The Alcohol Responsibility Deal – Unit Content Awareness

Alcohol is an accepted part of our society but there is an increasing burden of harm from its misuse. Alcohol-related crime and disorder costs the tax payer over £7.3 billion per year, workplace costs add up to around £6.4 billion and costs to the NHS around £2.7 billion.1

The Government has recognized that commercial organisations, such as supermarkets and food and drinks manufacturers, can influence choices that we make and have established ‘The Responsibility Deal’ to capitalise on this. Its aim is to bring together businesses and other agencies to work towards public health goals. Alcohol is one of its priority areas and one of the alcohol pledges is ‘…to provide simple and consistent information in the on-trade (e.g. pubs and clubs), to raise awareness of the unit content of alcoholic drinks…’2

Evidence of the possible benefits

Few peer-reviewed studies have assessed the impact of unit awareness on alcohol consumption. One small qualitative study of Australian undergraduate students suggested that unit labelling on drinks packaging is taken notice of, but it is used to choose the strongest drinks for the lowest costs, rather than moderate intake.3

There is more literature relating alcohol education in general, including school-based education, campaigns and labelling, but again the impact on behaviour is less clear. A randomised controlled trial involving 71 Japanese students showed that a 90 minute alcohol education session increased alcohol knowledge but did not change harmful drinking patterns.4 This is further supported by reviews from Foxcroft et al5 Giesbrecht6 and Barbor7 which conclude that there is little evidence of the effectiveness of education and persuasive interventions.

As part of the responsibility deal the drinks company Heineken has pledged to supply the on-trade with 11 million branded glasses showing alcohol unit information. There is no robust evidence that this will be effective at reducing alcohol consumption, although several large cohort studies from the USA have demonstrated an association between the ownership of alcohol-branded materials by young people and early-onset consumption and binge drinking.8

Evidence of possible risks

Focusing on interventions with a poor evidence base may not present value for money and detracts from interventions shown to work, including minimum pricing, reduced availability, screening and brief interventions.9

Several health groups, including the British Medical Association10 and the Royal College of Physicians11 have refused to sign up to the Responsibility Deal, stating that it doesn’t go far enough. Indeed, calls for a Framework Convention on Alcohol Control actively discourage commercial involvement in alcohol policy development.12

Implications for health and well-being

There is no evidence to show that this policy alone will impact on health and well-being.  The 2011 House of Lords inquiry13 concluded that non-regulatory interventions alone are unlikely to be effective at sustaining behaviour change. Alcohol harm minimisation is an important issue and in his review Giesbrecht calls for a phasing out of ineffective education and persuasive interventions, as well as seeking to ensure that all future interventions are evaluated.6

Author: Dr Elizabeth Orton, Lecturer and Specialty Registrar in Public Health, University of Nottingham

References
1. Academy of Medical Sciences (2004). Calling time: the nation’s drinking as a major health issue. Available at: http://www.acmedsci.ac.uk/p48prid16.html Accessed 27 October 2011.

2. Department of Health (2011). The Public Health Responsibility Deal. Available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_125237.pdf Accessed 29 July 2011

3. Jones SC, Gregory P. The impact of more visible standard drink labelling on youth alcohol consumption: helping young people drink (ir)responsibly? Drug Alcohol Rev 2009; 28(3):230-4.

4. Geshi M, Hirokawa K, Taniguchi T, Fujii Y, Kawakami N. Effects of alcohol-related health education on alcohol and drinking behavior awareness among Japanese junior college students: a randomized controlled trial. Acta Med Okayama 2007; 61(6):345-54.

5. Foxcroft DR, Ireland D, Lister-Sharp DJ, Lowe G, Breen R. Primary prevention for alcohol misuse in young people. Cochrane Database Syst Rev 2002(3):CD003024.

6. Giesbrecht N. Reducing alcohol-related damage in populations: rethinking the roles of education and persuasion interventions. Addiction 2007; 102(9):1345-9.

7. Babor T, Caetano R, Caswell S, Edwards G, Giesbrecht N, Graham K et al. (2003). Alcohol: No ordinary commodity. Research and public policy. Oxford, UK: Oxford University Press.

8. Anderson P, de Bruijn A, Angus K, Gordon R, Hastings G. Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies. Alcohol Alcohol 2009; 44(3):229-43.

9. National Institute for Health and Clinical Excellence (2010). Alcohol-use disorders: preventing the development of hazardous and harmful drinking (PH24). London: NICE.

10. Hawkes N. BMA meeting: BMA condemns government’s “responsibility deals” with food and drinks industry. BMJ 2011; 342:d4166.

11. Royal College of Physicians (2011) Key health organisations do not sign responsibility deal. Available at http://www.rcplondon.ac.uk/press-releases/key-health-organisations-do-not-sign-responsibility-deal Accessed 29 July 2011.    

12. Casswell S, Thamarangsi T. Reducing harm from alcohol: call to action. Lancet 2009; 373(9682):2247-57.

13. Science and Technology Select Committee (2011). Behaviour Change. HL (2010-12). London: The Stationery Office. Available at http://www.publications.parliament.uk/pa/ld201012/ldselect/ldsctech/179/179.pdf Accessed 29 July 2011.