Profit Before People: The commercial determinants of health and lessons from the tobacco epidemic (2023)

The scale of alcohol related harm

Harms arising from alcohol use are well documented, with over 200 diseases and conditions connected in some way to alcohol⁴¹. These harms are not just experienced by the person who drinks. Alcohol also impacts others in a negative way, including children and our wider communities. Alcohol-related harm is estimated to cost our society between £21 to £52 billion per year, and disproportionately impacts our more deprived communities. This inequality⁴² can be seen in our numbers for alcohol related death and disease. For example:

• In 2020, one in three of all alcohol specific deaths occurred in the most deprived 20% of the population, widening health inequalities⁴². 
• In 2021, there were 20,970 alcohol-related deaths in England, which is a rate of 38.5 per 100,000 people. The mortality rate was highest in the North-East region ⁴³
• The potential years of life lost (PYLL) due to alcohol-related conditions in the North-East remains significantly higher than the England rate. Nationally this equates to 293,979 potential years of male life lost, and in Gateshead this equates to 1333 years. For women the PYLL is lower than for men with a count of 138,058 nationally, and 592 for Gateshead, although the numbers show an increase on previous counts⁴³.  
• Whilst the North-East rate of admission episodes for under 18s for alcohol-specific conditions has come down over the last 20 years, it remains significantly higher than the England average. The rate per 100,000 for England is 626 per 100,000, compared with a North-East rate of 991 per 100,000, and a Gateshead rate of 1106 per 100,000⁴³.

The alcohol industry relies enormously on high-risk drinking to increase its revenue⁴⁴. The heaviest drinkers contribute the most to industry profits, therefore if the alcohol industry is in any way involved in influencing alcohol policy, there may be a significant conflict of interest as they have a vested interest in people drinking at higher levels. The price of alcohol is directly linked to alcohol harm. Evidence tells us that heavier drinkers tend to consume products that are cheaper and stronger on average⁴⁵. Tax design in the alcohol market). Alcohol taxation and pricing policies, such as minimum unit pricing (MUP), are some of the most effective and cost-effective measures to reduce alcohol harms⁴⁶. Whilst the other home nations have introduced MUP, we haven't in England, despite the emerging evidence of reduction in harm from Scotland. 

The alcohol industry uses tactics to influence the social norms around alcohol. This is seen within prolific marketing across all types of media, often with links to charity campaigns and sporting events, even though alcohol has a detrimental effect on health and performance. More subtle forms of influence are seen with product placement within television and film, merchandise such as greeting cards or mugs with alcohol related slogans, and 'nudges' which influence people in their consumer habits⁴⁷. Marketing of no and low alcohol products is another vehicle through which alcohol industry can influence us. The branding for these products is often almost identical to the products that contain alcohol. Whilst we have seen significant measures introduced to protect people from the influence from the TI, alcohol remains visible in our society to the point where it has become like wallpaper, and people no longer notice how it permeates through our society, influencing social norms. There is a lack of measures to address this despite the evidence of the harm alcohol causes, including the links to seven types of cancer. 

The current self-regulatory system governing alcohol marketing does not work - despite existing codes prohibiting the targeting of alcohol adverts to children, more than 80% see alcohol marketing monthly, most are aware of various alcohol brands, and children as young as nine can accurately describe alcohol brands' logos and colours⁴⁶.

The way alcohol is marketed normalises alcohol consumption and exposes children and vulnerable people to alcohol products, leading people to drink more and at an earlier age. 

By funding youth education programmes, the alcohol industry has been shown to deliver content to children and young people that normalises moderate consumption of alcohol and downplays the health risks. A review of alcohol industry funded school-based education also showed the programmes served industry interests by focussing on people having personal responsibility for their alcohol use and that alcohol harm stemmed from people making 'poor choices' rather than focusing on the environment in which people are expected to make those choices⁴⁸.

Children and young people, and people from lower socio-economic groups are priority groups to protect from the tactics of the alcohol industry. It is not okay for people to be exposed to an environment fuelled by the alcohol industry for their own gain, then to be blamed when their alcohol use becomes problematic.

References

41. WHO - alcohol (opens new window)

42.  Office for Health Improvement and Disparities (2023) GOV.UK alcohol profiles for England March 2023 update (opens new window)

43. 50.4 per 100,000 population), and in Gateshead was 44.8 per 100,000 population. (Local Alcohol Profiles for England - Data - OHID OHID local alcohol profiles England (opens new window)

44. Bhattacharya, A. et al. (2018) Wiley - how dependent is the alcohol industry on heavy drinking in England (opens new window)

45. SSRN - Tax Design in the Alcohol Market (opens new window)

46. World Health Organization (2018). SAFER: Raise prices on alcohol through excise taxes and pricing policies.WHO pricing policies (opens new window)

47. Pettigrew, M. et al (2020). Wiley - Dark Nudges and Sludge in Big Alcohol: Behavioural Economics, Cognitive Biases, and Alcohol Industry Corporate Social Responsibility (opens new window)

48.  van Schalkwyk, M. et al (2022)  Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes (opens new window)