Evidence (Personal Narrative): Alcohol – applying evidence-based policy is important for societies and individuals

I should explain that I am a gastroenterologist who is also training in population health.  Doctors working in A&E, psychiatry, medicine and general practice see the harms of alcohol on a daily basis, but one only need to walk through any town centre in the UK on a weekend evening to see its societal effects.  Excess alcohol consumption is closely linked to liver disease, and is especially prone to cause mortality in younger adults, but it is closely associated with mental health disorders, some cancers and increased blood pressure (in turn related to heart disease and stroke).

Although I do find helping people with liver disease recover from variceal bleeding and liver failure rewarding, alcohol-related harms, just like those of tobacco, are preventable by concerted public health action.  There is a wealth of publications and reports by clinicians and medical scientists on the topic of alcohol-related harms in the UK, with strong evidence of clinical- and cost-effectiveness that lowering availability and increasing the price of alcohol is protective on later health outcomes.  Enforced legislative measures to reduce drink-driving and directed interventions to those already at-risk drinkers also appear to be effective.

Medical research is required to find the evidence of alcohol-related harms but political motivation is required to ensure that ensuing policy is evidence-based (rather than used selectively to fit current policy).  Unfortunately, this political willpower has been lacking, and not just in the present Government.  Many of you may remember the previous Prime Minister pulling the rug from the Chief Medical Officer’s suggestion of minimal pricing for alcohol.  The Rt Hon Gordon Brown MP clearly didn’t understand the population health implications of alcohol-related harms or the policy in question when he talked about “not wanting the responsible, sensible majority of moderate drinkers to have to pay more or suffer as a result of the excesses of a small minority”.

But what about the current political climate and health reforms?   The Conservative-Liberal Democrat coalition have embraced the need to tackle alcohol-related harms, but their focus on the responsibility of the individual drinker does not seek to alter the surrounding environment substantially.  Although the role of ‘nudges’ and ‘changing the culture’ make great soundbites for the present administration, they do not have a proven evidence base.  This also applies to the responsibility partnerships, in which practically every sector apart from tobacco have been given a seat at the table for alcohol and other public health issues.  To be fair, they also plan on evaluating these endeavours, but one wonders, what is the hidden role of the alcohol and supermarket lobbies in shaping government policy?

The current government have taken small steps into introducing minimal pricing (albeit, this is estimated to affect less than 1 in 4000 drink deals, nor will it affect supermarkets) so there may be scope for optimism. But partly, due to the stigma of alcohol, what is being planned to allow systematic resource for the prevention/treatment of alcohol-related harms?  We don’t even systematically ask people how much they drink at the moment: for example, if you are a middle-aged person going to see your GP, he/she is more likely to know your blood cholesterol than your weekly alcohol consumption. Although there is a Department of Health Liver Strategy, current political uncertainty about the future of the public health and NHS funding has stalled any substantive plans, such as resources for alcohol treatment.

The current health reforms offers challenges and opportunities to tackle alcohol-related harms for high-risk drinkers as well as population health measures.  However, before further harms occur for both society and individual drinkers, policymakers need to embrace the evidence base to help clinicians put this into practice.

Evidence submission by: Dr Neeraj Bhala, MRC Health of the Public Fellow and Gastroenterology SpR, University of Oxford