Public Health (Alcohol) Bill 2015: RCPI President’s statement to the Dail Committee on Health and Children 10 March 2015

The following is a transcript of Professor Frank Murray's opening statement to the Dail Committee on Health and Children on 10 March 2015 in relation to the Public Health (Alcohol) Bill 2015.

Thank you very much for the opportunity to speak to your Committee about the Heads of the Public Health (Alcohol) Bill 2015. I am here today representing the Royal College of Physicians of Ireland (RCPI) Policy Group on Alcohol which has made a submission to you.

Our college represents over 10,000 Members and Fellows who work as hospital consultants, registrars and senior house officers and in other healthcare settings at home and abroad.

RCPI doctors work in 27 specialities, treating all medical conditions, including Cancer and Liver Disease in hospitals and community settings. They work on the frontline of the health services with nurses and other colleagues caring for patients - many of whom come to us as a result of hazardous or problem drinking.

It is estimated that 1,500 hospital beds are occupied every night in our hospitals directly because of the health harms caused by alcohol use – this costs about €1.2 billion annually. Given the current crisis, with hundreds of patients on trolleys in accident and emergency departments, this is a national shame.

As liver specialists we are saddened and shocked by the increased number of deaths due to cirrhosis of the liver which has doubled in the last 20 years. This reflects the doubling in alcohol consumption in Ireland in the last 50 years.

Alcohol is also classed as one of the most important causes of cancer in Ireland, primarily breast, colon and oesophageal. It is a factor in suicide, domestic abuse and accidents. One in 10 first admissions to Irish psychiatric hospitals is alcohol related and 25% of all injuries presenting to accident and emergency departments are alcohol related.

Ireland’s relationship with alcohol is at crisis point. The World Health Organisation tells us that almost half of all Irish drinkers engage in heavy episodic drinking on a regular basis and that Ireland is close to the top in binge drinking worldwide.

Research shows that about 80% of Irish adults consume alcohol and more than half of those are classified as harmful drinkers. Almost 10 per cent of those who consume alcohol are dependent - and this rises to 15 per cent among 18-24 year olds. This means that we live in a country where virtually every family is affected by alcohol.

As doctors, we are increasingly caring for almost 200,000 chronic dependent drinkers who are attending with organ damage, cancers, cirrhosis and liver failure, heart failure and problems related to the brain and nervous system.

Every weekend parents worry about their children getting involved in drinking games and being hurt or killed in road traffic accidents or in fights when they go out with their friends. Everyone is affected by the social disorder in towns and cities late at night.

There is also an enormous economic cost that we are all bearing. It costs €3.7 billion a year to provide healthcare and public order enforcement as a result of problem drinking. About a third of that – just over €1 billion – is spent annually by the Government on providing care in accident and emergency departments. This is an enormous sum that has the potential to do so much good in so many areas of Irish society if it could be otherwise deployed.

As advocates of public health measures, RCPI has commended Minister Leo Varadkar and the Government for introducing this legislation which is an important first step in tackling Ireland’s problem drinking. Legislators have listened to us and have taken action and we wish to support them fully. As you know we have come together with Alcohol Action Ireland to form the Alcohol Health Alliance Ireland to advocate for the adoption of the Public Health (Alcohol) Bill 2015.

The Bill contains many of the evidence-based measures that our policy group, which is made up of experts who are caring for people affected by alcohol use including liver specialists like myself, psychiatrists, paediatricians and general practitioners, have called for.

We know there are powerful and well resourced vested interests who will be working to dilute some aspects of this legislation to safeguard the profits they are required to deliver for their shareholders. It feels like we are constantly in a David versus Goliath situation but there is a groundswell of support for this legislation. Research by the Health Research Board showed a majority of the Irish public are supportive of measures to tackle problem drinking, even if they are not the most vocal in this debate.

There is plenty of public discourse about alcohol and our image as a nation of heavy drinkers. This is not something we are generally proud of and I believe the time is right to implement radical solutions to address this awful problem.

There are many people who are looking to you as legislators to now step up and grasp this opportunity to introduce new laws that I can assure you will immediately save lives. You should be confident that not only is this legislation necessary but it is what the public want.

The introduction of a Minimum Unit Price for alcohol, reducing the availability of alcohol and restrictions on advertising and labelling of alcohol products is the way forward if we are serious about changing the way people consume alcohol.

We are concerned about the lack of timelines provided in this Bill for the implementation of Minimum Unit Pricing as well as for a sponsorship ban and the statutory code on the display of alcohol and we call on you to guarantee that these measures will be enforced once the legislation is enacted.

Minimum Unit Pricing is the single most important aspect of this legislation. It will reduce the flood of harmful cheap alcohol that tends to be predominantly consumed by underage and young drinkers who binge drink as well as hazardous drinkers. Evidence from Canada shows that it will immediately mean that lives are saved and that fewer people are harmed as a result of their use of alcohol.

Ireland made history and showed great leadership in introducing the workplace smoking ban in 2004 in the face of a powerful tobacco lobby. We have the opportunity again, particularly as a small country, to take a lead role in regulating the sale of alcohol. As well as saving lives here the adoption of Minimum Unit Pricing would facilitate the implementation of similar legislation in the UK and further afield.

We support setting the MUP at least at €1 – the same price as a litre of milk. It needs to be around this price to be effective.
Whenever this gets discussed the debate quickly seems to focus on how much will a bottle of wine cost? Well there are about 8 to 10 units in a bottle of wine so that would price it between €8 and €10.

Interestingly countries like France and Italy who are major wine producers have managed to dramatically reduce national consumption of alcohol in recent years at a time when the amount of alcohol being consumed in Ireland is rapidly rising. There, consumers tend to drink better,or higher quality wines, for example and drink less of it.

We are not prohibitionists and most of us take a drink, but it is important to state that there is no safe level at which to consume alcohol.

Just in the last few weeks research published in the British Medical Journal debunked old myths about a drink being good for us with findings that drinking alcohol is of no benefit to anyone in terms of their health.

You don’t have to be addicted to alcohol to get cirrhosis of the liver. Forming a habit of regularly drinking pints or glasses of wine will damage your liver in a serious way over time. I am caring for many patients who have found themselves in this situation.

Tackling price and the availability of alcohol is the most effective way to change our relationship with alcohol. This is why we want to see separation of sales of alcohol so that it is not displayed beside everyday groceries.

We also welcome the intention to enable better enforcement of a ban on selling to those who are underage.

We can see how well environmental health officers have enforced the smoking ban. We want to see similar resources and priority given to policing sales to those who are underage as part of the new legislative package. The Bill should include provisions for strict regulation and enforcement around online drinks promotions, the number of outlets where alcohol can be purchased should be reduced, and there should be further restrictions on opening times.

We also want to see a timeframe introduced for the phasing out of sponsorship of sports events by the alcohol industry.

The tobacco industry opposed the move to ban advertising of their products in 2003 saying it would result in damage to sport. Clearly it didn’t and this argument is again being rolled out to protect lucrative campaigns that are enormously effective in terms of recruiting the next generation of drinkers.

It is disappointing that the Public Health (Alcohol) Bill won’t contain a ban on sports sponsorship. This is something we will continue to advocate. There is very strong evidence to link promotion of alcohol through sports sponsorship with early and more problematic alcohol consumption in young people.

Drinks companies are investing in advertising and sponsoring these events because they achieve their purpose – they boost alcohol sales.

We strongly recommend that a commencement date is set for the phasing out of alcohol sponsorship of sport in the medium term, and a target date to end all alcohol sport sponsorship in the longer-term.

In the weeks and months ahead you will hear about the “nanny state” and be questioned about why it is necessary to introduce measures that affect the entire population when hazardous drinking rests with a few.

More than 200,000 chronically dependent drinkers is a large number of people who require care and support whatever way you spin it.

International research as well as doctors, nurses and those on the frontline can tell you that Irish people generally drink in excess of recommended low risk limits.

There are also important issues of social justice in introducing the measures in this Bill. The socially disadvantaged suffer disproportionately from the effects of alcohol. These measures will help these individuals and reduce health inequality.

We have made great strides in terms of extending life expectancy but quality of that life can be infinitely improved by drinking less alcohol.

One of the leading public health advocates, Geoffrey Rose, tells us that the best way to address large-scale public health problems is to manipulate the environment and context.

In this case we are looking to you as legislators to control the price and availability of alcohol and seize the opportunity to finally help us to banish the drunken Irish image and save the next generation from certain health harms.

Let's grasp the opportunity to turn off the tap of cheap harmful alcohol and set a constructive path for drinking alcohol in Ireland.