradual erosion of commercial host liability (also referred to as dram shop liability) from 1989 to 2011.

Commercial host liability holds alcohol retailers liable for alcohol-attributable harms resulting from illegal alcohol sales to patrons who are intoxicated or underage at the time of service. It applies to both on-premise (bars, restaurants and clubs) and off-premise locations. The Community Preventive Services Task Force recently determined that commercial host liability was effective in reducing a range of harms from alcohol in states that have it, including a median six percent drop in alcohol-related motor vehicle crash deaths.

The report found that in recent years many states enacted legislation to protect retailers from commercial host liability by increasing the evidentiary requirements, limiting the amount of liability awards and/or protecting certain retailers from liability. For example, between 1989 and 2011, the number of states that recognized liability for serving intoxicated adults without restrictions declined from 25 to 21, and states with one of these major restrictions increased from 11 to 16. Maps illustrating the erosion of these laws can be accessed at the CAMY website here.

"The erosion of commercial host liability in recent decades is a public health failure that directly contributes to the exorbitant human and economic costs of excessive drinking," said lead study author James F. Mosher, JD, of Alcohol Policy Consultations, a public health legal consultancy in Felton, California. "Alcohol retailers who operate negligently and engage in illegal serving practices should not receive special protection, denying those who are injured their day in court."

The report also examined states' adoption of the Responsible Beverage Service (RBS) practices defense, an optional provision in commercial host liability laws first developed in 1985 as part of a project funded by the National Institute on Alcohol Abuse and Alcoholism. In states that have adopted it, retailers can avoid liability if they show that they adhered to RBS practices at the time of the alcohol service leading to the injury and lawsuit.

RBS practices include instituting effective ID checks, training staff on identifying signs of intoxication and discontinuing marketing practices that encourage intoxication, among others. The report found that only six states had adopted the RBS defense provision despite the potential benefits to both public health and retailers.

"These findings underscore the critical importance of commercial host liability laws," said David Jernigan, PhD, co-author of the report and CAMY director. "These laws have been proven to prevent alcohol sales to underage and intoxicated persons, and should be a priority for public health."

Excessive alcohol consumption is responsible for approximately 80,000 deaths in the U.S. each year. The economic cost of excessive drinking was an estimated $223.5 billion in 2006, or approximately $1.90 per drink consumed. Most binge drinkers (54.3%) who reported driving after their most recent binge drinking episode drank in an on-premises retail alcohol establishment such as a bar, club or restaurant, and 25.7 percent of this group reported consuming 10 or more drinks before getting behind the wheel. On- and off-premise alcohol retail outlets are also sources of alcohol for underage drinkers, particularly those aged 18 to 20 who have high rates of binge drinking and associated public health and safety problems.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our alcohol / addiction / illegal drugs section for the latest news on this subject.

Efficacy and the Strength of Evidence of U.S. Alcohol Control Policies, Toben F. Nelson, ScD, Ziming Xuan, ScD, Thomas F. Babor, PhD, Robert D. Brewer, MD, MSPH, Frank J. Chaloupka, PhD, Paul J. Gruenewald, PhD, Harold Holder, PhD, Michael Klitzner, PhD, James F. Mosher, JD, Rebecca L. Ramirez, MPH, Robert Reynolds, MA, Traci L. Toomey, PhD, Victoria Churchill, Timothy S Naimi, MD, MPH, American Journal of Preventive Medicine Volume 45, Issue 1 , Pages 19-28, July 2013, doi:10.1016/j.amepre.2013.03.008

This research was supported with funding from the Centers for Disease Control and Prevention.

Johns Hopkins University Bloomberg School of Public Health

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