Public Health (Alcohol) Bill 2015: Second Stage

I welcome the Minister to the House on this, our penultimate day of term. I heartily welcomed the initiation of the Public Health (Alcohol) Bill. As did Senator Burke, I participated in the hearings of Oireachtas Joint Committee on Health and Children on the scrutiny of the heads of the Bill. We covered the aspects of the Bill and I thank the Minister for taking on many of the committee’s recommendations in what we see today. It does show pre-legislative scrutiny works. The Bill is about reducing alcohol-related harm, improving people’s health and, ultimately, saving children’s lives. From my reading, a children’s rights focus is evident throughout the Bill.

I acknowledge and thank the Alcohol Health Alliance Ireland, which is spearheaded by the Royal College of Physicians of Ireland and Alcohol Action Ireland, for its work and advice to me in this area. In all of our debates on alcohol, even those on reducing the alcohol-related harm which we all agree is extensive and needs tackling, we feel we need to clarify that we are not anti-alcohol. This is because our relationship with alcohol is so twisted into our culture and psyche we do not wish to be portrayed as judgmental and anti-fun. I have been rapporteur for two EU reports on the issue of alcohol-related harm. I have seen the drinks industry in action first-hand so I have no doubt of the pressure it must have put on the Minister. At EU level, I was on the European Economic and Social Committee, which was small, and the industry tried to silence me and discredit me and undermine the work of the NGO for which I worked. Thankfully, the majority of my colleagues on the committee were willing to stand with me and face down the vested interests and defend the public good. This is what we are trying to do with the Bill.

My entry point to the issue is the impact of alcohol-related harm on children. Four in ten children in Ireland are at risk of being adversely affected by alcohol misuse. Four in ten child protection cases are associated with alcohol misuse. It is a significant contributor to the neglect and abuse of children, to domestic and sexual violence and family breakdown. I welcome the support for the Bill and its harm reduction measures from several sectors of the industry in Ireland, including the vintners’ associations, the majority of publicans, the National Off-Licence Association and the C&C Group.

I use the term “drinks industry” but I speak more about the giants who see Ireland as a small pawn in the global drinks industry. The drinks industry speaks about responsible drinking, but the way we drink in Ireland is only responsible for the huge profits the industry makes here every year. As soon as the Minister launched the Bill I could almost hear the smoke machine of the drinks industry spluttering into action and, through its puppet drinkaware.ie, a soon to be launched rebranding of MEAS, talk about the importance of education. We see drinks industry initiatives all the time and the involvement of the drinks industry in public health campaigns despite clear and definitive statements from the World Health Organization that it should have no role in public health initiatives.

Drinkaware.ie is funded by Diageo, Heineken and Irish Distillers. Earlier this year we saw it advertise for an education programme manager to head up an education programme targeting young people, parents and teachers. This is completely inappropriate. If I put it this way, who would entertain the idea of an education programme about the dangers of smoking being designed and delivered by an organisation that is funded by tobacco companies? We cannot let the drinks industry in whatever guise it manifests itself to go into schools and purport to educate our children about the usage of a substance on which its entire profit is made. I hope the Department of Education and Skills takes a firm stance. I have tried to raise this issue several times in the Seanad. There is no safe level of alcohol consumption for children and this is the clear message we must send. We know education informs our behaviour, but it does not influence our behaviour. It is the actions contained in the Bill which will change and reduce alcohol consumption.

I have no doubt that, as has happened in Scotland, the industry will go to court if it feels it can delay or frustrate the implementation of the Bill. In my opinion, this tells us the Minister is on the right track. With regard to sponsorship and sport, the drinks industry spends £800 million a year in the UK on advertising, and research has shown that children there as young as ten are familiar with, and can readily identify, alcohol brands, logos and characters from television. In many instances, recognition was greater for alcohol brands than for non-alcoholic products targeted at children. This tells me a lot. The study also provided new evidence that many children are familiar with the link between alcohol brands and the sports teams and tournaments they sponsor. This is why I welcomed the initiatives the Minister is taking. He knows my position, which is I would love to see a full ban, but I welcome what he is doing in this area to try to reduce the impact on children.

It was very interesting that in the days after the Bill was launched we saw a headline stating it would undermine the rugby World Cup. I cannot see the evidence for this. We have seen the rugby World Cup successfully held in France, which has a ban, and it made a profit. It made me think of FIFA, because it has influenced legislation in Brazil. Brazil has a law whereby alcohol is not sold in stadia, but a change will be made to enshrine the right to sell beer. Surprise, surprise, Budweiser is a big sponsor of FIFA. When the ban on tobacco sponsorship of sport was introduced we were told it would be the end of golf championships, and we would never see again championships such as the Carrolls Irish open. This has been disproved. It can still happen.

With regard to minimum unit pricing, over the past several years the alcohol strength of drinks has increased greatly. The alcohol strength of beers and wine has increased. The pricing the Minister will introduce is within the power of the drinks industry. If it reduces the alcohol strength we will not see price increases. It is simple because it has the power. The introduction of minimum unit pricing will not have an impact on people who drink alcohol in pubs, clubs and restaurants. We are speaking about off sales. People who drink alcohol purchased in supermarkets and consume it within the safe limits will pay 30 cent a week more, which is €15.70 over a full year, with minimum unit pricing. The difficulty is that people drinking cheap high-strength alcohol purchased in supermarkets and other retailers will notice, but we know this is what causes the most deaths, injuries, accidents and incidents. I recommend as reading the University of Sheffield report, which the committee dealt with during its hearings. We know minimum unit pricing works because we have seen it work in Canada.

I welcome what the Minister is doing with labelling. We very much see the importance of people having information. After we discussed it at the committee, we started looking more at labelling on bottles and we can see the misinformation, deliberate or not. It is very difficult to make informed decisions. For the first time, labels on alcohol products will include information which will tell consumers what they are consuming and the impact on their health and weight. More than 90% of Irish adults do not know what is meant by a standard drink. I must look it up and I am involved in the area. A total of 95% of people have said they support the labelling initiatives. The Minister knows I have raised with him the issue of cancer, and we know that alcohol is associated with 900 new cancer cases every year and 500 cancer deaths.

There is an issue with regard to structural separation, which the committee considered and brought to the Minister. I have read the explanatory memorandum which comes with the Bill. The Minister is taking a very pragmatic and easily implemented approach and I commend him for it. We have seen seepage in supermarkets with meal deals which normalise drinking wine every day. I commend the Minister on the pragmatic approach being taken. We will get to tease out each aspect of the report on Committee Stage and I say “Well done” to the Minister in respect of the children’s clothing issue also. We see the seepage on that matter throughout department stores. The Minister has my full support.

Full debate https://www.kildarestreet.com/sendebates/?id=2015-12-17a.93&s=jillian+van+turnhout#g103

EESC – Alcohol related harm – Opinion of the Rapporteur, Ms. van Turnhout

European Economic and Social Committee

SOC/340
Alcohol related harm

Brussels, 30 September 2009

OPINION
of the
European Economic and Social Committee
on
How to make the EU strategy on alcohol related harm sustainable, long-term and multisectoral (Exploratory opinion)

_____________

Rapporteur: Ms van Turnhout
_____________

In a letter dated 18 December 2008, in the context of the forthcoming Swedish Presidency of the European Union, the Swedish Minister for European Affairs asked the European Economic and Social Committee to draft an exploratory opinion on the following subject:

How to make the EU strategy on alcohol related harm sustainable, long-term and multisectoral.

The Section for Employment, Social Affairs and Citizenship, which was responsible for preparing the Committee’s work on the subject, adopted its opinion on 1 September 2009. The rapporteur was Ms van Turnhout.

At its 456 plenary session, held on 30 September 2009 and 1 October 2009 (meeting of 30 September 2009), the European Economic and Social Committee adopted the following opinion by 128 votes to 5 with 4 abstentions.

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1. Summary and recommendations

1.1 Drawn up in response to a request by the Swedish Presidency to the EESC, this exploratory Opinion focuses on how to make the EU strategy on alcohol related harm sustainable, long-term and multisectoral . The goal of the Swedish Presidency is to support the implementation of the horizontal EU alcohol strategy and the establishment of long-term preventive work at both EU and national level.

1.2 This Opinion builds on the previous EESC Opinion on alcohol related harm, which looked at five priority themes: protecting children; reducing alcohol related road accidents; preventing alcohol related harm among adults and in the workplace; information, education and raising awareness; and common evidence base .

1.3 The Opinion highlights the following four priorities of the Presidency:

– the impact of advertising and marketing on young people;
– the influence of price on the development of damage;
– children in focus – specifically foetal alcohol spectrum disorder and children in families; and
– the effects of harmful alcohol consumption on healthy and dignified ageing.

to achieve a comprehensive approach, all of the themes dealt with in both opinions and other relevant matters should be taken together.

1.4 Drinking patterns vary significantly across countries, but most consumers drink responsibly most of the time (see 3.2) . Having said that, the EESC is concerned that 15% of the EU adult population are estimated to drink at harmful levels on a regular basis, and that children are the most vulnerable to the harms caused by alcohol. Policy measures should be designed to reach those already drinking at harmful levels.

1.5 Alcohol marketing is one of the factors that increases the likelihood that children and adolescents will start to use alcohol, and will drink more if they are already using alcohol. Given this, the EESC calls for a reduction in the exposure of children to alcohol marketing.

1.6 Appropriately designed alcohol pricing policies can be effective levers in reducing alcohol related harm, particularly among low income and young people. The EESC believes that regulation governing the availability, distribution and promotion of alcohol is needed; self-regulation in this area is not enough.

1.7 To raise awareness about the risk of Foetal Alcohol Spectrum Disorder (FASD), the EESC supports national and EU level awareness-raising campaigns.

1.8 The EESC believes that more information is needed about the effects of harmful alcohol consumption on healthy and dignified ageing at an EU level.

1.9 The EESC recognises that alcohol policies should be comprehensive and include a variety of measures for which there is evidence of reducing harm.

2. Background

2.1 The European Union has competence and responsibility to address public health problems related to harmful and hazardous alcohol use on the basis of article 152 (1) of the Treaty , which states that Community action shall complement national policies.

2.2 Following the Council Recommendation of 2001 on the drinking of alcohol by young people , it invited the Commission to follow and assess developments and the measures taken, and to report back on the need for further actions.

2.3 In its Conclusions of June 2001 and of June 2004, the Commission was invited to put forward proposals for a comprehensive Community strategy aimed at reducing alcohol-related harm which would complement national policies .

2.4 In 2006, the Commission adopted the Communication: An EU Strategy to support member states in reducing alcohol related harm . It aims to “map actions” put in place by the Commission and Member States, and explains how the Commission can further supports and complements national health policies. The EESC believes that the Communication falls far short of a ‘comprehensive strategy’ as it does not provide a comprehensive and transparent analysis of all the relevant policy areas and of the difficulties some Member States have experienced in maintaining quality public health alcohol policies due to EU market rules . The Strategy also fails to acknowledge that alcohol is a psychoactive drug, a toxic substance when used to excess, and, for some, an addictive substance.

2.5 The European Court of Justice has repeatedly confirmed that reducing alcohol related harm is an important and valid public health goal, using measures deemed appropriate and in accordance with the principle of subsidiarity .

2.6 The EESC acknowledges the work performed by all relevant stakeholders within the European Alcohol and Health Forum since its launch in 2007. The EESC welcomes similar developments at local levels.

3. Overview of harmful effects

3.1 Globally, the European Union is the region where most alcohol is consumed, with 11 litres of pure alcohol consumed per person each year . Overall consumption declined between the 1970s and mid-1990s, since when it has remained relatively stable; however there are still differences between countries in terms of both consumption and harm, also in terms of the form the harm takes ; however, harmful drinking patterns remain significant .

3.2 Most consumers drink responsibly most of the time. However, the EESC is concerned that 55 million adults in the EU (15% of the adult population) are estimated to drink at harmful levels on a regular basis . Harmful alcohol consumption is estimated to be responsible for approximately 195 000 deaths a year in the EU due to accidents, liver disease, cancers and so forth. Harmful alcohol use is the third biggest cause of early death and illness in the EU .

3.3 The EESC believes that harmful alcohol consumption by individuals is not a problem that develops in isolation, but rather one that can have a variety of causes including poverty, social exclusion, family environment, and work-related stress.

3.4 While different cultural habits related to alcohol consumption across Europe exist, it can also be observed that different cultural habits related to harmful and hazardous alcohol consumption, including among children and adolescents, exist . The EESC urges the Commission and the Member States to take account of these national and local patterns when defining policies.

3.5 Children are particularly vulnerable to harms caused by alcohol. It is estimated that in the EU 5 to 9 million children in families are adversely affected by alcohol. Alcohol is a causal factor in 16% of cases of child abuse and neglect, and an estimated 60 000 underweight births each year are attributable to alcohol .

3.6 Harmful alcohol consumption can cause harm not only to the individual but also to third persons. Alcohol-related harm should also be addressed in the workplace, in the framework of health and safety regulations, which is primarily the responsibility of the employer. Workplace alcohol policies could help reduce alcohol-related accidents, absenteeism and increase working capacity. The EESC urges employers, trade unions, local authorities and other relevant organisations to closely cooperate and to undertake joint actions to reduce alcohol-related harm in workplaces.

3.7 Alcohol is an important commodity in the Europe creating jobs, generating revenue through taxes and contributing to the balance of trade. However, harmful alcohol drinking also affects the economy, due to increased health care and social costs, and loss of productivity. The cost of alcohol related harm to the EU’s economy was estimated at EUR 125 billion for 2003, equivalent to 1.3% of GDP .

4. The impact of advertising and marketing on young people

4.1 The EESC urges the Commission to acknowledge the WHO European Charter on Alcohol adopted by all EU Member States in 1995 and, in particular, the ethical principle that all children and adolescents have the right to grow up in an environment protected from the negative consequences of alcohol consumption and, to the extent possible, from the promotion of alcoholic beverages.

4.2 The EU Council recommendation urged Member States to establish effective mechanisms in the field of promotion, marketing and retailing and to ensure that alcohol products were not designed or promoted to appeal to children and adolescents.

4.3 Binge drinking by young adults (15-24 years) is a growing concern at EU and Member State level; 24% of drinkers in this age group reported binge drinking at least once a week in 2006 . Beer (40%) and spirits (30%) are the most often consumed alcoholic drinks among teenagers , followed by wine (13%), alcopops (11%) and cider (6%). Alcohol sales promotions such as “happy hour” and “two for one” promotions also increase alcohol consumption and the likelihood of binge drinking among youth . As a step forwards, the stricter enforcement of legal drinking age by authorities is required.

4.4 Alcohol advertising and marketing are influential in shaping young people’s attitudes to and perceptions of alcohol, and encouraging positive expectations of alcohol use amongst young people . A review of longitudinal studies by the Science Group of the European Alcohol and Health Forum found “consistent evidence to demonstrate an impact of alcohol advertising on the uptake of drinking among non-drinking young people, and increased consumption among their drinking peers. This finding is all the more striking, given that only a small part of a total marketing strategy has been studied” .

4.5 The EESC is concerned that alcohol marketing attracts underage drinkers , and draws attention to consistent findings that exposure to television and sponsorship that contains alcohol predicts the onset of youth drinking and increased drinking .

4.6 The WHO Expert Committee considered that “voluntary systems do not prevent the kind of marketing which has an impact on younger people and that self-regulation seems to work only to the extent that there is a current and credible threat of regulation by government” .

4.7 Actors in the alcohol beverage chain have declared their willingness to be more proactive in enforcing regulatory and self-regulatory measures . They have a role in working together with the Member States to ensure their products are produced, distributed and marketed in a responsible manner, contributing to reduce alcohol related harm.

4.8 The Audiovisual Media Services Directive helps set minimum standards for alcohol advertising. It specifies that “[…]alcohol advertisements shall […] not be aimed specifically at minors, shall not link the consumption of alcohol to enhanced physical performance, social or sexual success and shall not claim that it is a stimulant, a sedative or a means of resolving personal conflicts” . The EESC believes that this Directive alone is not sufficient to fully protect children from alcohol marketing.

4.9 The EESC urges that a reduction in the exposure of children to alcohol products, advertising and promotions be stated as a specific objective by the Commission, and that tighter regulation in this area be introduced.

5. The influence of price on alcohol related harms

5.1 There is increasing pan-European interest in measures to combat alcohol related harms. Alcohol is an important commodity in Europe, creating jobs, generating revenue through taxes and contributing to the EU economy through trade. However, an estimated 15% drinks at harmful levels generating harm for individuals and societies. In 2003, the cost of alcohol misuse in the EU was estimated at EUR 125 billion, equivalent of 1.3% GDP .

5.2 Based on the RAND study, there is a trend across the EU towards more off-trade alcohol consumption, which tends to be cheaper than alcohol sold on-trade . However, it should be noted that the study focused only on off trade alcohol prices and did not compare off trade prices to on trade prices.

5.3 Studies show that alcohol became more affordable across the EU between 1996 and 2004, in some countries by more than 50% . Evidence shows that there is a positive relationship between alcohol affordability and alcohol consumption in the EU .

5.4 Young people are sensitive to alcohol price increases, which lead to reduced frequency of drinking among young people and, to smaller quantities drunk in each drinking event . However, other studies show that young people may turn to more harmful drinking patterns in response to price increase, e.g. pre-drinking where people consume cheaper alcohol at home before going out. This finding has important implications for alcohol policy in the EU, particularly given the increase in harmful youth drinking.

5.5 An estimated 3.8% of all global deaths and 4.6% of global disability-adjusted life-years are attributed to alcohol. There is a positive relationship between alcohol consumption and traffic injuries and traffic deaths . Alcohol is the sole cause of some diseases such as alcoholic liver disease and alcohol-induced pancreatitis, and is a contributory cause of other diseases and injuries (e.g. certain types of cancer, heart disease and strokes and liver cirrhosis) . Harmful alcohol consumption is a contributory factor for crime, violence and family deprivation, risky sexual behaviour and sexually transmitted disease .

5.6 It is estimated that across the EU heavy episodic drinking contributes to 2 000 homicides, 17 000 traffic deaths (or one in three of all traffic fatalities), 27 000 accidental deaths and 10 000 suicides .

5.7 Alcohol pricing policies can be effective levers in reducing alcohol related harms . The EESC nevertheless believes that pricing policy should be considered when developing strategies to address alcohol related harm in a long-term, sustainable and multi-sectoral way.

5.8 Alcohol policies should be comprehensive and include a variety of measures for which there is evidence of an impact in reducing harm, such as drink drive policies and primary health based interventions. The EESC recognises that no single measure can solve alcohol related harm.

5.9 The EESC believes that efficient enforcement of regulation governing the availability, distribution and promotion of alcohol is needed. Self-regulation in this area is part of the solution, but in itself not sufficient. Restrictions on sales below cost and on sales promotions should be possible without being trade restrictive or in contravention with EU law.

6. Children in focus – specifically foetal alcohol spectrum disorder and children in families

6.1 The destiny of Europe depends on a healthy and productive population. The evidence that a higher proportion of the disease burden from harmful and hazardous alcohol consumption is experienced by young people is therefore of grave concern to the EESC .
6.2 The Commission recognises that children have a right to effective protection against economic exploitation and all forms of abuse . The EESC strongly supports this position.

6.3 The EESC notes that harmful and hazardous alcohol consumption impacts negatively not only on the drinker but on people other than the drinker, especially in relation to accidents, injuries and violence. In families, the EESC recognises that the most vulnerable group at risk are children.

6.4 It is estimated that 5 to 9 million children in families are adversely affected by alcohol, that alcohol is a contributing factor in 16% of cases of child abuse and neglect, as well as contributing to an estimated 60 000 underweight births each year . Further negative effects for children include poverty and social exclusion, which can affect their health, education and well-being both now and in the future.

6.5 Domestic violence, a serious problem in many countries , is strongly linked to problems of heavy drinking by the perpetrator . While domestic violence can occur in the absence of alcohol, heavy drinking can contribute to violence among some people. A reduction in heavy drinking benefits the victims and perpetrators of violence, and the children living in such families.

6.6 Alcohol can affect children even before they are born. Foetal alcohol spectrum disorder (FASD) describes a continuum of permanent birth defects (physical, behavioural and cognitive) caused by maternal consumption of alcohol during pregnancy.

6.7 Awareness about FASD and its effects is low. Disseminating evidence-based examples of preventive programmes to reduce alcohol harm during pregnancy is critical. The EESC supports the use of targeted EU and national Government campaigns to raise awareness about the risk of FASD.

7. The effects of harmful alcohol consumption on healthy and dignified ageing

7.1 Older people are more sensitive to the effects of alcohol. Specific problems include balance and risk of falling and the onset of health problems that can make older people more susceptible to alcohol. About a third of older people develop drinking problems for the first time in later life, often due to bereavement, physical ill-health, difficulty getting around and social isolation .

7.2 Harmful alcohol consumption can affect older people’s mental health in the form of: anxiety, depression and confusion.

7.3 Alcohol Use Disorders are common among older people, particularly among males who are socially isolated, and living alone . Problematic alcohol use is associated with widespread impairments in physical, psychological, social and cognitive health. Around 3% of those over 65 years suffer from these disorders , though many cases may go undetected as diagnostic criteria and screening are directed at younger adults. However, treating older people for alcohol problems is often easier than treating younger adults.

7.4 Alcohol can add to the effects of some medications, and reduce the effects of others. Raising awareness among care professionals, informal carers and older citizens of potential interaction between medication and alcohol is important.

7.5 The EESC believes that more needs to be done to address the wellbeing of the ageing population in the EU, including information about the effects of harmful alcohol consumption on healthy and dignified ageing at an EU level.

Brussels, 30 September 2009.

The President
of the
European Economic and Social Committee

Mario Sepi

The Lancet

In July 2021, Jillian co-authored an article in the world-renowned medical journal “The Lancet”