The musings of a fourth year English medical student

Friday, 7 March 2014

Should we adopt the minimum unit pricing for alcohol?

After the flop that tried to introduce minimum unit priced alcohol in 2010, alcohol is back up for discussion. 

Globally, 4.6% of ill-health and mortality is due to alcohol and 3.8% of deaths. In 2009, 6584 deaths were  directly related to alcohol abuse, mostly caused by alcoholic liver disease.

But wider than the diseases that an alcohol consumer can inflict on themselves, they also have an effect on society through drink-driving, crime, instability in families as well as in the workplace. The children's commissioner, Dr Maggie Atkinson, has stated that alcohol is a key factor in child protection issues and social work cases involving children and families.

What shocked me was to discover that in 47% of violent crimes in England and Wales alcohol has been consumed. One could argue that the introduction of a minimum unit pricing for alcohol would help to combat this percentage. 

In addition, the UK stands alone with Malta within Europe by retaining to the drink driving limit to 80mg per 100ml, compared to our neighbours adopting 50mg/100ml - a potentially life saving difference.

Is today's culture to blame? Most of us accept the stereotypes that the Scots and the uni students (particularly medical students, ironically) to be heavy drinkers;  it is not something to be questioned or critiqued but simply the way it is. Listen to any music in the UK music charts and you'll hear rappers and the likes of Miley Cyrus talking about all their 'bottles and ice'. Alcohol is just as seductive as smoking to some teenagers. And as the Student BMJ mentioned in their recent publication, alcoholic products are allowed to be advertised at films for unaccompanied 12 year olds.  

Excessive alcoholism needs to be taken seriously. As the Student BMJ pointed out, according to the ICD-10 (international classification of disease, 10th revision), there are over 200 diseases that can be caused, both directly and indirectly, by alcohol, including:
Cirrhosis of the liver
Cancers of: the liver, mouth, oropharynx, oesophagus, colon, rectum, breast
Hypertensive and ischaemic heart disease
Low birth weight and disorders arising in the perinatal period
Road traffic incidents
Falls, poisonings and other unintentional injury
Alcohol use disorders and unipolar depression

I wonder how many young people are made aware of all these risks. Without this knowledge, I don't see how we can look down at alcohol-abusing youths if they are not at liberty to make educated decisions. The alcohol industry and public figures only portray one side of alcohol consumption. No one speaks publicly about the disastrous effects of alcohol, and I don't know why that is. 

It does beg the question as to why alcohol is even legal. I wouldn't be surprised that, if alcohol was a new drug being introduced in British culture, analysis of it from the government would most likely deem the drug too harmful to be legalised. Like smoking, the longstanding prevalence of alcohol in today's society inhibits it's banning because if such a thing was to happen there would be nationwide uproar and the synthesis of an unregulated black market. But at least with smoking we're actually raising its more unglamorous, life-threatening profile. Youtube and UK television is littered with anti-passive smoking advertisements, we have the ban on smoking in public places, smoking companies are not permitted to advertise their products on UK television at any point, plus all smoking products must be clearly labelled that they can potentially kill its users. The disparity here is, quite frankly, ridiculous. 

So, getting back to the question, should we adopt the minimum unit pricing for alcohol?
In British Columbia they have found that a 10% increase in alcohol pricing has reduced the number of alcohol-related hospital admissions by nearly 9%. Alcohol attributable deaths also decreased by 32% after the introduction of a minimum unit price. This indicates that if we, too were to introduce such a scheme the effects could be very beneficial to UK health, especially as 45% of all alcohol consumed in the UK is bought by the heaviest 10% of drinkers. The number of alcohol-related admissions to hospital seem to be on the rise, so some action ought to be put in place. 

Scotland has already passed a bill requiring a minimum unit price of 50p per 8g unit of alcohol in 2012, however the bill has yet to take effect. 

Of course, most people in the UK do not drink alcohol to excess, therefore some feel that the minimum unit pricing would unfairly penalise those who already drink moderately. However, this argument falls short when if you were to model the estimates of 50p per unit then moderate users would be less than £10 worse off annually, compared to to heavy drinkers that would be almost £200 worse off if they continued to drink the same amount. 

It goes without saying that those on tighter budgets are going to suffer more from this ban than bigger earners. People on low incomes are believed to be most at risk of alcohol related harms, reinforcing the necessity for the minimum unit pricing for alcohol. 

If we want to increase national health, less alcohol needs to be consumed, and regular drinkers need to consistently consume in moderate quantities. Simple as. If the minimum unit pricing for alcohol is going to encourage that, then I'm all for it. 
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